Stories | 2022 Nursing Annual Report | Nicklaus Children's Health System

Helping Children Feel at Ease Around Needles

For children and their parents, coping with a medical procedure that involves a needle is never easy. The anxiety and stress can make it not only tough on the parents and their families, but nurses and other medical providers, as well. That’s why Nicklaus Children’s Hospital was pleased to partner with Smileyscope, a state-of-the-art virtual reality system that children wear during needle procedures to keep them calm and soothed. Nicklaus Children’s is among the first children’s hospitals in the nation and the first in South Florida to offer this child-friendly, immersive technology.

“Needle procedures can be very stressful for children of all ages,” said Dr. David Seo, Senior Vice President and Chief Information and Digital Officer for Nicklaus Children’s Health System. “The Smileyscope virtual reality tool supports our Emergency Department clinicians in providing the artful distraction that is so beneficial to children during such procedures. Families can request VR support to reduce their child’s discomfort and anxiety.”

The Smileyscope uses simulated VR experiences to reduce pain and anxiety and improve the overall patient experience. One of the most requested VR experiences sought by children is the underwater adventure, which features waves washing over the injection site and a fish nibbling on the child’s arm during the injection.

Clinical trials have shown this VR program can safely and effectively reduce pediatric needle pain by up to 60 percent and anxiety by 40 percent, allowing for a more comfortable and positive patient experience. Smileyscope can be used for a range of medical procedures such as vaccines, bloodwork, wound dressings, aesthetic inductions, nitrous oxide, and plaster cast applications/removals. Smileyscope has partnered with over 40 U.S. hospitals to implement their VR technology.

Immersive Bays: Improving the Dialysis Experience

Though hemodialysis is a necessary procedure for many patients, it can be tedious and time-consuming. The patient typically must sit still for many hours during the treatment. This is challenging for all patients, but especially children, who may have anxiety and stress over the procedure. When you consider children with autism or sensory sensitivities, it can often be more than they can handle.

Considering all these factors, the nurses at Nicklaus Children’s Hospital collaborated with the IT department and their patients to create immersive bays, treatment spaces that use dynamic lighting, sound, and visual effects to create a calming, engaging environment for patients. These multisensory experiences help reduce anxiety, especially for neurodivergent children with autism or sensory sensitivities.

The immersive setting transforms the dialysis experience from one that is clinical and intimidating to a setting that feels safe and even fun. Patients have been more cooperative and have settled into their treatments more quickly, improving the overall care and efficiency. With features like customizable themes, karaoke, and movies, immersive bays bring joy and comfort to an otherwise challenging medical routine.

Nicklaus Children's Hospital Creates the Center for Nursing Excellence

In 2024, nursing at Nicklaus Children’s took an important step forward with the development of the Center for Nursing Excellence. This dedicated hub is focused on advancing nursing practice, education, research, and leadership. It serves as a resource for nurses to develop professionally, improve patient care outcomes, and foster a culture of continuous learning and innovation. The Center for Nursing Excellence plays a crucial role in elevating the pediatric nursing profession and contributing to the overall success of our healthcare system.

The center will be an important component of nursing moving forward and helps nurses at Nicklaus Children’s in the following areas:

Professional development. Offers training, certifications, workshops, and mentorship programs to enhance nursing skills and career growth.
Research and evidence-based practice. Promotes scholarly activities and trains nurses in the use of research and data to improve clinical practice and health outcomes.
Quality and patient safety. Collaborates with interdisciplinary teams to implement best practices that ensure high-quality, patient-centered care.
Leadership and innovation. Supports leadership development programs and encourages nurses to take on leadership roles within the organization.
Recognition and retention. Creates initiatives to recognize nursing achievements, fostering job satisfaction, engagement and retention.
Advocacy. Supports nurses playing a crucial role in advocacy and health policy, ensuring that patients receive the best possible care while also preparing them to engage in conversations surrounding healthcare policies and practice.

