Transcription:
PICU Life with Tiffany Mullen, CNS

Trisha Williams:  Hi, guys! Welcome to the Advanced Practice Perspectives. I'm Trisha Williams.

Tobie O'Brien: And I'm Tobie O'Brien. This is a podcast created by advanced practice providers for advanced practice providers. We will be highlighting our amazing APPs here at Children's Mercy and do some education along the way.

Trisha Williams: We are so glad that you're joining us today. So sit back, tune in and let's get started.

Tobie O'Brien: Today, we have the pleasure of visiting with Tiffany Mullen. Tiffany is a clinical nurse specialist in the Pediatric Intensive Care Unit. Tiffany was also one of three amazing APPs who originally helped Trisha and I get this podcast up and running. Tiffany, along with Ryan Gentry and Mindy Eldridge allowed us to interview them back in the spring of 2020 to create a pilot podcast to pitch to our advanced practice leaders and the communications team. So we are so thrilled that she's joining us for real this time. Welcome, Tiffany.

Tiffany Mullen: Thanks for having me,

Trisha Williams: You get to join us for real. I'm so excited to have you, Tiffany. You were instrumental along with Ryan and Mindy getting our approval to move forward with this project. So thanks again from the bottom of our heart for helping us get this up and going. We are so excited to have you on our podcast today. So let's tell our listeners a little bit about who Tiffany is.

Tiffany Mullen: Okay. Well, I did my undergrad nursing school at KU. And then I worked for a really short time at KU with adults. And I have been in the pediatric ICU as a bedside nurse for right at 11 years now. And then as I was working in the ICU, I went to school to get my Masters in Clinical Nurse Specialist. And I chose this route because I wanted to be certified through the American Association of Critical Care Nurses, that's my professional organization. And I knew that I wanted to stay in critical care. So this seemed like the best fit for me and that's why I chose the CNS route.

Trisha Williams: Tiffany, how long have you been in your role as a clinical nurse specialist in the PICU here at Children's?

Tiffany Mullen: I have been in the role for almost five years now.

Trisha Williams: Wow!

Tiffany Mullen: It was a new role for the pediatric ICU and really for the whole organization to have a unit-based clinical nurse specialist. We have a handful of clinical nurse specialists that work in the organization, but the majority of them function as nurse practitioners.

Tobie O'Brien: Will you tell us about how you function in the PICU?

Tiffany Mullen: Every day is different, which is what I love about my role. A CNS is a master's prepared nurse, who the goal is to improve patient outcomes. So that's what I come to work every day to do. And you do it based on three spheres of influence.

The first is the patient. So I round with the teams on the ICU and help contribute to the plan of care on patients. And then the second sphere is nursing. So that's probably the biggest role that I take and that is supporting the bedside nurses. I do this by being a consult to them if they have questions on something. I do just-in-time training, just-in-time education, and just really offers support to the bedside staff. The third sphere of influence is organization. And I fulfill that one by doing a lot of policies, procedures and quality improvement projects.

Trisha Williams: Tell us a little bit about what just-in-time means.

Tiffany Mullen: Yeah. So when I am out on the unit and I see something, in the moment, I want to address it. So I want to give that bedside nurse a little bit of background, maybe give some reference to a policy that we have, just to help with identifying in the moment how to improve patient outcomes.

Tobie O'Brien: I see. I love that. I didn't spend very long in the PICU as an RN, but a bit of time. And I know that I could have used having someone like you to help me. I'm sure you are a great resource. So it sounds like a lot of your job is really being a resource to those nurses. And it sounds like also that is really where your passion lies as well as the patient outcome.

Tiffany Mullen: Absolutely. That's what I get fulfillment out of my role and why I love to be a CNS is because I influence patient outcomes by getting the nurses to provide the best care that we can at the bedside.

Trisha Williams: Can you share with us some of the quality improvement projects or research projects that you're currently involved in? Are they outcome-based looking at a specific patient population or... What'd you got going on?

