My Specialty

Clinical Navigator Perinatal Services, Michael Russo, Henry Mayo Newhall Hospital, Valencia

Improving processes and systems while empowering the nursing team

Please describe the trajectory of your nursing career.

I began my career in 2012 by finding an internship program in pediatrics at Children’s Hospital of Orange County. I floated a lot to the NICU there and fell in love with it. In 2013, I was trained as a staff nurse in the NICU at Cedars-Sinai. While working the night shift there, I earned my master’s  in nursing education, which led me to the career path I’m currently traveling.

Why did you choose pediatrics?

Both the relationships with the families and advocating for this very special population who can’t speak for themselves have always appealed to my heart. When I was in school, I knew pediatrics was for me. I so enjoy talking with the kids, helping them through rough procedures and counseling and supporting the parents. My ability to connect and ease worries took on a new level of importance when I started working in the NICU.

What is your position at Henry Mayo and what does it entail?

I’m the clinical navigator of the NICU, which along with L&D and postpartum comprise the perinatal department. As clinical navigator, I’m responsible for connecting with staff and assessing their skills over time. I also round on parents and families to troubleshoot any potential patient experience issues.

Being a navigator is an umbrella position that includes process improvement, troubleshooting clinical issues, unit-based issues, clinical skills assessments, systems analysis and collaboration with many other units. A navigator has so many things to do that we can’t just be put in a single box.

In order to navigate the realm of the NICU, you must have space, time and resources. I feel I have a lot of room to be creative and flexible in this position, whether it’s doing data entry, researching patients, pulling information for chart audit or creating education for the unit.

How does the clinical navigator support the NICU nurses?

I work very closely with the clinical manager of the NICU, but my role is definitely advisory. I make sure my nurses are heard, acknowledged and respected. I empower them to use their voices to speak up if there are issues in the unit or if a process needs improvement.

It could be as simple as improving and/or optimizing the documentation in the electronic medical record, or something more complex, like examining evidence-based research about a pathophysiologic process and sharing that knowledge with the nurses.

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Another recent example is that we completely revamped the policies and created charting interventions, flowsheets and order sets for our brand-new cooling blanket, which we will start using in March 2020. This is a huge deal. I am also creating brand-new competencies for new hires as well as annual education, skills fairs and educational modules.

You mentioned rounding to help address patient experience issues. Tell us about that.

There are times when a breakdown in communication occurs. Sometimes, a process needs to be explained again to a family member, or family members cannot advocate for themselves and stay confused in silence. It is my job to step in and help them feel comfortable enough to ask their questions without feeling embarrassed or ashamed. I like to say we become friends after these encounters and there is no longer an issue.

What’s it like working with parents whose children are very compromised and perhaps even dying?

It’s very complex. Nurses need to remember that even though they’re working a shift, the parents can’t just go home and leave it all behind them — this is their reality. If a nurse can give them just two or three extra minutes of attention or active listening, that patience and compassion can help to assuage some of their suffering.

These parents may be on the unit with their children for two or more consecutive months. Since the NICU is such a separate experience from the rest of their lives, it’s good for them to feel that we understand their situation and see their struggles. Parents visit daily, deliver breast milk and make enormous sacrifices on behalf of their very sick children. We’re all present for them and they always say thank you. I feel having someone to acknowledge their struggle is extremely important and helps the process of coping with being in the NICU.

I’m on the floor five days a week, so the parents see me regularly. No matter what’s going on, I check in with them, give them my card and provide ongoing support in whatever manner they need.

How do you handle the emotional fallout in the lives of your staff?

We commit ourselves to these struggling babies and their loving parents, making sure we give them everything they need, but of course we must also look after ourselves. As a staff, we frequently debrief about what’s happened on the unit, and we try to make sure that staff are doing okay. When staff members need extra support or guidance through the rough times, I make myself available so that they have a safe place to go with their feelings. If someone needs follow-up, I stay in communication with them and give reminders that I’m there for them.

How do you care for yourself?

With the many demands of this role, I still have to remember self-care. I work out five times a week, which helps me stay emotionally and physically balanced. Even though I’m tired and people say I’m crazy to go so often, I always choose to work out because I feel so much better afterwards.

What are some changes in technology that you see in NICU and acute pediatrics?

There are all different types of new equipment coming forward as well as new medications and other innovations; it’s truly amazing what’s out there. At this time, we are working with our medical director to find new products we can bring onboard to create even more positive outcomes, including medications, treatments, monitors and machinery.

What parts of your role most light your fire?

I love everything I do. I always look forward to going to work and I never say, “Oh no, tomorrow is Monday!” I constantly tap into all of my skills and talents. Everything requires my attention and I have to find a way to balance all of those buckets. The staff always knows that I’m there for them and am part of the team; that’s very gratifying. Also, like I said earlier, the relationships with patients and their parents are paramount for me.

What career advice can you offer to a nurse who is drawn to the NICU or to the clinical navigator role?

If there is a residency/transition program that is training in the NICU, I would try my best to get into that program. Try to seek out NICU opportunities in nursing school. My nursing career began in pediatrics, which was an amazing stepping stone and provided a wonderful foundation. After you are in the NICU for a certain amount of time, you can then pursue your NICU credential.

To be a clinical navigator, you need at least three years of NICU experience, experience with database entry and a master’s degree in nursing (preferably with a background in nursing education). I have my certification in the NICU and am also a certified lactation counselor.  It helps to be passionate about process improvement and empowering those around you. Valuing respect and the dignity of others will get you far in this role and in life.

Do you have specific career goals or things you’d like to accomplish?

I love research and education, and I really want to get back to that. There’s nothing like teaching in a classroom, trying various methods of reaching students and then seeing their eyes light up. It’s a great feeling. I’d really like to earn my Ph.D. in nursing. I could see becoming tenured faculty, teaching at the graduate level. I taught undergrad in the past and that was very fulfilling as well, so I’d like to do both. Nursing students are so thirsty for knowledge — that’s inspiring to me.


Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.


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