The following team members comprise the Center for Nursing Excellence:

Christina Llanez MSN, RN, NPD-BC, CNML. Director of Nursing Professional Development
- Monica Velasco MSN, RN, CPN. Horizon Program Nurse Specialist
Danielle Altares Sarik PhD, APRN, CPNP-PC, FAAN. Director of Nursing Research and Evidence-Based Practice
- Alexa Parra PhD, RN. Evidence-Based Practice- Specialist
Eric Cortes MBA BSN RN CNML NE-BC. Director Nursing Professional Practice
- Anel Godfrey MSN, APRN, FNP-C, CPN, RNC-NIC, C-ELBW. Manager of Professional Nursing Practice, Patient Navigation/Lactation/HAC Program
- Jenna Lang MSN, RN, CPN. Clinical Effectiveness Program Manager
Kristina Valiente Garcia DNP, APRN, FNP-BC. Director of Nursing Excellence and Workforce Engagement
- Amanda Schmitt MSN, APRN, CPNP-PC, CCRN, C-ELBW, NPD-BC. Magnet & Nursing Excellence Specialist

Advancing Leadership Excellence Through AONL Nurse Manager Transition to Practice Program

For novice nurse managers at Nicklaus Children’s Hospital, the transition can be exciting but challenging. In 2024, Nicklaus Children’s explored best practices and identified the American Organization for Nursing Leadership (AONL) Nurse Manager Transition to Practice Program, a program specifically designed to train incoming nurse managers for success.

The program is a structured, evidence-based program designed to support new nurse managers in developing essential leadership skills to facilitate an effective transition. The program delivers 25 contact hours of accredited education through online modules, monthly interactive sessions, and a robust mentorship component.

The 2024 inaugural cohort from Nicklaus Children’s Hospital consisted of six novice nurse managers with less than three years of experience who were paired with seasoned mentors using the Predictive Index™ to ensure compatibility in communication, learning, and leadership styles. Core topics include leadership identity, team management, healthcare operations, communication, and strategic decision-making. Mentorship was a central feature of the program, offering consistent guidance, real-world insights, and personalized support while fostering long-term relationships and professional growth.

Monthly sessions allowed mentees to engage in reflective discussions, receive feedback, and apply learned strategies in their daily roles. Mentors served as sounding boards, providing tips for success, encouraging self-awareness, and helping mentees navigate challenges such as crucial conversations, time management, and team building.

Participants reported improved confidence, stronger communication, enhanced decision-making, and a clearer understanding of hospital operations. The AONL Nurse Manager Self-Competency Assessment Tool identified growth in areas such as relationship management and human resource leadership, while highlighting opportunities in governance, finance, and policy. The program has plans for expansion and aims to track long-term outcomes like promotion rates and leadership readiness and supporting a sustainable pipeline of confident, capable nurse leaders.

Nursing Catalyst: Empowering Nurse Managers to Drive Transformational Change

Innovation in nursing is essential to advancing patient care and improving outcomes. Health Management Academy’s Nursing Catalyst Program’s Nurse Manager Idea Lab is a nine-month program designed This nine-month program is developed for high-performing frontline nurse managers at leading health systems nationwide. Through the program, participants collaboratively develop solutions to common challenges and implement an individual rapid-change pilot at their organization or unit. Participants benefit from the support of a national network of peers, individual mentorship, and access to a professional development training series.

In 2024, Nicklaus Children’s Hospital had several of its nurse managers participate in the program. Here is a roundup of the projects they worked on and implemented through the idea lab:

Leyden Diaz MBA, BSN, RN, PMH-BC, CPN, Nurse Manager, 2N and Psychiatry, worked on a program to provide support to new leaders and reduce turnover with a leadership-infused orientation program.
Diana L. Veras RN, MSN, CPN, Nurse Manager, Hialeah & Miami Lakes Urgent Care Centers, created a new recognition program for nurse supervisors at urgent care centers known as “SUPERHero of the Quarter.”
Dachel Carreno MSN, APRN, FNP-C, Nurse Manager, Minor Procedures and Colorectal Center, created a rest and recognition program to promote work-life balance and improve employees’ well-being.
Lisbeth Mosquera MSN APRN FNP-BC CPN, Nurse Manager, Emergency Department, is working on enhancing the triage process by incorporating AI and adding a second layer of decision-making to support patient safety and quality improvement.
Cristina M. Suarez MSN, APRN, CPN, Nurse Manager, 3South-Respiratory, worked on “nurse leader rounding,” a program to create relationships between leaders and families to impact the patient experience.

Improving the Nursing Experience Through LENS

The Leadership Exploration Nurse Shadowing (LENS) Experience is a valuable initiative designed to give nurses meaningful exposure to a wide range of leadership roles, from Clinical Coordinators to the Chief Nursing Officer. Through structured shadowing experiences, participating nurses gain firsthand insight into leadership responsibilities, decision-making processes, and the broader strategies that drive organizational success.

