Jemilat Siju, DNP, MSN, Vice President and Chief Nursing Officer for Ambulatory Care

Where can a nurse deliver culturally sensitive, age-specific nursing care for adult and pediatric patient populations while performing assessment, screening, patient education, and direct patient care? Ambulatory Care at the Mount Sinai Health System.

Jemilat Siju, DNP, MSN, RN, ANP-BC, OCN, is the Vice President and Chief Nursing Officer for Ambulatory Care for the Mount Sinai Health System. Dr. Siju says, “Care within the ambulatory setting is multispecialty and a place to learn and grow. If you are a nurse and looking for an exciting, collegial environment in which teamwork flourishes and nurses have a voice, ambulatory care is for you!”

Ambulatory care nursing is a unique realm of nursing practice that addresses health care needs for entire communities, population groups, families, and individuals. The ambulatory setting is not about delivering episodes of care, but rather, looking at the holistic patient.

Patients enter the ambulatory world with complex health issues they must grapple with while living in their communities and homes. Social determinants of health are at the forefront as each ambulatory nurse determines how the patient’s prescribed medical plan impacts the patient’s quality of life, well-being, and overall health in their home setting.

“In my role, I am trying to achieve an ideal ambulatory care platform that is a place where nurses feel empowered and have a voice, as the voice of the nurse is extremely important to  patient care quality and outcomes,” Dr. Siju says. “The goal is to create alignment and standardization across ambulatory, so that the care looks and feels the same as much as possible, regardless of what part of the Health System you are in.” She adds, “It is not cookie-cutter, but the core of the care we bring to our patients must be of the highest quality.”

The newly established Ambulatory New Graduate Fellowship Program at Mount Sinai immerses RN fellows in the growing ambulatory sector. The first cohort of students has started, with continuing plans to admit fellows twice a year.

“A nurse might be hired into pediatrics, but while in the fellowship program you get exposure to other ambulatory specialties—for example, adult health, ambulatory surgery, cardiology, etc.—with the aim of supporting you in discovering your true niche,” Dr. Siju says. “We are educating you in the classroom and providing built-in rotations where you may spend a day in the life of a cardiac nurse, even though you are working in pediatrics.”

Exposing new graduates in the fellowship program to ambulatory care helps them identify personal strengths and their desires for professional fulfillment. Dr. Siju says, “We can facilitate the process for new graduates to find their niche—sometimes we think we know what specialty we would like to work in, but later find out that we are built to do something else. Ambulatory Care at Mount Sinai supports you in finding your professional niche.”

Nursing ambulatory fellows rotate through several specialties with advanced team members, including rounds with Infection Prevention and learning about their preventive role in ambulatory care. Towards the end of the program, RN fellows have an opportunity to work with nursing leadership on a departmental quality improvement project or an evidence-based practice project to advance their leadership and research capabilities. In addition to the fellowship program for new graduate nurses, Mount Sinai has a robust supportive clinical environment for our experienced nurses as well.

She continues, “Nurses get an enriched experience in ambulatory care. Patients are still complex enough with their health care needs and nurses can address what happens to them in their community and how this impacts their health and access to care.”

Dr. Siju says, “I went through nursing school the long route—starting in an associate degree program, then obtaining my bachelor’s and then master’s degrees. When doing my associate degree, I worked as a nursing assistant on a surgical floor and really thought I wanted to be a surgical nurse; I loved it and I loved the nurses. But one day the Chief Nursing Officer looked at me and said, ‘You will be a great oncology nurse,’ and I thought if she saw that in me, then why not?” Following 18 months of work in oncology, her nurse leader suggested she consider a role in nursing leadership and so she did, working as a nurse manager for two years and growing in leadership experience since.

Dr. Siju joined Mount Sinai in 2012 as Nurse Manager for Mount Sinai Beth Israel’s Oncology Ambulatory Infusion Program and transitioned into ambulatory care in 2017. She pioneered the Nurse Leadership Course for the Mount Sinai Phillips School of Nursing and serves as an adjunct faculty member.

Dr. Siju has worked for Mount Sinai longer than any other employer because, she says, “Mount Sinai has created a growth pathway for me. When I feel like I need to continue growing and want something to keep me on my toes, Mount Sinai has been successful in making that happen for me. Every time I have felt like I needed to grow, I have had an opportunity here to do so. Many others have invested in my professional growth, and I am committed to paying it forward by doing the same for others. I look forward to an opportunity to work with you in ambulatory care.”

