It is difficult to provide a single patient story to reflect the special talents Rachel Eickhoff brings to nursing. Rather let me show you a 'day in the life' of Ms. Eickhoff. As we run the patient list in the morning, she is doing her own nursing assessment for each patient for what nursing needs they have and making her to-do list. This offloads me as the team leader from having to assess and assign her tasks making my job easier. First, she goes and spends 40 minutes with the wife of a man whose cancer has spread and whom Rachel knows that in the next few days a hospice conversation is likely to take place for this man. She discovers that the wife is struggling with caregiver burnout but also that their son committed suicide 20 years (still a raw wound) their daughter died a year ago from MS, their grandson is struggling with heroin addiction, and her sister just died in hospice 2 weeks ago. She provides support directly: provides caregiver resources and engages the chaplain for additional support and makes the teams aware of increased grief needs.

Next, she meets the family of a young 44-year-old woman on ECMO with severe COVID pneumonia who is not responding to therapy and whose prognosis is grave. Her family is very angry and distrustful of western medicine. They are also struggling with a lack of financial resources. She corrals social work and finds them parking passes and meal tickets -- a small but appreciated gesture. Rachel again provides a listening ear and support to them; getting to know them as people, trying to understand their point of view and where they are coming from. In doing so she is developing rapport with this family whose wrath most try to avoid. In the coming weeks, Rachel will build on this fragile bond day by day, giving them a place to dissipate their anger and talk about their daughter. Over time this opens a space for others (the ICU team) to begin end-of-life conversations in this tragic situation.

Next Rachel meets with a brand-new RN who is caring for a comatose patient who is dying of respiratory failure. The new RN is doing a good job caring for the patient, but deep down is worried if she is assessing the patient's dyspnea correctly and medicating for comfort correctly. The new RN doesn't say anything, but Rachel reaches out to her anyway because she remembers what it was like being new. She teaches the new RN how to assess dyspnea in a comatose patient, how to prioritize the comfort meds available to her, and compliments her on the great job she is doing. Not only is this great for the new RN, but this is also great for our team because in the past this would have generated a call to a clinician to come and assess the patient thus Rachel's actions also helped the entire palliative team as well as the new RN and the dying patient.

Next Rachel goes to see a patient being discharged. She discovers a complicated patient whose family is earnest but utterly overwhelmed by his medical complexity. She spends 30 minutes writing down a grid of his medication in a way the family can understand and arranging a follow-up appointment in clinic sooner than normal to make sure med management goes as expected after discharge (probably preventing readmission in the process). Now you may say "This is just good nursing care, what's so special about this." She did all of this of her own accord, no one prodding her. She just does what needs to be done for the patient to make sure they get what they need and don't fall through the cracks --- for every patient every day. She doesn't just tell the team to consult the chaplain, she calls the chaplain directly. She doesn't tell the team the family doesn't understand their meds, she sits down and writes them down in a way that makes sense to them and make a follow up appointment in order to prevent an error. She doesn't wait for the new RN to have a problem; she reaches out to her proactively. It is Rachel's initiative, her proactiveness, and her get-it-done attitude that makes her so incredibly special.