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Un estudio demuestra la importancia de garantizar el seguimiento del participante y del proveedor después de obtener el resultado de un examen de detección genético
Lanzada en asociación con el Desert Research Institute, una nueva investigación del proyecto Healthy Nevada Project® determina que un diagnóstico confirmado no siempre produce cambios en el cuidado del paciente. El hecho de entregar a las personas información de salud que pueda cambiar sus vidas no garantiza que las personas, o sus proveedores de atención médica, actuarán en consecuencia. La educación de seguimiento y las conversaciones sobre los planes de cuidado ejecutables con los pacientes y sus médicos son los próximos pasos clave, de acuerdo con la nueva investigación del Healthy Nevada Project. El Healthy Nevada Project es un proyecto de investigación y detección genética que se lanzó en 2016 como una asociación entre DRI y Renown Health. El proyecto ahora tiene más de 50,000 participantes y cuenta con secuenciación genética proporcionada por Helix. Entre septiembre de 2018 y septiembre de 2020, el Healthy Nevada Project notificó exitosamente a 293 participantes que estaban genéticamente en riesgo de desarrollar cáncer de pecho y ovario, síndrome de Lynch o hipercolesterolemia familiar hereditarios, tres afecciones genéticas comunes conocidas colectivamente como afecciones de Nivel 1 de los Centros para el Control y la Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC). En un estudio publicado hoy en Frontiers in Genetics, los científicos del Healthy Nevada Project analizaron qué impacto tuvo el hecho de notificar a un paciente sobre un resultado positivo para una condición de Nivel 1 de los CDC en el cuidado que recibió el paciente en los meses y años posteriores. Según sus resultados, entre los 293 participantes del Healthy Nevada Project que fueron notificados del riesgo genético de desarrollar una afección del Nivel 1 de los CDC, el 71 % de participantes con registros médicos electrónicos compartieron sus hallazgos con los proveedores de atención médica. Sin embargo, solo el 30 % de los registros médicos electrónicos de estos pacientes contenía documentación del diagnóstico genético, y solo el 10 % de los pacientes examinados experimentó un posible cambio en el cuidado después de recibir los resultados de su examen de detección genético. “El Healthy Nevada Project se implementó con un enfoque ‘sin intervención’ en el que los participantes reciben sus hallazgos y deciden con quiénes y cuándo desean compartirlos. Los hallazgos no se agregaron automáticamente a sus registros médicos electrónicos”, explicó el Dr. Gai Elhanan, científico de datos médicos en DRI y coautor del estudio. “Lo que estamos aprendiendo ahora es que para garantizar que los hallazgos genéticos importantes se integren en el régimen de cuidado, es importante que su incorporación en los registros médicos electrónicos forme parte del estudio”. Este estudio se basa en investigaciones anteriores del Healthy Nevada Project publicadas en Nature Medicine. En ellas se demuestra la importancia de realizar exámenes de detección para las afecciones del Nivel 1 de los CDC, las cuales afectan a aproximadamente a 1 de cada 75 personas y se pueden mitigar e incluso se puede evitar que se conviertan en enfermedades cuando se detectan en forma temprana. Este estudio determinó que hasta el 90 % de los casos con afecciones del Nivel 1 de los CDC no son detectados por los proveedores clínicos en las evaluaciones y los exámenes de detección que se realizan durante las visitas de cuidado clínico habitual. Durante el estudio actual, los científicos del Healthy Nevada Project descubrieron que el 19 % de participantes estudiados ya había desarrollado una de las afecciones del Nivel 1 de los CDC y, por lo tanto, podrían haberse beneficiado de una notificación más temprana sobre su afección. El equipo del estudio espera que sus hallazgos estimulen a los residentes de Nevada a obtener pruebas genéticas para estas afecciones relativamente comunes. Incluso si las personas son mayores o ya han sufrido enfermedades relacionadas con estas afecciones, las pruebas también podrían ser beneficiosas para los hermanos, los niños y los nietos que también pueden estar en riesgo