Hannah expressed concern to the medical team when it appeared that a prison guard was making code status decisions for an unresponsive, incarcerated patient. The patient had an anoxic brain injury and was not expected to survive the night. The team did not have a process for identifying the next of kin because the patient was an inmate in a local jail and the guard at the bedside said that he could make decisions for the patient.

Hannah recognized that inmates have the same rights to medical decision-making as other patients. She reached out to other intensive care units to see if they had experience with this type of situation and discovered that others had encountered the same issue. In each case, our ethics department had to be consulted to act as a liaison between the prison and the medical team.

The event occurred on the night shift when resources such as ethics were not available for immediate consultation. In response to this, Hannah elevated her concern to her nurse manager, who followed up with the clinical ethicist to start conversations about the need for a standard way of handling these situations. This led to representatives from nursing, ethics, legal, compliance, and the local sheriff department meeting and drafting a policy to address concerns. 

Hannah's courage to question authority and advocate on behalf of a vulnerable patient has brought forth change. This change will allow other patients in the same situation to have their wishes properly expressed and give staff the guidance they need to respond appropriately in life-and-death situations. The patient mentioned at the beginning of this nomination became an organ donor and gave the gift of life to others, surrounded by family members.