I was working in the ICU with Dr. B and it was a hectic day. It felt like we had turned over the whole ICU except for one or two patients and had to pull this nominee back into staffing to help accommodate the workload. I was fielding several calls from the transfer center when Dr. B admitted a stroke patient from the ER, who this nominee was taking care of. He had received TNK for an ischemic stroke with R-sided deficits and had some improvement but residual aphasia, droop, and mild weakness on the R side. He had been with us on the unit not long, maybe a couple of hours, when Dr. B came to me and asked what the process was for a post-TNK patient experiencing new onset numbness - is that a brain attack order for CT or just a stat CT? We got this all straight quickly and found the patient had experienced a hemorrhagic conversion after TNK administration.

I asked Dr. B what had changed to prompt this repeat CT, and he told me that this nominee had come to him after noticing the patient had a change in sensation in his R. Arm. I asked her later how she found this, and she said she saw that he was having trouble pulling his pants up after using the bathroom, which was a change for him. This patient was a very stoic man who had trouble communicating anyway due to his aphasia, but he definitely wouldn't have brought this to anyone's attention otherwise. It was her observational skills and perception that picked up on this incredibly subtle change in her patient. It allowed us to get imaging, give appropriate meds, and fly the patient out to MC all within an hour. I've spoken to a couple of colleagues downtown in Neuro about this, and they both agreed that this assessment change is something that even they, with their years of experience, wouldn't have picked up on and could have progressed to much more pronounced symptoms that last long-term. 

I cannot express enough how impressed I am with this nominee. We all know what a great nurse she is, but this shows how connected she is with her patients to be able to notice something as benign as having difficulty pulling your pants up and connecting that with an acute change in a neurologic status. During the whole process, she remained positive and reassuring to the patient and his daughter. I could tell they were nervous, but she kept them smiling and laughing, which cut down on everyone's stress levels immensely. I think this situation speaks to the softer, more subtle skills present in our more exceptional nurses. This nominee's ability to connect on a human level with the patients she cares for isn't something that can be taught, but is something to be more than commended as it leads to excellent results such as this. She saved a man from lifelong deficits with grace and skill I wish I could replicate in all our nurses.

Note: This is Jessica's 2nd DAISY Award!