I was provided the opportunity to observe Sarah provide compassionate and exemplary practice to an elderly patient in MICU who had advanced dementia and COVID-19. This was a time when COVID-19 positive patients could not have any visitors. Sarah was on the phone with the family communicating that the patient was not able to oxygenate effectively despite high oxygen delivery and that she would likely need to be intubated. The patient was very active, nonverbal, and very confused. She was unable to respond to simple commands and kept trying to get out of bed. She also had 2 IVs- 1 in both feet, and she was kicking her legs and displacing her gown. Sarah was asking about the patient's wishes and trying to connect the team with the family to ensure effective communication was occurring. She asked if I would help so she could go back in the room with the patient. Oh, and Sarah also was caring for another patient. Sarah would efficiently don her PPE and go into the room, try to soothe the patient, cover the patient to maintain her dignity, change the TV channel to one suggested by family, talk to the patient and reposition her to help keep her calm. Sarah also asked about a weighted blanket and the family said that yes, the patient likes that. Sarah was able to calm the patient- tears were in my eyes as I watched her provide compassionate care and advocate for her. The family stated she did not want heroic measures and that her baseline dementia was very severe. Through Sarah's advocacy and compassionate care, she collaborated with the team and the patient was provided comfort cares. The patient passed peacefully later that evening.
The above scenario is not unique to that day. Just this week she cared for a patient with only brainstem reflexes. She continued to role model again by respectively and directly working with the medical team to understand the patient's wishes by speaking with the family and to advocate for a palliative care consult. This constant role modeling to know and to understand patient wishes and to ensure communication is effective throughout the team is extraordinary because it is consistent, done in a very respectful manner, and despite all the other management tasks that she faces every day. Truly consistent with the recognition inspired by this award.
There was a staff nurse who was assaulted by an aggressive patient. This staff nurse was a recently hired new graduate and was traumatized by the situation as it unfolded on her busy Saturday morning. This nurse had to quickly get out of the room and trust that security and the healthcare team could calm this patient down. The MICU team was traumatized by this event as two of their staff nurses were nearly physically harmed. The situation could have resulted in a very bad outcome for the staff. Sarah helped the staff members process through this experience. She met with the staff members personally involved in the incident, had debriefings, provided resources for the staff member, and reached out to the LIPs to ensure timely communication and orders were discussed. She also organized a presentation on substance intoxication and withdrawal in the critically ill population in which she taped and shared with staff that was unable to attend in order to provide the knowledge needed to care for these challenging patient situations so that these patients receive compassionate care and that staff are safe- both physically and emotionally.
Sarah gives of herself fully to the MICU staff and patients. One of her responsibilities is to ensure there the staff nurse schedule is balanced so that adequate resources are available 24/7 and she is a master- both concretely on paper while personally considering the individualized preferences of her staff. She creates an environment around the schedule that ensures the scheduling committee on MICU she provides mutual respect and compassion to the staff nurses as together they ensure the patients are cared for. For example, again she makes it a point to understand what really matters to the nurses in order to help with their mental health as it relates to staffing. Maybe one nurse doesn't have daycare on Tuesdays, or another would rather pick up extra night shifts over days shifts or another is taking college classes on a Thursday. Together they make the best out of a tough situation. Staff know to go to Sarah to share their concerns and that they will be heard and supported.
One of the many positive characteristics of Sarah is that she truly is concerned about her leadership strategies to ensure that staff feel connected and appreciated in MICU. Her shared vision is that the staff feel valued and are successful in delivering quality patient care in the MICU. One way that she motivates staff to achieve better outcomes for themselves and for their patients is to physically take notes about the staff nurse attributes and concerns- where they are growing and where they recognize they are struggling. These notes are unique to each staff member. She then follows up with them and asks them how they are doing on these specifics. For example, a new orientee might verbalize fear of caring for a very sick patient and then a few months later Sarah will remind them of their fear and ask how that is going. Sometimes the staff might say- oh yes, I still need to work on that or laugh and say how much they have learned and grown. She helps them raise self-awareness of their strengths and weaknesses so that together the MICU can provide excellent quality care to their patients.
Sarah is a mentor to staff - one of the ways that she influences others is through her weekly "Friday Update" newsletters. These positive newsletters are uplifting and an effective way of communicating. She weaves in humor, recognition to staff for a job well done, changes that have or will occur, educational opportunities, and quality metrics and compliances. The newsletters are well received and read by staff, influencing staff behavior.
Let me help you understand how Sarah makes this happen. There was a very busy day when Sarah took over the role of the charge nurse. The day was described as a 'hell-fire" day - limited number of staff to get a break or lunch, patients with bedside emergencies as their conditions deteriorated, critical admissions, and time spent transferring patients to tests and to step down floors. When the shift was over and charge nurse duties were passed on to the next shift, Sarah finished all the things that had not yet been completed. Instead of leaving the unit then, she went to her office and wrote an email to each staff who was present that day and, with spot-on precision, recognized the individualized way each one of them supported each other to come together to provide quality patient care. As a leader, she demands teamwork and critical thinking. She is successful in her expectations because she role models teamwork and problem-solving and is available to assist when needed.
Sarah volunteered to present at our first multidisciplinary critical care conference in November 2019. She skillfully and effectively presented information on delirium to help the learner understand effective interventions to decrease delirium in the critical care setting. She professionally represented the great nurses from UIHC and the effective multidisciplinary teamwork.