Hallmark Health System (HHS) is one of only eight hospitals in the state, and less than 7 percent of hospitals in the United States, to achieve Magnet® recognition as a reflection of its nursing professionalism, teamwork and superiority in patient care. HHS is the only system in New England to receive this recognition.
Magnet® recognition is determined by the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®, which ensures that rigorous standards for nursing excellence are met. With this credential, HHS joins the Magnet® community, a select group of 401 health care organizations out of nearly 6,000 U.S. health care organizations.
Magnet® recognition has become the gold standard for nursing excellence and is taken into consideration when the public judges health care organizations. In fact, U.S. News & World Report’s annual showcase of “America’s Best Hospitals” includes Magnet® recognition in its ranking criteria for quality of inpatient care.
The Magnet® appraisers and commission reported that it was clear from the “board room to the bedside” that HHS has set a vision and focus on quality and safety. They applauded HHS for being a role model for other Magnet® hospitals in the following areas:
- Hospital programs dedicated to helping newly licensed nurses successfully transition to specialty areas of practice including the residency programs in Maternal-Newborn Services, Emergency Departments and the Medical-Surgical Telemetry Float Team.
- The hospital’s commitment to providing programs and services that serve the health care needs of our communities.
- The extensive use of research by nurses at all levels, noting that a culture of clinical inquiry is evident throughout the system.
To achieve Magnet® recognition, organizations must pass a rigorous and lengthy process that demands widespread participation from leadership and staff and includes demonstrating qualitative and quantitative evidence regarding patient care and outcomes and a rigorous onsite review process. Hallmark Health’s designation was achieved with a unanimous vote of approval by the Commission.
In particular, the Magnet® Model is designed to provide a framework for nursing practice, research and measurement of outcomes. Through this framework, ANCC can assess applicants across a number of components and dimensions to gauge an organization’s nursing excellence. The foundation of this model is composed of various elements deemed essential to delivering superior patient care. These include the quality of nursing leadership and coordination and collaboration across specialties, as well as processes for measuring and improving the quality and delivery of care.
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Our healthcare system
HHS, a community hospital system, consisting of two campuses and many outpatient centers, serves the population north of Boston, and is committed to the provision of quality patient care and dedication to the community. These commitments remain central to the organization’s mission, vision and core values with patient care as the cornerstone. HHS organizes goals and priorities across the HHS Cornerstones, to assure we are advancing across all of them and are ‘connecting the dots’ of interdependence. The Cornerstones include Growth, People, Quality, Service and Finance. The clinical care delivered at HHS has been recognized repeatedly by external sources.
The Department of Nursing’s mission, vision, values and philosophy were derived from those of the institution. Congruent with the HHS organizational mission, the mission of the HHS Department of Nursing is to provide quality care to the patients and families of the communities we serve. This mission fosters a nursing culture, which promotes nurse leadership and autonomy, professional development, critical thinking and cultural competence. The Department of Nursing vision states, “As professional nurses and members of the nursing care team, our most important responsibility is achieving positive outcomes for our patients and nursing staff. It is through our professional practice model that we fulfill our vision.” The HHS Nursing Philosophy states that in concert with the mission, vision and values of HHS, the professional nurse, with the support of the care team, embraces the following commitments to the internal and external community:
- We embrace respect as the cornerstone of our actions, supporting each other as well as the needs of our patients and their families while valuing cultural, ethnic and religious diversity regardless of race and social standing. We believe in upholding the dignity and worth of every member of our health care family and every patient we serve.
- We believe that by functioning within our professional standards of practice, we provide safe, quality patient care. Through our professional model of care delivery we promote competence, compassion, communication and critical thinking in health promotion and disease prevention across the continuum of life.
- We believe as professional nurses we practice autonomously with accountability and responsibility in managing and coordinating patient care. We are committed to advocating for patients to achieve optimal outcome oriented care.
- We are committed to collaboration with the entire health care team to provide the highest quality holistic patient and family-centered care.
- We are dedicated to providing comprehensive care guided by ethical principles and utilizing sound judgment.
- Our unique culture of caring embraces a shared governance model which promotes involvement of each individual toward the achievement of common goals.
- We believe that through a life-long commitment to our individual and collective professional growth and development, we promote optimal patient outcomes relying on the best of research and experience.
- It is in utilizing and sharing our experiential wisdom that we cultivate an environment of excellence and high professional and personal satisfaction.
The nursing strategic plan and goals are developed annually after a review of the institution’s strategic plan and goals that have been put forth by senior management. This process assures that institutional and departmental strategies and priorities are aligned and form the basis for development and achievement of individual goals.
HHS Strategic Plan
The HHS strategic goal is to demonstrate measurable improvement in advancing toward the HHS mission; to be the preferred provider of healthcare north of Boston. The 2011 strategic plan stated, “to continue to succeed in the current environment, while preparing HHS to successfully respond to change in the health care environment and the local economy.” HHS recognizes that in order to be successful HHS is required to adopt new organizational approaches and openness to new ideas and definitions of success. Underlying the system’s efforts across the five Cornerstones, stated above, is creating a ‘Culture of Confidence.’ HHS believes it is vital that even while we seek to always improve, we constantly recognize, communicate and celebrate successes and strengths both internally and externally.
