December 20, 2014

From The Editor

While we’re celebrating stars of the health care system—see "Top Doctors 2011" on p.50—let’s take a moment to look in on their can’t-do-without-’em teammates—the nurses. I caught up with nurse manager Erin Raney recently to check in on the state of her art here in Southwest Florida.

Erin came to Naples nine years ago as a staff nurse at NCH and is now in charge of 35 to 40 people in the orthopedic unit. If you’ve got a fracture or need a joint replaced, that’s where you go. Each nurse works three 12-hour shifts a week, and the job requires that you help decide treatment, carry out orders for medication, coordinate therapies, administer bedside treatments and provide emotional support to patients and family members. Erin gave me a sense of the drama and the challenges of ministering to a patient’s every need.

The Drama. "A couple of weeks ago," says Erin, "a man came in with a leg fracture from an ATV accident. He was in a lot of pain." The nurse noted the increasing pressure in his leg and feared that as it increased it was cutting off the circulation and could possibly require amputation. "Her early diagnosis," says Erin, "got the team in action." He was rushed to surgery for an incision to relieve the pressure, and the case went on normally from there.

More Drama. Erin tells of another kind of problem, the delicate art of facilitating people’s wishes. "We recently admitted a man with a hip fracture and multiple medical issues," she says. "He was saying, ‘I don’t want to go on.’ His wife was very upset. We brought up moving him to hospice, and we called his sons in on this, too." The family finally agreed to this and got the hospice service they felt was best under the circumstances.

No Drama, But Lots of Caring. "We may be highly trained," says Erin, "but we’ll do the most basic things to make our patients feel better. We will sweep floors. We’ll walk outside to the newspaper box so a patient will have a crossword puzzle. We’ll sometimes use our own money for a special treat from the cafeteria."

Challenges: Phasing in High-Tech. Erin and her team are right in the middle of the goodbye, paper‐hello, electronics revolution in hospital records and tracking systems. Now, a patient’s medications are in the computer, the doctor puts his orders there and a bar coding is included as a safety precaution. Erin says NCH is testing a new system that takes vital signs and flows them into medical records. Some doctors, she reports, are using iPads at patients’ bedsides and can, for example, show them their X-rays. NCH is also trying out smart-room technology with screens transmitting information helpful to those giving and receiving care. "This is all exciting, cutting-edge stuff for us," says Erin.

Challenges: Dealing with Pain and Loss. Says Erin: "Some nurses internalize the hurt from their most difficult cases; some like to talk it out with their colleagues. Early in my career, I used to go home asking myself what I could have done differently. Now, I’m just as caring, but try to remain confident in knowing that I did the best I could. We stay in touch with a number of the patients after their release and love to hear them saying things like ‘I’m golfing again and walking without a cane."

"I’d say, if you’ve got a break, you’ve caught a break if you’re in Erin’s unit. You can be sure of alert and cutting-edge treatment from people who care. What more could you ask?