On the Shoulders of Giants

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Tonight I attended something rare and spectacular. An elite fraternity of healthcare professionals – nursing assistants, unit clerks, nurses and physicians – celebrated a reunion. No paparazzi or line of adoring fans awaited us. None of us arrived in limos or walked a red carpet. Nevertheless, to be admitted into the event meant you possessed some level of superstardom in the world of critical care. At least that’s how I see my former teammates of the Rhoads 5 Trauma/Surgical Intensive Care Unit (SICU)

I recognize this sounds a bit braggadocios but, this unit’s accomplishments can back-up my claim. Recognized multiple times by the American Association of Critical Care Nurses’ (AACN) Beacon of Excellence Award, this unit distinguishes itself “by improving every facet of patient care”.  The SICU’s excellence is frequently praised by health care accrediting bodies including The Joint Commission and the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program. Numerous staff members received individual recognition for being the best of the best. Many former nurses are now advanced practice nursing leaders and researchers.

Now, I never intended to be a part of this team. My world of emergency nursing is so much different then practicing in a SICU. ED patient relationships are short-term where SICU relationships require long-term commitment. ED nurses find satisfaction sprinting towards immediate gratification. SICU nurses invest their time and skill with the mindset of a marathoner. An ED win is getting the multiple gun shot wounds victim to the OR in less then 15 minutes. A SICU win is the months of care that result in that same patient regaining the ability to breathe on his own. This chasm narrowed to a sidewalk crack for me while caring for one patient

That night, while working as Trauma Nurse 1 in the ED Trauma Bay, I got the call I dread most — officer down, gunshot. The patient arrived in an immediate fight for his life. His resuscitation became a brutal battle during which his heart stopped four times. His CT scan confirmed what we already knew — his wounds were fatal, he would not survive. Sustaining him long enough to get his wife to his bedside became our only option. Rhoads 5 SICU became his destination.

I called the SICU and gave a brief report. The receiving nurse said, “It sounds like you’re having a terrible night. Just bring him up and we’ll finish at the bedside.” I arrived to find five nurses waiting to assist in this brave officer’s transfer. “1, 2, 3” – we lifted as a unit and lowered him to his bed. Immediately, my monitor started screaming in alarm; his rhythm – V-fib. CPR and advanced cardiac life support (ACLS) started for round #5. It continued for the next 45 minutes until the SICU Fellow asked, “Does anyone have any other ideas?” Having no answer, I stepped away from the bed and faced the window. My emotions overcame me and tears started popping from my eyes. “Time of death 22:45”, said the fellow turning my tears into full on sobbing.

Suddenly, I felt a bear grab me, turn me around and envelop me in his arms. “It’s alright buddy, you did everything you could.” This SICU nurse stepped away and another followed. She too gave me the warmest hug and encouragement. My eyes started to clear and I realized I was at the beginning of a receiving line of SICU nurses, techs and physicians. They knew all too well what I was experiencing – a something outsiders rarely see. More than that though, these healers knew what I needed. They freely gave of themselves to help me put myself back together.

“If I ever leave ED nursing, I know exactly where I’m going”, I said to the ED tech as we walked back to the Trauma Bay.  This thought became reality five years later. The team welcomed me and took me under their wings. The smart, instinctive nurse I thought myself to be was quickly humbled. It felt like being a brand new nurse despite my many years of experience. It took over a year before I could walk onto the unit and feel any sense of confidence. I ended my SICU tour of duty six years later. I experienced what I needed to know about this world and it was time to go “home”.

Tonight though, as I look around the room I’m reminded of a quote by Sir Isaac Newton:

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Indeed! I could not be where I am today without the influence of these cherished people surrounding me. As I write these words, I realize their are 5 attributes that made Rhoads 5 special – critical thinking, collaboration, comedy, compassion and commitment.

Critical thinking replaced my nursing by instinct. Rhoads 5 taught me to gather a complete picture using my experience combined with the best evidence and input from my team to guide practice towards the best outcomes.

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Collaboration or co-laboring is all about teamwork – knowing you’re not alone is incredibly freeing. New equipment becomes less intimidating, caring for the sickest patient is less scary and an 800 lb patient is light work with many hands.

Comedy or a sense of humor is required if life and death is your business. First, if you can laugh at yourself, you’ll never fail to be amused. My bumblings pretending to be a SICU nurse became fodder for all. Second, laughing reduces tension and a well placed “dad joke” is medicine that cures all! Which reminds me:

Two peanuts were walking down the street — one was a salted!

The tears on the bad nights were balanced by the laughter on the good ones.

Compassion dominated care delivery on Rhoads 5. I knew this from the get go; it only became truer working directly on the team. The holistic approach to mind, body and soul leveled the playing field whether you were a member of a gang or a member of Congress. We brought our best and gave it to all, in this aspect.

Commitment to the patients, each other and to our mission inspired an “all-in” attitude.  This enabled the team to end every shift knowing the work we did mattered. It created senses of purpose and accomplishment even when we “lost”.

I’ve gone back to emergency nursing but I am not the same ER nurse. I am eternally grateful for these lessons and these marvelous people.

I’m Rhoads 5 proud!

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