Nurses may do even more than you think. Their varied roles are vital to the high-quality care our members receive.
At Kaiser Permanente, our nurses are remarkable. In different ways, they each contribute to the success of our mission. Through these nurse profiles, you’ll learn about some of the many roles our nurses play in providing high-quality care. Their compassion, integrity, and dedication shine through in everything they do.
Tamara K. Amundson, RN, is an advice and triage nurse at the Kaiser Permanente Appointment and Advice Call Center. She is one of 900 registered nurses who handle about 1 million member calls every month.
Our advice nurses answer a variety of member questions and concerns and also help members by providing information on specialty programs such as wellness coaching or advice before international travel.
“You make a difference in every call,” Amundson said.
The calls vary greatly. A recent call from a patient questioning a prescription turned into much-needed support for the loss of a child. Another call may be about chest pain, a patient feeling confused or depressed, or a mother worried about her baby not taking to breastfeeding.
“The next call comes quickly,” Amundson said. “It takes critical thinking skills.”
Telehealth nursing is unique. “Active listening and empathy are key,” according to Amundson.
“We have to rely on our knowledge and protocols,” Amundson said. “You have to be a quick thinker and really go through everything — their allergies, their age, their past diagnoses — and then get to the right outcome, whether it’s going to the emergency room, making an appointment for later, or consulting with an emergency room doctor or pharmacist — all while the patient is on the phone.”
“You have to be on at all times,” Amundson said. “You have to be able to multitask, stay calm, and be reassuring to patients who may be feeling unwell or even panicking.”
“I’m someone who is energized by this type of intensity. The mere nature of this job lifts you up because you are helping someone other than yourself. Also, the nurses on our team boost each other up in team meetings, and our manager may point out the good we did that day. And that’s how we stay energized.”
Gaylynn Ledda-Camara, RN, is an emergency room nurse at the Kaiser Permanente Moanalua Medical Center in Honolulu. She knows how important it is to be an advocate for patients and their families. In fact, her focus on advocacy saved a patient’s life.
A patient came in with arm pain. He figured the pain was from casting a fishing line.
“The way he appeared, and his wife’s concern, told me something more was wrong,” Ledda-Camara said.
So, she brought her concerns to the physician’s attention.
“We repeated the tests and discovered he was having a heart attack. He had several blockages that required emergency surgery,” Ledda-Camara said.
Ledda-Camara’s own health scare broadened her perspective of her work.
“I had a pretty rough year after being diagnosed with breast cancer,” she said. “I remember being put at ease when my nurse told me, ‘I’m a breast cancer survivor, and you are going to be OK.’“
After coming back to work, she came across someone her own age being diagnosed.
“I was able to tell them, ‘Hey, look at me. I am thriving. This is what you are going to look like a year from now.’”
“It’s the empathy and the understanding and being in the moment with the patients and their families that mean everything,” she said.
“It’s rewarding to provide high-quality care and see how it impacts a patient physically, spiritually, and emotionally. I see the effects firsthand, especially in the emergency room, because patients come in so acutely ill.”
“Every day, I feel grateful and accomplished because I see how I can touch patients’ lives. My peers’ dedication to providing outstanding patient care also motivates me.”
Jacob Reichardt, RN, is a home health nurse for Kaiser Permanente in the Northwest. He gets to know his patients and finds great satisfaction in making a difference in their lives.
One of his patients had lost the skin on one of his legs due to a dangerous and aggressive bacterial condition. Reichardt used various techniques to manage the wound until the patient qualified for a skin graft. Then, Reichardt continued to care for him until he was able to resume his old life.
“He and his wife sent me a thank-you letter from a hiking trip in Portugal,” Reichardt said. “This was after great concern that he would never walk again.”
Returning patients to their former quality of life is the goal in home health care. Kaiser Permanente cares for 230 home health patients in the Portland, Oregon, area.
Reichardt finds it interesting and challenging to work in a patient’s home. It’s very unlike the controlled setting of a hospital room: There may be limited space to perform treatments, expired medications that need to be responsibly disposed of, or a number of family members asking for more information and guidance.