In her role as System Vice President for Patient Care Services and Chief Nursing Officer (CNO), Nancy Gaden, MS, RN, NEA-BC is responsible for the systems and processes that support excellence in nursing practice and promote the optimum delivery of care to patients and families. One of her most important responsibilities is enhancing patient care quality. To effectively accomplish this, she has focused on the important role that nursing plays in patient safety and quality and has facilitated the development of a data-driven nursing quality program. She models a steady commitment to and actively advocates for the highest standards of professional practice, scholarship and clinical inquiry for all nurses at Hallmark Health.
Ms. Gaden oversees the Nursing Quality Program by creating an environment where quality data is collected, analyzed and reported. Steps are taken to continuously improve performance. Ms. Gaden focuses on improvement through both the conduct and utilization of nursing research. She maintains an environment that develops and supports professional nursing by leading, collaborating, and facilitating the practice of nursing. Ms. Gaden assists nursing leadership in problem solving, evaluation and improvement of delivery systems to improve patient care and outcomes. One arena where she does this is via the Chief Nurse Council (CNC). This forum coordinates and leads the quality program for the Nursing Department in collaboration with the Nursing Practice and Quality Council (NPQC), a component of the shared governance structure. Chaired by Ms. Gaden, the CNC monitors quality performance and makes quality management decisions directed toward improving care delivery, organizational performance and patient outcomes. The NPQC utilizes the best available evidence and data obtained through comprehensive, ongoing monitoring of patient processes and outcome indicators identified from established patient standards to make clinical and organizational decisions and drive policy development.
The CNC meets to examine progress toward established goals and is responsible for evaluating and overseeing all quality improvement initiatives for the Nursing Department. Evaluation of the quality plan is considered an iterative process; however, a formal review is completed during an annual retreat where major priorities are established by CNC and the Staff Nurse Council Congress. Priorities for the Nursing Department are determined by reviewing patterns and trends relative to nursing care activities during the previous 12 months. The evidence used for this ongoing review, outlined in the Nursing Quality Plan, includes:
- Communication from all unit-based councils
- Nursing sensitive indicator reports
- Progress reports by the Nursing Practice and Quality Council
- Nursing Education
- Patient and staff satisfaction data
- Patient Safety Event Reporting System summary reports.
As outlined in the Nursing Department Quality Program, goals for the current fiscal year support the organizational strategic priorities and include the areas of quality, service, growth, finance, staff and employee satisfaction. The Nursing Quality Plan outlines and defines organizational and unit-level goals to provide the highest possible quality patient centered nursing care.
The goals of the nursing quality program are as follows:
- To foster a commitment to the pursuit of quality improvement (QI) at all levels of nursing through the education and participation of staff in quality improvement initiatives and adoption of Lean methodologies. Nurses at all levels are coached in quality improvement methods and Lean strategies in several ways, including hospital orientation, annual performance reviews and participation in hospital-wide programs. The nursing quality improvement program teaches nurses how to identify nurse sensitive quality improvement initiatives, sample appropriately and analyze and interpret data.
- To utilize unit data as the basis for decision making regarding the delivery of nursing care. This is accomplished through systematic data collection and reporting on nurse sensitive measures, staffing effectiveness in relationship to key nursing measures, patient safety goals and patient satisfaction with nursing care. Nursing sensitive measures are identified, data collected, analyzed and communicated to nursing leadership and back to direct care nurses.
- To benchmark internal and key national measures. HHS reports extensively on many nationally benchmarked measures.
- To establish compliance with standards of care and regulatory requirements through ongoing monitoring of key measures. Nurse experts are available to assist nurses at all levels to comply with all established standards of care and regulatory requirements. Direct care nurses are also informed about rates of compliance and are encouraged to become directly involved in developing strategies for compliance. This occurs through staff meetings and involvement of staff in various committees.
- To develop and test outcomes which reflect the direct contribution of nursing care to the attainment of high quality patient outcomes. The Nursing Research Council and the Nursing Practice and Quality Council assist with selection, collection and analysis of data.
- To identify care issues that may benefit from performance improvement or focused evidence-based initiatives. The Nursing Research Council mentioned above assists with helping nurse leaders identify issues that could benefit from a quality improvement initiative. They also provide ongoing support throughout the QI process once the issue is identified.
- To educate staff on valid and reliable measurement methods of data collection and analysis. The Nursing Research Council assists nurse leaders and staff nurses at HHS in accurate and reliable data collection methods.
The organizational quality improvement program provides the infrastructure for improving outcomes and supports services that are consistent with the mission, vision and values of the institution.
To join our nursing team
To join our nursing team, please search our openings. For questions regarding openings at Melrose-Wakefield Hospital, call the Human Resources Department at 781-979-3764. For questions regarding openings at Lawrence Memorial Hospital, call the Human Resources Department at 781-306-6565.