y que posteriormente podrían someterse a exámenes de detección en caso de un hallazgo positivo. El equipo del estudio también incita a informar a los proveedores de atención médica sobre la importancia de incorporar diagnósticos genéticos en las recomendaciones farmacéuticas (por ejemplo, para la hipercolesterolemia familiar) y de tratamiento a los pacientes. “Como resultado de este análisis, los médicos de Renown Health y los investigadores del Healthy Nevada Project han logrado cambios significativos, lo que incluye la obtención del consentimiento informado de los participantes para incorporar hallazgos positivos de sus informes genéticos directamente en su registro médico electrónico”, explicó Daniel Kiser, M.S., científico auxiliar de investigación de ciencia de datos en DRI y coautor del estudio. “Esto ayudará tanto a los participantes como a sus proveedores de cuidado clínico, y a todo el estado a maximizar los beneficios a largo plazo de los exámenes de detección genéticos voluntarios basados en la población del Healthy Nevada Project”. Información adicional: El texto completo del estudio, Incomplete Penetrance of Population-Based Genetic Screening Results in Electronic Health Record, está disponible en Frontiers in Genetics: https://www.frontiersin.org/articles/10.3389/fgene.2022.866169/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Genetics&id=866169. Este proyecto fue financiado por Renown Health, fundación de Renown Health y la Oficina de Desarrollo Económico del Gobernador de Nevada. Entre los autores del estudio se incluyen Gai Elhanan (DRI), Daniel Kiser (DRI), Iva Neveux (DRI), Shaun Dabe (Renown Health), Alexander Bolze (Helix), William Metcalf (DRI), James Lu (Helix) y Joseph Grzymski (DRI/Renown Health). Para obtener más información sobre el Healthy Nevada Project® o para solicitar un examen de detección genético, visite: https://healthynv.org/ Acerca del DRI El Desert Research Institute (DRI) es un reconocido líder mundial en investigación ambiental básica y aplicada. Comprometidos con la excelencia e integridad científicas, el cuerpo docente del DRI, los estudiantes que trabajan juntos y el personal han desarrollado conocimientos científicos y tecnologías innovadoras en proyectos de investigación en todo el mundo. Desde 1959, la investigación de DRI ha profundizado el conocimiento científico sobre temas que van desde el impacto de los seres humanos en el medioambiente hasta el impacto del medioambiente en los seres humanos. Los hallazgos científicos impactantes y las soluciones inspiradoras del DRI apoyan la economía diversa de Nevada, proporcionan oportunidades educativas basadas en la ciencia e informan a legisladores, líderes empresariales y miembros de la comunidad. El DRI tiene campus en Las Vegas y Reno y funciona como el grupo de investigación sin fines de lucro del Sistema de Educación Superior de Nevada. Para obtener más información, visite www.dri.edu. Acerca de Renown Health Renown Health es la red de atención médica integrada de administración local y sin fines de lucro más grande de la región, que presta servicios a Nevada, Lake Tahoe y el noreste de California. Con una fuerza laboral diversa de más de 7,000 empleados, Renown ha fomentado una cultura de excelencia, determinación e innovación de larga data. La organización se compone de un centro de urgencias, dos hospitales de cuidados agudos, un hospital infantil, un hospital de rehabilitación, un grupo médico y una red de atención de urgencias y Hometown Health, la compañía de seguros sin fines de lucro más grande de la región y de propiedad local, Hometown Health. Actualmente, Renown está inscribiendo participantes en el estudio genético de salud poblacional basado en la comunidad más grande del mundo, el Healthy Nevada Project®. Visite renown.org para obtener más información. Acerca de Helix Helix es la compañía líder en genómica y vigilancia viral de la población cuyas operaciones se basan en el cuidado clínico, la investigación y el análisis de datos. Helix permite que los sistemas de salud, las empresas de ciencias biológicas, los pagadores y los socios gubernamentales aceleren la integración de los datos genómicos en el cuidado médico del paciente y en la toma de decisiones de salud pública. Obtenga más información en www.helix.com.
