Becca is a Clinical Staff Leader in the Pediatric Surgical Care Unit (PSCU). Around 5 pm I was called to assist with a patient and family in PSCU that wanted to leave prior to being cleared for discharge by the provider. When I arrived to the unit Becca and the provider updated me on the situation. The patient was a 17-year-old with an asthma exacerbation combined with an acute respiratory illness. She had just been decreased from continuous neb treatments to every 2-hour treatments. The plan of care was to see how well she tolerated the decrease in frequency over the next 12-24s before making a decision on discharge. The patient also struggled with significant anxiety and depression. She had been recently admitted to the hospital which was a very traumatic experience for her. The patient and her parents were insistent that she could go home and they would monitor her there and take her to the ER if her symptoms worsened. The patient's provider wanted us to pursue emergency medical custody of the patient if they still insisted on leaving. Becca and I were hopeful we could speak to the parents and the patient and quickly have their concerns resolved and keep the patient safely in the hospital until the next day when her condition could be re-evaluated.

Becca did an exceptional job taking the lead in the room to talk to the patient and her parents. She was calm and collected- listening to their concerns as well as their anger regarding the situation. Despite a few insults, a lot of cursing, and the patient threatening to "kick us in the face"- Becca was patient and kind. After being unable to find a resolution, we stepped out and regrouped for a plan.

Becca then got the parents to meet with us in the conference room and talk through their daughter's experiences in hospitals. Becca used her understanding nature and empathetic listening skills to encourage the patient's parents to open up and help work on a plan to keep her in the hospital overnight. The parents shared a previous traumatic experience that the patient had in which she had to be restrained in the hospital and admitted for several days and was critically ill. Becca encouraged the parents to be supportive of the need for the patient to stay in the hospital. She acknowledged how difficult this was for them and that she could help take the weight of some of the stress they were bearing. She got them to take a break from the unit, get some food, and then come back to talk to the patient about staying.

Finally, we were able to go back in and speak with the patient and her parents again. Becca was able to encourage the parents to communicate with the patient that we were unable to work out a discharge plan for that moment and that we would continue to work on a plan. The patient really wanted to get a shower with her own favorite products. Becca worked with the care team to get approval for the patient to shower. She then left the hospital at 10 pm to run to the store, pick up all of the patient's favorite products, and bring them back for her so she could shower.

This diligent and caring effort by Becca resulted in the patient being able to stay until she could be evaluated for a safe medically stable discharge. I believe Becca was solely focused on keeping the patient safe at a time when the patient and parents needed an advocate without even realizing it. It was clear to me that day that Becca is a patient-centered leader who has mastered the art of navigating crucial conversations.

And at the end of the night, in true nurse leader fashion- Becca was more worried about me than herself. Before saying goodbye at 10 pm she gave me all of the snacks on her desk even though we had both missed dinner that night. I am so thankful to work with such a skilled and committed nurse leader.