Professional Practice Model
The HHS professional practice model is the foundation of nursing practice, guides the nursing strategic plan, fosters the development of goals and is supported by the shared governance structure. The professional practice model drives how nurses practice, collaborate with other members of the healthcare team, communicate and develop professionally to provide the highest quality patient care. The professional practice model is in alignment with and integrated with the nursing mission, vision and values. The philosophy of nursing at HHS is grounded in the passionate belief that the needs of the individual patient direct the nursing care received by the patient. Nursing care at HHS is patient-centered and characterized by a mutually respectful nurse-patient relationship and framed within the care delivery model- Synergy. The HHS Professional Practice Model consists of the shared governance structure, the professional recognition program, nursing peer review, the nursing quality plan and the synergy model of care. Professional Model components are held together and supported by HHS structure and processes outlined in policy and procedures, ANA Scope and Standards of Practice and the ANA Code of Ethics. The professional governance model maintains and enhances nursing practice through empowerment and point of service decision-making. Nurses at all levels are empowered to affect decision-making through the shared governance structure and the support provided by the Chief Nursing Officer.
Integrated with this professional practice model is the Synergy Model of care delivery, which describes a patient-nurse relationship that supports the primacy of patients. With this framework, patient needs are matched to a nurse’s level of expertise to deliver the best nursing care possible. Direct care nurses at HHS are actively involved with the development, application, evaluation, adaptation and modification of the professional practice model via strategic planning, the shared governance structure and participation on interdisciplinary committees and teams. To sustain their individual and collective commitment to excellence in nursing practice, HHS nurses continually evaluate the systems and structures that affect the care of patients. The review process includes appropriateness based on current scientific and nursing knowledge, relevant clinical, ethical and legal concerns and, as appropriate, findings from quality improvement and other evaluation methods.
The role of the UBPC is to oversee, direct, communicate and support clinical practice as it relates to patient care, nursing practice and performance and the care delivery model at the unit/service level.The council represents the individual needs and issues of the unit or service. Each unit or service, where appropriate, will have a unit-based practice council.
Nursing Leadership Council
We, the Nursing Leadership team at Hallmark Health, will cultivate and sustain an environment that embraces the forces of magnetism exemplifying nursing and leadership excellence.
We, the Nursing Leadership Team of the Hallmark Health System, integrate the standards of best practices; building upon each other's strengths, fostering collaboration, open communication and critical thinking. We promote professionalism in nursing that is centered on the ideas of caring, safety, quality, diversity, mutual respect and trust. We are committed to autonomy, accountability, lifelong learning, and a passion for excellence.
Team Values and Behaviors
Diane Hanley, MS, RN-BC, EJD
Diane is currently the Associate Chief Nursing Officer at Hallmark Health,Professional Practice, Nursing Quality and Educationfor Hallmark Health System.
Diane received her BS from Saint Anselm College in Manchester NH and her MS from Salem State College in Salem MA. She has successfully completed her Executive Juris Doctorate - Health Law as a distinguished scholar.
Diane has over 30 years of nursing experience in hospital organizations in a variety of positions. Diane's professional experience includes being the Chair and member of the Massachusetts Board of Registration in Nursing for five years, the Director of Practice and Quality, and the Director of Cancer Care Education and Practice and Quality.
Among her many accomplishments she cites: Achieving Magnet designation at two institutions, developing and implementing the Nursing Quality dashboard, co-led two successful JCAHO hospital surveys, developed and implemented student placement program for area schools of Nursing.
Diane is credited with over 20 presentations and 10 publications and is a member of many professional organizations.
Judy Thorpe, MS, RN, NE-BC
Judy is currently the Associate Chief Nursing Officer at Hallmark Health,Nursing Operations, Melrose-Wakefield Hospital. Judy received her BS, Magna Cum Laude from Duke University in Durham NC and her MS from Boston College in Chestnut Hill MA. She is certified in Six Sigma (green belt). She began her career as a staff nurse in the Cardiothoracic ICU at Memorial Hospital, UNC-Chapel Hill, NC. After graduation from Boston College, she worked for almost twenty years as a nurse manager in both academic and community hospitals in the greater Boston area.
In addition, she has been responsible for the implementation of a variety of projects aimed at patient safety and satisfaction including electronic medication administration with bedside scanning. In her role, she is responsible for nursing operations at Melrose-Wakefield Hospital including inpatient medical/surgical, intensive care, obstetrics, surgical services and inpatient psychiatry.
Nancy Pheonix Bittner, PhD, CNS, RN
Dr. Nancy Phoenix Bittner, PhD, CNS, RN- Dr. Bittner is Vice President for Education at Lawrence Memorial/Regis College Nursing and Radiography Programs, Hallmark Health System and has held multiple roles in professional and academic nursing settings. Dr. Bittner’s major academic roles have included positions within faculty roles as Professor and within multiple leadership roles most recently as Assistant and then Associate Dean for the School of Nursing, Science and Health Professions at Regis College. She received her Diploma in Nursing at Memorial School of Nursing in Albany, NY, BSN from SUNY and her Masters and PhD from the University of Rhode Island.
In addition, Dr. Bittner has held a number of practice based roles including Critical Care Clinical Nurse Specialist and Nurse Research Scientist most recently here at HHS. Dr. Bittner’s other work has included the development and implementation of global initiatives such as the Community Health Nursing Clinical Experience and Mission in Villa El Salvador, Peru. Dr. Bittner’s Professional Accomplishments related to work in evaluation include appointments to New England Association of Schools and Colleges (NEASC) as a program evaluator as well as a Site Evaluator for Massachusetts Department of Higher Education (DHE). She has been a Program Evaluator for National League for Nursing Accrediting Commission since 2001 and a member of the Evaluation Review Panel since 2004.
