Within the Pediatric ICU, we pride ourselves on the ability to provide complex life and, oftentimes, limb-saving care to some of the smallest critical patients in the area. Despite our excellent teams and the highly skilled care we deliver, sometimes the limitations of the situation result in a less-than-ideal outcome. In these times, it is often the compassion of the team that surrounds our patients that allows these tragedies to become bearable. One of these team members is OR Nurse Corey Livingston.

We recently admitted a young boy who survived a golf cart accident, brought to our emergency department without his left arm. Our ER stabilized him for surgery, and upon arrival of his traumatically amputated arm to the ER from the scene, he was rushed to the OR to reattach his arm. The next few days were incredibly difficult for the patient, his family, and our staff. Great measures were taken to keep the arm, and the boy, alive. The room temperature was maintained at the maximum heat settings on the thermostat to improve perfusion. Countless pain medications were utilized to keep the boy comfortable, with every movement and turn causing discomfort. As you can imagine this was a team effort, with the patient and his parents committing to endure every discomfort that came at the benefit of the arm. Unfortunately, despite these efforts, one Saturday morning perfusion began to decrease to the re-attached arm.

Within a matter of hours, the patient, his family, and all the bedside staff involved had to accept the worst-case scenario - that all this pain, effort, time, and care may be unsuccessful in allowing the boy to keep his arm. As we swallowed this thought and anxiously worked to prepare our patient for the operating room, in yet another attempt to save his arm, we were introduced to our operating room nurse for the day - Corey Livingston. Despite having no previous background on the patient, Corey entered this situation level-headed and provided both knowledgeable and compassionate care. She went above and beyond in her role, addressing the anxiety of the patient and his family while advocating for their presence in all steps of the perioperative process. Due to the patient's anxiety and weariness, Corey collaborated with the bedside ICU team to perform multiple nursing care interventions during the procedure while the patient was under anesthesia. She communicated phenomenally throughout the perioperative period, instilling us with confidence for the coming hours. When the patient faced difficulty tolerating the PACU process, she communicated with the ICU team to ensure the safe and prompt return of the child to his room. The determination was made that the boy would need the arm to be amputated the next day, after an arduous attempt by the orthopedic surgical team to save it.

The night was filled with anxiety, anticipation, and grief as the surgery ahead was pondered by all involved. As the surgical team arrived the next morning, we were happy to be met with a familiar face - Nurse Corey. Again, she took charge of the bedside care throughout the case. She educated the family as to that day's expectations and communicated with the child to put him at ease. She called the PICU with developments throughout the case and again coordinated his post-operative care. All these tasks were done without question or complaint, and her eagerness to participate motivated all of us to be our best.

To perform this highly, in such a specialized case, with a pediatric patient, on a weekend, demonstrates that Corey is a caring, knowledgeable, skilled nurse who is extremely deserving of this DAISY Nomination and any other praise due. We, the patient, and their family are truly indebted to her.