All nursing jobs have instances of stressful situations in them. It’s the nature of the field. But working at a Shock Trauma Center can be even more so.
Rashidah B. Francisco, BSN, RN, CCRN, CPAN, TCRN, with the Lung Rescue Unit at the University of Maryland R Adams Cowley Shock Trauma Center (STC), took some time to answer our questions about her amazing job.
What follows is an edited version of our Q&A:
As a Shock Trauma Nurse, what does your job entail? What do you do on a daily basis?
On the Lung Rescue Unit, our shifts are extremely unpredictable. Taking care of some of the sickest patients in the state of Maryland—and possibly the world—at the only Primary Adult Resource Center is something that demands skill, dedication, communication, and a sense of teamwork like no other.
Our exclusive Veno-Veno extracorporeal membrane oxygenation (VV ECMO) unit at Shock Trauma is one of the only units of its kind in the country. Our patient population on this unit consists of patients in need of a machine that bypasses their lungs to deliver 100% oxygen to the patient’s blood, as their lungs are incapable of this function. Having the critical care skills, knowledge, and critical thinking to recognize when your patient is in trouble is half the battle of managing this patient population.
Our patients are suffering from acute illnesses and come to us at the most critical moment in their lives. Because of this, we have little time to think, but must come together as a team and put our skills and expertise to work. The interventions for our VV ECMO patients can also be very different from your typical ICU patients, but are directly in line with evidence-based practices. We may prone our ECMO patients, walk them, and get them out of bed daily and into a chair to optimize their recovery.
Why did you choose to work at Shock Trauma? How long have you worked there? What prepared you to be able to work in such a stressful environment?
Coming to Shock Trauma was not my initial plan, but critical care has always been a dream of mine. I have been in the nursing profession for almost 20 years (three as a patient care technician, 11 as an LPN, and seven as an RN). After going through a critical care fellowship at a large hospital in Virginia, and spending a couple of years on their complex critical care unit, I felt that I was ready for something bigger and more challenging. I wanted something that would enhance my skills, and push me to go further in bettering myself and my career.
When asking myself where I could go to be a part of the best, where only the best is expected of me, and where my skills and education would be the only determining factor in how far I can go in my career, I chose Shock Trauma. I have been at STC for over 4 years, and there is not one day that I have not been pleased with my career choice.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Gratefulness and self-reflection helps me to de-stress. Reflecting with my team and relying on them while I am at STC helps me to keep things into perspective.
What are the biggest challenges of your job?
The biggest challenge of my job is knowing that I cannot save everybody—that everyone’s story is not to be taken on as my burden, but it is my duty to do the best that I can. Knowing that I am human, and I can only do so much. Remembering that I am here by choice, and that some of my patients, no matter what choices they have made, are there because they have to be, and are depending on me to utilize my skills to help them in their most critical hour. Remembering that it could be me lying in the bed, and them taking care of me.
What are the greatest rewards?
Seeing a patient get off of ECMO and return home or go to one of our critical care units. Just seeing that they have reached a point where they are able to evade such a lifesaving piece of equipment is a reward. Hearing a patient’s voice after they have been extubated. Seeing them walk after being in the prone position intermittently for days. Hearing that a patient who has been waiting months for lungs has finally gotten them.
Being a part of a team—that these things are just as important to them as they are to me—is also a reward in itself. To have someone who is going through the struggle with you and cares as much as you do.
What would you say to someone considering this type of work? What kind of training or background should he or she get?
No matter what your background, come with a sense of teamwork, with a sense of family, and with the ability to take on the most challenging situations, but with the humblest attitudes. Be ready to learn, no matter what you think you know. At STC, you will see and learn things beyond what you even thought. Have a strong critical care background for some of our units, but if not, have an open mind and a willingness to learn. Be ready to see and care for people who are very different from what you may have experienced, but be ready to save them, and care for them as if they are one of your family members.
Is there anything else that is important for fellow nurses to know?
Wearing the pink uniform is something that for the last four years I have been very proud of. It is to me like putting an “S” on my chest when getting ready for my shift. However, it is something that comes with a heavy responsibility and a possession of skills that I am expected to have and use when I walk through the doors of STC. My days are not blissful, my days are not easy, but they have been more rewarding at STC than they have my entire nursing career.