Dr. Bittner is involved in professional organizations as well as key committees at the state, regional and national level focusing on addressing the issues related to nursing education. Currently, she is a Co-leader for the Massachusetts Action Coalition, and member of the DHE Education Redesign Institute Committee. In her practice area of critical care, she is a member of the AACN Horizon’s Education Committee and President of the American Association of Critical Care Nurses, Greater Boston Chapter.
Dr. Bittner’s program of research is focused on critical thinking, delegation and missed care. Her most recent publications include articles regarding this line of research in addition to other research on the nursing faculty shortage and global initiatives. She has conducted numerous presentations related to her research at the state, regional, national and international levels.
Cheryl Warren, MS, RN, System Director of Clinical and Fiscal Integration
Cheryl Warren, MS, RN, leads the case management department for Hallmark Health System. (HHS). Cheryl possesses a wide range of leadership skills. Her past experience includes management positions at Boston Medical Center where she was responsible for Case Management and several other hospital departments. She has a strong foundation in leadership and extensive experience in care coordination, discharge planning and utilization management. Cheryl brings that broad care management experience to HHS and assures that we provide our patients the right care at the right place and time.
Carol Downes, MSN/MBA, RNC
Carol Downes is the Director of Maternal-Newborn Nursing at Melrose-Wakefield Hospital. As such, she is responsible for oversight of Labor and Delivery, the Mother-Baby Unit and the Special Care Nursery.
Carol has worked at Melrose-Wakefield Hospital for more than 30 years in a variety of clinical settings within Maternal-Newborn Services. She has been a member of the nursing leadership team since 1999..
Carol holds a baccalaureate degree in nursing from Salem State College and is a graduate of Salem State College’s MSN/MBA Program. She is certified in Inpatient Obstetric Nursing by The National Certification Corporation and is board certified in Nursing Administration Advanced by the American Nurses Credentialing Center.
Dauren Nowell, BSN, RN
Dauren Nowell currently holds the position of Director of Psychiatric Nursing at the Lawrence Memorial Hospital of Hallmark Health Systems. This position assumes 24-hour responsibility and accountability for care delivery and resource allocation on the two inpatient Geriatric Medical-Psychiatric Units (18 bed non-secured unit and a 16 bed secured unit) on the Lawrence campus.
Ms. Nowell oversees a multidisciplinary team comprised of nurses, nursing assistants, social workers, occupational therapy staff, mental health workers, and secretarial support staff. She is responsible for implementing all operational and administrative decisions for the Medical-Psychiatric Program. She works collaboratively with the Associate Chief Nursing Officer, the System Director of Behavioral Health Services, the Chief of Psychiatry and other directors at Hallmark Health to continually promote high quality patient care.
Ms. Nowell has worked at the Lawrence Memorial Hospital for the past 15 years. During this time, she has successfully led her team through Joint Commission and Department of Mental Health re-licensing surveys, has positively impacted quality care on her units through the implementation of best practices and has given numerous presentations related to the behavioral health issues of older adults.
Ms. Nowell holds a baccalaureate degree in Nursing from Marquette University and is currently enrolled in graduate studies at Regis College. She is currently a member of the Massachusetts Organization of Nurse Executives.
Carol Plotkin, LICSW
Carol Plotkin LICSW, is the System Director for Behavioral Health at Hallmark.Ms Plotkin has more than 30 years of experience in behavioral health care delivery systems, including hospitals, outpatient services, and managed care.Prior to joining Hallmark in 2009, Carol held positions as the Executive Director of Psychiatric Services at Cape Cod Healthcare and as Vice President of Program Development for Health Partners New England.Throughout her career she has been responsible for overall operations for a variety of Behavioral Health programs throughout New England, including adult, geriatric and child inpatient units, crisis assessment teams, and outpatient clinics.Ms. Plotkin continues to partner with colleagues to promote excellence in patient focused behavioral health care that meet the needs of the community.She has a particular interest in safety initiatives, restraint prevention and the integration of behavioral health and primary care.
Ms. Plotkin has consulted locally and nationally on clinical operations and customer service in health care. She has worked in the areas of managed care, physician education and clinical practice.Ms. Plotkin is a graduate of the University of Massachusetts at Amherst and Rutgers University Graduate School of Social Work.She is an active volunteer with the American Red Cross as a Mental Health Disaster Specialist.
Kathleen Taylor, RN, BA
Kathleen Taylor is in the new position of the Nursing Informatics Specialist. She has a B.A. in biology from Trinity University in Washington D.C. and a baccalaureate degree in Nursing from Holy Family University in Philadelphia. Her experience has been in psychiatric nursing and as a nurse on a TCU unit. Most recently she has been a Nursing Informatics Educator. She will be part of the team that will implement new clinical information systems and monitor their impact on nursing care. " I recall the first time I was able to pull up a patient's lab value quickly because of the new computer system my hospital had just rolled out, and that planted the seed that brought me to nursing informatics. I want others to have that same positive experience with computers that I had."