Robin Ferrer, MBA, MSN, RN, Vice President of Emergency Services

Patients sometimes experience the Emergency Department (ED) as a place where things are uncertain, unexpected, and people may look and behave strangely—a bit like Lewis Carroll’s “Through the Looking-Glass,” Robin Ferrer, MBA, MSN, RN, likes to say.

“Emergency Departments are the looking glass into the hospital,” Mr. Ferrer, Vice President of Emergency Services for the Mount Sinai Health System, says, “and for some people, their impression of the Mount Sinai organization lies with that visit to one of our emergency departments.”

Mr. Ferrer joined Mount Sinai Health System in early 2021, as New York was continuing to experience COVID-19 hospitalizations and illness while facing the challenge of vaccinating millions of people. Mr. Ferrer oversees clinical operations and nursing personnel across all Emergency Departments for Mount Sinai Health System. His leadership role advocates for the advancement and improvement of Emergency Services. “I think the pandemic had a big impact on our front lines, particularly the ED, where we are the first receivers of patients. One week was managing COVID-19 and the next week was managing something entirely different,” he says. “The biggest challenge for staffing in the ED is at the nursing level, by virtue of what nurses do—being primary caregivers at the bedside, managing most of the services and treatments, getting patients to their CT scans and X-rays, hooking up IVs, making sure medications are given and orders are completed.”

Mr. Ferrer, who also serves as an adjunct professor at the College of Mount Saint Vincent, teaching Business and Health Care Administration, is committed to helping others move forward. “My ultimate goal as a leader is to enable other people to be successful. I have always said, when I don’t feel myself doing that, I should question why I am in leadership.”

Mr. Ferrer frequently references two population groups he is responsible for: patients and staff. “Successfully taking care of staff and the environment where they work will result in positive patient outcomes.” He adds, “Patients are ultimately the beneficiaries of every decision we make. I want to be sure when we make a decision, that it is grounded in principle and the patient will benefit from the outcome, and our staff will feel the decision represents a step in the right direction.”

Mr. Ferrer grew up in New York City in what he describes as a “pretty dire situation.” As a child he was sent to the Milton Hershey School in Hershey, Pennsylvania, and now sees that experience as a buttress for his personal journey towards leadership and a desire to help and support others.

“Milton Hershey School is where I learned leadership skills and discipline. I didn’t know anyone when I arrived, but I found myself surrounded by an army of people willing to help and support me to be successful,” he says. “I understand we all have a story, and we need to take a moment to listen and appreciate where people come from and how their past has enabled their future. That resonates with me most.”

Mr. Ferrer started as a bedside nurse in the Emergency Department at NewYork-Presbyterian/Columbia University Irving Medical Center and quickly felt a gravitation towards leadership. After completing his Master of Business Administration from the College of Mount Saint Vincent in New York City, Mr. Ferrer spent the next 15 years in leadership roles. As Director of Operations at NewYork Presbyterian Hospital, Mr. Ferrer managed multiple service lines and departments, including the Adult Emergency Department, Psychiatric Emergency, Outpatient Psychiatry, Respiratory Therapy, Hemodialysis, and the Pulmonary Function Lab.

Giving people a chance and reflecting on his own experience of having others provide strong mentorship and guidance has influenced Mr. Ferrer’s belief that new nurse graduates can be successful starting their career in the Emergency Department. He says, “Before I started, there was some hesitancy about taking new graduates into the ED.”

When Mr. Ferrer inquired about that hesitancy, the response was almost always the same: they don’t have experience. “I said to myself, these new graduates just finished school and are bursting with excitement, ready to go, and hungry for an opportunity. Why don’t we just provide appropriate onboarding and training so they can be a part of our team?”

Fast forward 18 months, and the Mount Sinai Emergency Department Nursing Fellowship program now boasts of a 98 percent retention rate. This 24-week program includes simulations, online modules, and hands-on training. Fellows are paired with an experienced registered nurse from the ED staff and work with nurse preceptors. Mr. Ferrer believed new graduate nursing students could successfully transition to practice in the ED. “The driving force was putting together a robust curriculum so after six months nurses would feel comfortable and safe with the resources around them.” He continues, “We are going into our fifth cohort and have 32 people who started this month across all of our emergency departments who are new graduates from all over the country.”

“Give people an opportunity and a chance and set them up for success, and you will be astounded by how well people do just by giving them that opportunity.”

