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In June, Guitar Center’s Orange Park, Florida location surprised a local nurse to help her to continue making music and inspiring her patients.
During National Hospital Week in May, Shondra Diggett, a nurse in the behavioral unit of Orange Park Medical Center, performed a short set that happened to be covered by a local news station. In fact, Diggett had been regularly performing for her patients, expanding her audience to include fellow staff and hospital visitors. The growing publicity of both her talent and belief in the healing power of music caught the attention of Ron Japinga, Guitar Center’s CEO, who felt compelled to show his gratitude to Diggett.
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“When I saw Shondra’s story on the news, I was moved by her performance and felt compelled to do something to support her. I hope her story inspires more medical professionals to tap into the healing power of music,” said Japinga.
With the help of Devon Dame, store manager of the Orange Park location, the company was able to “pay it forward” with a gift card donation to Diggett. Dame reflected on the experience, “ Shondra was very surprised and delighted that we were giving her this gift; you could see that she was not expecting anything like this. It was a wonderful moment to be able to watch someone who has contributed so much to the community receive such a generous gift.”
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A spokesperson for Orange Park Medical Center remarked, “It was difficult to tell under her mask, but you could see a big smile in her eyes. She kept looking at Devon in shock and trying to control her excitement. Days later, she was still shocked by the generosity shown to her from Guitar Center.” Diggett plans on using the gift card to begin formal lessons with Guitar Center’s vibrant lesson program and purchase her dream guitar.
For more information from Guitar Center, please visit https://www.guitarcenter.com/ .
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“Nurse Play” – Created and Written by James Wilkinson; Directed by Joe Juknievich; Stage Management by Tori Skoniecki; Movement Director Kayleigh Kane. Presented by Exiled Theatre at Boston Playwright’s Theatre, 949 Commonwealth Avenue, Boston through December 17
“Black Pawn to E four,” says Nurse, engaging in a verbal game of chess with her bed-bound, disabled patient, Joe. “White pawn to E five” Joe defiantly replies. Nurse sits alone at the only table in the small, poorly lit room, sunglasses over her hollowed-out eyes and a stack of Blondie records next to her record player, waiting to make her next move.
On the surface, this may seem like a tense game of chess between two people who have long been frustrated with each other’s shortcomings, but the story soon reveals a much deeper, combative and abusive relationship that these two have been enduring for quite some time. James Wilkinson’s “Nurse Play”, which premiered this past weekend at the Boston Playwrights Theatre, raises larger questions following its bizarre start, setting up the audience for a story that has all the markings of a toxic marriage.
The one-act black comedy takes place in the room of a random boarding house in an unspecified town, immediately establishing the sense of surrealism that this oddly satisfying work is grounded in. While we don’t know how long Nurse and Joe have been holed up in this bleak room, their often explosive irritation with each other makes it seem like it has been eternity.
Life is slowly wasting away, however, for Joe (Cody Sloan), whose highly contagious and deadly disease leaves him disconnected from the outside world. Nurse (Susannah Wilson), who is stuck with him until his end (for reasons that are unknown to us), seems to wield the power between them for the most part. As Joe squirms and aches, begging for injections of pain medicine, shouting out his hallucinations of the outside world, Nurse responds accordingly, injecting him, feeding him his cigarettes. But even though she is helping him, her cynical, micro-aggressive demeanor acts as a form of abuse towards Joe: constantly referring to him as a bag of meat rotting away, torturing him by singing along to her blaring Blondie records. The only thing that brings them together seems to be fear, when the frightening and unexplained knocking on the door comes once again. Both characters remain fixated on the outside world: who is at the door? Is “the light” coming from out there? And can Joe remember what the grass looked like, what the gulls sounded like? Though they both seem to want this outside world, they cannot bring themselves to re-engage with it.
The co-dependency that is beneath Joe and Nurse’s torturing of one another is suddenly challenged when the domineering behavior of Nurse becomes too much for Joe, and he suddenly, somehow, vanishes. Nurse, who up until this point presents herself as an independent woman, finds herself calling Joe’s name, wanting to hear the sound of his voice, but hearing nothing. When she falls, missing her chair and landing on the floor, she begins to realize she is completely alone. Her blindness is not the problem – she believes in “focusing on tangible reality” and belittles the importance of vision. The problem is that without Joe, she must put her emotional independence to the test.
Sloan’s spot-on portrayal of the doomed, paranoid Joe struggling to maintain hope, and Wilson’s ferocity as the damaged Nurse give the story real depth. Both effectively capture the nuances of their characters, and Wilson’s understated yet beautiful vocal riffing of classic Blondie melodies show the joyful side of Nurse, while Sloan’s effortless shifts from victim to oppressor are creepy to watch.
