Brooke Rennels was the charge nurse in the St. Louis Children's Hospital PICU on a day with three very sick admissions to the floor. Two children in full cardiac arrest were admitted to the unit and passed during the same shift. In addition, one child was admitted in the process of herniation related to a rapidly expanding brain tumor. In addition to her charge RN responsibilities, Brooke assisted in the room with all three of these admissions, and was especially inspiring in the management of one of the children admitted in full cardiac arrest. This child had suffered severe burns to his entire body and was admitted to the PICU in a physical condition rarely seen by even our most experienced PICU care providers and exceptional compared to our most severe trauma cases.

As a result, the child's physical state evoked strong emotional and physical responses from the child's large family and ancillary staff. Brooke not only assisted in resuscitation attempts for this child, but also helped to manage work flow and the overall temperament of the unit by channeling foot traffic in and around the room, restricting non essential providers and staff allowed into the room, and delegating psychosocial support resources for the family. These interventions were essential in promoting a safe, distraction free environment for the patient's family and care team while also maintaining an environment of calm normalcy in a seemingly impossible situation for other families in the PICU.

After unsuccessful resuscitation attempts, Brooke then went on to assist the child's bedside RN with end-of-life care and coordinated the bereavement interventions for the child and the family. She then assisted the same RN with admitting a second full-on cardiac arrest into the same room shortly after completion of the burn victim's end of life care.

By mobilizing and delegating resources such as social work, nursing management, and chaplaincy, a full scale multi-diciplinary effort quickly and calmly ensued to prevent further escalation of hysteria among the large number of the child's visitors and to protect and maintain the well being of the staff in light of caring for such an exceptionally graphic victim of trauma. In tumultuous circumstances. Brooke's leadership actions were essential in maintaining the smooth and efficient function of the unit, thereby empowering staff to continue providing excellent life saving care to their patients and their families.