Kristin Lewicki, RN, BSN

Kristin Lewicki, RN, BSN, is a staff nurse at The Mount Sinai Hospital and recently received a letter of praise from a grateful patient’s family member:

“I would like you to know of the above-and-beyond, excellent care that my husband has received from Ms. Lewicki. He is very ill, and his case is complicated. Throughout this and previous stays, he has had the great good fortune to be under the care of Nurse Lewicki for a majority of the time. I can say with complete honesty that never, in any other hospital, has he ever had such compassionate and professional and thorough treatment as hers. She cares for his physical and medical needs seamlessly, while also sensitive to the human being as an individual. I know when he is cared for by her, he is in the safest, most capable hands. Ms. Lewicki is a gem, and I’m so thankful your hospital put her in our path to be a bright light in a long, rough journey for my husband and our family.”

Destiny R. Campbell, MSN, RN, Interim Nurse Manager Oncology, echoes these words. “Kristin has a heart of gold and goes above and beyond to ensure her patients feel welcomed, safe, and heard.”

Kristin is humble when responding to these words of praise. “I’m beyond grateful to be recognized and honored by such a prestigious medical health system,” she says. “When you work with the best, you show up and bring your best! I love being a nurse and offer my heart and soul to every patient and peer. My job brings many challenges—physically, mentally, and emotionally—but the rewards of human connection are beyond everlasting. My patients have made being a nurse a gift that I can share.”

Priscilla Samuel, DNP, FNP-BC, RN

According to a report by the Institute of Medicine, the demand for health care services is increasing significantly. The U.S. patient population continues to grow, age, and become sicker, while a nationwide shortage of primary care physicians is projected to more than double by the year 2030. Fortunately, advanced practice nurses (APNs) represent the largest growing segment of our country’s primary care workforce and a ready solution to ensuring access to high-quality care.

Throughout Mount Sinai Health System, APNs have been successfully integrated into team-based models for the past 30-plus years as part of a continuous effort to enhance quality, safety, and patient satisfaction. They have proven their role as essential to delivering the best of patient care. They help improve access to care, add efficiency to workflows, and provide continuity of care and specialty-based expertise, while minimizing duplication of clinical effort and promoting the appropriate and timely use of the team members.

The Mount Sinai Health System today employs more than 900 advanced practice nurses. Given this large and growing presence, in 2022, Beth Oliver, DNP, RN, FAAN, Chief Nursing Executive for the Health System, appointed Priscilla Samuel, DNP, FNP-BC, RN, as Vice President of Advanced Practice Nursing for the Mount Sinai Health System.

The current health care landscape further highlights the value these providers bring to the communities they serve. “Mount Sinai has seen the number of practicing advanced practice nurses grow from 15 nurse practitioners in the 1990s to 900 advanced practice nurses in 2023,” says Dr. Samuel. “This increase in APNs requires centralized coordination to manage core functions and provide support and resources in the key areas of service, engagement, safety, quality, stewardship, and innovation. My focus is on establishing a framework to help guide advanced practice nurses in prioritizing enterprise-wide initiatives, achieving system and departmental goals and metrics, and furthering their own professional and personal career aspirations.”

In addition to providing strategic direction and developing organizational strategies, Dr. Samuel is responsible for advocating, promoting, and elevating APN practice. “The key is to create a sustainable infrastructure that supports APN excellence,” says Dr. Samuel, “And developing a leadership model is a vital component.” For example, since joining Mount Sinai, she has promoted director-level APN leadership roles at two Health System sites, The Mount Sinai Hospital and Mount Sinai South Nassau, to address the particular needs of these professionals within their respective practice environments.

Mount Sinai continues to recognize the value and impact of integrating advanced practice providers (APPs) into the innovative team-based care models, and in January 2022 established the Center for Advanced Practice. “Both my Physician Assistant (PA) counterpart, Heather Isola, and I are working closely to strategize and provide guidance toward developing an environment in which APNs and PAs are supported, valued, and empowered,” Dr. Samuel says.

“Our overarching goal is to become a center of excellence and a national model for advanced practice provider practice. The Center is designed to provide comprehensive support to all Mount Sinai APPs, while ensuring a systemwide standard of care and practice by blending practice, education, research, and professional growth. The objective is to facilitate pathways for career development, expansion of clinical expertise, and the capturing of productivity,” says Dr. Samuel. “We also support advocacy for these professionals to practice at the top of licensure and leverage the unique versatility of APPs to better meet the needs of our continually evolving health care ecosystems.”

“Mount Sinai advanced practice nurses are poised to be leaders in advancing health care delivery in the United States,” says Dr. Samuel. “I stepped into my role fully recognizing the vital role of a collaborative leadership team.”

She adds, “The Chief Medical Officer, Chief Nursing Officer, advanced practice provider clinical leads, as well as medical and nursing, quality, human resources, and medical staff services leaders play critical roles in supporting and advancing the APN role within our organization. I am humbled by the tremendous support I continue to receive from both nursing and medical leadership in developing a centralized model for advanced practice nursing at Mount Sinai. The future is bright.”