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Renown Institute Expands Partnership to Offer ELF Testing
Juntos, realizarán pruebas a más de 30,000 participantes del estudio elegibles antes de 2023 para determinar el riesgo de cirrosis y enfermedades relacionadas con el hígado. Renown Institute for Health Innovation (IHI) announced today that the organization and Gilead Sciences, Inc. will be joining forces with Siemens Healthineers to offer the Enhanced Liver Fibrosis (ELF™) Test to people with risks for nonalcoholic steatohepatitis (NASH) enrolled in the Healthy Nevada Project (HNP). The ELF Test will help identify people most at risk for progressing to cirrhosis and liver-related outcomes and allow healthcare providers to intervene before irreparable damage occurs. This noninvasive blood test uses three serum biomarkers to create an ELF score from a predefined algorithm, which can be used by doctors to help evaluate if a patient requires increased medical care and monitoring for their condition. La enfermedad de hígado graso no alcohólico (EHGNA), que incluye la EHNA, es frecuente en Nevada y está subdiagnosticada, y probablemente afecte a más de 500,000 adultos en nuestro estado. If undetected and untreated, NASH can result in liver cirrhosis and may require liver transplantation or lead to death. Hay más de 12,000 personas en la lista de espera para trasplante de hígado en los EE. UU. y esta cifra continúa aumentando debido al incremento en la prevalencia de la EHGNA. “Thanks to important data collected through our Nonalcoholic Steatohepatitis Liver Disease Genome Atlas study, we now know that NASH is prevalent in the state of Nevada,” said Tony Slonim, M.D., DrPH, FACHE, president and CEO of Renown Health. “We are proud to expand our partnership with Gilead and begin working with Siemens Healthineers to improve health of those with liver disease and to take early detection one step further by offering Enhanced Liver Fibrosis, ELF testing for patients of Renown Health. This test provides our team of highly-skilled physicians an advanced, noninvasive method to actively assess dynamic liver fibrosis in study participants and intervene whenever necessary, contributing to a healthier Nevada.” “Gilead believes that noninvasive tests, including the ELF Test, will help improve the experience of people living with NASH. These tests may help to diagnose liver disease, monitor disease progression and evaluate responses to treatment without the requirement for liver biopsy,” said Rob Myers, MD, Vice President, Liver Fibrosis Clinical Research at Gilead Sciences. “The ELF Test has proven itself to be a valuable tool in NASH management and we hope this partnership will further support its use in routine care.” “We are very pleased that NASH patients in the Healthy Nevada Project now have access to the ELF Test which offers clinically useful prognostic information for their condition with the convenience of a simple blood test. Using our advanced laboratory expertise together with Renown IHI and Gilead, we can work towards better understanding of NASH and liver disease in a representative patient population,” said Sebastian Kronmueller, Head of Molecular Diagnostics at Siemens Healthineers. “We launched the Healthy Nevada Project to help people understand more about their health, to identify serious health risks, and to give people access to innovations like the ELF Test, so they can live their best lives,” said Renown’s chief scientific officer, Dr. Joseph Grzymski, who is also a research professor at the Desert Research Institute and principal investigator of the Healthy Nevada Project. Es increíblemente gratificante poder informar hallazgos clínicos para ayudar a nuestros 50,000 participantes voluntarios del estudio y asistir a los proveedores de atención médica a ayudar a sus pacientes”. La provisión de la prueba de ELF se basa en una colaboración estratégica anunciada previamente entre el Renown IHI y Gilead en julio de 2019. Esta sociedad en curso tiene como objetivo recopilar y analizar datos de salud genéticos y electrónicos anónimos de 60,000 participantes del estudio elegibles con el fin de mejorar la comprensión de la EHGNA y la EHNA y para potencialmente orientar el desarrollo de opciones de tratamiento para estas enfermedades. Acerca de la EHGNA y la EHNA La EHGNA es una acumulación de grasa en el hígado en personas que no tienen antecedentes de abuso de alcohol. Es normal que el hígado contenga algo de grasa, pero si más del 5 por ciento del contenido hepático es grasa, se considera hígado graso (esteatosis). NASH is the most severe form of NAFLD in which a person has liver cell damage and inflammation of the liver. Inflammation and liver cell damage can cause fibrosis, or scarring of the liver, and can cause decreased liver function (1). The symptoms of NASH are often silent or non-specific, making it difficult to diagnose. Aproximadamente, un tercio de las personas con EHNA desarrollan cirrosis o daño hepático irreversible (2). About the ELF™ Test The ELF Test is a noninvasive blood test that can quickly identify which patients are at an elevated risk for developing cirrhosis and other liver-related clinical events (LREs). In contrast to standard liver enzyme tests that reflect liver damage that has already occurred, the ELF Test combines three serum direct biomarkers of active fibrosis. The ELF Test algorithm measures each of these biomarkers to create an ELF score, which can be used as an aid to assess the risk for future disease progression. Doctors may use this ELF score to help evaluate if a patient requires increased medical care and monitoring for their condition. Individuals interested in determining their risk for NASH and its progression are encouraged to enroll in the Nonalcoholic Steatohepatitis Liver Disease Genome Atlas study. Those who have already consented and participated in the study will be contacted with more information on how to receive an ELF blood test. Para