Superlatives: An Alternate List for Nurses Week

Photo from otisarchives4, via Flickr.

By Marcy Phipps, BSN, RN, CCRN. We originally published this post in 2010, but it’s so good we wanted to share it again this week. Enjoy!

During Nurses Week (May 6–12), the hospital where I work gives out endearing little trophies as awards for “nursing superlatives.” Ballots are distributed with predetermined categories, and the categories are usually fun and relatively straightforward. They include:

  • Best at Starting an IV
  • Most Likely to Crack a Raunchy Joke before Noon
  • Most Likely to Cry at Some Point during a Shift
  • Funniest Nurse
  • Most “Germ-a-Phobic” Nurse

The contests and catered meals, fun gifts, and light-hearted spirit of Nurses Week make it one of the nicest work weeks of the year, and we all come out of it feeling appreciated. But, in consideration of nursing superlatives, I’d like to propose some new categories. Although these titles won’t fit on the trophy plates, I think they’re worthy of recognition.

  • Most Likely to Notice, By the Tone of Another Nurse’s Voice, That Said Nurse Is Approaching a ‘Tilt’ Level of Stress, and Intervene Accordingly
  • Most Likely to Volunteer to Assist with Postmortem Care  (a job that nobody looks forward to, but that’s nonetheless important)
  • Most Likely to Accompanying Another Nurse on the Transport of an Unstable Patient to a Necessary Scan
  • Most Flexible; or Most Likely to Switch Shifts on Short Notice to Accommodate Another Nurse’s Unexpected Family Events

I’m often caught off guard by how perceptive my team is. The subtle interactions among us frequently surprise me, but they shouldn’t. We know each other’s strengths, weaknesses, and quirks very well. We make each other better and build each other up, and the security provided by that connectedness is priceless and vital.

I don’t mean to imply that we’re perfect. I’m not even sure we’re unique. But our engagements with each other make our team far stronger than the sum of its parts—and it shows in the care we provide. […]

Nursing Reads: A Powerful New Novel Evokes Diverse Perspectives on an Organ Transplant


By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

The Heart, a new novel by Maylis de Kerangal, caught my attention with a cover art image suggestive of the vascular and as beautiful as an angiogram. Taking place over a 24-hour period, the novel describes a 19-year-old accident victim who suffers brain death and the people who are connected to the heart transplant that follows: his parents, the doctors and nurses, the recipient of the heart. As a nurse who’s seen the organ transplant process from a number of angles, I wasn’t sure how De Kerangal could possibly navigate such material.

But the novel, which has been ably translated from French, is both subtle and powerful, casting light on the complexity of every character, from the pre-accident vitality of Simon, the donor, to the conflicted gratitude of the heart recipient; from the inexperienced ICU nurse to the surgeons.

Two important characters are nurses, though they are only a part of the larger picture:

Cordelia Owl, Simon’s ICU nurse, is an inexperienced practitioner. She carries out her nursing tasks in a distracted, perfunctory manner, speaking aloud to the unresponsive Simon as she cares for him. In doing so, she inadvertently intensifies the anguish of his parents, who are standing nearby and struggling with the concept of brain death.

Though her behavior shocks the attending physician, she’s not dealt with harshly. The physician tells her: “that young man is dead . . . the appearance of his body seems to contradict the facts . . . such words, spoken in the context of treatment, blur the message we are trying to communicate.”

Here and again later, the young Cordelia is guided toward insight, leaving me finally with the impression that there is hope for her to grow and rise above her distractions. I’ve precepted new nurses and students like her who are not yet aware of how nursing care touches people and how its reach far surpasses the “chartable” tasks.

Thomas Remige, the organ donation coordinator, is an experienced nurse who describes his ICU background as “an underworld, a parallel universe, a subterranean space on the edge of the ordinary world . . . .” He sings to clear his head, fills his life with birds and music, and ponders “the singular uncertainty on the threshold of living” and “the human body and its uses.” He’s not only adept at taking care of patients but also a master of reading the subtle cues of their loved ones, knowing what needs to be said, when to stay quiet, when to hold a hand, and when to step out. I appreciated his character and connected with him, as I have known many excellent nurses like him in the ICU. […]

Rightness: A Flight Nurse Taps Into the Universal Language of Nursing

“Immersed in a nursing role that I didn’t even know existed when I entered the profession, I find there to be a common language—one rooted in science but strongest in humanity and compassion, transcending culture, geography, and words.”