Tiffany Mullen: Yeah, so we actually split this past summer. We were a really big combined ICU. And now we split into a pediatric ICU that has med-surg patients. And then we have our cardiac ICU that takes care of the cardiac population. I cover both of them. So I will do projects and work on both patient populations, which is really fun because I love the variety.

So a couple of projects that I have going on right now is a midline chest incision for our cardiac patients. When they come back from the OR, they're always admitted to our cardiac ICU. And so we recover them and then we send them to the floor or we send them home. But most of the time we send them to the floor and one of the aspects of our work is to care for those incisions when they come back.

So we standardized the care for those midline chest incisions and did education of the staff, picked specific products that we wanted to use and rolled that out to staff. So we've been live with that for about six months now and it's going well. And one of the outcomes for that is watching our surgical site infections for our cardiac patients.

Trisha Williams: And I'm guessing you've seen a huge improvement with the standardization.

Tiffany Mullen: Yeah, we watch our incidence of surgical site infections, but the other outcome for it is just clarity on this practice, which is really important. You don't want everybody doing something different. And so what we're seeing with this standardization and really having it laid out on a piece of paper and within the orders is that everybody who walks into the room is treating that midline chest incision the same as the next.

Trisha Williams: Standard work is very important.

Tobie O'Brien: I know you mentioned that there's other CNSs, but they sort of function as nurse practitioners. Are you one of the only ones in the PICU right now?

Tiffany Mullen: Yes, I am the only CNS in the PICU.

Trisha Williams: And how many beds is our PICU up to now? Because when I worked there, it was 23 beds. And I can only imagine it's way bigger than that now.

Tiffany Mullen: Yeah, we went up to 41 beds. That was when we were combined ICU. And then we spilled over to the adjacent unit. And we are in the midst of construction, so it kind of depends on what stage of the construction we're in, but we have 41 beds on our original unit and then we have 17 on the overflow unit that we can use right now at the moment. But we will end up having 65 beds total.

Trisha Williams: And then how many will split from med-surg to CVICU?

Tiffany Mullen: I am not really sure where the construction ended up on that one.

Trisha Williams: Okay. Fair statement. But I mean, that's a huge undertaking for you and the number of nurses that you do the just-in-time education is large. I can only imagine what the number of staff is. So kind of lead us through a little bit about how you do that and how you have that professional educational conversation in the moment when things may be a little bit tense or high, but most important to do the education. So can you kind of lead us into how that happens and what some techniques on what you do?

Tiffany Mullen: Yeah, it kind of just comes back to being a change agent and being an effective change leader. And part of that is just earning the trust of the end users. So I spend as much time as I possibly can out on the unit, getting to know people. I have worked with the educators so that I do a presentation to the new hires so that they can get to know me as soon as they hit the doors.

And then I continue to engage with staff at every quarterly update. I always have time that they have to hear me talk about something and then just getting out on the unit and talking to people and getting to know them and having that foundational relationship really helps in those moments to coach and mentor. And I think it goes back to being a good coach and mentor, which our leadership team is really focusing on lately and being able to provide that professional helpful, meaningful feedback in the moment.

And I would say my biggest thing is that I just want whoever I'm giving feedback to know it, that it's coming from a good place and that I genuinely want them to be the best that they can be so that they can take the best care of our patients possible.

Trisha Williams: I can only imagine the fantastic job that you're doing. You said two pretty profound things that stuck out to me in your statement is being a change leader and gaining the trust of the end user. And I love that. And I think that everybody listening to this podcast can take away that tidbit of information. So good work, Tiffany.

Tiffany Mullen: Yeah. It's important to know I think that we can't all do our jobs by ourselves. I can't do my job without my bedside nurses, without our physician, without our advanced practice nurses who are at the bedside with the patients. And they can't do it without the other people as part of that team. And I think part of that team also includes the patient and the family, which sometimes we forget about in pediatrics, but they are there and we need to include them in everything that we do.

