Valentina Obreja Left Romania with Luggage and a Dream. Now She’s an Award-winning Nurse

Valentina Obreja Left Romania with Luggage and a Dream. Now She’s an Award-winning Nurse

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 dissertation  at 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. 

New Grad Residency Program Takes Nurses From Books to Bedside

New Grad Residency Program Takes Nurses From Books to Bedside

Few, if any, new nurse graduates walk onto a hospital unit on their first day brimming with confidence, much less clinical expertise. Thus, new grad residency programs help transition nurses from the world of textbooks to the realities of the bedside.

At UMass Memorial Health , new grads can find a wealth of support in the organization’s graduate residency program, which accepted its first cohort in 2007.  Two campuses, University and Memorial, host the program.

Year-long program

The one-year program has various components. During the first 13 weeks of the program,  new grads are establishing their foundational practice, notes Karen Uttaro, MS, RN, NPD-BC, NEA-BC, senior director, professional practice, quality and regulatory readiness, UMass Memorial Medical Center. Nurses are placed in a unit, based on their skill set and where a position may be vacant, and assigned a preceptor.

Working with the preceptor, they refine the skills learned in nursing school. What’s more, the new grads meet weekly with fellow new grads and members of the nursing leadership team. The 13 weeks are an average time, which can be tailored to individual needs until a nurse can practice independently.

Besides working with a preceptor, the new grads attend class weekly, where “we have a chance to emphasize key components around clinical skills,” says Uttaro. “It’s that sense of community and support. And that’s the undercurrent and the foundation of our program, to really make sure that they feel supported,” she says.

After that first 13-week component, new grads have a monthly three-hour check-in. Instructors review a topic, such as mock resuscitation, or bring in a subject matter expert, notes Uttaro.  “It’s really building on their knowledge and skills throughout that whole first year,” she says. Finally, at the end of the year, the new grads have conversations about their professional goals to foster life-long learning.

Learning from each other

Not only do the new grads learn from the seasoned nurses, but the reverse also is true, notes Uttaro. “Our seasoned nurses know the new grads will teach them just as much as the seasoned nurses are going to teach our novices because they have strengths in both generations.” For instance, baby boomers and Gen Xers may not be as strong in evidence-based practice and where you find those resources, Uttaro notes, whereas Gen Z’s and millennials are very savvy with that information. “It’s establishing that common ground that they’re going to get something from each.”

One new grad who went through the program, Brittany Garlisi, BSN, RN, says that she was under the misconception of the old axiom that “Nurses eat their young.” But when she was paired with one of the oldest nurses on her unit, “I was pleasantly surprised to find that they were one of the most kind and nurturing teachers I could have had.”

Striking gold

As a new grad, Danyel Stone, BSN, RN, CCRN found support in the program. Having graduated from nursing school in December 2020, she started in the new grad program in March 2021.

“It’s a lot to start off as a new RN, especially because I feel like 80-90% of the job you will learn in person while you’re working,” she says.  “Starting off as a new nurse, I was very, very nervous going into it. And I think that being part of the residency program really helped me stay grounded.”

Coming from a previous career as a securities broker, Garlisi felt anxious about working as a new nurse. “I felt that even though I had the book knowledge, I did not have much of the practical knowledge. So it made me very nervous to be doing a lot of things for the first time as a registered nurse as opposed to being oriented and having a support network to really teach me.”

“I thought I was just signing up for some kind of mentorship but I really felt that I struck gold. It really was way better than I could have anticipated.”

Growing program

Typically, notes Uttaro, each cohort has 50 new grads. Each year, the hospital supports three cohorts, one starting in March, then August, then December.  This year, Uttaro expects to have as many as 150 new grads, with a target of 200 to 250 new grads in 2023.

Impact of COVID

As with virtually every aspect of healthcare, COVID threw a wrench into the residency program.

The cohort that was to start the program in March 2020 couldn’t go onto the units. Instead, the new grads worked as a prone team. “We found a different role for them to leverage their nursing knowledge,” says Uttaro. “And we were able to foster skills like leadership and teamwork and communication.”