By Marcy Phipps, BSN, RN, CCRN, chief flight nurse at Global Jetcare

MarcyPhipps_Flight_NursingI’m standing in the doorway of our plane, watching our patient sleep and eyeing the monitor. The monitor’s beeps keep steady time and mix with the sounds of the pounding waves that batter the atoll.

We’ve stopped for fuel on this narrow runway that stretches down a spit of land in the Pacific. As the sun rises we snack on cold gyudon, a Japanese dish we picked up in Guam. It’s not the best breakfast, but somehow feels right—like a lot of other aspects of this job lately.

We’d started our mission in eastern Asia, picking up an American citizen who’d fallen ill in a city that didn’t cater to tourists and where almost no one spoke English.

While there, our crew’s handler—someone whose job it is to facilitate our lodging, transportation, and generally ease our way—had taken us to a dimly lit restaurant on a back street and treated us to a myriad of local delicacies, some of which I recognized, many of which I didn’t. My usual morning run had led me through parks and a street market crowded with live chickens and full of fruits and vegetables I’d never seen.

But the ‘rightness’ I felt was owed entirely to the experience I had at the foreign hospital. […]

February 1st, 2016|nursing perspective|4 Comments

Thanksgiving in the ICU: Woven into the Tapestry of Traditions

By Marcy Phipps, BSN, RN, CCRN. Editor’s note: This post, originally published in 2011, remains as timely as ever. The author is now chief flight nurse at Global Jetcare.) 


I’ll be working this Thanksgiving. I’ve worked so many Thanksgivings that the ICU feels woven into the tapestry of my own traditions. I don’t really mind; the cafeteria serves a fitting feast that’s embellished by the homemade treats we bring in, and although we won’t actually be watching it, the Macy’s parade will be on. Somehow, the smells and sounds I associate with the holiday will mix and mingle with the usual bustle of critical care, and it’ll feel like Thanksgiving. It’s actually a nice day to be at the hospital—for the nurses, that is.

For our patients and their families, I know hospital holidays fall far short. We have one patient, in particular, who’s been with us for a while. Her husband’s been a fixture at her side throughout her stay, and I expect to find him stationed there this Thanksgiving. Hospital turkey and television won’t give him the comfort or peace that he seeks, and I don’t know that he’ll be giving thanks. For many weeks I’ve watched him skirt a fine line between gratitude and despair; things could always be worse, but they could certainly be better.

When I stop to count my blessings, I’m overwhelmed. I belong to a profession that I’m passionate about—one that brings me great […]

The Underlying Connection Is Nursing

Angel sculpture on grave marker photo by author

Marcy Phipps, BSN, RN, CCRN, ATCN, TNCC, an ICU nurse who recently took up flight nursing, is an occasional contributor to this blog.

I recently experienced a series of events that seemed interconnected and orchestrated.

It started with my usual morning run. I was jogging out of my neighborhood, already sweating in the summer heat and absorbed—coincidentally—in an audio podcast about trauma care, when I came upon a man sprawled in the middle of a usually very busy thoroughfare. His motorcycle, badly damaged, was lying on its side next to a car with a crumpled door panel. The accident had clearly just occurred—traffic hadn’t yet backed up and no sirens could be heard heralding imminent assistance.

I had the weird sensation that I’d been running to the accident all along. I held his C-spine and monitored his neuro status while an off-duty paramedic managed the scene. Unexpectedly, a cardiologist I sometimes work with emerged from a nearby café and held his fingers to the man’s radial pulse, and then several more off-duty paramedics arrived.

