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Dome - Q&A With Karen Haller

May 2010

Q&A With Karen Haller

Date: May 7, 2010

Vice President for Nursing and Patient Care, The Johns Hopkins Hospital

Karen Haller
Karen Haller

In the 19 years that National Nurses Week (May 6 to 12) has been celebrated, the nursing profession has experienced monumental changes. Just as she has championed the increasing responsibilities and expertise of her staff, Karen Haller, vice president for nursing and patient care services at The Johns Hopkins Hospital, has played a major role in those changes. She also has led efforts to improve patient safety, overcome a severe nursing shortage and embrace sweeping technological advances. During a period of relative calm before the big shift to the new clinical buildings, Dome sat down with Haller to get her thoughts on the present and future of nursing at Johns Hopkins and beyond.

How would you gauge the current state of nursing at Hopkins Hospital?

I think we’re at a good time right now. We’re well staffed. We have a lot of experienced nurses, and we’re better educated and younger than the national average. Of our 2,351 nurses, 78 percent have a bachelor of science in nursing compared to 50 percent nationally. Seventy-six percent of us work full time, so we’re not a part-time staff.

We have great diversity. The nursing profession used to attract white women. But today, you can’t run a profession that attracts only white women. There aren’t enough, and it’s disproportionate to the population. We’re making better progress with minorities than with men. Minorities comprise 35 percent of our R.N. staff, but men represent 13 percent.

We’re also doing very well garnering awards. I’m most proud of last year’s recognition by the American Nurses Association with the award for Outstanding Nursing Quality.

The momentary lull in the nursing shortage affords us the luxury to think forward a bit.

What are you thinking about?

For this coming year, I’m really looking at the staffing plan for the new clinical building. We’ll need every nurse we have on board and then some. The building will hold about the same number of beds, but the shift from general care to more ICU beds will require more nurses. To staff the new clinical campus, we will be bringing on 531 new full-time people; of these, 143 will be R.N.s.

There are going to be challenges: Some nursing units are disbanding, so those  nurses will go into new units with new team members. In these areas, we’re almost building the staffing plan from scratch.

Also, nurses will need to learn the new equipment, navigate the building’s large footprint, and learn how to move patients around for tests and other reasons. We can’t go into the building for training until about three months in advance.

We’re aiming to pilot everything before the move. On Nelson 8, for example, we’re working out the bugs of the new nurse call system, which streamlines electronic communication among practitioners. That way, we won’t be experimenting when we move into the new building. The same goes for all equipment and devices.

How is the nursing profession evolving?

Computer systems certainly will change our practice. We want to have computers at the bedside, where nurses can pull up data. They’ll be able to know what happened at a patient’s last clinic visit and use the data to determine, for example, whether or not a patient is taking prescribed medications. A nurse can review records with the patient at the point of care. The nurse also can enter new data so that it’s available to a physician at a different location.


We’re also doing very well garnering awards. I’m most proud of last year’s recognition by the American Nurses Association with the award for Outstanding Nursing Quality.


Everything moves here—physicians, patients, equipment, medication and information. We currently don’t have any way to alert a physician that a patient has been sent to Radiology for two and a half hours. Or calls often go out to locate equipment, such as patient analgesic pumps. Introducing radio-frequency identification tags will make it possible to track patients and equipment. The new building will have the wiring to make this possible.

What advances are driving changes in nursing practice?

With progress in medical technology, training has moved from the classroom to simulation education and online learning opportunities. With simulation training, nurses can learn to place IVs and do other procedures without jeopardizing the safety of patients. A response to cardiac arrest can be practiced in a lab, where a new nurse is debriefed as part of an interdisciplinary team. That’s really powerful.

These changes have also fostered an environment conducive to patient-centered care, where providers collaborate. It’s not about what the captain of the ship dictates anymore; it’s what does everybody bring to the collective understanding of what’s best for the patient.

Patients have become really smart about their care, and we need to make them part of the team by explaining medical information in layman’s terms and listening to what they’re saying about their goals for care. 

Have these innovations led to greater collaboration with the Johns Hopkins University School of Nursing?

We work together to offer non-credit career development through the Institute for Johns Hopkins Nursing, such as last year’s conference on simulation education for nurse educators. The institute is a way of recognizing this campus as an academic nursing center. The expertise of Dean Martha Hill’s faculty and graduate students at the school of nursing helps our nursing staff to think more carefully about patient safety and evidence-based practice.

Do you also anticipate nursing at the four Hopkins hospitals working in a more collaborative way in the future?

The nursing directors at all four hospitals are already meeting quarterly with deans from the school of nursing to share best practices.  For example, we have shared our expertise in preparing for Magnet recognition, but learned recently from Bayview about their nursing dashboards. Our award-winning experts in evidence-based practice have consulted with the group at Suburban.

Will health care reform bring about changes for the nursing profession?

When 32 million more people have health insurance, the primary care system will have to reinvent itself to handle people in real time when they’re sick and need help. We’ll have to staff that. There aren’t enough primary care physicians available, so we’ll have to rely more heavily on nurse practitioners. They are a cost-effective solution to manage routine health problems.                                        —Reported by Stephanie Shapiro