Because many new grads lost out on clinical time during COVID, notes Uttaro, the program re-emphasized skills the grads didn’t get.

Measuring success

The program can measure success in two ways, notes Uttaro. First, in November 2021, the program achieved accreditation from the ANCC Practice Transition Accreditation Program (PTAP). “So we have the external validation that our program is evidence-based and meets the rigorous criteria of that organization,” Uttaro says.

Second, retention of new grads pre-pandemic was 100% at the one-year mark, 92% at the two-year mark, and 88% at the three-year mark, according to Uttaro. “We retained our novice nurses for the long haul,” she notes.  “I think it’s really planting the seed and being that coach for them that keeps them in our village,” she says.

Fostering respectful communication is one hallmark of the program. “Most of the bad things that happen in healthcare are a result of communication breakdown,” Uttaro says. “In this program, and throughout the organization, we emphasize asking questions in a respectful way. If it doesn’t feel right in your gut, you don’t need to know why, you just need to know whom to talk to. Being able to say, ‘I think something isn’t right,’ really reinforces that communication is essential to all aspects of your practice.”

Healthcare is a very complex environment right now, notes Uttaro, “and making sure that the new grads are positioned for success is our top priority.”

My Clinicals Experience: On the Trauma Unit

My Clinicals Experience: On the Trauma Unit

Many nurses can’t wait to experience the urgency and pace of a trauma unit, but what is it really like to work on one? Marissa Kesse (Nu ’23), a BSN student at the University of Pennsylvania School of Nursing , shares her clinicals experience.
I was so excited to have been placed on the trauma unit: emergent gunshot wounds, groups of nurses on top of a patient performing CPR, code reds, blues, and greens. To me, trauma held the glitz and glam of nursing.

The first day, however, was quite underwhelming. It consisted of us students feeling as though we were hounding our nurses searching for something to see, but the nurses telling us there just didn’t happen to be much happening on that day.

“Granted, my expectations did stem from shows like Grey’s Anatomy—which should have been my first red flag….”

We, the nursing students, sat soberly as a group working on our 20-page care plans for our patients, feeling sad and what we thought was boredom. We were surprised when nurses would come to join us by the computer to work on their own charting, and they would express their thankfulness for an unusually nice, slow day.

Some of my fellow classmates began to agree, but I knew exactly what I had planned to see on the trauma unit and that’s what I was still waiting on. Granted, my expectations did stem from shows like Grey’s Anatomy—which should have been my first red flag….

The next week I certainly found what I thought I was looking for. The first patient I saw was a young boy involved in a gang-related shooting, having received multiple gunshots to the chest.

Before we entered my nurse gave me a warning that the patient was young, to make sure I was prepared- with which I quickly brushed her off and asserted I was ready. In my mind, this was exactly what I had been waiting for; indeed, the patient was a bit young but I reassured myself this would soon be an everyday thing.

When we entered, the patient had two chest tubes with multiple extended suture sites from the many surgeries he underwent. We were going in for our morning rounds which meant we would be checking the chest tube drainage and sites underneath the bandages, and performing some wound care.

“It felt as though every time the nurse adjusted the tube in his chest, there was a 32 Fr tube going through my own chest…”

As I saw the young boy churn from pain while trying to keep a brave face while we tried to perform care, it took everything within me to not cry. It felt as though every time the nurse adjusted the tube in his chest, there was a 32 Fr tube going through my own chest and, it was the sadness of the entire situation that made it the most unbearable feeling.

I love to volunteer my time at the local West Philly elementary schools and high schools. Looking at the young 16-year-old boy, I could imagine how easily that could have been any of my students. And, more times than not it would not even be their fault.

As I walk through the local schools that feel and look almost like a prison, I see how much more funding these schools need in order to provide their bright students with what they deserve.

I work in the school libraries with a team from Penn, as the School District of Philadelphia had to fire their entire librarian staff years ago due to a lack in funding. I can see how easy at times it may be to fall right through the cracks as young, impressionable boys and girls; how easy at times it may be to cling to an “out” in a hard life.