It seemed fortuitous to me at the time—not the accident, of course, but the proximity of medical personnel who were so quickly available. And I had the impression that, despite not having worn a helmet, the motorcycle rider would be okay. He was talking to me, after all, and I didn’t see any obvious deformities or signs of severe injury.

About a week later, with the motorcyclist (and a shred of doubt) in the back of my mind, I glanced through the obituary section of the local paper. I should say that I almost never read the newspaper. When I do, I don’t look at the obituaries. And yet, on this rare occasion, I saw that not only had the motorcyclist succumbed to his injuries several days after his accident, but also that a patient with whom I’d developed a friendship several years ago had died, and that his memorial service was the following day. […]

Flight Nursing Notes – The Feel of a Homecoming

Observations of an experienced ICU nurse and long-time AJN blogger who recently made the transition to flight nursing.

clouds-photo-from-airplaneMarcy Phipps, BSN, RN, CCRN, ATCN, TNCC, is an occasional contributor to this blog. Some details have been changed to protect patient privacy.

“We’ve been married for 58 years,” my patient’s wife says. “Fifty-eight years…”

She turns her attention from me and gazes out the window of the plane.

We are on a medevac flight, 35,000 feet over the Pacific en route to an urban, American hospital near “home.” Her husband is being transferred to receive aggressive care for a grave illness.

We collected him hours earlier from a hospital on a foreign island. Local paramedics picked my partner and me up from the barren, windy tarmac. As we sped to the hospital in the back of an ambulance with a cracked windshield, the driver turned to warn us that we were going to “the worst hospital in the city.”

“It’s open-air,” he told us, as he dodged mopeds and swerved through narrow, crowded streets.

This didn’t surprise me. I’d been forewarned that hospital conditions on many of these remote islands could be shocking when compared to American standards. It was something I’d been curious to see firsthand.

Yet when we picked our patient up, we found him in a small and clean room in an intensive care unit. Despite the paramedic’s prediction and the visibly run-down hospital, he appeared well cared for and attended to. His wife told me later that she believed her constant presence at his bedside had guaranteed his good care.

And now it’s two in the morning and I sit in a private jet with the flight medic, tending our patient, who is remarkably stable and tolerating the flight with ease. We are also tending to his wife, albeit in less obvious ways. He’s secured to a stretcher; she sits in a bucket seat at his feet, nervously watching his chest rise and fall with the ventilator-delivered breaths. Each time I assess him or check his vital signs she looks at me anxiously. […]

July 14th, 2014|career, Nursing|3 Comments

Not Compatible With Nursing

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

photo 1-1 Photo by the author

“His family knows this is not a survivable injury, right?”

This question, posed to me in the doorway of my patient’s room by a trauma surgeon I regard as brilliant, caught me off guard.

“No,” I said. “They don’t know that.”

He frowned at me, mumbled something about false hopes, then moved away to continue his rounds.

This wasn’t the only physician who’d expressed a strong opinion regarding my patient’s mortality—a consultant had deemed his injuries “not compatible with life.” But I’d been caring for this man, as a 1:1 assignment because of his high acuity, for every shift for weeks. It seemed obvious to me that my patient’s continued presence in the ICU—and his relative stability on that particular day—directly opposed the dire predictions. The man’s family did not see his situation as hopeless, and neither did I.

And yet days after the surgeon uttered those words, my patient suffered a complication and became so unstable that for hours he teetered between life and death. The resuscitation effort was massive—and no one mentioned survivability. No one behaved like there was even a shred of futility in bringing to bear the full force of medical interventions. I never left his bedside, determined that, if my patient were to die, it would not be for a lack of vigilance and intervention on the part of his nurse. […]

Taking Flight: A Nurse Recharges Her Batteries

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

interior, BK 117 medical helicopter interior, BK 117 medical helicopter

You’re part of a fixed-wing flight transport team called to pick up a 32-year-old male who’s been involved in a paragliding accident in Puerto Rico. Upon landing, you see an ambulance at the end of the tarmac. As you exit your plane, the ambulance pulls up and the crew opens the back door of the rig. They pull the patient out on a stretcher and hand you a folder of X-rays, saying, “He’s all yours.”