Tobie O'Brien: I mean, primarily why we do this is for them. And I do think hearing everything that you said, it's no surprise that Children's Mercy has received its fifth Magnet Recognition. Hearing you talk about the support that you offer the nurses and sort of encouragement or fostering this learning or desire to learn more and to just better themselves as bedside nurses. And also, it sounds like just so they don't have to fear that sort of in-time correction and that it's something more that you're basically doing it to better them and to improve patient outcomes. And I think that all plays into why we did receive this honor. Can you tell us a little bit about the Magnet Recognition?

Tiffany Mullen: Yeah, I think Magnet is so important for our organization. It's one of the things that people look to when they are looking for a job. It's one of the things that they look for in an organization when they're looking for a place to have their child cared for. And not only is it just a title, but It speaks to the organization as a whole.

I had the pleasure of being in on some of the interviews for Magnet for a variety of reasons. And in one of them, the entire group was brought to tears listening to one of the nurses explain her contributions for the last 30 years. And that's a great thing about this organization is that you see people who have been here for 30 years and that's not uncommon. And it's because of the family that we've built as a team here. And I think it's so huge and we have the support of being cutting edge and doing projects and having the resources to provide for our patients. We aren't strapped for resources as much as others are. And it's amazing to see that support so that we can be the best that we can be.

Trisha Williams: Yeah. I had the honor of sitting in on a couple of those meetings as well. And I think as advanced practice providers, we forget the impact that we have on magnet designation. It's for nursing, but we are nurses too.

I remember reading what one of the Magnet surveyor said, is that we were not a golden nugget, we were a golden boulder as advanced practice providers. So I think that speaks huge for who we are as a group. And I feel like at Children's Mercy, we are provided with a ton of resources to grow our practice as advanced practice providers and participate in research and QI and really grow and become who we want to become to provide the best patient care that we can for the children at Children's Mercy. So I am honored to be a part of the fifth Magnet designation. So it's a big deal.

Tiffany Mullen: Absolutely. The APRNs, the sessions that I sat in with the surveyors, they were just blown away about the work that we do here and the support, you know, from your previous podcasts and Cathy Cartwright talking about the fellowship program and just the opportunities that we have to continue growing from the day we start to the day that we retire.

Trisha Williams: Correct. Yeah. You know, the Academy for Professional Development and all of the tasks forces and leadership groups that we have. I mean, I can't even name them all. There are so many great and amazing things that we have available to us at Children's Mercy.

Tobie O'Brien: Yeah, we certainly do have a lot of support that other advanced practice providers may not have in other places. So I feel very privileged to work at Children's Mercy to be able to have the opportunities that I've had just by working here.

Tiffany Mullen: Absolutely.

Tobie O'Brien: Well, Tiffany, we end each episode with a question for our guests. So if you could go back to when you were one year out of your master's program and working as a clinical nurse specialist, what advice would you give yourself?

Tiffany Mullen: Oh, there's so many things. I think the biggest thing is to start small, because small changes lead to big impacts. And the other piece of advice that I would give myself is to take away at least one thing from every experience, whether it's good or bad, there's something to learn from every experience that we encounter.

Tobie O'Brien: Agreed.

Trisha Williams: That is a great one. I love that. Yeah. I try to think, "Okay, what am I supposed to learn from this? Good, bad, ugly, everything in between. What am I supposed to learn?" And I think that that is great advice to your young self four years ago.

Well, Tiffany, thank you so much for joining us today. I always love chatting with you and catching up. Listeners may know that you and I used work the trenches together. So it was really an honor to speak with you. And again, thank you for the role that you played to get us where we are at today.

Tobie O'Brien: Yes. Thank you, Tiffany.

Tiffany Mullen: Thanks so much for having me.

Trisha Williams: You're so welcome. Listeners, thanks for tuning in today. In honor of February being Heart Awareness Month, our next episode will feature Megan Jensen. She is an inpatient APRN in our fantastic Ward Family Heart Center.

Tobie O'Brien: If you have a topic you would like to hear about or you are interested in being a guest, you can email us at tdobrien@cmh.edu or email Tricia at twilliams@cmh.edu. Once again, thanks to Tiffany and thank you guys so much for listening to the Advanced Practice Perspectives podcast.