Rachel has shown tremendous growth in her clinical skills which she applies to both our ICU and IMCU level patients. Her greatest skill is recognizing when a patient's condition is deteriorating before it gets to a critical point, and then advocating for the appropriate care and clinical intervention with the nursing and medical staff. Her early identification of problems is respected by all members of the interdisciplinary team, so much so that when one of the cardiology PAs was orienting a PA student, I overheard her saying, 'When Rachel calls you need to listen to what she says.'
This clinical skill allows Rachel to provide compassionate care to patients and families. An example of when clinical skills, compassionate care, exemplary service and commitment to excellence were on full display was when at the end of a 12-hour shift she and I had to take over care of a very sick patient who had open heart surgery and experienced an RV infarct necessitating a two RN and medic transport to OHSU at 1930. She and I took over care of this patient, made sure she was ready for transport (she was very unstable so this took about 40 minutes until we both felt we could comfortably transport the patient). This took lots of compassionate communication with the rest of the care team, the family and with each other. The patient had a balloon pump, ET tube, PA catheter, chest tubes, pacing wires, Foley catheter and arterial line to manage. She was very critically ill, acidotic and requiring not only management of all those devices, but multiple blood transfusions and medication boluses. Rachel led the team by coordinating our transport onto the ambulance stretcher, communicating the location of and ensuring safety of all the necessary devices. It was a chore requiring 14 people to load the patient into the ambulance during which time the patient became exposed. Rachel quickly noticed this and covered her up. During the harrowing ambulance ride to OHSU, we transfused 10 units of blood and pushed as many or more amps of Epinephrine and bicarb, all the while maintaining vigilance over the patient's condition and all devices. Our goal was to get her up to OHSU so that their team could evaluate the next surgical option to give the patient the best chance for survival.
This transportation couldn't have been successfully accomplished without being partnered with a nurse who exemplifies all aspects of a DAISY Award nurse. We communicated clearly with each other the whole way as well as with the EMTs.
A second example of how Rachel readily shares her clinical knowledge in her various roles she plays on our unit (charge, resource and ICU level RN), was when two a half years ago she volunteered to be a mentor for one of our new graduate nurses. Through working with this nurse, Rachel became a member of SPT, and is now its chair, has taken on coordinating our latest Beacon Award submission and most importantly has helped guide this nurse through not just the required 1 year for mentorship, but through the first 2 years of her practice at the mentee's request. They have attended conferences together to help foster professional development and increase their clinical knowledge, including traveling to last year's NTI. Rachel was the only mentor who mentored the same nurse for 2 years and that nurse is a thriving member of our CVCU team.