Cierra Bembridge Oliver took care of the two sickest patients in the MICU on Christmas Day. Her first patient was a polysubstance overdose with bradycardia, shock requiring vasopressors, and every possible form of cardiac ectopy imaginable. Due to the nature of their ingestions, the patient required hemodialysis (CRRT was not an option given the substance ingested), and Cierra did a masterful job of titrating vasopressor support so that this patient could receive this potentially life-saving treatment. 

This patient also required lab draws every six hours, in addition to EKGs (which are performed by RNs in the MICU) every six hours to assess for QRS widening, and administration of activated charcoal via an NG tube. Cierra ensured that all the EKGs and labs were collected precisely on time, charcoal was administered promptly once the NG tube was confirmed, and she was cognizant of the rhythm changes the patient exhibited. She also made the medical team aware of any changes in the patient's condition. In addition, she was very kind and supportive of the patient's spouse, who was understandably having a very difficult time with their loved one on a ventilator and undergoing emergency dialysis on Christmas Day. 

Her second patient was in profound cardiogenic and distributive/vasoplegic shock, in addition to being intubated and on CRRT. Cierra tirelessly titrated three different vasoactive agents in addition to running CRRT and troubleshooting issues with flows and alarms. When the patient needed to go to the CT scan, she led the team to the scanner without a single utterance of frustration or hesitancy. The patient was extremely sick, and it would have been easy to make the case that the patient was 'too unstable' to travel to CT, but Cierra understood that the CT was needed to find the source of the patient's shock and as such she made it happen without hesitation, calling the CT department to ensure they were ready to decrease the amount of time the patient spent out of the MICU. 

Cierra was quick to notify the medical team when the patient began to have blood in their ET tube and quickly procured the equipment needed to perform an emergency bronchoscopy to assess for the source of bleeding. As if this wasn't enough, she continued to advocate for her patient when I wanted to try a novel medication (hydroxocobalamin) to see if it would help with the patient's vasoplegia. Cierra had never given this medicine before (I have only ordered it once before, and it was administered by the pharmacy in that instance), and called the pharmacy to ensure she was giving the medicine in the correct dose and at the correct rate, and that it would not cause interactions with the half-dozen other IV medicines the patient was being administered. 

Throughout this ordeal, she remained caring and helpful to the patient's spouse at the bedside, as well as other family members who came to visit. In both instances, families stated to me that they were glad their loved ones had such a caring and attentive nurse. These were two patients who could have easily justified 1:1 staffing (in fact, that change was made for the night team that evening), but Cierra handled her assignment with aplomb. She was prompt, detail-oriented, and communicated well amongst her nursing colleagues as well as the medical team. On the rare instances where she was not able to be at two places at once, she engaged her colleagues to facilitate her patients' care. The fact that she did all of this on Christmas Day, with limited staffing across multiple departments and while missing her first Christmas as a newlywed, makes her accomplishments all the more impressive. 

Cierra exemplified the indomitable spirit and tireless professionalism that make our MICU nurses great and upheld the highest standards of the nursing profession in doing so.