“Think Forward and Be Part of the Solution”

Susan Mascitelli has executive responsibility for the Department of Patient Services at NewYork-Presbyterian Hospital (NYP) and acts on behalf of the Chief Executive Officer as official Liaison to the hospital’s Board of Trustees. In addition, she is the senior hospital executive in charge of the Global Services program and has responsibility for the hospital’s volunteer, pastoral care, and administrator-on-call functions.

Mascitelli has four decades of hospital experience in patient care and management and has held leadership roles in many of NYP’s quality, patient safety, and regulatory initiatives. Starting her career as a staff nurse at NYP in the cardiac intensive care unit, she obtained her undergraduate degree from Columbia Nursing and a certificate in executive leadership from Harvard Business School. She received a Distinguished Alumni Award from Columbia Nursing this year.

Q: You've been on the front-line of hospital-related ethics issues for more than a decade. Traditional bioethics often fails to address issues relevant to advanced practice nurses working in today’s health care workplace. For instance, the legal definition of death, assisted suicide and euthanasia may affect DNP medication prescription and decisions about care sites. What new ethical responsibilities face advanced practice nurses and nurse researchers that are specific to their roles?

As a nurse and a nurse leader, I have seen laws and regulations grow and change regarding the ethical norms surrounding patients’ rights and the legal definition of death, including many differences between individual states. Part of the responsibility of an advanced practice nurse is to be aware, knowledgeable and conversant about the laws and regulations in the state that they are practicing in. Many of the ethical dilemmas facing nurses involve complex determinations regarding the right thing to do for a particular patient. For example, when it comes to end-of-life issues, getting to know a patient’s belief system is critical. This can be done by talking with patients directly or with their family if they are not able to speak for themselves. Nurses need to work in an interdisciplinary group of health professionals including physicians, trained ethicists, social workers, psychiatrists, and patient advocates to reach the best course of action for the patient.

Q: As the Vice President for Patient Services at NYP, you shared in the responsibility for bottom-line business performance. How do you balance profitability and safety in a hospital setting?

Quality and safety always have to come first, and to balance that with profitability, you have to focus on working more efficiently. At NYP, 60 percent of our cost and expenses relate to our labor force, so hiring the most efficient and appropriate candidates whose skills can be leveraged in multiple areas is crucial. For example, we hire chaplains to help our patients and staff and to meet pastoral care standards. Employing chaplains who are also credentialed to teach residents and students ultimately increases their value for both patients and the hospital. All hospitals are trying to find efficiencies in sharing data between systems that are both HIPAA compliant and result in faster, safer and higher quality care. Another example of balancing these needs is evidenced by hospital mergers and acquisitions to find the “right-size” for the right market share as well as leveraging their purchase power enabling them to buy the highest quality products at the most competitive price.

Q: You are also involved in patient satisfaction surveys at NYP. What are some of the biggest takeaways from these surveys nurses could apply to their daily work?

When reviewing patient satisfaction surveys, the overall trend line is more important than focusing on one snapshot in time. Nurses should pay more attention to trends. For example, we anticipate lower patient satisfaction results in December and January because no one wants to be in the hospital during the holidays, so we anticipate dips year over year. Nurses and others think of creative ways to try and address this with patients and families.

There is a very clear correlation between overall patient satisfaction and overall nursing satisfaction—if the patient liked their nurse, they are usually very satisfied with the overall hospital experience. Nurses should take pride in this and recognize how powerful they are. If they don’t have access to these data, they should ask their supervisor to see it; they can take ownership of the data and utilize it in productive and creative ways. As an example, when satisfaction ratings regarding pain management are low, nurses should ask themselves what they can do to improve the situation. That could mean joining a multi-disciplinary team or committee on “response to pain.” Nurses must think forward and be part of the solution. Today’s graduating nurses are extremely proficient in technology, which gives them a terrific advantage finding creative solutions. APRNs have great, innovative ideas that many of us, like me, who have been here a long time, need to hear.

Q: As someone who has been responsible for recruiting, hiring, and training master's level nurses, what skill set and qualities do you look for that meets the evolving needs of patients in a quickly changing hospital environment?

Taking care of patients in a complex environment requires maturity and thoughtfulness, and most of all life experience. You may have multiple educational degrees but if you have never directly cared for patients who are scared and in pain you may lack the skills and instincts to be a caring compassionate professional. Being able to listen, maintain a degree of calmness and compassion, being responsive and highly-skilled are qualities that I look for in potential job candidates.

Q: According to the Joint Commission, “treatment delays, medical errors, and generally unsafe practices thrive in the presence of patient congestion.” What can nurses do to improve patient flow?

At NYP, I serve as the executive sponsor for the leadership standards of the Joint Commission; one of those standards relates to “patient flow” so I am very aware of the importance of making sure that the staff at all levels,  understands the elements involved and that the data is valued by the organization. Nurses make an impact on patient flow every day by advocating for their patients and ensuring that timely and appropriate care is provided.

For a nurse in the emergency department a bird’s eye view of patient flow may look like this: The patient comes in, gets diagnosed, is admitted, and is eventually moved to the appropriate unit.  Nurses need to take a step back and break down that data— the door to triage time, door to practitioner time, practitioner to decision point time, time from admission to getting a bed, how long it takes for a CT scan to be ordered, performed and then interpreted, etc. When nurses are aware of the data, it can inform their thinking and enable them to be part of a solution. Being conversant and knowledgeable about patient flow may make the practitioner think twice about ordering another test in the ED, which could slow the process down and may not be needed.

Q: If you could go back in time, what advice would you tell yourself as a nursing student?

When you are in school and are working as a new nurse, you are understandably anxious about the tasks at hand and learning how to do the job. I would tell my younger self to think big and trust my instincts: Nurses have incredible ideas and do amazing work—they serve as leaders in academic medical centers, they provide care in communities, they run clinics that keeps the population healthier. They are capable of creatively voicing great ideas about making health care better for patients, providers, and their families.