Angela Green, Ph.D., and Melissa Macogay, D.N.P., both started their nursing careers at the same place — the bedside.

Green now is vice president and chief patient safety and quality officer at Johns Hopkins All Children’s Hospital, and Macogay is vice president and chief nursing officer. Their careers illustrate the many roles nurses play at the hospital.

“One of the cool things about being a nurse is that you have so many opportunities,” Green says. “I describe my career trajectory as a jungle gym. At each phase, I could see about five to 10 years out. I had a clinical staff nurse life. I had a nurse practitioner life. I had academic faculty life. And then I've had sort of two totally different focus areas in hospital administration. There’s so much opportunity and so much variety in the roles of nursing that the sky's the limit for things that people can do.”

Macogay started as a clinical nurse in the pediatric intensive care unit at The Johns Hopkins Hospital in Baltimore. She has expanded to more clinical and leadership positions since joining Johns Hopkins All Children’s in 2008.

“I love how diverse the nursing profession is,” Macogay says. “There really are a great deal of opportunities. I really enjoy the comradery and supportive nature of nursing. It’s like we all look out for one another, teach each other, provide mentorship and help our fellow nurses step into new opportunities.”

Nurses make up more than 30 percent of the workforce at Johns Hopkins All Children’s. There are more than 1,000 full- and part-time nurses working in a variety of roles from pediatric clinical specialties, to clinical and translational research, health informatics and more.

We thought we’d take a closer look at just a few roles nurses play at Johns Hopkins All Children’s:

Advanced-Practice Provider (APP): APPs include nurse practitioners, nurse anesthetists, nurse midwives, clinical nurse specialists and physician assistants. They receive extra training in their specialties and play a key role in health care with duties that often overlap with those of physicians. Joanne Christopher-Hines, D.N.P., M.S.N. Ed., APRN, is an APP Education Specialist at Johns Hopkins All Children’s. She facilitates clinical education for APPs, from orientation and transition to practice, ongoing competency evaluation and professional development. She also is the program director for the Advanced Practice Provider Acute Care Fellowship Program.

“As health care changes at such a rapid pace, I realize that younger generations of health care professionals are learning more innovative strategies that address our modern times,” says Christopher-Hines, who joined the hospital staff in 2018 after a varied nursing career in south Florida. “Traditional ways of thinking are being challenged and I want to be at an institution on the cusp of innovation.”

Clinical Database Administrator: The hospital participates in a variety of clinical registries specific to a disease, condition, procedure, device, etc. Clinical database administrators are nurses based in the Patient Safety & Quality Division with at least three years of direct experience caring for patients. They maintain and update specific databases. JoAnn DeRosa, B.S.N., R.N., CCRP, manages Johns Hopkins All Children’s contribution to the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database, which is the largest database in North America dealing with congenital cardiac malformations. She spends most of her time reviewing heart surgery patients’ electronic medical records and entering the data into a complex STS database, sending updates to STS twice a year. She supplies data for various monitoring dashboards and research and quality improvement projects.

“This job is more than ‘just entering data,’ as people would think,” says DeRosa, who started at the hospital in 2002 and previously worked as an OR nurse and a research nurse, taking a five-year break to work elsewhere along the way. She started her current role in 2019. “It’s playing a part in taking a look at what we are doing, monitoring trends and safety, in order to make sure we are doing the best we can do for our patients. To always make sure we are watching the way we do things and making changes if changes need to be made.”

Infection Preventionists: This team is involved in virtually all aspects of the hospital from clinical to cleaning procedures. The core responsibility is to protect patients and staff from potential harmful infection. “When I came to this role, I thought I had a good idea of what Infection Prevention does but quickly realized how involved we are in so many aspects of the hospital,” says Chris Mize, R.N., M.S.N., C.I.C., who started at Johns Hopkins All Children’s in 1996 and worked in the pediatric intensive care unit until joining Infection Prevention in 2012. “It wasn’t just preventing and investigating hospital acquired infections or being sure staff washed their hands and complied with using their personal protective equipment. This team is involved with nearly every department.”

The coronavirus pandemic has added to the challenge. “Each day was something different and trying to figure out how that fits into our daily functions throughout the facility,” Mize says. “This was and is challenging for everyone. You may have an idea in the morning of what you plan to do, but it takes one phone call or question to change the priority.”

Lactation Specialist: The lactation specialists at Johns Hopkins All Children’s currently all are nurses who are International Board Certified Lactation Consultants, but a nursing degree isn’t required for the position. They provide comprehensive care to breastfeeding mothers and babies throughout the hospital. “We are often hands-on at the bedside, helping families meet their feeding goals and coming up with individualized plans,” says Megan Howard, B.S.W., B.S.N., IBCLC. The team conducts research and quality improvement projects to improve the experience and care for mothers and provides education and advocacy.

Nursing Informatics Specialist R.N.: This role focuses on technology, data and the development of electronic medical record projects that support evidence-based practice while meeting regulatory requirements. The informatics team works to streamline documentation workflows, helping improve accuracy and allowing clinicians more time to spend with patients and families. Alex Schultz, M.S.N., R.N., has worked at Johns Hopkins All Children’s for almost nine years. He developed an interest in informatics when he worked in the pediatric intensive care unit. Treating critically ill children with advanced therapies taught him the importance of what technology and data can do to empower clinicians and make a difference in patient care. “A nurse can work at the bedside, manage a team, work with datasets, or work with technology to improve patient care,” Schultz says. “The variety of roles to contribute to patient care is unique in our profession, which, to me, makes it the best job in the world!”

Quality Advisor: In a nutshell, a quality advisor nurse seeks to clear obstacles. “We try to help process owners create or modify their processes to make it really easy for people to do the right thing with patient safety as our No. 1 priority,” says Kyle Jordan, B.S.N., R.N., BMT-CN, one of six quality advisors at the hospital. In cases where an outcome isn’t ideal or a process is challenging to follow, the quality advisor brings the team together and helps members to evaluate the process and implement improvements.

Jordan specializes in the Cancer & Blood Disorders Institute, where he worked before switching to the Quality Advisor role in the Patient Safety & Quality Division nearly two years ago. He started at the hospital in the nursing residency program before joining full time in 2016. “I could see I was doing stuff to make our patients safer. Not only does it make our patients safer but it's better for staff to have processes that are safe and effective to use. So then I got hooked, and I got more and more involved in it.”

R.N. Specialty Care coordinators: Lisa Tetreault, B.S.N., R.N., CCRP, works in the Institute for Brain Protection Sciences, coordinating care in multidisciplinary specialty clinics devoted to conditions such as spina bifida, brachial plexus and skeletal dysplasia. She collaborates with specialty providers and support services to ensure patients are scheduled to see the right providers, complete procedures and testing to manage their complex conditions, and provides families with education and resources.

“Being able to make a difference and help families that often are overwhelmed with coordinating the many visits they need for their child’s care is what attracted me to this position,” says Tetreault, who originally started working at the hospital in 1992 and returned in 2010 after a five-year break. “My career in nursing has been and continues to be amazing. I was always able to do what I liked, from my passion working in the operating room, to shifting and pivoting hours and positions to meet the needs of my family. Nursing allowed me to do that. The joy of nursing for me is working with and learning from the brilliant minds that surrounded me every day and extending some of that knowledge to our patients and families.”

This just a sampling of roles nurses play at Johns Hopkins All Children’s. Just about everywhere you look you’ll find a nurse, including at the very top. The president of the Johns Hopkins Health System is a nurse, Kevin Sowers, M.S.N., R.N., FAAN.