Margie Harrier's office is a fairly spare place "a dingy little hole," as she calls it. An inspirational quote hangs on the wall; a few ornaments punctuate the bare bookshelves.

But Harrier, vice president of clinical and patient care services for Good Samaritan Hospital, doesn't much care because she spends most of her time roaming the hospital, checking in on patients, responding to family crises, and acting as intermediary between doctors, staff and executives.

Harrier is, in essence, the hospital's chief nurse, one of four vice presidents who report directly to the chief executive, and a primary information conduit for getting problems solved.

"It all hinges on communications," Harrier says. "Most people don't like to be confrontational. It takes them a while to get past that, but once they feel like they're not injuring me by being honest, that's when we really get down to work."

Harrier's 12-hour day starts at the hospital at 6:30 a.m. One recent day began with an executive meeting, followed by a stop to see the director of the operating room, Karen Bopp. Harrier is there to view a demonstration of a piece of surgical equipment one of the doctors has been pushing the hospital to purchase.

"In the old days, if doctors wanted to access your gall bladder, they'd make an incision in your side, from here to here," Bopp explains, using her finger to draw a foot-long line along her side. "Then they'd pull you apart like this (digging her fingers into her side) to get under the liver, where the gall bladder resides. Afterwards the patient had to stay in the hospital for six weeks, and it hurt like you-know-what."

Now gall bladder surgery doesn't even require an overnight stay in the hospital.

Bopp picks up a piece of equipment that resembles a long, metal turkey baster to demonstrate. "Now they just put this endoscope into your abdomen," she says, poking herself in the belly with the thing, "and inflate your abdomen with carbon dioxide." The pointed end of the endoscope holds a camera lens. The image of the patient's interior appears on a video screen, which the doctor uses to navigate.

The piece of equipment Harrier is there to see is a voice-activated robotic arm, which could take the place of the nurse who holds the endoscope in place during the gall bladder surgery. The physician wears a headset to give the robotic arm voice commands, moving the endoscope so the doctor can view different parts of the abdomen.

After a quick demonstration, Harrier asks, "What type of training sessions do you have? I assume surgeons don't go in to operate on a patient the first day."

"Actually, they do," Bopp replies. "The arm moves basically the same way they'd move by hand up, down, right, left. The learning curve is about four cases. They do go through a training session, and we make sure that every surgeon knows how to operate the whole machine. But there's this cheat sheet, which they can put up in the OR and refer to."

Harrier then turns to Barbara Gennarelli, the nurse educator for the operating room, and asks for an update on a new nurse training program Gennarelli has been directing. With the current nursing shortage, operating-room nurses are extremely hard to come by, so Good Samaritan has started training nurses on-site. The only requirement for the program is that the nurses have a minimum of six months experience.

"It's going well," said Gennarelli. "They've finished their didactic. They're scrubbing and cleaning and just loving it. The day isn't long enough for them."

Next comes a quick update from Bopp on an operating-room open house on Nov. 14, during "operating-room recognition week." Vendors displayed their wares: harmonic scalpels, heart valves and other products. One room was filled with antique machines, unearthed during a recent housecleaning. An old EKG machine still sat in the conference room, a wood box with a tongue of graph paper hanging out its side.

"Waves of nurses from the CSU and ICU came in," said Bopp. "They had never been in OR before. We're cloistered over here. We wear different outfits, we hang out together, it's like belonging to a secret club."

"We should do an open house once a year," Harrier says, and Bopp agrees.

En route to her next meeting, Harrier is waylaid by a staff physician.

"How about those Japanese-speaking nurses? There's not a person out there who speaks Japanese, except the laboratory girl," the physician says.

"They are very hard to find, but I do have the vice president of human resources looking into that," Harrier replies.

"You might talk to the Japanese medical staff," he suggests, citing the name and phone number of a physician.

"I'll give him a call," Harrier says, moving on to her next meeting. That session is with Rebecca Shehee, director of development, and Tom Baumann, who is in charge of recruiting doctors. It takes place in a glassed-in meeting room surrounded on all sides by administrative offices.

Shehee's job is to help the hospital secure funds from various foundations. "And the competition is really stiff," she says. "It's not like the patients go away if you don't get the funds."

Under state law, hospitals are required to assess and provide for community needs. Good Samaritan is located near downtown, in an area largely populated by Asians, with six different Asian languages predominating. The hospital had recently received a charitable grant from a nearby non-profit group, and is using the money to provide various services to the community.

"What's the time frame? I know they want to see us working on this," says Harrier.

"The plan will be in place for all the components by Jan. 1," Baumann answers.

Harrier asks Baumann for an update on the recruitment of bilingual Japanese nurses.

"They are really few and far between," says Baumann. "There's the one who is applying if you saw her cover letter, she's been hired by another hospital already, but she's very eager to come to Good Sam."

Then she brings up another issue: "How are the Korean mothers acclimatizing to the change?"

Good Samaritan had recently implemented "couplet care," where babies are left in the room with new mothers. In the Korean culture, Harrier says, the baby is traditionally removed from the mother for the first month of life, and is cared for by the mother-in-law, while the mother spends the month in bed. So couplet care is a major departure from tradition.

"The first three mothers really liked having the baby there," said Baumann. "And they like it because it's almost as if the hospital makes them do it, so they're not breaking with tradition. It's the mother-in-law who doesn't like it so much. And they love that Korean nurse."

After checking in briefly with her secretary, Harrier heads off to check on activities on the seventh floor. Before talking with the head nurse there, she stops in to ask a patient about the service.

On this particular day, the seventh floor is fairly quiet. Harrier introduces herself to a patient, who is lying on his side under a white blanket, watching television.

"If there's one thing we at the hospital could improve, what would that be?" she asks.

"You could fix the air conditioning," he says. "I can't turn it on or off in the room. Either I'm freezing at night or it's not working at all. There were also a bunch of spider webs in there," he said, pointing to the vent. "But I told them about it, and they cleaned it up this morning. Otherwise everything's great."

Harrier lets the floor director know about the air conditioning problem.

That said, she hurries off to her next meeting.

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