obtener más información o para inscribirse, comuníquese a la casilla de correo RenownIHI@renown.org o al teléfono (775) 982-6914. The Enhanced Liver Fibrosis (ELF™) Test kit is not available for sale in the U.S. Product availability may vary from country to country and is subject to varying regulatory requirements. In the U.S., the ELF Testing Service is available from Siemens Healthcare Laboratory, LLC (SHL), a CLIA-certified laboratory located in Berkeley, Calif. The ELF Testing Service, including the establishment of performance characteristics, was developed by SHL. The ELF Test has not been cleared or approved by the U.S. Food and Drug Administration. SHL is regulated under CLIA as qualified to perform high complexity testing. The ELF Test is used for clinical purposes and should not be regarded as investigational use only or research use only. About Renown Health Renown Health is the region’s largest, locally owned and governed, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. Con una fuerza laboral diversa de más de 7,000 empleados, Renown ha fomentado una cultura de excelencia, determinación e innovación de larga data. La organización se compone de un centro de urgencias, dos hospitales de cuidados agudos, un hospital infantil, un hospital de rehabilitación, un grupo médico y una red de atención de urgencias y Hometown Health, la compañía de seguros sin fines de lucro más grande de la región y de propiedad local, Hometown Health. Renown’s institute model addresses social determinants of health and includes: Child Health, Behavioral Health & Addiction, Healthy Aging and Health Innovation. Clinical institutes include: Cancer, Heart and Vascular Health, Neurosciences and Robotic Surgery. Actualmente, Renown está inscribiendo participantes en el estudio genético de salud poblacional basado en la comunidad más grande del mundo, el Healthy Nevada Project®. For more information visit, renown.org. About the Renown Institute for Health Innovation Renown Institute for Health Innovation is a collaboration between Renown Health - a locally governed and locally owned, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California; and the Desert Research Institute - a recognized world leader in investigating the effects of natural and human-induced environmental change and advancing technologies aimed at assessing a changing planet. Renown IHI research teams are focused on integrating personal healthcare and environmental data with socioeconomic determinants to help Nevada address some of its most complex environmental health problems; while simultaneously expanding the state’s access to leading-edge clinical trials and fostering new connections with biotechnology and pharmaceutical companies. Learn more at healthynv.org. Renown Health es la red de atención médica más completa e integrada de Nevada y mantiene registros médicos electrónicos para 1.02 millones de pacientes registrados. En 2016, Renown Health y el Desert Research Institute crearon el Healthy Nevada Project (HNP), el primer estudio de salud poblacional basado en la comunidad del país. En 2017, el HNP comenzó una sociedad con Helix para aprovechar sus servicios de salud poblacional, la secuenciación Exome+™ y las herramientas de participación del consumidor. The HNP is now an ongoing collaboration between Renown IHI, the Desert Research Institute, a global leader in environmental data and applied research, and Helix, a personal genomics company. HNP combines genetic, environmental, social and clinical data to address individual and community health needs with the goal of improving health across the state and the nation. El HNP actualmente tiene más de 60,000 participantes. For more information, visit healthynv.org. About Siemens Healthineers Siemens Healthineers AG (listed in Frankfurt, Germany: SHL) is shaping the future of Healthcare. As a leading medical technology company headquartered in Erlangen, Germany, Siemens Healthineers enables healthcare providers worldwide through its regional companies to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, improving the patient experience, and digitalizing healthcare. Siemens Healthineers is continuously developing its product and service portfolio, with AI-supported applications and digital offerings that play an increasingly important role in the next generation of medical technology. These new applications will enhance the company’s foundation in in-vitro diagnostic, image-guided therapy, and in-vivo diagnostics. Siemens Healthineers also provides a range of services and solutions to enhance healthcare providers ability to provide high-quality, efficient care to patients. En el año fiscal 2020, que finalizó el 30 de septiembre de 2020, Siemens Healthineers, que tiene aproximadamente 54,000 empleados en todo el mundo, generó ingresos por €14.5 mil millones y un EBIT ajustado de €2.2 mil millones. Encontrará más información disponible en www.siemens-healthineers.com.Media Contacto de Siemens Healthineers: Lance LongwellM: 610-448-6341E: lance.longwell@siemens-healthineers.com
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Research Shows Genetic Approaches to Breast Cancer Screenings Yield More Accurate Results
