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On Its Own Terms: An ICU Nurse Considers Human Adaptability

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. Some of the patient’s identifying details in this post have been changed to protect privacy.

by ashraful kadir/ flickr

I caught an airing of The Shawshank Redemption the other day. It’s one of my favorite movies—full of irony and rich with messages of hope and perseverance.

There’s one line from the movie, in particular, that I love:

“Get busy living, or get busy dying.”

It’s one of my favorite movie quotes, and one that plagued me at work recently as I took care of a woman who’d suffered such a high-level fracture to her cervical spine that her injury was compared to an internal decapitation.

Her doctors had talked with her and her family at length about her injuries and prognosis, and although she’d initially indicated that she wanted to withdraw aggressive care, as time passed her directives became inconsistent—she’d tell her husband one thing, her medical team something else. On the day I was her nurse, she looked at me and very clearly mouthed the words “I don’t want to die,” then shut her eyes tight, ending our brief conversation as effectively as if she’d stood and left the room.

I think that most of the time, at least in the ICU where I work, people aren’t “getting […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:07:26-05:00May 30th, 2013|Nursing, nursing perspective, Patients|3 Comments

Good Medicine

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

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:07:48-05:00April 22nd, 2013|nursing perspective|5 Comments

When Nurse-Patient Boundaries Blur, in Fact or Fiction

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. She currently has an essay appearing in The Examined Life Journal.

Courtesy of the author

Professional boundaries, as defined by the National Council of State Boards of Nursing (NCSBN), are “the spaces between the nurse’s power and the patient’s vulnerability.” The NCSBN describes the nurse–patient relationship as a continuum, with “too little care provider involvement” at one end and “too much care provider involvement” on the other.

The ideal therapeutic nurse–patient relationship lies in the middle, with “no definite lines separating the zone of helpfulness from the ends of the continuum.” I don’t love the indeterminate nature of that definition, but I understand it.

Some time ago, I was surprised by a friendship that developed between a patient and me. It was an unusual circumstance, in that the patient was in the ICU for a very long time for chronic problems that didn’t affect his mental capacity. I was his nurse many times, and through idle chatter during routine care we discovered not only a shared appreciation of literature in general, but a fondness for many of the same authors and books. I started thinking of books I’d bring him, hoping to augment the tedium of his hospital stay. At some point, I started thinking […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:04-05:00March 15th, 2013|Ethics, nursing perspective, Patients|7 Comments

Unanticipated Codes

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. She currently has an essay appearing in The Examined Life Journal.

Code cart/courtesy of author

My mentor once told me that there are almost never unanticipated cardiac arrests in the ICU. I’ve found this to be true. Certain indicators, like laboratory abnormalities or particular cardiac rhythms, can foretell a Code, and sometimes subtle signs trigger an instinctual foreboding that I’ve learned never to ignore.

The conviction that a Code Blue can be anticipated provides a sense of security; if the arrest is anticipated, then it may be preventable. And when it’s inevitable, at least anticipation allows for preparation. I strongly believe this. And yet this weekend my patient coded and I was caught completely off guard.

I had just remarked to one of my colleagues that my petite, elderly Chinese patient (some identifying details have been changed) was looking so much better than she had when I’d admitted her earlier that day from the floor—she’d been in respiratory distress, in a hypertensive crisis, and in need of immediate dialysis. All of the various specialty consultants had seen her and collaborated and I’d had the thought that Ms. M’s day would end very well, that it would be one of those nursing shifts where I’d see a metamorphosis […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:15-05:00February 20th, 2013|nursing perspective|5 Comments

The Depression Project

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. She currently has an essay appearing in The Examined Life Journal.

Wikimedia Commons

Lately, as a long-time runner, I can’t help but draw parallels between working on a nursing research project and training for a distance race set far in the future. Especially in the middle of a long run, when frazzled edges smooth out and clarity settles over me, the similarities between the two are striking. Both require inspiration and a goal, fluid planning and accommodation for the unexpected, and patience.

I casually refer to the nursing research project I’m involved in as “The Depression Project.” It was borne of concern among the ICU nurses about the mental states of the trauma patients in our unit. As the bedside care providers, we often come to know our patients very well; we don’t just care for these people, we sincerely care, and so we’re troubled when we observe, time and again, trauma patients who seem to lose the motivation to engage in their recoveries. They become flat and despondent; they lose hope.

It’s clear to the nurses that while the physical injuries sustained present enormous challenges, the emotional toll is sometimes just as debilitating—yet underestimated. And so we devised a study to illustrate the correlation of depression and recovery.

It’s […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:35-05:00January 9th, 2013|career, Nursing, nursing research, patient experience, Patients|4 Comments

The Patient With No Name: When Nursing Illuminates Literature

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN. She doesn’t usually write about books in her posts, so we hope you enjoy this change of pace.

