We have a patient on our unit, Ms. W, who is an end stage heart failure patient with an LVAD (left ventricular assist device) and has been with us for almost two months. She has had a very complicated hospital course, in addition to her disease processes she has struggled with severe chronic pain and has not been able to wean off the ventilator. She now has a tracheostomy and PEG tube. Now that she has overcome almost all of her acute issues we are working with her on physical rehabilitation and transitioning her from the vent to a trach collar. She is now able to walk in the hallway, walking a little further each day and spending a little more time each day on the trach collar. Charlie took a special interest in the patient and invested her time in organizing a personalized progress binder for Ms. W. Inside she compiled a calendar for each day to track how far Ms. W walked, her arm and leg exercises and how long she was on the trach collar, how much oxygen she required and how well she tolerated it. She also put in reference sheets which illustrate each of her daily arm and leg exercises and a detailed spreadsheet of her pain management regimen. Charlie went above her regular duties to provide Ms. W with a tool to empower Ms. W in her rehabilitation and a visual for her to see the tremendous progress she is making. Ms. W was so appreciative of this generous act.

Charlie has also invested herself in educating another patient with an upcoming complex discharge from the ICU. This patient was basically a "long term" ICU patient whom we struggled for months to transition to home to spend his final days. She created a binder for this patient with all of his medications and explained the indications and instructions in easy to understand terms. She knew that the success of him being able to stay at home was dependent upon his and his caretaker's education and understanding of his medication regimen. He survived at home longer than any of his medical team expected, and Charlie contributed to make this happen. It was the best gift anyone can offer a patient, a chance of a quality of life when facing a devastating diagnosis.

Charlie is very committed to the little things that make a big difference in patient's lives. She is often a champion for important unit initiatives that can make nurses roll their eyes. For example, she is our CAUTI champion, and helps educate and audit compliance with our indwelling catheters to prevent infection. Her efforts, which are often unappreciated, prevent nurses and aids from giving our patient's hospital acquired urinary infections. This is to the point of encouraging staff to weigh each pad when a patient is incontinent, rather than inserting an indwelling catheter for nurse convenience. With her pad weighing initiative, we are able to keep the doctor's plan of care up to date on our heart failure patients' intake and output. This takes the guessing game out of their incontinence.