“I get to do something that makes a real difference in people’s lives every day. As a home health nurse, I follow patients for more than a few days. I take a patient with a skin graft and see him walk again.”
Ariel Miguel, RN, is the lead nurse for postanesthesia care at the Kaiser Permanente Franklin Medical Offices in Denver.
“We are the first people the patients see when they wake up from anesthesia. We reassure them that their surgery is finished, and we monitor them while they’re recovering,” said Miguel.
Recently, Miguel and the postanesthesia care team cared for a patient who wasn’t breathing after surgery. Miguel helped the anesthesiologist open the patient’s airway and provided breathing treatment and medications.
The patient soon began breathing on her own.
At the surgery center where Miguel works, patients are generally able to go home the same day they have surgery. Postoperative nurses assess patients’ airways and vital signs. They also manage pain and nausea.
“You get to see a variety of surgeries at the postanesthesia care unit,” Miguel said. “When a patient is not doing well, everyone converges on the patient. We troubleshoot collectively as a team to get the best possible outcome for the patient.”
“I always wanted to be in a career where I helped people. Two of my older brothers are also nurses, and I fell in love with it. I feel it is the ultimate honor when my coworkers personally ask me to take care of them or their family members after surgery.”
Betty M. Rice, RN, is a director for adult family medicine for Kaiser Permanente in southern Maryland and Washington, D.C. She believes it’s the little things that show patients that you see them as a person and not just a number in the waiting room.
At one point, a patient with diabetes was brought into the clinic in a wheelchair every week. Rice would dress her wound. She noticed that from time to time, the patient appeared a little down.
“One particular day, I took a marker and drew flowers and a sun on her bandage,” Rice said. “That put the biggest smile on her face!”
Patients typically begin their health care journey in Adult Family Medicine with a wellness check and preventive health care, such as immunizations. The COVID-19 pandemic led to many members delaying needed vaccinations.
In 2022, Kaiser Permanente’s Adult and Family Medicine nurses provided 38,624 general vaccinations, other than COVID-19, to our members in Baltimore, Northern Virginia, Southern Maryland, and Washington, D.C.
“As a young girl, I had to take my parents to doctor’s appointments to help them with a language barrier. I think of my parents when I see patients who need extra help. It means something to me. I think it changes their visit when they have someone who truly cares about them.”
Marleen Vasquez, RN, is a maternal child health nurse and certified lactation consultant for Kaiser Permanente’s Obstetric Remote Monitoring Program in Georgia. One of the things Vasquez loves most about her job is her weekly outreach calls with patients. During those calls, she checks on her patients’ blood pressure and other issues that may impact their pregnancy.
Vasquez remembers one pregnant patient of advanced maternal age who had high blood pressure. She suddenly lost the pregnancy and became depressed.
Vasquez followed her through 6 weeks of postpartum care and encouraged her to ask for help.
“It was a huge impact for her. She told me, ‘I can’t believe how far I’ve come.’”
Six months later, she was back with a new pregnancy.
“Because of our relationship, I quickly got her emotional support. She eventually gave birth to a full-term, healthy baby boy.”
In Georgia, high blood pressure and related conditions are a major cause of maternal deaths. Vasquez helped launch the remote monitoring program in 2019. The program eliminated maternal deaths due to high blood pressure among our members in Georgia.
In 2020, the program added monitoring for diabetes. The program serves a monthly average of 80 pregnant patients with diabetes and 170 pregnant patients with high blood pressure in Georgia. The program has spread to Colorado, Maryland, Northern California, Virginia, and Washington, D.C. It will launch in Oregon, Hawaii, and Southern California in 2023.
In early 2022, the remote monitoring team grew to include clinical social workers, a complex care coordinator nurse, and a nutritionist. The specialists address challenges that may pose health threats — for example, financial problems, lack of housing, domestic violence, or other medical conditions, such as breast cancer.
“My passion comes from knowing that I have an impact on mothers and help keep them and their babies healthy. I feel I can really do something tangible that mothers can walk away with. Go and live your best life with your beautiful little baby — that’s my mantra!”
Sue L. Davis, RN, is on Kaiser Permanente’s Depression Care Management team and part of the new Collaborative Care Program in Washington state. Davis pioneered the role of the registered nurse in the program.