Anthony Alley, BSN, RN, NE-BC
Anthony J. Alley BSN, RN, NE-BC has been employed at Hallmark Health Systemfor the past eight years where he has assumed progressive leadership roles. Anthony is currently the Patient Care Director for The Center for Orthopedics and Sports Medicine as well as Medical 4, a 38 bed Medical-Surgical, Pediatrics and Hospice Unit and Cummings Orthopedic Surgical 5 both at Melrose-Wakefield Hospital. In addition, Anthony co-chairs the Hallmark Health Ethics Committee and is a voting member of the Institutional Review Board. Anthony graduated with his BSN from the University of Massachusetts, Boston with the honor of Summa Cum Laude. He is currently matriculated in the MSN program at Loyola University with a specialty in Health Care Systems Management. Anthony recently earned his Nurse Executive certification through the American Nurses Credentialing Center.
Anthony is a member of Sigma Theta Tau, the national nursing honor society, as well as the American Organization of Nurse Executives, the American Nurses Association, the National Association of Orthopaedic Nurses and the Academy of Medical Surgical Nurses, which he currently serves as President-Elect for the Greater Boston Chapter #123. Anthony has also been an active member of The American Assembly of Men in Nursing and has presented his poster on Men in Nursing: A Historical Perspective at events such as the Christine Cameron Nursing Research Symposium and the Massachusetts Board of Nursing Centennial Celebration.
Anthony is passionate about nursing research and evidence-based practices, quality patient care, shared governance, and the importance of professional practice.
Karen Costigan, BSN, RN, NE-BC
Karen Costigan, BSN, RN, NE-BC is a long term employee of Hallmark Health System with twenty five years of nursing experience in critical care and progressive leadership roles. She currently provides direction and strategic planning as the Patient Care Director for a diverse 39-bed medical, surgical, and cardiac unit at Melrose-Wakefield Hospital.
Karen co-chairs the Patient and Family Education Council and Fall Prevention Committee. She is passionate about quality patient care, a culture of safety and promotion of health and well-being.
In August of 2010, Karen traveled to Haiti leading a group of Hallmark Health System employees providing care to the residences of Northern Haiti, as well as, educational services to their caregivers.
She is currently pursuing a Masters Degree in Nursing Leadership and Health Administration at Regis College. She has been involved in research and is NIH certified. She has recently earned her Nurse Executive certification through the American Nurses Credentialing Center and is a member of the American Organization of Nurse Executives.
Brenda MacPherson, BSN, RN-BC
Brenda MacPherson, BSN, RN-BC currently holds the position of wound care nurse at Hallmark Health System (HHS). MacPherson started working at HHS in 1992 in dietary. She obtained her BA in athletic training and worked for HHS's Rehabilitation Services Department as an athletic trainer. She obtained her ASN from Bunker Hill Community College in 2008 and started working in a long-term acute care facility specializing in wounds. She graduated with her BSN from the University of Massachusetts Boston in 2010 and will be finishing her Master’s degree in forensic nursing at Fitchburg State University in 2014.
In 2010 she began working on Melrose-Wakefield Hospitals' Medical 5, a medical-surgical telemetry unit and was a resource for patients with wounds and pressure ulcer prevention. She was a clinical teacher on Medical 5’s Dedicated Education Unit (DEU) for the Lawrence Memorial-Regis College Nursing Program and co-chair of the New Grad Resident Council. MacPherson has been involved with Medical 5's Unit Council, Falls, Safe Patient Handling, Patient/Family Education Committees and is co-chair of the Wound Care and Prevention Committee. She has been a presenter and a poster presenter at the Christine Cameron Symposium for Evidenced Based Practice.
She traveled to Haiti in 2012 with HHS physicians and employees to help provide care and help educate staff. She is a member of Sigma Theta Tau and International Association of Forensic Nurses.
Lisa Duffy, MS, CCNS, RN-BC
Lisa Duffy is currently the Patient Care Director of West 2, 3 and the ICU at Lawrence Memorial Hospital/Hallmark Health System in Medford. She has worked in many areas of clinical practice as well as academic during her career. She received her BSN from Salem State College, in Salem, MA and her Master’s Degree as an Acute/Critical Care Clinical Nurse Specialist from Regis College in Weston, MA. Lisa has worked in many roles throughout her nursing career; her specialties include oncology, IV therapy, telemetry, medical/surgical, critical care, orthopedics and urology. After receiving her Master’s degree she worked as a Clinical Nurse Specialist in the education department here at Hallmark Health. She also worked as adjunct faculty for the School of Nursing at Regis College. Thereafter she joined the staff development department overseeing the inpatient clinical areas as well as instructing at the Center for Professional Development. Lisa is certified through the AACN as a Critical Care Clinical Nurse Specialist. She is also a member of the American Association of Critical Care Nurses.
The Hallmark Health System professional model of care is the Synergy Model – a holistic model where patient/family needs are matched to a nurse’s level of expertise, which directly contributes to optimal patient outcomes. The Synergy Model specifically describes relevant aspects of the nurse-patient, nurse-nurse and nurse-system relationships. The Synergy Model, developed by the American Association of Critical Care Nurses, describes a patient-nurse relationship that supports the primacy of patients and families. All nurse-patient/family assignments are based upon matching patient/family needs to nurse competencies.