“My view of trauma has changed quite a bit.”

My view of trauma has changed quite a bit. I find trauma to be a sad place as many of the patients there were going about their day when someone else made a mistake that completely turned their life over.

My second patient, a hardy construction worker, was involved in a massive car accident that left him in a coma for weeks and now can barely stand during physical therapy without his heart rate, blood pressure, and respiratory rate skyrocketing.

Despite this, I was still so impressed with how much optimism and hope the man had. He was so engaged with his care, sharing how he watched all his surgical operations on YouTube to understand what had been done. The patient always had a hearty spirit with the medical team and continued to push himself to do his very best during physical therapy sessions.

As I shared my reflection, a seasoned nurse reminded me that these new feelings I was experiencing are normal and natural. These feelings were what would make me “a good nurse.”

My short time on the trauma unit has taught me more about how to maneuver being a nurse than any nursing semester I have ever had, and I am so thankful for it.

I look forward to seeing what my clinical journey will continue to show me about myself. Next stop… the cardiac unit.

(If you are a University of Pennsylvania nursing student, you can submit your own story here.)

Nurse of the Week: Sam Roecker Ready to Rock Her Scrubs for Nurses at Boston Marathon

Nurse of the Week: Sam Roecker Ready to Rock Her Scrubs for Nurses at Boston Marathon

The scrub wardrobe of Philadelphia nurse and elite marathoner Samantha Roecker, RN is undergoing an unprecedented stress test this month. One might even say that her scrubs are moonlighting, but it’s for a good cause.

Our Nurse of the Week is running through the Philadelphia streets in her scrubs as she prepares to achieve the “fastest marathon run in a nurse’s uniform” at the Boston Marathon on April 18, 2022.

While some fellow distance runners cheerfully concern-troll her about potential chafing, Roecker’s unusual athletic apparel has been fine so far, and at the marathon will be worn in honor of her profession – and of the sponsors behind her fundraising run to support the  American Nurses Foundation’s mental health and wellness programs. (The American Nurses Foundation and Moxie Scrubs are backing her effort).

“I was trying to think of what I could do to make running not a selfish thing, but a meaningful thing.”

Sam Roecker, RNHer inspiration for the fund-raiser was her fellow nurses – and her own experience. Roecker observed, “It seems like every day there’s a new story about nurse burnout or health-care workers struggling.” And, when she picked up first-hand frontline experience earlier this year, she became keenly aware of nurses’ urgent need for more robust mental/emotional support systems.

“On top of really tough diagnoses like cancer or brain fluid leaks or whatever we deal with on a ‘normal’ daily basis,” Roecker said, “Pandemic worries about who’s going to accompany somebody to the hospital during their chemotherapy treatment or how they would get a test prior to treatment — all of those unknown stressors and barriers added up.”

Apparently, the inspiration struck while she was showering one day: “I was trying to think of what I could do to make running not a selfish thing, but a meaningful thing,” she told Runner’s World.

Like many nurses, the Philly RN always has a lot going on. Roecker is currently working 25 hours a week as an RN at an otolaryngology clinic while pursuing an FNP degree at Penn Nursing at the University of Pennsylvania and puts in 20 clinical hours a week at Cooper University Hospital. On top of that, she manages to run 90 to 100 miles every week.

Nurses supporting nurses

She is a passionate and competitive runner, and her marathon project combines her love of the sport with her dedication to nursing and helping others. As Roecker puts it on her American Nurse’s Foundation fundraising page, “Over the last two years, I have witnessed and personally experienced the effect that the COVID pandemic has had on healthcare workers’ mental health and wellbeing. This April, I am combining my two passions and attempting to break the World Record for ‘fastest marathon run in a nurse’s uniform’ at the Boston Marathon.”

The funds that Sam will raise will go towards the American Nurses Foundation’s Well-Being Initiative programs supporting the mental health and wellness of RNs. The initiative offers RNs access to free therapy resources, expressive writing programs, financial consulting, podcasts and mobile apps dedicated to mental health and well-being, and content dedicated to grief and bereavement.

