About Marcy Phipps, BSN, RN, CCRN, CFRN

Chief flight nurse at an international air ambulance service.

No Explanation Required: A Preceptor’s Tale

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN. She has also contributed a number of thought-provoking posts to this blog (here’s the most recent).

I’ve been precepting a new ICU nurse intern, which I generally enjoy doing. The only downside (from the preceptor’s perspective) is that I’m obliged to call ahead and request “unstable” assignments. This is meant to enhance the clinical aspect of the internship, and it definitely does.  Considering that I work in a trauma center, though, reserving the sickest patient in the unit feels a bit like ordering up a large serving of chaos. And although I can request the assignment, I can’t predict what will be learned.

Our most recent patient was a new admission with a traumatic brain injury. At the start of our shift he had a grim neuro prognosis and was hemodynamically unstable. His condition deteriorated throughout the day and he was eventually diagnosed as brain-dead. His family chose to donate his organs.

Taking care of an organ donor is difficult. Brain-dead patients are inherently unstable, yet certain parameters must be maintained to ensure adequate organ perfusion. It’s tedious and meticulous.  It also requires a shift of perspective—ironically, even though the patient is legally […]

2016-11-21T13:15:13-05:00October 20th, 2010|Nursing, nursing perspective, students|5 Comments
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Neither Crime Nor Demeanor

By Marcy Phipps. Marcy is an RN in St. Petersburg, Florida. Her essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN, and she has contributed several thoughtful posts to this blog in recent months (here’s the previous one).

My patient’s ICU stay was short, as his injuries were fairly unremarkable. Far more striking were the circumstances of his admission; he’d been injured while committing an appalling act of grisly violence. An armed police officer stood sentry at his bedside, and the nature of his crimes gave him a sinister notoriety among the medical staff.

“Alleged” crimes, I should say.

But it was difficult to give him the benefit of the doubt. I’d read the paper and seen the crime scene photos on the news.  The media’s case against him made his innocence hard to fathom, and as a police officer’s daughter I found myself inclined to prejudice. I not only planned on, but also counted on disliking him, at least on some level. Although I would certainly provide care to this man, I exempted myself from caring about him as an individual.

I was surprised to find his demeanor dramatically different than my expectations. He was soft-spoken and retiring, exceedingly polite and appreciative.

I don’t mean to imply that we chatted. Our conversations were limited to his physical condition and general plan of care. He never acknowledged the officer at the bedside or spoke of his alleged crimes, and neither did I.

It’s possible […]

2016-11-21T13:15:59-05:00August 25th, 2010|Nursing, nursing stories|2 Comments
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Reflections on the Freedom to Harm Yourself

By Marcy Phipps, RN

(Identifying details of the patient and clinician mentioned in this post have been changed to protect their anonymity.)

Last week I took care of a woman who’d shot herself in the abdomen. This was the third suicide attempt she’d survived. She was physically compromised, to say the least, and was looking at a long recovery. Her despondence was palpable. 

A clinical psychologist came to evaluate her and determined that she was experiencing major depression with suicidal ideations. 

Usually, such patients are “Baker Acted.” In accordance with the Florida Mental Health Act, commonly referred to as the Baker Act, individuals who are deemed to be a danger to themselves or to others are held involuntarily and transferred to a treatment facility.

But because this patient stated to the psychologist that she was not only willing to seek mental health treatment, but also planned on checking herself into a facility near her home, she didn’t qualify to be involuntarily hospitalized. She was free to leave at any time.

As the psychologist explained to me, the first criterion of the Baker Act only considers whether or not the person in question is refusing treatment. According to Florida Statute 394.463, as long as said person does not refuse to be examined, the Baker Act does not apply.          

Although the psychologist […]

2016-11-21T13:16:51-05:00July 8th, 2010|Ethics, nursing perspective, Patients|3 Comments
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The Long Fall

I wish I could make sense out of why these events unfold on days that start out completely ordinary. I suppose what I’m trying to say is that our lives and goodbyes are completely unpredictable. And it occurs to me that, regardless of the starting height, all falls are “long falls,” and they all happen way too fast.

2016-11-21T13:17:13-05:00June 16th, 2010|Nursing, nursing stories|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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