Introduction The Synergy Model describes a cluster of personal characteristics that each patient and family brings to a healthcare situation. These 8 characteristics are dynamic and span a continuum of health to illness and include: stability, complexity, vulnerability, predictability, resiliency, participation in decision-making, participation in care, and resource availability. Nursing competencies, derived from the needs of patients, are also described in terms of evolving professional practice. The Synergy Model describes eight dimensions of nursing practice that span the continuum from competent nurse to master clinician nurse. These include clinical judgment, clinical inquiry, caring practices, response to diversity, advocacy/moral agency, facilitation of learning, collaboration and systems thinking. These competencies reflect a dynamic integration of knowledge, skills, experience, and attitudes needed to meet patient’s needs and optimize patient outcomes. The Hallmark Health System professional advancement program is based upon evolving expertise within these eight dimensions of nursing practice.
Within the Synergy Model and consistent with patient/family-centered-care, patients and families are, or assisted to become, active participants in the patient/family-nurse interaction. The interaction is synergistic; specifically, it is reciprocating and co-constituting. The nurse comes to “know” the patient and family and the patient and family comes to “know” the nurse. When this relationship demonstrates engagement and synergistic then optimal patient outcomes are more apt to occur.
- We believe that excellence in care is provided through meaningful therapeutic relationships with patients and their families, continuity in care is a core element of our model of care.
- In support of fostering therapeutic patient/family-nurse relationships, the Clinical Nurse Leaders and Staff Nurses work together to build continuity in nursing care over the patient’s illness trajectory by assigning a limited number of nurses to the patient/family.
- As colleagues, more experienced nurses mentor less experienced nurses.
- Since the needs of patients vary across the system, we have a varying number of Staff Nurses and Advanced Practice Nurses who provide varying levels of expertise on each unit to best accommodate patient needs.
Assumptions: Each patient and family is unique with various capacities for health and vulnerability to illness. Patients possess a singular genetic and biological makeup that establishes their capacity for health. Each individual practices various degrees of healthy behaviors, for example, healthy diet, exercise, and stress reduction. Each lives in a community with different economic structures, government, social organization and community perceptions. All exist within a macro social structure consisting of societal infrastructure, the physical environment, cultural characteristics, and population perceptions. All these factors place the patient in context of an individual within a unique environment and circumstance that impacts the nursing care required of the particular patient and family.
Patient Characteristics of Concern to Nursing
Stability is the ability to maintain a steady state. Stability can be used to describe any vacillating phenomena that impacts nursing care; for example: physiological stability, psychological stability, emotional stability, family or social stability.
Complexity is defined as the intricate entanglement of two or more systems. This characteristic includes multiple systems and/or therapies, for example, body systems, family and social systems, and/or therapeutic interventions.
Vulnerability is a susceptibility to stressors that may adversely affect patient outcomes. Patient vulnerability considers the patient’s risk for adverse outcomes. For example, individuals may present with co-morbid conditions that place them at high risk for associated adverse outcomes and/or patients receiving certain therapies may be at risk for associated complications. Anticipatory assessment and management of associated risks or co-morbid conditions impacts the patient’s nursing care and recovery.
Predictability is the characteristic that allows one to expect a certain trajectory of illness. While most patients have a predictable course of illness, some individuals do not respond in the typical fashion. When predictable, the patient’s care can be managed using traditional practice guidelines; when unpredictable, practice guidelines are not helpful. Also, when the patient or their diagnosis is unknown, one cannot anticipate the patient’s response to interventions or predict the patient’s trajectory of illness.
Resiliency is the capacity to return to a restorative level of functioning using compensatory and coping mechanisms. Given the patient’s individuality, some patients easily return to a stabile state where others do not. How a nurse approaches and plans interventions that may challenge the patient’s stability is certainly based upon the individual’s capacity to restore homeostasis.
Participation in decision-making describes the extent to which the patient or family engages in decision-making. The patient’s and family’s capacity, desire, and level of decision-making in daily management and overall treatment vary dramatically within the care environment. At different points during their illness, the nurse stands in for, or beside a patient and family to support them though a decision that will impact their care and management.
Participation in care describes the extent to which the patient and family participates in care activities. Again, the patient’s and family’s capacity, desire, and level of participation in care vary dramatically within the care environment. At different points during their illness, the nurse either provides or helps the patient and family give care.
Resource availability is the extent of resources the patient, family, or community brings to the care situation. Resources include personal, physiological, social, technical and financial. The extent of available resource impacts the level of support nurses need to provide patients and their families.
Nurse Competencies of Concern to Patients and Their Families
The Synergy Model nurse dimensions are used to frame nursing competence within Hallmark Health System. The competencies form the basis of the nursing job descriptions. Evolving expertise in each dimension is linked to the Hallmark Health System Department of Nursing Professional Recognition Program. As individual nurses level’s of expertise are determined, an optimal balance of clinician, advanced clinician, expert clinician and master clinicians on a unit is determined based upon the patient population served.
Clinical judgment is the ability of nurses to use their clinical knowledge to affect patient outcome. It is defined as clinical reasoning, which includes clinical decision-making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and experiential knowledge. Patricia Benner’s From Novice to Expert has enriched how the Nursing profession has come to understand clinical knowledge development. Clinical wisdom is not solely dependent on years of experience but on experience gained from years of learning and applying knowledge gained to each successive patient.
Clinical inquiry involves resolving clinical problems that occur at the bedside and in the care environment. It is an ongoing process of questioning and evaluating practice and providing informed practice and creating practice changes or innovation through research utilization and experiential learning. It is a matter of asking good questions, delving into the literature to answer those questions, and bringing the best evidence to the bedside. Clinical inquiry is all about seeing, questioning, finding the evidence, and making practice changes.
