For 15 months, the staff in the medical unit caring for adult bone marrow transplant patients—some of the sickest patients at Duke University Hospital—worked in a space not much larger than half of a basketball court, while its own unit underwent renovations.

But instead of getting frustrated, the employees on 9200 unit learned to move on, and even saw humor in their situation. And when they started laughing, they started coming closer together.

"We realized that we were just going to have to deal with very crowded conditions, and we found ways to do that," recalled nurse Lisa Colosimo. "One day, there were just two of us on duty as nurses because some people were out. We were sitting in our little central nurses' area when we realized that it had the same shape as the "bridge" on Star Trek. So we spent the day pretending we were on board the Enterprise."

From March 2002 to the beginning of July 2003, the 30 full-time staffers on 9200 worked that way, sharing a small space in the neighboring 9300 unit. For working in these conditions and maintaining high levels of patient care on the unit, the staff this year received one of six Teamwork Awards presented by Duke University President Nannerl O. Keohane.

The award honors teams at Duke who design creative and broad-based solutions to important issues or problems. Five other teams from Duke University Health System, Duke University, and Raleigh Community Hospital also won awards (see sidebar).

"More than 30 teams, representing over 400 employees, were nominated for this award," said Keohane at the official luncheon November 10 recognizing the winners. "The selection team had a tough job, but chose the six winners because of their creative solutions and interdepartmental work that highlighted the importance of teamwork."

Working on Top of Each Other
For the staff of 9200, the award recognizes what staff members called a "tumultuous and very challenging" year, but one that had a happy ending.

Bone marrow transplant patients have special needs. Because the treatment is rebuilding their immune systems, patients must receive treatment in an area with clean air flow to reduce the potential for infection.

The unit's move—and the associated challenges—was necessitated by the $4.8 million renovation of the 16-bed unit. The renovation has provided the unit with the latest technology to provide patients with a safe, cleaner environment for their recovery. During the renovations, the entire unit made do in an eight-room area on the 9300 unit. The area was suitable for bone marrow transplant patients because it had a special enclosed ceiling and was sealed for air pressure protection.

There was little effect on patient care. But for the staff, the loss of working area made a dramatic difference.

"We were right on top of each other for the 15 months," said nurse Jeanne Verrecchio. "Our only break room was a storage area where we fit in a table and five chairs. This isn't a unit where you can leave the area for long during the day. The type of care is very intensive. Few of us would leave for lunch because that's all the way down on the first floor, so we'd all be in the break room eating together."

Staff members said from the start they knew that the renovations in their old unit would make the transition worthwhile.

"But we knew there were going to be stressful moments," Verrecchio said. "When the beds were full and some staff was off during the holidays ... there was some snapping and disagreements. Before, if the conflicts had happened, maybe one person would have gone off somewhere, and it would have simmered and continued. But because we were so close together, it forced us to resolve them and move on. And that's what we did."

Added Colosimo, "We could have just gotten frustrated, but instead we found a way to bring a sense of humor.

Sharing the Load
"It also changed the way we worked together," said Colosimo. "Before, everyone had their own patients, and as a general rule you didn't concern yourself with others' patients. But when we were at 9300, there was so little room you had to know everything about all the patients. If a group of people were conferring about a patient, everyone was right there. Everyone was involved."

One of the most rewarding moments for the bone marrow transplant staff is when patients get strong enough to start taking short walks. Colosimo remembers the challenge of leading patients through a hallway packed with people, computers, and equipment.

"There was a month in which we had three patients taking walks five times a day," she said. "If you get a patient walking five times a day, that's really something to celebrate, and here we had three patients doing it. It was a challenge, but we had nurses clearing the way for them. That's just what you had to do. We were going to make it happen."

Assistance from the staff on 9300 also made everything work, the nurses said. Colosimo praised her colleagues on 9300 for always finding time to help out, even sometimes providing extra beds for patients. "They were very good to us," she said.

William T. Fulkerson, the unit's administrative director, came aboard in the middle of the group's stay at 9300. He, along with medical director Nelson Chao, MD, and clinical operations director Angela Johns, joined in nominating the unit for the Teamwork Award. Carolyn Carpenter, associate operating officer for oncology services, sent in the initial nomination.

"I could not be happier the way the staff stepped up to the challenges during the project," Fulkerson said.