So far, Roecker has raised over $21,000 toward her $26,200 goal. You can support your colleagues by helping her reach that goal or surpass it by adding your mite to her fundraising page: https://givetonursing.networkforgood.com/projects/152794-samantha-roecker-marathon-fundraiser.

For more on Sam Roecker’s marathon-in-uniform and chafing concerns, see the Runner’s World story or see her interview with the Inquirer.

What To Expect During Your First Clinical Rotation

What To Expect During Your First Clinical Rotation

Nursing school involves both theoretical and practical learning. You have to know how to care for patients in a variety of contexts before you can earn your license and work as a registered nurse. Your nursing school clinical rotations will be an important tool in putting your knowledge to the test and learning practical applications.

Most nursing students are excited to start their first clinical rotations, but the experience can also be a little scary. When you’ve never worked in a clinical setting before, it can be very intimidating to work with real patients.

Not sure what to expect? Here’s what you need to know before your first clinical assignment.

What are nursing school clinicals and how do they work?

Nursing school clinicals bring students out of the classroom and into a healthcare setting so they can work with actual patients. These rotations are designed so that students can apply what they have learned in the classroom.

In addition to creating a controlled learning environment for practicing skills and asking questions, nursing students can get a feel for clinical work and identify any gaps they may need to work on. Students will have the guidance of a designated, experienced nurse (sometimes known as a preceptor) to provide support when they need it and to help ensure high-quality patient care.

Practicing in clinical settings allows nurses to gain skills and confidence while they still have access to a dedicated mentor. It is also important for evaluating a nursing student’s readiness for unsupervised work in a clinical setting.

Steps to prepare for your clinicals

Once you’ve got your clinical rotation set up, you should take some time to prepare so you’re not scrambling to get ready on your first morning. Get a good night’s sleep so you can think clearly and arrive with a positive attitude.

Get all of your supplies together the night before. Prepare a healthy snack or lunch in advance so you don’t get too hungry during your shift. Also, make sure to eat breakfast in the morning—you want to be fueled for the day ahead. It’s a good idea to write down any key information before your first rotation, such as what you should know about a patient before providing care. Plan to arrive early so you’re not worrying about being late!

What do I need to be successful?

You’ll need some basic supplies for your clinicals. Your school should tell you what kinds of scrubs you’ll need. It’s important to wear comfortable shoes as you’ll be on your feet all day, and consider compression socks to prevent blood clots and other issues.

There are various medical supplies you’ll need as a nurse, including a high-quality stethoscope and possibly a blood pressure cuff. You should also bring small items like scissors, hemostats, and a small flashlight.

You will also want to have a watch with a second hand, a small notebook and pen, a clipboard, a calculator, and a clip or holder for your ID badge. You might also want to bring in reference materials in case you need them. Don’t forget your water bottle to stay hydrated!

During your nursing school clinicals, the most important thing you can bring to the table is a good attitude. You will make mistakes, but try to look at them as learning experiences and maintain a positive, helpful attitude. Don’t forget to ask questions!

What will my daily routine be like?

Your routine will evolve as you go through your clinical experience. On your first day, some of the pressure will be off as you’re likely to start by doing more observation than direct patient care. Absorb as much as you can and be as helpful as possible.

Once you’ve gained some experience and confidence, you’ll be assigned patients to care for. Your daily routine will depend on your patients’ needs and the requirements of the facility. Remember, each clinical setting is a little bit different, so expect that you’ll need a little time to get used to the routine.

What will I learn?

Initially, you’ll learn by watching an experienced nurse. It isn’t in patients’ best interests to be cared for by someone who doesn’t know what they’re doing! However, you will get hands-on experience during your clinicals and you will learn from both observation and direct practice.

You will learn how to gather information on a patient, take vital signs, and provide miscellaneous care tasks, including giving medication and helping with general hygiene and comfort tasks. You will typically get a chance to work in several different clinical rotations to learn how a nurse functions in each department.

You will also learn about proper patient interactions. A big part of nursing is connecting with patients and helping to keep them calm so they can heal. You will get a chance to practice your bedside manner with patients and their families during your clinicals. Be a sponge during your clinical rotation. This is your chance to see what a nurse’s daily rounds look like. Ask questions and take in all that you can.