Caring practices makes our clinical judgment visible. Caring practices include a constellation of nursing activities which are responsive to the uniqueness of the patient and family and that create a compassionate and therapeutic environment with the aim of promoting comfort and preventing suffering. Caring practices, such as presence and vigilance, create a safe environment for patients to be sick in. Caring practices, extended to all members of the care team, creates a therapeutic milieu. Caring practices include not only what nurses do but also how they do it. Pain assessment and management are fundamental caring activities. Nurses are engaged during difficult situations, they help the patient and families understand and decide out how best they can get though tough situations. All patients are unique with different values and beliefs that nurses learn so they can know what is important to the patient and their family.
Response to diversity involves the sensitivity to recognize, appreciate, and incorporate differences in the provision of care. Differences may include, but are not limited to: individuality, cultural differences, spiritual beliefs, gender, racial, ethnicity, family configuration lifestyle, socioeconomic status, age, values, alternative medicine involving patients/families and members of the healthcare team. Nurses help families identify, for themselves, what is important to them as individuals and support them though difficult decisions.
Advocacy/moral agency involves working on another’s behalf and representing the concerns of the patient/family/community and serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within the clinical setting. Because of Nursing’s unique relationship with patients and families, nurses often are the voice for patients who cannot speak for themselves. Nurses carry on the moral tradition of nursing and serve as the patient and family’s moral agent; the person in whom things matter, the person who takes a stand and gives voice to patient and family concerns.
Facilitator of learning refers to nurses’ competency in facilitating patient, family and staff learning. This includes supporting a learning environment characterized by safe discourse, mentoring and team development. Teaching and patient and family learning is embedded in care, from our first interaction, where we orient patients and family to the care environment, to our last interaction, where we finalize instructions for home. We also assume major responsibility in coaching and mentoring the next generation of nurses and members of the interdisciplinary team.
Collaboration includes working with others (patient, family, healthcare providers, colleagues, community) in a way that promotes and encourages each person’s contributions. Collaboration involves intradisciplinary and interdisciplinary work with colleagues and ability to negotiate and resolve conflict. The nurse is the one person who knows the care environment and can pull a team of caregivers together in the best interest of the patient and family.
Systems’ thinking includes appreciating the care environment from a perspective that recognizes the inter-relationships that exist within and across healthcare settings. Making complex systems safe for patients is a skill. Whereas competent nurses operative on a micro level (unit and shift focus) and are just beginning to develop system savvy and strategies to facilitate change, expert nurses operate on a macro level (program and episode of illness focus), possess system savvy and easily apply a variety of strategies to facilitate change within complex systems.
American Nurses Association (2003). Nursing’s social policy statement (2nd ed.). Washington, DC.
Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics. Benner, P., Tanner, C., Chesla, C., (1996). Clinical Wisdom and Interventions in Critical Care: A Thinking in Action Approach. Springer Publishing Co.
Benner P. (1984). From novice to expert: excellence and power in clinical nursing practice. Addison-Wesley Publishing Co., Inc.
Curley MAQ. Synergy: From Theory to Practice. Synergy: Continued. Origins of Synergy. Synergy in Publication. In MAQ. Curley (Editor). The State of Synergy. Excellence in Nursing Knowledge 2004; 1(1) www.nursingknowledge.org/enk
Curley, M.A. (1998). Patient-nurse synergy: optimizing patients' outcomes. American Journal of Critical Care, 7(1), 64-72.
Curley, M., & Wallace, J. (1992). Effects of the nursing participation model of care on parental stress in the PICU: a replication. Pediatric Nursing, 7(6), 377-385.
Curley, M. (1988). Effects of the nursing mutual participation model of care on parental stress in the PICU. Heart Lung, 17(6), 682-688.
Hagerty, B., & Patusky, K. (2003). Reconceptualizing the nurse-patient relationship. Journal of Nursing Scholarship, 35 (2). 145-149.
Tanner, C.A., Benner, P., Chesla, C., Gordon, D.R. (1993). The phenomenology of knowing the patient. Image, 25, 273-280.
The Massachusetts Nurse Practice Act: Massachusetts General Laws (M.G.L) chapters 13, 14, 14a, 15, 15d and chapter 112, 74-81c of 244 CMR sections 3.00-9.00
The DAISY Award for Extraordinary Nurses
In 2008, Hallmark Health System (HHS) joined over 600 healthcare organizations throughout the country in the DAISY Foundation. DAISY stands for “Diseases Attacking the Immune System”. The organization was founded November, 1999 in memory of J. Patrick Barnes who died at 33 from complications of ITP (Idiopathic Thrombocytopenia Purpura).
The DAISY Foundation was established to honor nurses. The Barnes family was awestruck by the care and compassion Pat received from his nurses during his 8 week hospitalization. DAISY recognizes and says thank you to nurses by:
• Honoring the super-human work nurses do at the bedside every day.
• Funding research: The J. Patrick Barnes Grants for Nursing Research and Evidence-Based Practice Projects
• Honoring nursing faculty: The DAISY Faculty Award
The American Organization of Nurse Executives (AONE) and its chapters collaborate to help expand DAISY to hospitals throughout the United States. American Nurse Credentialing Center (ANCC) supports The DAISY Award for all Magnet® and Pathways to Excellence organizations – and those on the journey.