DeeQuiency M. Donerson is studying in nursing school, but unlike some students, he already knows what he wants to be after he becomes an RN: a travel nurse. Since May 2010, Donerson has been working as a Certified Surgical Technician with Trustaff, and he likes what he does so much that he now wants to take on more and become a nurse.
“Every contract is 13-week assignments. I am almost always offered an extension because of my knowledge of surgical procedures. The longest contract I have done was nine months in Miami, Florida, which was a great experience,” says Donerson. “I wanted to become a traveler to gain as much experience as possible of surgical procedures, doctors’ preferences, instrumentation, and sterile supplies.”
Before 2007, Donerson wasn’t in the health care field at all. In fact, he worked as manual laborer making minimum wage. At the time, he even had to live out of his car. He decided that he wanted to attend surgical technology school, but when he had to fill out the application and include his address, Donerson wrote in his license plate number. Luckily for him, college staff realized that he was homeless and arranged for him to live in a dorm for the rest of that school year.
When a Trustaff representative spoke to college students about becoming a traveling health care worker, Donerson was interested. After graduating and getting a year of experience, Donerson became a travel CST. His first assignment was in the Virgin Islands. After that, he traveled the country, working in Louisiana, California, North Dakota, and in several cities in Florida.
Donerson says that he loves working with his recruiter, Danny Laurence. “He basically knows exactly what I’m thinking before each contract and after,” says Donerson. He also recommends that nurses thinking of becoming travel nurses be on a first-name basis with their recruiters. “Not having a great recruiter will more than likely end in disaster for a contract,” he says.
Dealing with negative patients is never easy. They can monopolize your time, make you angry, and frustrate everyone they come into contact with. What can you do?
According to a number of experts, quite a lot.
“I approach patient interactions using the nursing process of assessment, planning, intervention, and evaluation. These steps are taken with patience and understanding,” says Cynthia Rochon, MBA, BSN, RN, Director of Nursing, Behavioral Health Services, Largo Medical Center. “In order to assist with a problem, you first have to understand the root cause. Never make assumptions because that can lead to more negativity. After gaining a clear understanding of the problem or patient care need, you provide an explanation of how the nurse can assist to remedy the problem or facilitate access to the resource who can provide further assistance. The last step is evaluation—validate that the patient has a clear understanding of how to follow up on directions that have been provided. Patient education is an important component of nursing care. When communicating with empathy, the patient experience will usually change from a negative experience into a positive interaction.”
Oftentimes, patients become negative because they are scared, says Jodi De Luca, a licensed clinical psychologist working in the Emergency Department at Boulder Community Hospital in Colorado. “Firm empathy and compassion are an example of setting structure and limitations. Be kind, respectful, and validate the patient’s feelings, but remain professional and clarify unacceptable behavior and/or unrealistic patient expectations.”
“Although it’s true we deal with these patients in the same manner we would other patients, it does take a lot of listening on our end to determine where the negativity is coming from,” says Debra Moore, RN, Director of Nursing of the BrightStar Care Edmond/Oklahoma City as well as the Midwest Region Nurse of the Year for 2017. “They could feel mad because they’re sick, missing a spouse from a recent death, or they may have just heard some bad news or had a frustrating experience in some other area of their lives. After we determine the cause, we talk with the patients and reassure them that we are going to care for them as much as they will let us. These patients may also need a lot of education on their diagnosis and what we can do to help. While it may take time for them to trust us, they will see that we are there for them and that they still have free rein over their lives. We honor them. It will take them sitting back and observing exactly what great care we can provide them. This will, in turn, help them relax and trust us in the end.”
Kristin Baird, RN, BSN, MHA, president and CEO of the Baird Group, is a consultant who coaches and trains nurses and nurse leaders. She shares two of her training points:
1. Suspend judgement and assume a neutral position.
By doing this, you position yourself for great empathy. Empathy is portrayed more through non-verbal behaviors than verbal, but both matter. When a patient feels you are showing empathy, they will have greater trust.
2. Use empathy statements and body language that will diffuse anger.
Try sitting by the patient, touching his/her arm or hand, and saying something like, “You sound upset.” By validating them with your words and showing compassion with touch, you are demonstrating that you care.
Nurses do so much more during one day than the average person may think. We know that they do more than take vitals, change bedpans, and give shots, but others may not. In fact, we know that nurses often make amazing differences in the lives of their patients. And they love doing it.
Here are a couple stories from nurses who have done just that.
