Nurses can often discuss or debate the nature of nursing or what combination of skills, knowledge and attitude constitute the necessary competencies that combine to create an effective nurse or even one that is exceptional. What defies debate is that Rachael Corona exemplifies the finest combination of critical thinking, patient focused care, effective communication skills, and commitment to evidence based practice and quality improvement that can be found in a well-educated, committed professional nurse.

Recently, there was a situation that was an excellent illustration of her competence. Rachael manages the practice of a surgical oncologist and had their patient, who had a distal pancreatectomy, return early for a postoperative appointment because the patient had complained about increasing abdominal pain. Rachael brought her to the office off our usual clinical hours to be examined by a physician and have the patient's pain treated. Although the patient had no changes to either her vital signs and only minimal outward changes to her clinical appearance, Rachael noticed that her surgical drainage was an unusual color. The surgical oncology resident assessed the patient, diagnosed a surface cellulitis and was proceeding to send the patient home with antibiotics.

Rachael disagreed with this diagnosis and asked a senior nurse in the practice to assess the patient and verify Rachael's clinical suspicion. Both nurses disagreed with the resident and his assessment; nursing felt that not only were labs required but also a CT scan should be ordered to assess for the existence and extent of a pancreatic leak. Rachael communicated her disagreement with the physician in a respectful manner, explaining why we thought he was incorrect in his diagnosis and then called the attending physician to add additional information to the resident's diagnosis and for further instruction. The attending physician agreed with Rachael-labs and a CT scan was ordered immediately. Rachael refused to let the patient go home until results were reviewed. She communicated the plan of care with the patient and displayed sensitivity to their comfort and needs. She did not want the patient and her family to travel home until she was sure the patient was alright as they lived in a rural area far from our hospital. Throughout the encounter, she displayed high degree of personal and professional responsibility for the patient in her care.

Rachael vigilantly kept looking for the results so that the patient didn't have an undue wait. Test results indicated that she was correct; the CT confirmed the patient had an infection secondary to a pancreatic leak with an impressively elevated white blood cell count. In addition, there was a pleural effusion. The patient was directly admitted for IV antibiotics, another drain placement, and even required immediate insertion of a chest tube. Had the patient gone home, she likely would have returned that evening with severe sepsis and her outcome may have been less favorable. To the resident's credit he acknowledged that Rachael had been right, thanked the nurses for their help, displaying humility and grace and said that medicine was a team sport. Our estimation of his character went up and we were all able to display excellent teamwork to the benefit of our patient.

Rachael displays good clinical judgment, critical thinking, Intelligence, kindness, and good natured fun-she goes out of her way through large and small acts to provide great patient care. Since joining our team she has brought a lot of joy and laughter to the surgical oncology group, along with a wonderful work ethic and caring, patient demeanor to all her coworkers. She uses evidence-based practice by researching the most effective current treatments in order to provide exceptional patient care. She goes out of her way to obtain medical and nursing education and is always looking for improvement. She has taken on more than her fair share of work and made personal sacrifice, so that her colleague had the necessary time to study to complete a doctoral project and study for boards, all without a moment of complaint. I have had the opportunity to work with the finest of nurses in two countries and from many states and can confidently say that Rachael Corona makes me proud every day to be her coworker and fellow nurse. She is a credit to nursing and to our organization.