I am an Army Veteran and Registered Nurse on W4 Oncology at the Louis Stokes Cleveland VA Medical Center. While in the military, I had the opportunity to serve under many great leaders. I am honored to say that privilege has continued here at the VA. I have had the pleasure of taking care of our nation's Heroes under the direction of Rachel Zjaba for six months. Since she accepted the position, Rachel has done an outstanding job not just as the manager but also as the leader of our oncology unit. Rachel's love for the nursing profession and our Veterans is evident in her work. Her impact is felt through the environment she has cultivated, evidenced by unit metrics and exemplified by her actions. 

The environment of trust and support on the floor has led to an increase in staff engagement and going above and beyond what is asked. Since assuming her role, Rachel has reinstated and revamped the Unit Practice Council (UPC), giving all staff a voice and avenue to address issues. In addition, the UPC has orchestrated events to improve unit morale and cohesiveness. Staff are currently working on performance improvement projects to decrease the time of chemotherapy initiation for scheduled admissions. Wound care champions are conducting skin checks and making wound rounds to ensure proper treatment and prevention measures are implemented for our veterans. Patient education champions are empowering patients by increasing health literacy, allowing patients to play a more informed and active role in their healthcare. Staff are involved in staffing methodology for the unit, have input for self-scheduling, and are consulted for input when decisions for the unit are being made.

The path toward ANCC Magnet designation is a long process. Rachel is doing her part in transforming the culture of our unit. She not only understands the framework for the ANCC Pathway to Excellence but also applies it to her work in the unit. The principles outlined in the framework are felt and appreciated by the floor staff. Through advocacy and appropriate staffing, she has allowed for shared governance, quality improvement, peer review, evidence-based practice, collegial teamwork, nursing research to flourish. This has created a positive impact on retention and unit morale.

Rachel's nonbiased and nonjudgmental approach allows for open and effective communication. Her open-door policy and effective problem-solving skills make staff feel comfortable approaching her when an issue arises. One example of this was highlighted during a recent event. An RN was caring for Mr. S, a multiple myeloma patient with skeletal metastasis. Mr. S had gone through extensive treatment-oriented therapy, including chemotherapy, immunotherapy, and radiation. The progression of the cancer was causing compression of the spinal cord, taking away his mobility and independence. Mr. S was evaluated by neurosurgery and was deemed to not be a surgical candidate. After a long battle with his disease, Mr. and Mrs. S decided to pursue palliative treatment. The VA was offering patients marital vow renewals for Valentine's Day. Mrs. S expressed to his RN how nice this would be to do but she didn’t feel Mr. S was strong enough to go to the hospital chapel. The RN then approached Rachel for help facilitating Mr. and Mrs. S in their vow renewal. The nurse was able to orchestrate the vow renewal in the patient’s room. She was then able to have pictures of the event printed and framed for Mr. and Mrs. S. They were extremely touched and expressed their deepest gratitude. I was taking care of Mr. S a few days later and Mrs. S was brought to tears recalling the experience. 

Unit metrics are an objective way to evaluate how a unit is performing. From the time Rachel took ownership of our unit we have seen the same or a decrease in CLABSI rates, CAUTI rates and HAPI rates. There has been an increase in influenza and pneumonia vaccination rates, an increase in BCMA med scanning and an increase in PRN pain reassessments. In addition, the All-Employees Survey (AES) showed an increase in data sharing, data use authenticity, opportunity, and staff engagement. It is evident, subjectively and objectively, that Rachel has had a positive impact on the unit. 

“The day the soldiers stop bringing you their problems is the day you stop leading them. They have either lost confidence that you can help them or concluded that you do not care. Either case is a failure of leadership” (Colin Powell). This is a quote that really resonated with me and I feel Rachel embodies for the staff on her unit. She has created an environment of trust and support through being an open and effective communicator and problem solver ensuring staff feel comfortable coming to her with their problems. This has led to increased staff involvement in performance improvement projects, floor champions, UPC and unit morale. This in turn has had a positive impact on the quality of patient care and patient outcomes.