Shortly before his 60th birthday, life had become exceptionally difficult for one of Huda Scheidelman’s patients. Scheidelman, RN, and a home care nurse with the Visiting Nurse Service of New York, saw these terrible changes. Once a man who loved to explore the city, she saw his health going downhill. He was severely depressed after a recent divorce, he wasn’t following the meal plan from his dietitian, his blood sugars were out of control, and he quit his job as his diabetes made walking painful. Scheidelman decided to mix compassion, facts, and some tough love to get her patient back to his former health. It took some time, but he slowly changed his ways—he quit smoking, got back on insulin, and began following his diet. “Thank you,” he said on a recent visit. “I don’t know what I would have done without you.”
The Social One
Patricia O’Berg, PCCN, RN, BSN, a clinical instructor at the State College of Florida as well as an ICU nurse at Englewood Community Hospital in Englewood, Florida, had a passion for nursing that began at an early age. She didn’t pursue nursing, though, until later in life. After she had a career in public relations and raised a family, O’Berg decided that her passion for being a nurse was “alive and well.”
While earning her bachelor’s degree in nursing, O’Berg decided to participate in a study abroad program in Nicaragua. She immediately realized that missionary nursing touched a special place in her heart, allowing her to care for many underprivileged residents of small villages. By contributing her nursing talent and compassionate care with a small team, O’Berg helped to treat more than 1,000 patients with a variety of health conditions over the course of only five days.
Since then, O’Berg commits to annual visits to the villages of Nicaragua as a clinical instructor to help save patients who wouldn’t otherwise receive care. That’s how she garnered the nickname The Social One—because she has such a passion for people and loves to heal.
In honor of Transplant Nurses Day—April 19—we decided to ask a transplant nurse what it’s like to work in this part of the nursing field. Austin Timmons, BSN, RN, CNOR, an Operating Room Registered Nurse at Largo Medical Center in Largo, Florida. Took times to answers some questions for us. What follows is an edited version of our interview.
As a transplant nurse, what does your job entail? What do you do on a daily basis?
A transplant nurse’s job entails many criteria including patient education, clinical care, and patient safety as well as a wide array of interdisciplinary coordination within the hospital. Transplant nurses work closely with transplant physicians, pharmacists, the lab, anesthesia, Organ Procurement Organizations (OPOs), perfusionists, surgical scrub technicians, and other specialists to coordinate the best care possible for our patients.
As an Operating Room nurse specifically, I focus–along with other members of the OR team–on providing the most current standards of care to our patients in a safe and respectful manner. We handle setting up supplies for a transplant procedure, providing education for our patients, keeping the patients safe under anesthesia, handling donor organs, and eventually taking our patients safely to a recovery unit to begin their journey with their new organ.
Why did you choose this field of nursing?
I personally chose this field of nursing to help expand the transplant services within our community and to assist in offering the best care possible for the patients that we receive. We all work closely together and have our own roles to make the procedure come together as a whole. We have a growing presence in our community, and, as a healthcare team, we are proud to be a part of the transplant program.
What are the biggest challenges of your job?
One of the biggest challenges of my job includes seeing the patient immediately before surgery. This is always an emotional time for them, and as nurses, we are able to comfort and sympathize with them at the bedside before the procedure begins. We are constantly in close contact with family members during the procedure to keep them involved and are available for their support as well.
What are the greatest rewards?
On the other side of the coin, the greatest reward as a transplant nurse in the operating room is seeing the patients after the procedure is complete–witnessing their joy and appreciation for this gift of life. For example, after one of our kidney transplant recipients had been brought to the Intensive Care Unit and woke up, the patient began to cry out of joy when they saw they were making their own urine for the first time in over a year. Knowing that our team has played an integral part in such a big milestone for their health is a great feeling.
What would you say to someone considering this type of nursing work?
To someone considering this type of work I would say, “Go for it!” It is a rewarding experience and allows you to work with many different departments and specialties, all of which have one common goal in mind. I believe compassion, attention to detail, organization, highly developed communication skills, and transplant-specific education are needed for this type of nursing work.
Is there anything I haven’t asked you about being a transplant nurse that is important for people to know?
One other thing that I would add is the involvement with our local population. The Transplant Institute of Florida at Largo Medical Center works with Life Link and other organizations to support community-centered events and education regarding donation and transplantation. These events help to strengthen our presence and help reach out to people in need.