Dr. Nurse Promotes Primary Care for Her Patients

	Dr. Miriam Carasa

A caring, compassionate, one-on-one relationship between nurse and patient helps to improve healing, says Dr. Miriam Carasa of Woodhull Medical and Mental Health Center in Brooklyn. And one thing fosters the patient-nurse bond more than anything else: continuity of care, in which a patient has the same nurses throughout his or her stay.

“If you really know the person you’re caring for, you know how to approach them. Because you develop trust, you can influence them in a positive way. You can also meet their needs much more holistically, looking at all aspects of care, not just their pathology,” explains Dr. Carasa, Ed.D, RN, who is the Chief Nurse Executive/Deputy Executive Director at Woodhull.

When Dr. Carasa arrived at Woodhull in 2010 to assume her present post, she was immediately focused on improving the continuity of care and led the hospital to adopt the primary nursing model, so named because one nurse on the nursing team is given the principal responsibility for each patient.

Because Woodhull’s nurses work flextime – putting in shifts of 11-1/2 hours, three days a week – Dr. Carasa needed to adapt the system to her staff. Today, all medical/surgical, psychiatry and critical care units have adopted this model.

“We develop a core of people who are very involved with each patient. The primary nurse is key, and other members of the nursing team are equally invested,” Dr. Carasa says.

Primary nursing care made all the difference to the young man suddenly felled by adult respiratory distress syndrome. His lungs were not functioning and he had to spend several months at Woodhull, with his mother by his side.

“The son was so sick, intubated. The primary ICU nurse developed a therapeutic relationship with both the son and the mother,” Dr. Carasa recalls. “The mother spoke little English, but the nurse spoke Polish and was able to communicate and comfort her, and with the added help of a certified interpreter, was able to help the family make important decisions.”

In the end, the patient recovered well. And when one nurse cares for one patient, a happy outcome gives that nurse a sense of accomplishment. “We can say, ‘Look – MY patient is going home today! I contributed to my patient’s positive outcome!’ ”

Dr. Carasa, who was a grammar school teacher in her native Cuba and became a nurse after coming to the U.S., is also a tireless mentor of her fellow nurses, pushing them to get additional degrees and specialty certifications, using her own achievements to inspire others. Her colleagues say she’s empathetic yet firm, encouraging them to make the move into nursing leadership.

Recently, Dr. Carasa was named a 2013 NY/NJ Nurse.com Nursing Excellence regional finalist in the category of Advancing and Leading the Profession. Six national winners will be announced in the fall of 2013.

Dr. Carasa came to New York City from Cuba when she was in her early 20s and has been a nurse for 36 years. Here, a job as a medical assistant led to nursing school. Besides her nursing degree, she has a Masters in Health Services Administration from The New School, a second Masters and a Doctorate in Nursing from Teachers College at Columbia University, and is a board-certified Nurse Executive. Initially working as a critical care nurse, she later served in leadership positions at various hospitals.

For years, she and her husband, a retired AT&T electronics engineer who speaks “very little Spanish,” enjoyed “exciting” scuba diving vacations. On swimming with hammerhead sharks she says, joking: “They really don’t eat you!” And yes, she knows how to make Cuban rice and her beloved black beans, along with avocado salad and fried plantains. But today, she’s more of a “health nut.”

Says Dr. Edward Fishkin, the hospital’s medical director: “She has brought a whole new spirit to the nursing department. And she is visionary in setting up systems and processes in care.”

“Anything that has to do with promoting nursing,” Dr. Carasa says, “I’m all for it!”

May 2013