An apple for the student

What are those red apples on the doors of patient rooms at Martin Luther King, Jr. Community Hospital (MLKCH)? The answer has to do with saving lives and pioneering new and better ways to take care of some of the most complex cases in healthcare. It also has to do with a young and passionately committed nurse named Diane Fortin.

Diane, 36, works the night shift on the third floor of MLKCH. Her job is to care for patients in the “MedSurg/Telemetry” Department—acutely ill patients recovering from surgery or suffering from heart disease or complications from diabetes.

Most of these patients are from South Los Angeles, one of the most medically underserved communities in the nation. These kinds of patients are Diane’s calling. Like them, she grew up in a disadvantaged community in Naples, FL. Not the Naples of million-dollar beach homes and wealthy retirees, but the other Naples, where the low-income housecleaners and servers and gardeners lived, with “the same lack of education and lack of trust as in South LA, and the same lack of access to high-quality care,” Diane recalled. “I could relate.”

She wanted out. That desire propelled Diane to California where she hoped to be a fashion designer. To make ends meet, she worked in an assisted living facility and learned that she loved to care for people. Her patients in turn told her she had a gift for nursing.

She listened and went back to school to get her nursing degree. It was there she heard for the first time about South LA—the huge health challenges, the heartbreaking closure of the old public hospital in 2007. She also heard about plans to open a new, private hospital that would finally bring quality care to a long-neglected community.

“I knew MLKCH was where I wanted to be,” Diane recalled. “I had set my sights on coming here, even before they built it.”

MLKCH policy required all nurses to have at least one year of hospital experience. Diane was still working on her nursing degree, but she wanted to position herself to get an MLKCH nursing job. In June of 2015, one month before the new Martin Luther King, Jr. Community Hospital opened, Diane effectively took a demotion to join the hospital. Instead of being a nurse, she would start as a nurse assistant.

“I really believed in the hospital,” she said. “I just loved working here. This is where I wanted to put my experience and time.”

Now all she needed was a foot in the door to a job as a nurse. That opportunity came in 2017 when MLKCH launched the Nurse Residency and Fellowship program, a prestigious year-long residency program to jumpstart the careers of new nursing school graduates with guided, on-the-job experience. Diane was one of eight candidates accepted into the program.

Our residency program gave her what she needed: experience and mentoring. In return, Diane and her student nurse colleagues gave MLKCH something unexpected: a new policy that demonstrates the power and innovative potential of young nurses.

The Nurse Residency and Fellowship program was a “pure learning environment,” said Diane. “It gave us a chance to really think about the things we were seeing. When you have the time and the guidance, you can start to think creatively about the bigger picture.”

What she and her residency colleagues saw were diabetic patients being admitted with catastrophically high blood sugar levels.

People with diabetes have little or no insulin, a hormone that regulates energy in the body. To stay healthy, they must inject insulin. How much is the critical question, as both too little or too much can result in illness, even coma or death.

To know, blood must be tested just before a patient eats. That test determines the correct dose of insulin.

Yet MLKCH allows patients to schedule their own meals. Patients can call for room service at any time. How would nurses know when to test?

In a pilot project that would be adopted hospital-wide and presented at a national conference as an example of best practices, Diane and her colleagues came up with a plan. Diabetic patients would get a red apple sticker on the door to their rooms. Servers delivering meals would see the apple and alert the nurse before entering the room. The nurse would then conduct the blood test at the exact right moment: just before the meal. That test would also set the clock on when insulin would be administered: precisely 15 minutes after the test.

“It was simple and smart,” said Rita Calderon, MLKCH Nurse Manager. “These young nurses found an easy, visual way for nurses and Food Services to coordinate. In the process, they established a best practice standard for patient care.”

Patients noticed too. As part of the Red Apple Program, nurses educate patients on how critical timing is in the treatment of diabetes. It is hoped that seeing the precise schedule in practice will help people with diabetes stay healthy after they leave the hospital.

Diane and the seven other nurses in the Nurse Residency and Fellowship program graduated this past December. All received job offers from MLKCH.

“It was incredible,” said Diane. “I went from a [patient care technician] to a new nurse on the floor to assisting in writing a policy all within the space of two years. I can’t think of another hospital that lets new nurses do so much.”

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Read more about our Nurse Residency and Fellowship program