Kaiser Permanente formed the Collaborative Care Program in Washington in September 2022 with a goal of bringing mental health services into primary care. The program team includes a registered nurse, a licensed clinical social worker, and a psychiatrist. They work with primary care doctors to identify patients in need of mental health care. Then, they reach out to patients and connect them to treatment. The idea is to offer help rather than leaving it to patients to seek treatment on their own.
Early results for the program are promising. So far, 3 out of every 4 patients in the program have reported improvement with their depression symptoms.
An early success for Davis came from caring for a patient who had been diagnosed with depression after becoming a widow.
“I was thrilled to have the patient achieve remission without even taking medications,” Davis said.
Davis drew on her recent training in helping patients manage depression and anxiety. She helped her patient review her life holistically and make positive changes.
Together, they set simple, measurable goals. One was getting outside and getting exercise every day. Davis also encouraged her to work with a diabetes nurse to get her blood sugar under control.
“Helping patients teaches me something professionally and personally every day, without fail.”
“Recently, I was helping a patient who was having trouble staying asleep. I suggested easing off caffeine in the evenings, but that didn’t help. It was the patient’s diabetes nurse who asked her to check her blood sugar levels when she awakens in the night. That’s when I learned that low blood sugar can disrupt your sleep.”
Divina Perez, RN, is the pediatrics charge nurse at the Kaiser Permanente Fontana Medical Center in Fontana, California.
Recently, Perez cared for a child who had multiple issues, including a breathing condition that caused his heart to stop temporarily. Understandably, this upset the child’s mother greatly.
Perez responded to the mother’s distress several times during the hospital stay. “Everybody’s our patient,” Perez said.
Even after the child was well enough to leave the hospital, Perez continued to provide support. For example, the mother reached out for help with the child’s medication.
“We treat the family as a unit. If there is something that the parents need or they notice something is off, we have to listen,” Perez said.
Leadership and problem-solving are traits Perez uses in her roles on multiple committees. For example, she provides nurse feedback to support improvement projects throughout Southern California. She also co-leads the shared governance council with the chief nurse executive at our Fontana Medical Center. The council shares and spreads key information, such as new research findings, throughout the hospital staff.
The work of these committees is critical in creating a culture of excellence that can lead to Magnet® designation. Magnet designation is the highest honor a hospital can receive from the American Nurses Credentialing Center for nursing excellence.
Seven Kaiser Permanente facilities have achieved Magnet designation. Magnet-designated facilities are known for their superior patient outcomes. They’re also known for having highly engaged nurses and collaborative relationships within the health care team.
“It's just a feeling that you want to make a child’s overall experience in the hospital better. When you do, it sparks something in you. You want to do something better and better every day.”
Brenda L Peterson, RN, is a clinical nurse leader and the director of tele-critical care for Kaiser Permanente.
Using remote video tools, our tele-critical care nurses can look into any hospital room and respond to patient emergencies quickly.
“It’s an added layer of medical support to the bedside team,” Peterson said.
In one case, it took only seconds for one of the nurses on her team to alert the tele-critical care physician and hospital staff about an unresponsive patient. That quick response and resulting teamwork were critical to reviving the patient.
“We focus on proactive work,” Peterson said. “We virtually enter every intensive care unit patient room via a bedside camera and actively review patient charts to see if we can improve the condition of that patient.”
The team, located in a central site away from the hospital, collaborates with the bedside clinical team from each hospital. Since the program’s launch in 2019, early reports have shown mortality in the ICU dropped by 17%. The length of time patients spend in the ICU dropped by 13.9 hours. Total hospital stays were reduced by 28.5 hours.
“We are at a desk with 8 computer screens. We have algorithms that help us review each patient. For example, when a patient stops breathing or their heart is in trouble, we can hit one button and ‘camera in’ within seconds. We lead the emergency until the bedside team can arrive. The partnership saves lives.”
“I’ve always wanted to be a nurse, and I’ve loved it. I have the privilege of walking people through difficult times in their lives. The impact you have on people is something you don’t find in any other profession. It is truly a blessing to be able to touch a life every day.”
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