Care that Inspires Hope and Improves Health

In 2007, Mindy K. Mund, BSN, RN, CBN, a nurse at Cleveland Clinic Weston Hospital, became the first person in Florida to hold the Certified Bariatric Nurse (CBN) credential. She was one of 305 people who sat for the state’s inaugural bariatric nursing exam. “Earning CBN certification was a proud moment in my career,” she shares.

Awarded by the American Society for Metabolic and Bariatric Surgery (ASMBS), the designation signifies a nurse’s expertise in delivering high-quality care to patients undergoing metabolic or bariatric surgery. Mund, who joined Weston’s Bariatric Department in 2005 as the Bariatric Program Coordinator, was instrumental in helping the hospital become the first in Florida to be accredited as a Bariatric Center of Excellence by the American College of Surgeons and ASMBS.

“We were the first hospital in the area to earn the distinction,” she recalls. “We had a Fellowship in place, we were seeing patients from all over the world, and our surgeons were performing 500 to 550 surgeries a year.”

Cleveland Clinic Florida continues to hold Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accreditation, as does the health system’s Main Campus, Martin North, Hillcrest, Fairview and Akron General hospitals — committing to the highest standards for patient safety, care quality and outcomes.

Holistic nursing that supports and improves health

Nurses like Mund are uniquely trained to provide holistic care to individuals with obesity. These specialists work in a variety of settings, including preoperative, operative and postoperative hospital units, outpatient surgical centers, weight management clinics and private practices. In particular, nurses support patients who are undergoing weight-loss surgeries like gastric bypass or sleeve gastrectomy, as well as those managing chronic obesity through lifestyle interventions.

In addition to a strong clinical foundation, empathy and compassion fuel the work of these specialists. Mund emphasizes how frequently patients turn to nurses for emotional support and help in managing the psychological effects that can result from their lifestyle changes.

“I enjoy working with these patients because they aren’t sick – they’re just reaching out for help,” Mund explains. “They’re looking for encouragement, reassurance and a few kind words. Bariatric patients are grateful to hear a nurse say that they’re going to get over this hurdle and be ok.”

According to the National Institutes of Health (NIH), more than two in five adults (42.4%) are dealing with obesity, a disease that can increase a person’s risk for death and illnesses, including diabetes, hypertension, sleep apnea, high cholesterol and coronary artery disease. The condition can also diminish one’s quality of life. For patients with severe obesity, bariatric surgery is often considered the most effective treatment.

“When I ask my patients why they decided to have bariatric surgery, they often describe simple pleasures like traveling on an airplane or being present for their grandkids,” Mund says. “Helping them is my way of extending an olive branch, and the reward at the end is tremendous — the stories will bring you to tears.”

Angela Gromovsky, APRN-CNP, MSN, is a nurse practitioner in the outpatient bariatric center at Cleveland Clinic Akron General. Like Mund, she considers her career choice gratifying and meaningful.

“I love seeing postop patients when they return for their one-year visit because it gives us an opportunity to talk about the non-scale-related victories they have achieved through weight loss,” she says. “Moms will describe sitting on the floor to play with their kids. Some patients are even able to discontinue their medications for chronic issues like hypertension, diabetes and high cholesterol, and others report significantly less joint pain. It’s amazing to see your patients living a more fulfilling life.”

Skilled, specialized and highly coordinated care

As an advanced practice nurse, Gromovsky guides patients through pre- and postoperative processes and offers education on weight-loss and -maintenance strategies. She also prescribes anti-obesity medications to those who require additional support to reach a healthier weight.

“I aid with medication management and use my clinical skills to monitor patients for overall physical and mental health, metabolism and nutritional status,” she explains. “I also partner with various medical specialists to augment the care I provide.”

Gromovsky explains that bariatric nurses work closely with physicians, dietitians, psychologists, exercise physiologists, clerical caregivers and other providers to optimize outcomes and support patients’ long-term success.

“Patients have monthly visits with our clinical team, which are designed to prepare them physically, medically, emotionally and socially for bariatric surgery and the new life they’ll create in the months and years that follow,” she says. “Teamwork is especially important when managing this population, so we encourage frequent, open communication.”

For a patient to be approved for bariatric surgery — medically and by their insurance carrier — they must meet outlined medical, psychological and nutritional clearances and testing requirements, Gromovsky says. Post-surgery, patients are encouraged to follow prescribed guidelines and recommendations to maintain a healthier lifestyle.

Patients who have bariatric surgery at Weston receive thorough post-surgical bedside education from Mund. “Before I walk into a patient’s room, I review their chart and meet with the surgeon to ensure continuity of the care plan,” she explains.

Among her many responsibilities, Mund trains inpatient medical-surgical nurses how to manage bariatric patients with sensitivity. “I love this part of my job because it gives me an opportunity to address the stigma associated with obesity,” she says. “Sensitivity training requires you to put yourself in the patient’s shoes – and it encourages other caregivers to do the same.”

Much of Mund’s work focuses on the development of safe, high-quality care environments through the creation and implementation of clinical training modules, unit-based resources, and policies and procedures tailored to the specific needs of bariatric patients.

With 40 years of nursing experience, Mund marvels at how far bariatric care has come.

“I remember when obesity was first recognized as a disease,” she says. “People realized they needed help, but it wasn’t always available. It’s an honor to now be able to offer these patients compassion, empathy, patience and positivity. My motto, which I share with my patients, is: Don’t look back unless you are planning on going that way.”