Wilkerson has crafted a strange new work that may not be everyone’s cup of tea, but for the esoteric theatre-lover, “Nurse Play” certainly fits the bill. For more info, go to:
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Nurse Allie Schulten plays tic-tac-toe with cancer patient Grant Wolf through a hospital room window, hoping to cheer up the seven-year-old while social distancing.
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Nurse Allie Schulten had to find a new way to cheer up her young cancer patient.
Sometimes it's the simple thrills that keep you going, and Grant Wolf knows that better than most.
The 7-year-old from Cincinnati, Ohio, has been battling brain cancer and undergoing treatment at Cincinnati Children's Hospital for the past nine months, and as he endures chemotherapy, the stuffed animals nurse Allie Schulten leaves behind never fail to bring on a grin.
"It's her signature," Grant's mom Sara Wolf explained. "Each time she changes the linens she leaves a little friend for Grant to come back to and the smile on his face when he discovers it is priceless."
But since April, Schulten hasn't been able to leave her customary gift in Grant's hospital room. Nurse-to-patient contact is kept to a minimum for the time being due to social-distancing restrictions related to COVID-19. Schulten had to find a new way to cheer up Grant, and that came in the form of X's and O's.
"I drew a tic-tac-toe board on his door as a way of asking if he wanted to play," Schulten said. "I still wanted to be able to interact with him and help bring a smile to his face without entering his room."
The young cancer patient took to Schulten's gesture, grabbing a dry erase marker to make the first move on the glass door between them. The first game took place on April 17, and since then, the pair plays a few games every day that Grant is in for his round of treatment.
"He always gives me a smirk when he sees me start drawing on the window and by the time he gets to the window has a smile from ear-to-ear," Schulten said. "But the biggest smiles and infectious giggling come when he gets a win. Oncology patients like Grant show me every day the true meaning of a fighting spirit."
Laughter, it seems, is the best medicine to help pass the time.
"Tic-tac-toe is fun and I like writing on the windows," Grant said. "My nurses are nice and they take good care of me."
The hospital shared a photo of the ongoing games between Grant and Schulten in a Facebook post that has since received thousands of likes and hundreds of shares, all commending the nurse for going the extra mile with her young patient.
"These onocology nurses have been some of the most amazing people we've met on this journey," Sara Wolf said. "All the creative ways they've come up with to bring a smile to Grant's face and help ease his anxieties as he battles brain cancer, it makes a world of difference and they should be so proud of the work they do."
Grant is scheduled to receive his sixth and hopefully last round of chemotherapy next month.
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Promoting patient safety and improving the quality of patient care
Written by Michael Wong, JD, Founder & Executive Director of PPAHS
As founder and executive director PPAHS, when I speak at conferences about the Physician-Patient Alliance for Health & Safety support for continuous electronic monitoring of patients receiving opioids , I am often asked two questions:
I personally believe that nurses play a vital role in the how well patients recover, how quickly they recover and are discharged from hospital and sent home. Ideally, a nurse should be at every patient’s bedside watching, observing and caring for that patient on a continual basis.
Lillee Gelinas, RN, MSN, FAAN (then vice-president and chief nursing officer, VHA Inc.; now Editor-in-Chief, American Nurse Today) told me , “Too much of nurses’ time is spent in activities other than in actual patient care. The majority of nurses’ time is spent in ‘hunting’ and ‘gathering’ types of activities, like finding the right supplies. In addition, they are documenting, coordinating care, and administering medications. Not enough time is actually being spent at the patient’s bedside, assessing, teaching and caring.”
We need nurses doing more nursing. A time and motion study of 767 medical-surgical nurses in 36 hospitals found that only 7.2% of their time (31 minutes during a typical 10 hour shift) is spent with the patient performing tasks, such as assessing the patient and reading vital signs. During a 10-hour shift, the study found nurses’ time was spent in numerous activities, as shown in the chart below:
That’s 24 x 7 observation – nurses scheduled a continuous basis with the task of observing the patient. Would this require more nurses? Yes! Is this economically feasible? No, hospital economics makes this prohibitive, if not impossible.
In addition, the reality of the current work environment is that a frenetic pace, high workload and numerous administrative demands reduce nursing time with patients. So, to deal with the demands of the work environment and the needs of multiple patients, technology should be seen as an adjunct to safe care, and used by nurses as a ‘technological safety net’ to support their practice in providing optimal patient outcomes. An average ICU, for example, has 15 different pieces of technology in the patient’s room, none of which talk to each other, so the nurse is the neural network. Instead, the right technology should help “connect the dots.”
