Embracing Change

Submitted by Maria C. Hatter, RN, BSN

Tags: critical care Emergency nurse ICU ICU Nurse nursing experiences surgical unit transition

Embracing Change

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“Do one thing every day that scares you,” is one of my favorite quotes by Eleanor Roosevelt.  It is the primary reason that I chose to become a nurse.  Nursing is a career that has so many various facets that I can’t imagine being able to experience them all in one lifetime.  I recently transferred to the Trauma Surgical Intensive Care Unit (TSICU) in September of 2009 after spending 4 years in the Emergency Department.  The change was initially awkward and uncomfortable for me given my Type A personality, a factor that drives me to do my job proficiently.  I like being competent at my job.  In the ER, I had become a resource to my co-workers.  I now realized that I was able to gain a lot of personal satisfaction from helping others do their job well when I was in the Emergency Department.  However, once I transferred to the TSICU I felt like I was no longer an expert at my job and that I was the one now being assisted by my peers which placed me out of my comfort zone.  Nevertheless, I persevered because having grown up as the child of a military officer; I was perpetually the “new kid” due to the cycles of job transfers that resulting moving every two-three years.  It had taught me that change and growth are sometimes difficult and painful but at the same time exciting and if you stay the course, one would ultimately become a better version of themself.

Then it happened- one of those amazing moments that makes you feel like you “hit the ball out of the park”; a pivotal moment in the patient’s care in which you realize that you contributed in making a difference in their outcome.  My patient was a 54-year-old male that had suffered a hemorrhagic stroke seven days prior while hiking in Chile.  That patient had been treated initially in Chile and then flown to Florida for treatment.  The patient’s wife had flown from their home in Maine to Florida to be by his side.  The patient had been in our ICU for three days.  This was my first day with this patient.  He had a history of a CVA in 2001 according to his wife without any residual deficits.  This current stroke had left the patient aphasic and with a slight hemiparesis on his right side.  The patient was running a fever of 38.5 degrees Celsius and his white blood cell count was continually increasing despite the patient’s antibiotic regimen.  His primary team had come by to see him and they had written new orders to PAN culture the patient.  I came to the patient’s bedside and explained to the patient and his wife why I was taking two peripheral blood specimens, urine and sputum specimens.  Both the patient and his wife granted permission for the specimens to be collected. However the patient’s wife then inquired as to the results of her husband’s first set of cultures that where done upon his initial arrival.  I told her that I would look up the results and let her know the outcomes.

When I looked up the patient’s results in our computer system, I noted that the tip of a central line catheter had been sent to microbiology for culture.  When the patient had arrived to our hospital, one of the treatments implemented by his primary care team in response to his increased white blood cell count and fevers had been to change the central line access that had been placed initially in Peru.  The catheter tip of the central line had returned a positive culture result for pseudomonas bacteria.  I reviewed the patient’s MAR and noted that his current antibiotics would not treat this bacterium. 

The week before I had learned in the Fundamental Critical Care Support (FCCS) course that patients with pseudomonas bacteria need to be treated with Vancomycin or Daptomycin and that the dosage of Levaquin that the patient was currently taking needed to be increased in order to effectively treat and resolve his acute infection.  I consulted with our pharmacist who not only happened to be on the unit at the time, but was the individual whom had taught the pharmacology section of the FCCS the week prior.  He concurred with my assessment in regards to the patient’s medication regimen and the changes that needed to be implemented in order to benefit the patient’s hospital outcome.  I then promptly called the resident on the primary team and discussed with her the results that I had uncovered and the solutions I was proposing.  She agreed and gave me the verbal orders necessary to implement the changes to the patient’s care.  I then shared the results with the patient and his wife along with the resolutions to be implemented.  The following weekend when I returned to the unit, I learned that the patient was improving and had been downgraded to a medical surgical unit.

It was definitely an “ah-ah” moment for me.  This was a moment when I felt like I made a difference in my patient’s care and his outcome in a very positive way.  In that moment I felt like I had become the nurse that I had aspired to be five years ago, as well as being transitioned from an ER nurse to an ICU nurse.