Clinical researchers with the Healthy Nevada Project co-author research paper with findings that emphasize the need for a comprehensive approach to breast cancer risk assessment – including a focus on genetic medicine – to help ensure that individuals at high risk are identified and supported proactively rather than reactively. Breast cancer is a leading cause of cancer death among women in the United States. According to the American Cancer Society, about 1 in 8 women will develop breast cancer and about 1 in 39 women will die from breast cancer. Breast cancer is associated with increased age, hereditary factors, obesity, and alcohol use. Since 1990, breast cancer death rates have declined progressively due to advancements in treatment and detection. In Nevada there are an estimated 2,310 new breast cancer cases a year, and genetic mutations such as in the genes BRCA1 or BRCA2 remain a top risk factor for this prevalent disease. Recognizing the urgency for progress in breast cancer research, a collaborative effort between physicians, advanced practice providers and scientists from the Healthy Nevada Project® (HNP) and Helix have unveiled groundbreaking research. This study explores how genetic screenings are a necessary supplement to traditional testing methods, together offering more accurate insights into a patient's likelihood of developing breast cancer in the future. HNP is operated by Renown Genomic Medicine and the Institute for Health Innovation and is one of the largest community-based population health studies in the country. Their team works in collaboration with Helix, a leader in precision health that delivers comprehensive genomic solutions. Together, this dynamic partnership aims to understand breast cancer risk factors and pave the way for more effective preventative measures. The combined research team studied 25,591 female HNP participants to evaluate the performance of different genetic screening approaches to identify women at high risk of breast cancer. The results of this research suggest that a combined monogenic, or single-gene, and polygenic, or multi-gene, approach to breast cancer screenings helped produce more accurate results and more closely identify study participants who have a high genetic risk of developing the disease. "Based on this research, we are advocating a shift in approach which would improve breast cancer risk assessment through a combination of effective family history ascertainment and genetic screening,” said Joseph Grzymski, PhD, principal investigator of the Healthy Nevada Project, research professor at the University of Nevada, Reno School of Medicine and co-author of the breast cancer research paper. “This tailored approach, founded on the assessment of individual genetic risk, not only intends to elevate patient well-being but also will improve efficiency and equity in healthcare." Complementing the team’s research on leveraging genetics to identify women at low genetic risk of breast cancer that could safely defer mammogram screenings by five to 10 years that was released in late 2023 in JAMA Oncology, the study suggests that incorporating genetic information can assist in personalizing breast cancer screenings and optimizing the use of screening resources. "Existing disparities persist across various facets of breast cancer screening and treatment; however, genetic screening is clearly a powerful tool to help facilitate early intervention for those at higher risk,” said Jamie Schnell Blitstein, APRN, a primary care nurse practitioner at Renown Health and co-author of the breast cancer research paper. “By placing a heightened focus on risk, we underscore the pivotal role of preventative breast cancer screening.” Despite the availability of effective methods for early screening, co-authors of this research found that 78 percent of women with a family history of breast cancer had their risk ascertained only after a breast cancer diagnosis. The findings emphasize the need for a comprehensive approach to breast cancer risk assessment – including a focus on genetic medicine – to help ensure that individuals at high risk are identified and supported proactively rather than reactively. “These findings that can profoundly impact how healthcare is delivered were only made possible by all the participants who were willing to consent to research,” said Alex Bolze, PhD from Helix and co-author of the publication. “Broad-scale collaboration projects like these between Renown Health and UNR that engage large populations where participants share both their genetic information as well as electronic health records drive advancements in preventative medicine, as well as fundamental biological research.” The research paper was officially accepted on Jan. 29, 2024, and will be published by Elsevier, Inc. on behalf of the American College of Medical Genetics and Genomics. The contents of the paper will appear in the international journal Genetics in Medicine Open. Read the full article by visiting sciencedirect.com. The Healthy Nevada Project is currently recruiting new study participants. Free to all Nevadans with a saliva sample or blood draw, participants and their referring providers receive access to whole-exome sequencing and clinical grade results that help provide insight into their unique genetic risks tied to heart disease and certain cancers. If you are interested in enrolling in the study, schedule a Virtual Consent Appointment through MyChart or contact the Renown Institute for Health Innovation at RenownIHI@renown.org or (775) 982-6914 to be connected to a Genomic Representative. About Renown Health Renown Health is the region’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. Con una fuerza laboral diversa de más de 7,000 empleados, Renown ha fomentado una cultura de excelencia, determinación e innovación de larga data. La organización se compone de un centro de urgencias, dos hospitales de cuidados agudos, un hospital infantil, un hospital de rehabilitación, un grupo médico y una red de atención de urgencias y Hometown Health, la compañía de seguros sin fines de lucro más grande de la región y de propiedad local, Hometown Health. Renown is currently enrolling participants in the largest community-based genetic population health study, the Healthy Nevada Project®. To join the Renown Health team, visit renown.org/careers. Acerca de Helix Helix es la compañía líder en genómica y vigilancia viral de la población cuyas operaciones se basan en el cuidado clínico, la investigación y el análisis de datos. Helix enables health systems, life sciences companies, payers, and government partners to accelerate the integration of genomic data into patient care and public health decision-making. Learn more at helix.com.