As Julie Morath, RN, MS (then Chief Quality and Safety Officer at Vanderbilt University; now President/CEO, Hospital Quality Institute) explained, “Human vigilance is required but insufficient; continuous electronic monitoring needs to be there to support and backup nurses, and allow them to visit a patient while monitors are continuously assessing other patients for various physiological parameters (such as, oxygenation with pulse oximeter or adequacy of ventilation with capnography).”
“The stakes are just too high,” explained Morath. “We have a life in our hands – someone’s family member or loved one. If we want nurses to use technology, they need to be part of the decision to use it and buy it. They need to receive adequate training and continuing support. Doing this appropriately engages nurses as accountable and active partners and members of the problem-solving team in patient safety.”
Technology can assist better nursing care, by continuously electronically monitoring patients to support nursing rounds. This technological vigilance may provide nurses the piece of mind to care for patients, without jeopardizing patient safety. However, for monitoring technology to be of benefit, two issues must be addressed:
The second question that I’m asked about continuous monitoring is “Why has continuous monitoring been so slow to be adopted by hospitals?” Underlying this question is the thought that if continuous electronic monitoring is “good”, then why are more hospitals and clinicians using it.
As Gina Pugliese (formerly vice president, Premier Safety Institute; board of advisors, PPAHS) recently wrote , “Despite efforts to increase awareness of electronic monitoring efficacy, the adoption on general patient care units has been relatively slow. The good news for this technology is that it has advanced significantly in the past few years to the point in which it can be used reliably on both intubated and non-intubated patients, adult and pediatric, as well as those patients receiving oxygen.” –
First, let me discuss whether monitoring is “good” – that is, whether it solves a real problem.
PPAHS has recommended that all patients receiving opioids be monitored with pulse oximetry for oxygenation and with capnography for adequacy of ventilation . Both pulse oximetry and capnography are not new technologies, as they are standard equipment mandated to be used in all surgeries by the American Society of Anesthesiologists .
Monitoring patients with pulse oximetry and capnography have been used for many years; however, the application of monitoring patients outside the operating room is a new application. ECRI Institute in its annual Top 10 Technology Hazards again named opioid safety in its 2017 list , saying:
“Patients receiving opioids—such as morphine, hydromorphone, or fentanyl—are at risk for drug-induced respiratory depression. If not detected, this condition can quickly lead to anoxic brain injury or death. Thus, spot checks every few hours of a patient’s oxygenation and ventilation are inadequate.
“ECRI Institute recommends that healthcare facilities implement measures to continuously monitor the adequacy of ventilation of these patients and has recently tested and rated monitoring devices for this application.”
But, it’s not just ECRI which believes that patients receiving opioids should be continuously electronically monitored. The AAMI National Coalition to Promote Continuous Monitoring of Patients on Opioids was co-convened by many organizations, including:
This vision of continuous monitoring for patients receiving opioids has been endorsed by organizations, including:
The real reason I believe for the slow adoption of continuous electronic monitoring outside of the OR is cost. Lynn Razzano and I wrote in our article, “ Financial Objections Don’t Add Up in Monitoring Debate ” that there costs associated with not monitoring, as well as a return on investment for monitoring:
Although hospitals may have resource limitations, there are increased costs associated with failing to adhere to best practices. An analysis of more than 3,300 closed claims of the American Society of Anesthesiologists (ASA) by Julia I. Metzner, MD, “Risks of Anesthesia at Remote Locations” shows that the median payment per claim can be $210,000 for events that occur in the operating room and $330,000 for those outside the operating room. This analysis concluded that these adverse events were due to substandard care or preventable by improved monitoring.
Additionally, there are hospitals that have identified a significant return on investment with implementing continuous monitoring. For example:
St Joseph/Candler Hospitals in Savannah, GA, has experienced more than 10 years of “event free” years monitoring patients receiving opioids. During a five-year period, St Joseph/Candler calculated that it saved $4 million (estimated potential expenses averted, not including potential litigation costs) and had a five-year return on investment of $2.5 million.
In research conducted at Boston’s Brigham and Women’s Hospital, Eyal Zimlichman, MD, MSc, and his colleagues determined that implementation of a continuous monitoring system was “associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital.” For a podcast with Dr. Zimlichman on this research, please click here.
These resource factors—professional liability associated with failure to monitor and a return on investment—would seem to indicate that continuous electronic monitoring saves hospital significant costs rather than resulting in higher expenditures.
We concluded our article by asking what are the real obstacles to continuous electronic monitoring?:
There are clearly patient safety initiatives that can be instituted and implemented that would result in cost savings, effectiveness, and a significant improvement in patient harm events from lack of or inadequate monitoring protocols.
This would suggest that it may not be resources, but resource allocation that may be the obstacle. If so, what really are the key obstacles within institutions that are stopping the implementation of these and other patient safety initiatives?

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