Nurse practitioner Judy Vire has dedicated her life to establishing care for patients in rural parts of Central Texas. Her clinic, Kocurek & James, is one of a few providers offering medical care to communities desperate for easier access.
Vire has a master’s degree in nursing, was a nursing educator, and worked in many nursing roles, but she said her love of small-town America and the people there inspires her life’s work.
Daily Nurse proudly names Judy Vire the Nurse of the Week for her dedication to providing access to care to small-town and rural communities and caring for the most vulnerable patients, those who are unable to leave their homes.
Vire and her family settled in Flatonia, where she helped open the Rural Health Clinic in Flatonia and Schulenberg. Medical care is paramount for people in this rural part of Central Texas.
“It’s critical. Without having access to care close to home, people would be commuting into Austin, Katy, Victoria — that’s at least an hour’s drive any way you go,” Vire says. “These small communities depend on having these home-grown clinics close to home for convenience and access to care.”
Vire often makes house calls to the most vulnerable patients who cannot leave their homes.
“Because it’s a rural area, we serve an older population. The 65 and older are our largest population, and they, of course, need the most care,” Vire explains.
Regardless of whether a patient is old or young, Vire believes establishing trust is most important.
“Healthcare is personal. And when you have to tell someone bad news that impacts their lives, that is very personal, and people let you do that and trust you to do that,” she says.
That trust, she says, is why she’s given over 40 years to this career. Throughout her time at the Schulenberg clinic, she has seen generations of families making a daily impact on these communities.
In 2003, Vire was named Nurse Practitioner of the Year, and this year, she’s a Remarkable Woman nominee.
“It feels wonderful, and I was very surprised because there are a whole lot of more remarkable women than myself,” she says.
When asked about her most treasured career accomplishment at this clinic, she said it’s time.
“Maybe it’s longevity,” Vire says. “I can’t believe it’s been 30-some-odd years, and I am still doing this. I am proud of that.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Valentina Obreja has dedicated her career to improving care for ICU patients at UCLA Health.
“Never give up” are three words that have defined much of Obreja’s adult life. It’s what she told herself when she and her husband left Romania in 2006 with little more than four pieces of luggage and a dream to start a new life in the U.S.
It’s what she told herself while bagging groceries at a supermarket as she awaited approval to take her nursing licensure exam. It was also her dedication message in her doctoral dissertationat UCLA School of Nursing in 2021, and it’s what she tells her patients in the intensive care unit every day.
Valentina Obreja, DNP, AG/AC, NP-BC, a clinical nurse in the Cardiothoracic ICU at UCLA Health, has been named Nurse of the Week by Daily Nurse. Obreja has dedicated her career to improving the care of ICU patients receiving Extra Corporeal Membrane Oxygenation (ECMO) for the past 17 years.
ECMO is essentially a heart/lung bypass machine that takes over the work of the patient’s heart and lungs, giving the native organs time to heal. This complex medical equipment, combined with therapy, offers a lifeline to critically ill patients. During the COVID-19 pandemic, ECMO was used to support some patients with COVID-19 infection, whereas it was primarily used during open-heart surgery or as supportive therapy for patients awaiting lung or heart transplants.
Dr. Obreja Finds Fulfillment
For Dr. Obreja, working with such patients is not just a career – it’s a calling. Although she graduated from medical school and had an established career as a physician in Romania, she says nursing is where she has found fulfillment.
“It’s the most generous and gratifying profession ever,” she says. “I think it’s the connection with the patient – with a human and human nature – and the complexity of the role when you’re in the middle of the chaos trying to align all the factors in the ICU environment.”
Soon after passing her nursing boards, Dr. Obreja interviewed for a position at UCLA Health, where she started in the medical observation unit. With the expansion of the ICU to 24 beds, she transferred to her current position.
Living under communism in Romania meant her career opportunities there were limited, she says. It was her dream to work at UCLA Health.
“I always wanted to have the experience of working and doing my profession in an intense environment, and then to be surrounded with people interested in research and approaching very complex cases.”