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20 Years of Compassion and Dedication
When you meet Poeth Kilonzo, Director of Oncology Nursing at Renown Health, you are immediately greeted with a warm smile that puts your mind at ease. Within the William N. Pennington Cancer Institute, Poeth enjoys a strong reputation among her employees and patients as someone they can always rely on, no matter how rough the tides may flow. As an incredibly humble oncology professional, you may not realize that behind that smile is the power of a best-in-class nurse and leader holding a 20+ year career of diverse nursing experience and leadership excellence – dedicating the majority of her service to Renown Health. Join us as we dive into Poeth’s unique journey through Renown. Finding Her Passion Ever since she could remember, Poeth has been a “people person.” Above all else, she cared for people – and she cared a lot. What better place for her to be than healthcare? After moving to northern Nevada from Kenya, she began working in private patient care working with home health and dementia patients while taking classes at Truckee Meadows Community College (TMCC) in 2000. One day, a patient asked her a question that would change the course of her career journey: Did you ever think about becoming a nurse? Driven by not only the words of encouragement of her patients and supervisors in home health but also the rallying support from her family and friends, including her husband and high school friend, who both have decades of experience interacting with nurses in healthcare (with her husband spending many of those years at Renown), Poeth knew this was the path she was meant to take. “That was it; it was like a light switch had flipped,” said Poeth. “I switched to nursing overnight.” According to Poeth, TMCC’s nursing program offered her an incredibly supportive environment, which was especially important as she was a young mom at the time. Working in healthcare, going to nursing school and raising a family all at the same time is no easy task, but to Poeth, this was her calling. “Regardless of my path, I knew I wanted to be a nurse that was close to patients, sitting with them and holding their hand throughout their treatment,” said Poeth. During nursing school, Poeth completed clinicals at several hospitals in Reno – three of them were at Renown Health (known as Washoe Medical Center at the time). What immediately stood out to her was the passion of the pediatrics unit, especially in the neonatal intensive care unit (NICU). “While I knew that pediatrics wasn’t going to be my arena, some of the best times in my life were during my pediatrics clinical,” said Poeth. “It opened me up to how welcoming Renown is.” While doing her rotations, nursing leaders helped Poeth and her fellow classmates discover Renown’s Nurse Apprentice program, an apprenticeship designed exclusively for local northern Nevada nursing students. One of those leaders asked her, “have you considered doing a rotation in oncology?” And another light switch flipped. “Bingo. I am becoming an oncology nurse apprentice,” Poeth recalls. And that’s exactly what she did. After her four-month apprenticeship ended in February 2002, she walked into her interview with Joanna Gold, who would end up being her supervisor and one of her greatest mentors until she passed away in recent years. With her experience and enthusiastic spirit on her side, Poeth fervently expressed her passion and interest in working in oncology. And Joanna saw all of that and more. In June 2002, Poeth was presented with a two-year oncology RN contract, which she easily signed – however, she knew right then and there but she was not going anywhere. Renown was her home, and oncology ignited the fire within her. “The nurses in this unit are part of what kept me here,” Poeth remembers. “These nurses would really do anything for their patients. The commitment and love they all had for one another truly was like family. It inspired me to learn more and give even better care to my patients." To Poeth, it didn’t feel like she was coming to work just to do a job – she was following her dreams. “You don’t think about the work you do; you think about the service,” said Poeth. From there, Poeth spent three years on the floor as an oncology RN and became a night shift supervisor in 2005. She was thriving. But this part of her journey was only the beginning. When Opportunity Arises, Take It In March 2007, Poeth and her husband welcomed their third child – and for her, working a day shift position would serve her the best at her current stage of life. This revelation led her down to Renown South Meadows Medical Center, where she became a staff nurse in Medical Telemetry. It was in the telemetry unit where Poeth contributed to one of the largest digital transformations Renown would ever go through: transitioning from paper records to electronic records on EPIC. From there, Poeth was inspired to get back into leadership in 2012 as the Supervisor of Clinical Nursing overseeing nurses, clinical outcomes and payroll in the