Pathway to Leadership

Dr. Samuel brings vast clinical and leadership experience to her role. She is a board certified Family Nurse Practitioner and holds a Master of Science in Nursing from Columbia University and a Doctor of Nursing Practice from Case Western Reserve University. She previously served as an Associate Dean for Nurse Practitioner Clinical Affairs at the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. There, she was one of the founding members and architects of a national model for an innovative graduate nursing education program. Unlike at traditional programs, students improve their critical thinking and clinical skills through a unique curriculum that includes problem-based learning, small group sessions, and experiential hands-on learning. Dr. Samuel also served as the first corporate director for advanced practice nursing at Northwell Health, New York State’s largest health care provider and private employer, with more than 20 hospitals and more than 850 outpatient facilities.

Wendy O’Brien, BSN, MBA

Nurses serve as patient advocates and caregivers, and typically stay far away from the world of business and finances. But Beth Oliver, DNP, RN, FAAN, Chief Nurse Executive at Mount Sinai Health System, has always known nurses are critically connected to an organization’s financial health.

To address this connection, Dr. Oliver developed a first-of-its-kind position to substantiate the financial value of the more than 8,000 nurses at Mount Sinai Health System.

In 2021, Dr. Oliver appointed Wendy O’Brien, BSN, MBA, as Vice President and Chief of Nursing Finance for the Mount Sinai Health System with a goal of shining a light on the financial contribution and value of Mount Sinai nurses.

Ms. O’Brien brings more than two decades of professional front-line nursing and nursing leadership to her role, including serving as Vice President and Chief Nursing Officer at Mount Sinai West. As Chief Nursing Finance Officer, priorities include analyzing staffing practice across Mount Sinai sites, serving as a resource for nursing leadership to manage expenses, and partnering with the Office for Diversity and Inclusion to ensure equitable policies and practices in work assignments and compensation.

One of her priorities is to tie the work of nurses to revenue and illuminate how reduced readmission rates for hospitals can be directly based on education that is driven by nurses. She says, “Hospitals thrive because of nursing.” Nursing leads the initiatives in meeting quality outcomes, including patient experience and the prevention of injuries such as infections, pressure injuries, and falls. She explains, “It is the nurse’s work that is tied to that and therefore the revenue is tied to nursing.”

Ms. O’Brien was born on the island of Trinidad and spent her early years growing up in Brooklyn, where she attended Clara Barton High School for Health Professions. “In high school, the best students were the students in the nursing program. I had to join them,” she says. She graduated from the Practical Nursing Program at Clara Barton and continued her quest for knowledge and understanding. Her unusual career path, more than anything, was driven by her constant curiosity and desire to understand the synergy of people and the work they do.

After her family moved to New Jersey, Ms. O’Brien attended Seton Hall University in South Orange, earning a Bachelor of Science in Biology, all the while working as an LPN. Following her mother’s direction that she “should be a nurse,” she furthered her nursing education, attending Union County College in Union, New Jersey, while doing clinical rotations at Elizabeth General Hospital in Elizabeth, New Jersey, and earning her Associate Degree in Nursing. Ms. O’Brien went on to earn a Master of Business Administration in Health Care/Health Care Administration, Management, from Nova Southeastern University in Fort Lauderdale, Florida, and then returned to complete her Bachelor of Science in Nursing from Chamberlain University. Ms. O’Brien says, “Nursing has afforded me the life I have grown to love. Nursing has allowed me to be in touch with patients and people in need. It brought out the more compassionate side of me, and shapes who I am as a person.”

The COVID-19 pandemic shined a light on hospitals and health care systems and the delivery of front-line care to patients and communities. During this time, health systems faced historic numbers of patients, revenue losses, and unprecedented expenses. It may seem obvious that nursing is an investment towards financial profitability, but oftentimes the work nurses do every day is difficult to directly link to revenue.

“COVID-19 shined a light on the financial aspect; the need to staff appropriately to meet clinical outcomes,” Ms. O’Brien says. “Quality outcomes connect to and lead to fiscal viability.”

Nurses are often unaware of the costs of care for the settings in which they work, and Ms. O’Brien’s work in this distinctive role strives to quantify the work of the more than 8,000 Mount Sinai nurses and how it directly links to revenue—how nurses can decrease the risk of patient falls, or decrease rates of pressure injuries, and therefore prevent readmissions and impact lengths of stay.