In the U.S., she has earned both a master’s degree and a doctoral degree in nursing practice at UCLA School of Nursing. She also achieved national certification at the Fuld National Institute for Evidence-based Practice at Ohio State University School of Nursing, which she says helped ground her in the fundamentals of delivering care that incorporates current scientific evidence, clinical expertise, and patient/family preference.
Putting Knowledge into Practice
As part of Dr. Obreja’s doctoral studies, she worked on a project to safely mobilize ECMO patients, many of whom were physically debilitated. Using her knowledge of evidence-based practice, she turned to the literature, created the protocol, and began implementing the project in her unit.
“It was perfect timing,” she says. “It was in the midst of the craziness of the pandemic, working extra shifts and working at the bedside with all that protective equipment. I think the combination kept me focused outside of work, pushed me forward, and motivated me to make it to the end.”
But that wasn’t the end.
Another project soon materialized, prompting Dr. Obreja to look critically at their practice of dressing changes on ECMO patients. Next, she worked with the ECMO coordinator, critical nurse specialists, leadership, and the nursing team to implement guidelines for caring for ECMO patients.
“It was one project after another, and at some point, that helped the ECMO program to consolidate and get better,” she notes. “It’s essentially new knowledge, analyzing all the ECMO results. We need to know beyond stories and successes what it is exactly. ECMO is an expensive technology, and it’s not suitable for everybody. Trying to get better in this is the work that we are currently doing.”
Dr. Obreja Recognized by Scientific COmmunity
Meanwhile, the mobility protocol was presented at an international conference, “which meant for me endorsement from the scientific community,” she says. Another endorsement soon followed; last year, she was one of 30 nurses – 10 from UCLA Heath – to be honored by the Simms/Mann Family Foundation’s Off the Chart program, which recognizes nurses for outstanding care.
By the program’s design, recipients embody “a bias toward action, capacity for self-direction, originality and creative instincts, courageous and bold thinking, and the potential to achieve even more.”
The honor surprised Dr. Obreja, as was the $10,000 award that came with it.
“Looking back, I feel like nursing is my passion, so I don’t feel like I worked for it,” she says. “It was a super surprise, but I’m proud of this award. It’s inspiring, reassuring me that I’m doing what I’m doing well.”
Embracing Discomfort
Dr. Obreja has found stepping outside her comfort zone in certain situations means accepting a challenge. That was her experience when she left Romania.
“Everybody recognizes that the first year of being an immigrant is the toughest,” she says. “It’s a cultural shock. It’s not having your friends and family for support. And I very much remember that what I missed the most was the rain. Somebody told me, ‘Oh, this is homesickness.’ But we were determined to make it.”
She shared some stories of discomfort with students at UCLA School of Nursing, where she was a lecturer.
“It helps me to connect with the students,” she says. “They are scared about the program, deadlines, and requirements. So, I keep telling them that being uncomfortable is normal, like gaining a new skill, which, with hard work, will grow. I want to give them the confidence from the beginning that they made a great choice, whatever their interest will bring them in the future.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
The American Association of Critical-Care Nurses (AACN) is bringing the lessons learned from its proven nurse leadership and innovation program and its Healthy Work Environment (HWE) initiative to help nurses at hospitals around the country improve the health of their workplaces.
AACN Clinical Scene Investigator (CSI) Academy is a unit-based program using implementation science to leverage direct care nurses’ expertise and build additional skills, preparing and supporting them as clinician leaders who effect positive changes that improve patient, nurse, and hospital outcomes.
Building on CSI Academy’s successful 11-year history and the documented benefits of sustaining an HWE, AACN has established a special version of its 12-month, team-oriented CSI program that will focus on the implementation of “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards).
The initial cohort is underway in Los Angeles, with nurses from Los Angeles General Medical Center and Cedars-Sinai Medical Center. Nurses from Ohio, Oregon, Delaware, Texas, and Washington hospitals will participate in other regional cohorts launching through spring 2024. The program will eventually encompass 80 teams with three to four nurses each.
The HWE standards are the cornerstone of AACN’s comprehensive HWE initiative, a long-term commitment to creating environments where nurses can provide the highest standards of safe, compassionate patient care while being fulfilled at work.