LENS plays a critical role in building a strong leadership pipeline, fostering professional growth, strengthening cross-departmental collaboration, and ensuring a sustainable leadership structure that supports excellence in patient care. As part of Nicklaus Children Hospital’s strategic focus on internal leadership investment, the measurable impact of the LENS program over the past two years has been significant.

In 2023, the program facilitated 21 LENS experiences. These experiences directly contributed to the advancement of three participants, with two individuals earning formal promotions into leadership roles and one nurse stepping into an interim leadership position. This early success demonstrated the effectiveness of the LENS experience in preparing nurses for expanded leadership responsibilities and supporting our succession planning efforts.

Building on that foundation, 2024 saw a significant expansion of the program’s reach and impact. A total of 61 LENS experiences were completed, nearly tripling the participation from the previous year. This substantial increase in engagement led to even more impressive outcomes, with five participants securing interim leadership roles and another five achieving formal promotions. The growth from 21 to 61 experiences reflects not only heightened interest and participation but also the organization's strengthened commitment to leadership development through LENS.

The LENS Program equips nurses with the skills, knowledge, and exposure needed to transition successfully into leadership positions. It has proven to be a critical driver of professional advancement and leadership readiness within our nursing workforce.

Training Nursing Graduates in Evidence-Based Practices (EBP)

The Johns Hopkins Evidence-Based Practice (EBP) Model is a comprehensive, problem-solving approach that is designed to support clinical decision-making. The Horizon Nurse Residency Program at Nicklaus Children’s Hospital integrates a comprehensive Evidence-Based Practice/Quality Improvement (EBP/QI) framework, based on the Johns Hopkins EBP Model, to foster evidence-informed decision-making and professional growth among new graduate nurses.

Since its implementation in March 2020, the program has included a six-month Practice Immersion Series that guides nurse residents through the full EBP cycle—from problem identification and literature review to implementation, translation, and dissemination of findings. Clinical Education Specialists, trained in Johns Hopkins EBP methodology, serve as mentors, offering individualized support and ensuring nurse residents are equipped to lead practice improvements in their respective units.

Evaluation data from 2021 to 2023, gathered via the Evidence-Based Practice Beliefs Scale and the EBP Competency Scale Survey, show clear trends of improvement. The program targets a mean score of ≥ 4.0 on the Beliefs Scale (indicating "Agree" or "Strongly Agree") and a mean score of ≥ 3.0 on the Competency Scale (indicating “Competent” or “Highly Competent”).

From 2021 to 2023, the Beliefs Scale scores rose steadily from an average of 3.97 to 4.26, surpassing the target by 2022. Similarly, Competency scores increased from 2.85 in 2021 to 3.19 in 2023, demonstrating progressive growth in nurse residents' ability to apply EBP concepts in practice.

These results affirm the program’s success in not only building belief in the value of EBP but also in equipping nurse residents with the necessary skills for implementation. Upon graduation, nurse residents exit the program with elevated confidence, a commitment to evidence-based care, and the leadership skills needed to drive meaningful, sustainable change. Additionally, numerous nurse residents have disseminated their projects at regional, state, and national levels, further reinforcing the program’s impact on advancing a culture of inquiry, leadership, scholarly practice, collaboration and sustainable practice change across the organization.

Advancing Ethical Practices with a Dedicated Bioethics RN Position

A focus on ethical practices is critically important in healthcare. Nicklaus Children’s Hospital prioritizes bioethics and has developed a Bioethics Program. In 2024, the hospital took another important step in its dedication to ethics by appointing Arielle Gurien as the first dedicated Bioethics RN at the hospital.

As the health care providers on the front lines of patient interactions, nurses play a critical role in identifying and advocating for ethical care. These decisions can involve everything from basic treatments to informed consent, end-of-life decisions, and resource allocation. By appointing Arielle to the role of Bioethics RN, the hospital demonstrates its recognition of the importance of nursing in bioethics and seeks to include nurses in these important decisions in the years ahead.

Arielle has several important responsibilities as the Bioethics RN at Nicklaus Children’s. One of the most important is educating novice nurses on the importance of ethical practices. “I have advanced ethical practices through educational presentations for Horizon nurses residents and upcoming sessions at the Nursing Academy,” she says.

Arielle also expanded the Bioethics Committee and established a Bioethics Taskforce, in an effort to promote awareness of available resources to assist in facilitating ethics discussions. She strengthened the hospital’s ethical framework by initiating “ethics rounds” in collaboration with the organization’s Well-Being Clinician, Diego Gonzalez. Most importantly, she serves as a trusted resource for ethics and nursing, supporting colleagues and promoting ethical decision-making across the organization.