In a Nurse’s Shoes
words by maryann brinley / photography by andrew hanenberg
10:00 a.m., UMDNJ-University Hospital, H-Level
o walk four miles a day … sounds like a nice exercise goal. For nurses, it’s an on-the-job reality.
Rita Babu, RN, who may travel even further than four — an estimate by time and motion researchers — is in charge on this hospital wing. “Acute care, medical-surgical nursing at its best is performed here,” says the nurse manager as we start down the hall, checking patients, greeting staff and visitors, advising medical residents, holding a hand, and spreading good will. Her warm enthusiasm is a balm, quickly and easily felt by everyone she touches. Her energy level is nearly non-stop, and always on the upbeat.
“They are the most vulnerable patients and caring for them is so rewarding. You make a difference in each patient’s life,” says Babu, an oncology certified nurse. “Everyone here is treated with dignity and respect. We are advocates for our patients and coordinators of their care. Our patients are not just their diagnoses. They are human beings.”
One man fell down his steps, became paralyzed and was admitted. Yesterday, he almost died. The emergency code to revive him was called by his night nurse, on duty until 7 a.m. “Many responders came running but it was the nurse who assessed his condition, called the code, started CPR, and made sure resuscitation equipment was on hand. When the doctors arrived, it was this nurse who provided all the critical information: the patient’s diagnosis, the event that led to the code, his vital signs, medical history, and medications. That nurse in room 307 did this in just a few seconds. Armed with the information she provided, the physicians tailored the emergency treatment and successfully revived him. Even the fastest doctor takes a minute to get here but it is in the first couple of minutes that you can save a patient’s life,” Babu explains. “Healthcare delivery and professional nursing are so complex. As a manager, I ensure that systems and processes are developed and implemented, that the nursing staff coordinates everything with the physicians and other healthcare-givers, and that this team of professional collaborators plans the next steps in treatment.”
The image of the female nurse wearing a white hat and waiting quietly to be told what to do is no longer true. Nursing has been transformed and this transformation is evident here.
By a hospital room window, a small woman is eating breakfast. “How are you today?” Babu asks, leaning over to pat her arm. This patient just had her leg amputated. “Our nurses will teach her how to care for the amputated limb until it heals and she can be fitted with a prosthesis,” Babu says. “The nurses will show her how to keep her skin supple and prevent pressure sores. They will encourage her to walk and reinforce the crutch training lessons taught by a physical therapist.”
We move on. A Spanish-speaking woman who received chemotherapy a week ago is experiencing gastrointestinal problems so a special interpreter phone is pulled from the cabinet and plugged into a line in her room. Babu can now gather information using Elsa, the interpreter on the speaker phone line, as her go-between. Quickly, it is determined that medication for the pain and diarrhea could be causing this patient’s troubles. “We have other drug options and nutrition choices,” Babu reassures her. “There are many different ways of managing symptoms.” Patience and optimism are in the air here, no matter what the diagnoses may be.
Now we meet elderly Ms. A, who speaks only Creole. “This lady would lie in bed without even blinking her eyes. Her condition was so serious that we started preparing for long-term care placement and possible death.” While her family struggled to make difficult decisions, the nurses continued their care, talking to Ms. A, administering care and medication though she never responded. One day, Babu recalls, “A nurse said her name as usual, and Ms. A looked straight at her. She was still there. So the staff and family changed course and began guiding her back to everyday life, so she would be able to bathe and feed herself.” She was even enrolled in a nursing initiative known as the PALM Program (Planned Activity, Less Medication), to receive cognitive and social stimulation through art therapies. “She is getting ready to go home to her family now,” Babu smiles, “and it was our nursing care that brought her back.
“Here is another success story,” Babu says excitedly, heading into the next room. “Look at this gentleman. Doesn’t he look great?” A shy, slightly-built fellow grins up at us. He was admitted weeks before with lung cancer that had metastasized to his brain. His prognosis was poor. Then his situation worsened further. “He was quite sick,” Babu explains. The patient developed Stevens-Johnson Syndrome, an allergic reaction to dilantin, an anti-seizure medication prescribed to minimize the effects of the brain metastasis. His skin sloughed off. “It turned bright red, blistered, and then peeled away,” Babu says. “It was his nurse who first noticed that something was wrong, reviewed his medications, and called the doctor’s attention to the dilantin. By then, this patient had been given three doses. He lost skin on his face, eyelids, and mouth. These areas were like second degree burns. His recovery has been remarkable. In fact, look at his new skin,” Babu says, “Soft and smooth, like a baby’s. This patient was admitted with no hope of recovery. Thanks to the sharp skills of these nurses, he will soon go home.”
On the H-level medical/surgical unit, Babu and nurses like Gemelia Jeffrey, RN, Jocelyn Crevecoeur, RN, Ike Celestin, RN, Joseph Mercado, RN, Jo-Anne Bruno, RN, Jeannette Lee, RN, and others treat not just the medical but also the social and psychological conditions. “Life is so precious,” Babu says. “Nurses are vital in the preventive, healing and restoring process.”
Her boss, Theresa Rejrat, RN, MA, UH Vice-President for Patient Care Services, agrees and asks, “Just what is it that nurses do? Many non-nurses, even staff who work in hospitals every day, do not have a clear understanding of the role of the professional nurse.” Yet, nurses are responsible for the core processes of the hospital, “the primary function and service offered to patients: assessing, problem identifying, planning care, implementing the care and evaluating it,” Rejrat says. From the hospital operations to the outcomes, quality, service reputation and clinical regulatory compliance, nurses do it all at the point of patient and family care. Rejrat explains that physicians apply this process as well, but for doctors, the focus is specific to a disease or condition while a nurse’s job is broader. Nurses intervene “not only on the condition but on all other aspects of human life, recognizing patient and family as a unique entity.”
H-level nurse, Gemelia Jeffrey, a four-year veteran, certainly knows this to be true. We hover in the hallway quietly as she recalls a gentleman with pancreatic cancer. “I will never forget him. He was in his 70s and so appreciative. He went through hell,” she says. Unable to eat at first, he received nutrition intravenously. As his condition improved, nurses collaborated with the nutritionists to build him up. He wanted to be able to eat foods he liked. Always kept informed about his treatments, this patient made decisions about his care and after a month spent on H level, on his discharge day, “He did not want to leave us,” recalls Jeffrey. “So he started
And so did she.
Nursing Numbers: The Large and the Small
At UMDNJ-University Hospital last year, 19,000 adults and 936 children were admitted, which means the nursing staff of 768 completed approximately 20,000 initial assessments, according to Rejrat. Then, at least another 1 million reassessments were done. Nurses monitored and cared for more than 17,000 people who were sedated or anesthetized for surgery. More than 666,400 medications were administered. Nurses guided more than 1,900 moms and their families through labor and delivery. And in the emergency department, the nurses triaged care in almost 100,000 visits.
Nurses are able to pick up individual symptomatic shifts in “their patients even before conditions manifest in a crisis,” according to Rejrat. Early response teams have been created in hospitals by accrediting agencies to react quickly whenever a nurse identifies something as going wrong, even when objective indications like changes in vital signs don’t support it.
To get a sense of just how dynamic nurses’ days can be, UMDNJ employees were invited to walk in their shoes during National Nurses Week last May. Participants — from the materials management supervisor to a pharmacist, finance officer, hospital support specialist and school administrator — were often in awe shadowing these healthcare experts. Margorie Michele, in the UMDNJ-New Jersey Medical School Human Resources Department, reported, “Even wearing comfortable shoes, after an hour of standing, I thought I was going to pass out.”