How will I be graded and evaluated?

The good news about clinical rotations is that you will have a lot of prior knowledge to draw on from your coursework and studying should be minimal. Generally, you will be evaluated and graded on criteria such as attendance, preparedness, and participation. You may also have some homework, but it is likely to relate to the work you’re doing, such as creating care plans.

If you go into your rotation with a positive, receptive attitude, you should do just fine. Be on time, do your homework, and make sure you’re as prepared as possible for each day. If you do that, you should have no trouble passing your clinicals.

What happens next?

Clinical rotations are a core part of your nursing education. You will get the opportunity to spend many hours observing patient care and providing it yourself. Once you’ve satisfied the requirements for clinical hours and passed your classes, you can graduate.

Then, you will need to take the licensure exam so you can become an RN. There are many steps to becoming a nurse because safe patient care requires in-depth knowledge and practice. Take advantage of your clinicals to prepare you for your licensure exams and your first job as a registered nurse!

Interprofessional Clinicals for Nursing and Med Students: Wave of the Future?

Interprofessional Clinicals for Nursing and Med Students: Wave of the Future?

Twelve med students and twelve BSN students from NYU Rory Meyers College of Nursing are learning how to work together in a groundbreaking interprofessional collaboration program.

The future nurses and physicians are doing their clinical rotations in tandem based on a new collaborative model for nursing education, with an emphasis on considering the environmental factors that influence a patient’s health.

“To my knowledge, there isn’t another structured interprofessional education program like this at other nursing schools.”

The program, which takes place at NYU Langone Hospital—Long Island, aims to develop effective working relationships between different types of healthcare students and practitioners to support health outcomes. Research shows that interprofessional healthcare has many benefits, not only improving patient care, but collaboration can lead to fewer preventable errors, reduced healthcare costs, and improved working relationships.

“To my knowledge, there isn’t another structured interprofessional education program like this at other nursing schools. Some schools do one-off interprofessional simulations or experiences, but our program at NYU Langone Hospital—Long Island is unique,” said Selena Gilles, associate dean of the undergraduate BS nursing program at NYU Meyers and a Long Island resident.

 

“The essence of what healthcare should be in the 21st century.”

Twelve nursing students were selected to participate in the program’s first cohort, which began in the fall of 2021. On their clinical days at NYU Langone Hospital—Long Island, each nursing student is paired with a medical student. The dyads are assigned to care for the same patients and work together to assess them, develop care plans, and attend rounds and “huddles” of interdisciplinary healthcare teams where their assessments and care plans are discussed.

“This program speaks to the importance of collaborative practice,” said Vincenza Coughlin, the director of professional nursing practice and education at NYU Langone Hospital—Long Island. “We each bring our unique and complementary knowledge and skills when working together in patient care.”

Notably, the students assess patients’ social determinants of health—the environmental conditions such as housing, education level, income, and access to healthy foods that can influence one’s health. This holistic view of people encourages students to think beyond a diagnosis, including how patients end up in the hospital, what hospital services could benefit them, and how to improve health after discharge, beyond the hospital setting.

“Nursing and medical students forming one team, and working toward the same goal of moving patients toward wellness, is really the essence of what healthcare should be in the 21st century,” said Alice Nash, system senior director of nursing professional development & clinical outcomes at NYU Langone Health.

The interprofessional education program, which will run for five years, is funded by a $7 million gift from Howard Meyers and his late wife Rory. The funds provide full-tuition scholarships plus room and board for the school year for the nursing students selected.

“Throughout the COVID-19 pandemic, healthcare professionals have pivoted to work in new ways as interdisciplinary teams, with nurses working closely alongside doctors, respiratory therapists, physical therapists, and others,” said Eileen Sullivan-Marx, dean of NYU Rory Meyers College of Nursing. “While interprofessional education has long been an interest of ours at NYU, teamwork has never been more important and we are thrilled that this interprofessional program is now underway preparing a new generation of nurses and physicians.”