Findings from AACN’s most recent National Nurse Work Environments study indicate healthcare teams who have implemented the HWE standards or are in the process of doing so report better results than those who have not. Teams implementing HWE standards reported higher nurse well-being scores, improved staffing with an appropriate skill mix, and higher quality of patient care, among other outcomes.
“A healthy work environment is an essential element to nurse recruitment, satisfaction and retention, while also improving patient, nurse and hospital outcomes,” said AACN Chief Clinical Officer Vicki Good, DNP, RN, CENP, CPPS. “While the positive impact of HWEs has been demonstrated through decades of research, the nursing community still struggles to translate evidence into practice and gain sustained support for HWE implementation. We aim to change that.”
A grant from the AACN Innovation Fund is underwriting the program, with participating hospitals paying a fee of up to $1,500 per unit and providing paid time away from patient care for nurses to participate in the program and attend CSI Academy workshops and sessions.
CSI Academy encourages participating teams of nurses to immediately apply what they learn in a capstone project that improves outcomes in their units. Over the past 11 years, participants have reported achieving significant results, including:
Reduced length of stay, ventilator days, infection rates, delirium, pressure injuries and falls
An average median return on investment of 605% per team
Nationwide, more than 512 nurses at 105 hospitals in 15 states have completed the CSI Academy program since its launch in 2012. The program has touched over 1.2 million patients and over 7,200 nurses, with an estimated positive fiscal impact on hospitals of $111 million.
AACN offers access to its online collection of CSI Academy innovation projects― including project plans, clinical interventions, data collection tools, outcomes, and references ― as part of the program’s goal to inspire and empower as many progressive and critical care nurses as possible. With over 115,000 unique downloads of project materials, the CSI innovation project library has become a resource for hospitals, healthcare administrators, and clinical leaders seeking solutions that improve outcomes and reduce costs.
To learn more about bringing CSI Academy to your hospital or health system, visit the CSI Academy FAQ page.
ER nurse Melanie Park has seen an increase in the number of visits to hospital emergency rooms by people experiencing homelessness. She blames the lack of homeless shelters in the Plant City, Florida, area.
Despite the challenges, Park has been doing her best to assist these patients and was recently recognized by HCA Florida Hospitals with a humanitarian award for her efforts.
Daily Nurse is proud to name Melanie Park our Nurse of the Week for her humanitarian work to aid Plant City’s homeless.
Park, a Plant City native, has been working as an ER nurse for 40 years. She has recently expanded her work beyond the HCA Florida Plant City emergency room, helping give homeless patients necessities after receiving medical care.
She calls the project “Mel’s Closet,” which Park launched after giving a patient new shoes six years ago.
“Her shoes were held together with rubber bands,” she recalls. “She was excited. She walked out straighter and with pride.”
‘Mel’s Closet’ is stocked with men’s, women’s, and children’s clothing, which Park uses most of her money to supply.
After retirement, she plans to focus on Mel’s Closet full-time.
“It makes you feel good to make people feel good,” she says. “I was born in Plant City. This is my home. I want to make it a better place.”
If you’d like to donate items to support ‘Mel’s Care Closet,’ contact HCA Emergency Department Manager Derika Graham. ‘Mel’s Closet’s’ greatest need is socks and men’s and children’s clothing. Donations should be new items with tags.
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
A federal study shows that nearly half of healthcare workers reported feeling burned out last year. Research suggests nurses are especially vulnerable to burnout, which can impact their care.
In collaboration with the Global Health Reporting Center and with support from the Pulitzer Center, Stephanie Sy reports from Columbus, Ohio, for a PBS NewsHour series, Critical Care: The Future of Nursing.
The segment profiles four nurses at different places in their nursing careers and the impact of nurse burnout.
-Sarah Kincaid, a family nurse practitioner in Columbus, Ohio
–Bernadette Melnyk, chief wellness officer at Ohio State University, and co-author of the books:
-Taylor Schwein is a psychiatric nurse practitioner in training. She teaches a cognitive skills building program for fellow Ohio State University students called Mindstrong.
-Yang Du, a nursing student at Ohio State University.