Nurse staffing can provide considerable advantage to hospitals and, as a result, better financial performance. “This role of nursing leading finance is not completely adopted within nursing itself,” Ms. O’Brien says. “We are still tied to the clinical aspect of what we do that sometimes makes it hard to embrace the business side of it.”

Ms. O’Brien’s work underscores the true value of nursing in health care and the impact on society as a whole. She speaks for every nurse working at Mount Sinai Health System when she says, “Whatever happens in that microcosm of a hospital impacts the community. The community relies on us to provide that care.”

Esther Moas Pandey, DNP, MS, RN

A nurse finishing up a busy shift at the end of a long week typically breathes a sigh of relief, knowing the next 24 hours will bring a well-deserved day off. It is gratifying to know that a patient who has been on the unit for several weeks will be discharged the next day. But—and especially if the discharge occurs on the nurse’s day off—that satisfaction is mixed with worry for the patient’s health status at home. Many nurses worry about what happens to their patients after they leave the acute care setting.

The health of many individuals, families, and communities is compromised by social determinants of health. Social determinants of health are conditions that influence health outcomes. They are not medical entities, but rather conditions into which a person is born, grows up, lives, and works. Addressing social determinants is the path to improving a population’s health.

Social determinants of health can influence health equity in positive and negative ways—food insecurity, income, housing, access to affordable health services. Social determinants of health can influence health even more than health care or individual lifestyle choices.

Nurses promote quality health care for all and can have a vital role in addressing social and health inequities by implementing social determinants of health screening.

Mount Sinai Health Partners, a clinically integrated network of Mount Sinai’s full-time faculty and community-based providers that sets the Health System’s strategic population health management goals, builds relationships with the population of Mount Sinai patients. Esther Moas Pandey, DNP, MS, RN, has been at Mount Sinai Health System for more than five years and began her career in the Population Health Division at Mount Sinai Health Partners.

“For purposes of population health, we look at utilization. Putting together clinical teams that manage utilization. We assess how our patients are doing—their goals, the need to remove barriers, make a discharge plan. The focus is to get our patients home,” says Dr. Moas Pandey.

Beth Oliver, DNP, RN, FAAN, Chief Nurse Executive at Mount Sinai Health System, recognized this work on population health across Mount Sinai sites, and said, “You need to be on the nursing team!” Dr. Oliver appointed Dr. Moas  Pandey as Vice President of Care Transitions for Mount Sinai Health System, putting someone with a storied career into the role. “I started as a visiting nurse. I loved home care. I lived and breathed home care for ten years and this was skilled nursing care, private duty, custodial, and administrative.”

Dr. Moas Pandey was previously Senior Director for post-acute care services. She has more than a decade of experience in post-acute care operations, which are a bridge between care services and rehabilitation for patients to return home following hospitalization. Prior to joining Mount Sinai, she was a Corporate Director at ArchCare and served as Regional Director and Administrator for Premier Home Health Care, Inc.’s private duty and certified home health divisions in New York City. Dr. Moas Pandey holds a Doctor of Nursing Practice degree from Yale University, and a Master of Science from New York University.

Under the guidance of Dr. Oliver, Dr. Moas Pandey and her nursing team assumed leadership of Mount Sinai’s Transitions of Care Center. This centralized telephone-based discharge program is staffed by Mount Sinai registered nurses specially trained in hospital discharge protocols. The Transitions of Care Center’s nurses call Mount Sinai Health System patients 24 to 72 hours after they leave the hospital, reviewing and addressing each patient’s discharge plan of care.

Mount Sinai Health System is one of the few places in the country with a dedicated team of nurses whose full-time work is to call patients to prevent avoidable readmissions. A milestone was reached in April 2022, focusing on transportation and food insecurity. Transitions of Care Center nurses ask patients: “How will you get to your follow-up appointment? Do you need assistance with that?” Nurses ask about food insecurity and access to healthy foods. Registered nurses have the clinical knowledge to discuss specific foods such as a heart-healthy diet and other nutritionally sound meals.

Dr. Oliver has continued to push for a more comprehensive and widespread strategy and says, “We need to do more. We need to put together a social determinants strategy for all nurses across the whole Health System.” Consequently, efforts continue to incorporate social determinants into the daily work of all nurses across every Mount Sinai site.

Dr. Moas Pandey works with nurses to bridge nursing care on the acute side to a patient’s care after they leave the hospital—to make sure patients are successful with their health plan after they leave acute care. “Population health can really speak to the ‘why’ of nursing—to the social justice piece. We know we cannot keep patients at home without addressing their barriers to care and social determinants of health. This is the new rule of nursing.”