medical/telemetry unit and intensive care unit (ICU). The timing of her leadership role lined up perfectly with her decision to take her skills to the next level, achieving a bachelor’s degree from Nevada State College in 2016. The timing of her degree lined up perfectly with what was about to come; she embarked on her first leadership role at Renown This is where she would happily stay for 11 years, eventually becoming the Manager of Nursing in telemetry and the ICU, noting that Renown South Meadows felt like a second home to her. “I wore many hats at South Meadows,” Poeth recalls. “From piloting back coding and handling compliance work to being on the patient floor and heading up South Meadows’ first high school hospital volunteer program, I got very involved. We had seven years without having a single nurse traveler in our unit." It wasn’t long before Poeth was inspired to expand her education even further, and she graduated in January 2018 with a master’s degree in nursing clinical leadership from Western Governors University. Thanks to Renown’s educational assistance programs, our health system invested directly in Poeth’s education with tuition reimbursement and a $1,000 nursing scholarship. Soon after celebrating her achievement, Jennifer Allen Fleiner – who was the Director of Nursing at Renown South Meadows at the time – asked Poeth yet another question that would bring her to the precipice of another career detour: “Have you ever considered transferring from South Meadows to Renown Regional?” Moments later, Alicia Glassco, Director of Nursing for Renown Regional, asked her the same question, noting that the hospital’s neurosurgery unit needed the leadership of someone just like Poeth. “It took me a whole week to make a decision, because this was one of the toughest decisions I’ve ever made in my life,” said Poeth. “I truly loved South Meadows. After that week, my leader told me, ‘you know what, Poeth? You’ve reached your pinnacle. You need and deserve a new challenge. Learn from this new team and teach them something. I think you have a huge opportunity for growth.” So, Poeth decided to apply for the position and shadow the neurosurgery team, where unlike her unit, the majority of the team at the time were travelers. But this was a challenge Poeth was up to – so she was accepted into the role. “At the end of the day, these patients deserved consistent care,” Poeth emphasized. “I knew I had to take this position for the patients – they were the ones who sold me on this job. They are the reason why we are all here. It was important for me to be an advocate for them.” The big hills to climb didn’t slow down Poeth; in fact, the exact opposite happened. Within her first year in the neurosurgery unit, her team onboarded 18 new graduates and replaced travelers. “We were hiring like crazy,” said Poeth. “My standing agenda at all section meetings focused on hiring and our quality metrics. I started having a relationship with our doctors. Once we created a strong doctor/nurse collaboration, our nurses started staying with us longer.” Everything on the unit was going great. Then, COVID-19 hit. “Since we had private patient rooms, our unit became the first COVID unit at Renown Regional,” Poeth recalls. “My whole staff that I had built up had to be distributed elsewhere. I started caring for COVID patients. We relied on our Infection Prevention team a lot. And at the same time, I was worried about my family in Africa.” Despite the stressful nature that the pandemic brought upon health systems everywhere, according to Poeth, she knew she had to continue on. “The neurosurgery team ended up merging with orthopedic trauma, which was very difficult,” said Poeth. “We went from 28 beds to 58 beds. The key to success here was training. Nurses are very resilient, and through training, we were able to stabilize the unit.” Noticing the opportunity for virtual demonstrations that were previously offered only in-person, Poeth spearheaded online trainings for nursing, physical therapy, mobility, head injuries and more, allowing teams across Renown to upskill in safe spaces. These programs continued throughout the pandemic, and Poeth was proud to be a figurehead through it all, helping to stabilize the unit while creating strong relationships with the entire team, many of whom followed her from Renown South Meadows to Renown Regional. Then, she gets another visitor – her Chief Nursing Executive – in her office with yet another opportunity. Have You Considered... In September 2022, Chief Nursing Executive Melodie Osborn walked into Poeth’s office with those three words that Poeth has heard for decades: “Have you considered...” “Before Melodie could even finish, I thought, ‘I have considered A LOT in my career!’” said Poeth. Melodie told Poeth that the William N. Pennington Cancer Institute was looking for a Director of Oncology Nursing, noting that this could be yet another growth opportunity for her and a chance for her to go back to her roots. “I had just celebrated my twentieth year at Renown; I knew this was going to be a decision I really had to think about,” said Poeth. “Everyone believed in me. Alicia Glassco told me, ‘Poeth, you are ready for this. Go for it.’ Once I applied for the position and started getting my updated chemotherapy certifications, I thought, ‘they are right; I got this.’” At this point in her career, Poeth had been hyper-focused on inpatient care, and this role would be her first time caring for patients in the outpatient setting. After going through the interview process, however, Poeth knew that this was where she was meant to be yet again – and colleagues she hadn’t seen in years reaffirmed that commitment. “I felt the most excited about the job when I toured the facility,” Poeth recalls. “I’ll never forget what one of the infusion nurses told me on my tour. She told me, ‘I don’t know if you remember me, but I remember you; I came from Renown South Meadows, and you were so nice to me as I was precepting as a new nurse. Your kindness was unforgettable to me.’ The fact that people like her wanted me in the unit so badly inspired me to come back.” Soon enough, Poeth became the Director of Oncology Nursing, a position she still proudly holds to this day. Once she was hired, she immediately went into deep learning mode, mastering skills such as revenue integrity, credentialing and the insurance process. She attributes Supervisor of Infusion Kaitlin Hildebrand and Director of Radiation Oncology Services Susan Cox for helping her succeed. Shortly after assuming the position, Poeth noticed yet another opportunity for cross-training within the organization to combat short staffing – training nurses from the Float Pool to care for patients in Infusion Services. “Between May and July of this year, we trained six nurses from Float Pool to do infusion therapy services, which offered so much relief to my team; I am so thankful to Rendee Perry, the Manager of Nursing in our Float Pool unit, and her team for their support,” said Poeth. “My mission in outpatient oncology is to serve the staff and patient population and create those strong relationships." Poeth's efforts to circumvent nurse burnout go beyond cross-training – as a director, she is always there for her team members no matter what, leading with kindness every step of the way. “I never miss a 7:45 a.m. huddle unless I am in a ‘cannot miss’ commitment; I want my employees to always know that I am there for them and that they are cared for both on and off the job,” Poeth emphasizes. “I want them to feel like they are valued, their families are valued and their mental health is valued; after all, without my team, we cannot care for patients. It’s important for them to know that I am here to be a security blanket and that there is always something we can do to solve a problem." Today, Poeth enjoys a full team of core Renown staff members whom patients look forward to seeing – and the high patient satisfaction scores to prove it. “Our team is so established that patients feel comfort in knowing they are always going to know exactly who they are being treated by,” said Poeth. “We will always work to maintain that consistency.” Staying True to the Mission Renown’s mission of making a genuine difference in the health and well-being of our community resonates closely with Poeth. Before she arrives at the infusion unit every day, she asks herself: What can I do to make it easier for my team to deliver care? “It takes a village to deliver the care we do,” said Poeth. “Our nurses are priceless. You can’t place a monetary value on dealing with life and death every day. This is what inspires me. It’s all about helping each other out and keeping those relationships strong.” Maintaining those relationships on the floor, according to Poeth, requires one main ingredient: work-life balance. “I want my nurses to be able to balance sending their kids to kindergarten and giving their patients their first chemotherapy treatments,” Poeth emphasizes. “I genuinely care about their lives. It’s nice when you get to know your team’s children, grandkids, spouse and hobbies. I’m grateful that Renown has given us the autonomy to foster that flexible environment within our teams. It is so rewarding to have such a strong impact on these employees.” To Poeth, it’s all about doing and then duplicating. Luckily for her team and infusion patients in northern Nevada, a new infusion center at Renown South Meadows is planned to open in the coming years as part of our commitment to expanding care. Her team is excited to grow their expertise down to south Reno – Poeth's original home hospital. “I strongly believe that as nurses, we are meant to be where we are meant to be at the time,” said Poeth. “Be kind to yourself and remember your ‘why.’ Take advantage of the opportunity you have.” To all nurses (and future nurses) out there, Poeth wants you to know that you are welcomed and valued. You are saving lives every day, and to her, that is worth everything. “Always remain focused, even throughout all the challenges. Never forget why you got into nursing. And lastly, always stay true to your own mission,” closes Poeth.