After four days of intensive training in the Air Medical Crew Core Curriculum course, my team was given that scenario as a group assignment on the last day of class. We were given a folder of radiology films and briefed on our patient’s vital signs and our assessment findings. We conducted a quick “field interpretation” of his X-rays and presented our interventions, along with our concerns and specific accommodations for transporting this unstable patient to Florida in a Learjet.

This was no ordinary class. Offered to nurses and other medical personnel interested in flight medicine—either on emergency response helicopters or fixed-wing transports—it included safety briefings, aircraft orientation, and worst-case-scenario land survival instructions. Among other activities, we visited with a helicopter crew and watched someone try to ignite a Nomex flight suit with a magnesium fire (it really will not burn). Lectures included transport considerations for specific patient populations including trauma, shock, neurologic injury, and burns. Flight physiology was discussed in depth. All in all, it was probably the coolest class I’ve ever taken—and I learned far more than I’d ever expected.

Just a few of the things I didn’t know:

  • At altitude, because of Boyle’s law, a simple pneumothorax may become a tension pneumothorax.
  • Pneumocephalus can be detrimental—or fatal.
  • The pressure in an endotracheal tube (ETT) cuff will increase, potentially resulting in airway ischemia.
  • Because of Dalton’s law, the fraction of inspired oxygen (FiO2) required by your patient will change and can be precisely calculated based on altitude and barometric pressure.

I’m certain the patient in our scenario made it back to the United States safely. My team, which was comprised of two nurses and three paramedics, caught the important injuries on the X-ray films we’d been provided. We knew, based on our assessment findings, which problems were emergent and required intervention before the flight, as well as how our various scopes of practice would dictate the actions taken. We knew exactly how much oxygen we’d need for the flight, based on the elevation we’d be flying at, and how many canisters that would require. […]

September 9th, 2013|career, nursing perspective|1 Comment

Something Like Grace

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

ViewFromPlaneWindowMark was in town to be the best man in an old friend’s wedding—on a vacation, of sorts—when the unthinkable happened and he was involved in a horrendous traffic accident. He was ejected from his rental car. His injuries were severe and life threatening.

Mark’s family was halfway across the country. Getting to Mark quickly seemed impossible. But this is where the story takes a turn:

Mark’s family found a flight leaving that morning from their local airport, with the exact number of available seats that they needed. As they bought the tickets, they explained the nature of their emergency. They got to the airport in the nick of time. While checking in, they were approached by an airline employee who asked if they’d already arranged a rental car. They told him that they hadn’t—they hadn’t even stopped to get their clothes.

They didn’t know it at the time, but the employee who’d approached them was the pilot of the plane. He’d learned of the family emergency and held the plane for them. He knew how serious Mark’s accident had been, as he’d happened to drive right past the accident scene on his way to the airport before the first leg of the flight.

When the plane landed, the pilot requested that Mark’s family […]

Get the Job Done

By Marcy Phipps, RN, a regular contributor to this blog. Her essay “The Love Song of Frank” was published in the May (2012) issue of AJN.

Dietetics class for nurses, 1918/Cornell University Library/via Flickr Nursing students, 1918/Cornell University Library/via Flickr

I remember being a new nurse and having an order to place a Foley catheter in a female patient.

I was filled with dread. Urinary catheter placement was the only skill I’d failed in nursing school (I’d contaminated my sterile field), and placing a catheter in this patient was sure to be a challenge, as she was obese and unable to cooperate. It was not a one-person job, even for a far more experienced nurse.

When I asked a coworker for help, she sighed and said, “I don’t have time. This isn’t nursing school, you know. You just do the best you can and get the job done.”

Oddly, as clearly as I remember the situation and the nurse’s response, I don’t recall the outcome of the task—only my feelings of incompetence and the impression of a complete lack of support. I can only hope that my patient didn’t suffer any consequences of my inexperience, because I’m sure I did what my coworker advised—there’s no doubt I got the job done.

I precept new nurses frequently, and sometimes I hear the echo of that long ago nurse’s response in my mind. Just last week, […]

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