I didn’t know much about The English Patient when I picked it up recently at a library book sale—I only dimly recalled that the novel had been made into a movie I’d never seen. Since it was published by Michael Ondaatje in 1993, I can hardly blame a lack of time for my lapse. Yet I found myself glad I hadn’t read it until now, as my own nursing experiences suffused my reading of it, leaving me more deeply moved than I might have been otherwise.

The novel is set in the final days of World War II, in a bombed Italian villa that had served as a war hospital. As the story opens, the makeshift hospital has been recently evacuated, with patients and medical staff relocating to Pisa. One nurse remains, though—a young Canadian named Hana. Described as “shell-shocked” due to her experiences during the war, she refuses to leave the damaged hospital or a nameless English patient, who she insists is too fragile to be moved.

Other characters come […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:53-05:00November 16th, 2012|nursing perspective, patient experience, Patients|4 Comments

Can’t Even Think About It: An ICU Nurse’s Personal Taboo

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

The weekend was busy in the ICU; several critically ill trauma patients were admitted in quick succession and the unit was filled with grieving families. The air was heavy with tragedy and misery, and it was draining to work under such weight.

I had a single day off, which didn’t feel like enough, and when I returned to work there were new patients in the beds and the mood in the unit had drastically changed. Disarming, but not surprising; the ICU is always the same and yet different.

One of the young patients from the weekend had become an organ donor, which had been anticipated and was considered a positive outcome, relatively. In discussing the weekend events and the ways in which things had resolved, one of my colleagues mentioned that, if given the opportunity, she’d embrace the chance to go to the operating room with the organ procurement team. Her beloved niece had been an organ donor and she sees organ donation as a validation and continuance of life, an ultimate example of “paying it forward.” She takes great comfort in knowing that her niece did not die in vain; lives were saved. She’d like to see, firsthand, the workings of the surgical team as they extract the organs.

“I would never do that,” […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:07-05:00October 10th, 2012|nursing perspective, Patients|4 Comments

Passion and Fear: Signs of a Kindred Nursing Spirit

Florence Nightingale in Crimean War, from Wikipedia Commons

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

“It’s not that we want something bad to happen; we just want to be there when it does.”

One of my colleagues recently saw that phrase on a T-shirt, and it perfectly echoes the sentiment of the ICU nurses I work with. We’re prepared for crises, primed for instability—and the lower acuity patients who have been populating the ICU lately leave many of us restless and discontented. We start to miss the dramatic cases, the incredible saves and miracles; we miss using our skills. We do see the irony of being in the awkward position of wishing for trauma patients, yet not actually wishing ill on anyone.

I haven’t always embraced unstable patients. When I was a new nurse I simultaneously dreaded yet was drawn to the instability of the ICU. I remember the early morning drives into work, a time of quiet anticipation filled with a gnawing fear that I’d make a mistake or be inexcusably inadequate at a crucial time. I’d pray to gods above to be good enough, to be up to the tasks of the day; I clearly recall, more than once, taking report on an unstable patient and getting physically sick. Dramatic, I know, but born […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:21-05:00September 12th, 2012|career, nursing perspective|1 Comment

Success Being Relative

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

blood bags/ by montuno, via flickr

We trouped in from the parking garage through the fading starlight of early dawn to find most of night shift gathered in one room. Portable surgical lights added to the overhead fluorescence, casting a striking glare on the scene. The patient was ominously flat: his positioning and pallor an instant indicator of his perfusion status, which was confirmed by a quick glance at the monitor. His blood pressure, we said among ourselves, was “in the toilet.”

He’d been in a motor vehicle accident and had suffered a prolonged extrication. There’d been a fatality at the scene. He wasn’t my patient (although he was everyone’s patient, really), so I’m not the one who got the long report. I didn’t know each and every one of his injuries, but I knew the only one that was relevant at the time—his liver was badly fractured and he was bleeding out. His abdomen was hugely distended and firm. He was cold to the touch, and his skin bore the expected pallor of a man in shock.

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:30-05:00August 8th, 2012|nursing perspective, nursing stories|2 Comments

Road Trip: Rehab for the ICU Nurse

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

I took care of Gloria when she was admitted to the ICU after being involved in a high-speed, head-on collision. Although her injuries were very serious, my initial instinct was that she’d recover. I had a good feeling about her; as it turned out, I’d made a mistake in underestimating her mortality.

But everyone did, I think.

For the first few days her plan of care was routine and she progressed as expected. After several surgeries she was being successfully weaned from the ventilator. There was a plan for extubation. Gloria was awake and cooperative with all aspects of treatment.

She had an engaging spirit, and although she was never able to communicate with us well, we became attached to her and quite protective; we often requested taking care of her as our shift assignment, and later become strained and snappish with one another as unexpected complications propelled her along a steep and steady decline. Rehabilitation was ultimately traded for an extended ICU stay; extubation plans were cancelled in lieu of a tracheostomy.

I work among a group of passionate people. We’re determined and diligent. Because of that, a patient’s death in the ICU sometimes feels like a failure. We’re […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:09:40-05:00July 16th, 2012|nursing perspective|4 Comments

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