New London - Registered nurse Kayla Bonollo sat at the bedside of a 64-year-old Gales Ferry woman last week, inputting information about the severe abdominal cramps, fatigue, unintended weight loss and other symptoms that had brought the woman to Lawrence & Memorial Hospital into a computer on wheels, better known by nurses as a COW.
"I want you to do everything you can to keep me going," the woman told Bonollo, after she had entered her patient's blood pressure, temperature and symptoms into the computer, checked her heart and breathing and started an IV.
"I love new nurses," added the woman, who declined to give her name. "They're so insightful."
Just nine weeks ago, Bonollo, 23, probably wouldn't have inspired the same confidence in her patients. She was brand new to the patient intake routine and just about everything else about being a full-fledged nurse. By Monday when the Gales Ferry patient came into her care, Bonollo was feeling confident, well organized and ready for just about any medical situation.
"It's very different from the academic world," said Bonollo, a Westerly resident and recent graduate from the nursing program at the University of Rhode Island. "When I was in school, IV pumps scared me to death, but here, I just do it. I've learned to prioritize. I was nervous to talk to doctors when I first came, but now I just call them. They're very nice."
Bonollo is among the latest group of nurses newly hired at L&M to go through its Clinical Design Unit, a kind of post-graduate, real-life training program to ease new nurses into the hospital. Created two years ago, it's been a success at improving retention of new nurses and served as a setting for trying new methods and procedures to improve patient care and efficiency, said Kerin DeCruz, assistant chief nursing officer.
"We found that new nurses needed a bridge from learning to practice," said DeCruz, adding that thus far, about 70 nurses have completed or are currently enrolled in the program.
Of the 58 nurses who finished the 12-week program and moved on to permanent jobs, DeCruz said, all but three or four are still at the hospital. That's a vast improvement over national nurse attrition rates of 22.4 percent in the first year.
"To beat the national benchmark and have them stay at L&M was our vision," she said.
The special unit has just eight patient beds. When they first enter the unit, new nurses are assigned just one or two patients and have the close supervision of Nurse Manager Patricia Egan and other senior nurses. As they hone their skills in hands-on learning, simulation exercises and periodic computerized tests, they are put in charge of up to four patients. A variety of cases come to the unit, from post-operative gall bladder surgery recovery patients to those admitted from the emergency room. Over the 12-week program, Bonollo and fellow new nurse Amanda Bernatchy, a 25-year-old graduate of Central Connecticut State University, have cared for patients with flare-ups of chronic pain and other symptoms of sickle cell anemia, patients with cellulitis, gastrointestinal problems, and psychiatric issues.
"I've learned to deal with different patients," Bernatchy said. "I hadn't had to deal with psychiatric patients before, and I was scared at first, but now I'm much more comfortable. I feel confident in my judgment now. In this unit, you have no choice but to learn."
Both Bernatchy and Bonollo will finish in the unit on Dec. 8 and be assigned to another area of the hospital. Bernatchy is hoping for a position in the emergency department or in oncology. Bonollo is eyeing positions in the float pool, where she'd be assigned to different units based on need, or the renal and respiratory area.
Two of Bonollo's most important learning experiences, she recalled, involved responding to the unexpected. In the first, a woman came to the unit after an appendectomy. During a routine check, Bonollo looked at the lab test results and noticed something was awry, so she alerted her supervisors. The woman, it turned out, was bleeding internally and needed a blood transfusion and other care.
In the other case, she responded to the call button activated by a 96-year-old patient admitted to L&M after a bad fall. His breath was very labored, even though he was receiving oxygen therapy.
"At first I didn't know what to do," she said.
Egan came to help, "then I called a code," Bonollo said, referring to the high-alert signal used when a patient needs emergency care. "The respiratory therapist came, two doctors from radiology came. We inserted a catheter because his lungs were filling up with fluid."
The team gave him medication and tried to calm him down. Ultimately, the man's breathing was restored and a few days later, he was able to go home.
"I was nervous at first, but with (Egan) near me, I felt like I could handle it again," Bonollo said. "It's nice to learn here and ease into it. It's not overwhelming."