Who can nominate the Nurses? Nominations can be submitted by patients, families, colleagues, physicians, and other staff. The DAISY award is focused on the compassionate care and memorable moments nurses provide their patients … as well as great clinical skill. Every nomination tells a story.
Hallmark Health System DAISY Awards winners:
May 2008Talin Barsoumian, MSN, RN-BC West 3Lawrence Memorial Hospital
Kathy Ledoux, RNMedical 3Melrose Wakefield Hospital
August 2008Beth Reid, BSN, RN, PCCN Medical 5Melrose Wakefield Hospital
Marissa Tribble, RN West 2Lawrence Memorial Hospital
November 2008Jennifer Yap, BSN, RNMedical 5 Melrose Wakefield Hospital
Kathy Charbonnier, BSN, RN, CCRN West 3Lawrence Memorial Hospital
February 2009Gerry Goulet, BSN, RN South 1Lawrence Memorial Hospital
Barbara Harris, BSN, RN, PCCNMedical 3Melrose Wakefield Hospital
May 2009Marjorie Moss, BSN, RN, CCRNMedical ICUMelrose Wakefield Hospital
Michelle Harrington, BSN, RN, CCRN ICULawrence Memorial Hospital
October 2009Nicole Bates, BSN, RN, PCCNMedical 5Melrose Wakefield Hospital
Francesca Nepomuceno, ASN, RNWest 3Lawrence Memorial Hospital
March 2010Jennifer Ulicny, BSN, RN System Float TeamHallmark Health System
November 2010Hilary Otway, ASN, RN West 3Lawrence Memorial Hospital
Kellie Story, ASN, RNMedical ICUMelrose Wakefield Hospital
May 2011Karen Masucci, ASN, RN West 2Lawrence Memorial Hospital
Sharon Turcotte, BSN, RN-BC, CWS Staff DevelopmentHallmark Health System
Beverly Turino, RNMedical 3Melrose Wakefield Hospital
January 2012Mary Hughes, RNManaged CareMelrose Wakefield HospitalJulie Maloof, RNWest 3Lawrence Memorial Hospital
Jennifer Barnes, ASN, RN-BCMedical 6Melrose Wakefield Hospital
If you would like to share nominate a nurse, click here and submit your story.
Consistent and Visible Support
- Mutual commitment to learn and grow together
- Belief in the character and competence of each other, including clinical competence, interpersonal competence, cultural competence, leadership competence, and critical thinking ability
- Recognizing the intrinsic value of each member of the care delivery team
Open and Honest Communication
- Belief in the importance of direct, open, honest and timely communication
In concert with the mission, vision and values of Hallmark Health, the professional nurse, with the support of the nursing care team, embraces the following commitments to our internal and external community:
- We embrace RESPECT as the cornerstone of our actions, supporting each other as well as the needs of our patients and their families while valuing cultural, ethnic and religious diversity regardless of race and social standing. We believe in upholding the DIGNITY and WORTH of every member of our health care family and every patient we serve.
- We believe that by functioning within our professional standards of practice, we provide safe, quality patient care. Through our care delivery model we promote COMPETENCE, COMPASSION, COMMUNICATION and CRITICAL THINKING in health promotion and disease prevention across the continuum of life.
- We believe as professional nurses we practice AUTONOMOUSLY with ACCOUNTABILITY and RESPONSIBILITY in managing and coordinating patient care. We are committed to ADVOCATING for patients to achieve optimal outcome oriented care.
- We are committed to COLLABORATION with the entire health care team to provide the highest quality holistic patient and family-centered care.
- We are DEDICATED to providing comprehensive care guided by ethical principles and utilizing sound judgment.
- Our unique culture of caring embraces a SHARED GOVERNANCE MODEL which promotes involvement of each individual toward the achievement of common goals.
- We believe that through a life-long commitment to our individual and collective professional growth and development, we promote optimal patient outcomes relying on the best of research and experience.
- It is in utilizing and sharing our experiential wisdom that we cultivate an environment of excellence and high professional and personal satisfaction.
Professional Recognition Program
Downloadable DOC - 209kb
Nursing Service Organization & By-Laws
Downloadable DOC - 136kb
The mission of the Hallmark Health Department of Nursing is to provide quality care to patients and families of the communities we serve. This mission fosters a nursing culture which promotes nurse leadership and autonomy, professional development, critical thinking and cultural competence.
As professional nurses and members of the nursing care team, our most important responsibility is achieving positive outcomes for our patients and nursing staff. It is through our professional practice model that we fulfill our vision.
National League for Nursing
The Lawrence Memorial/Regis College Nursing Program as part of Regis College School of Nursing and Health Professions has been designated a Center of Excellence in Nursing Education by the National League for Nursing (NLN). It is the first NLN Center of Excellence designation in New England and there are fewer than 25 in the country.
Each year since 2004, the NLN has invited nursing schools to apply for this designation based on their ability to demonstrate sustained excellence in faculty development, nursing education research, or student learning and professional development. Schools must also have a proven commitment to continuous quality improvement.
Nursing News is a newsletter for and by Hallmark Health System nurses. Our goal is to communicate important information and celebrate our accomplishments. We invite all nursing colleagues to share stories about their professional practice, unitsuccesses and performance improvement projects.
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