On watch

On watch …

Health care is littered with acronyms. R.N. is one of the most important.

By April Frawley
Until her graduation in December, Kristen Lewis divided her time between her duties as a UF Health Jacksonville nurse in the mother-baby unit and a UF College of Nursing nurse-midwifery student.

Until her graduation in December, Kristen Lewis divided her time between her duties as a UF Health Jacksonville nurse in the mother-baby unit and a UF College of Nursing nurse-midwifery student.

The monitors beep a steady cadence as nurses flit across the room, curtains ruffling as they pass by to check on their patients, most still groggy from surgery. The lights are low inside the recovery unit on the second floor of UF Health Shands Hospital, and the sounds are muted, aside from the ever-present beeping. Standing near one of the curtains, Jesse Stubblefield, R.N., taps on a computer. She’s been at work less than an hour and her first patient of the day sits a few feet away, a 1-year-old boy cradled in his mother’s arms.

Stepping closer, she leans down, smiling at the little boy, Myles Cobb, who’s recovering from a minor surgery. She grins as she checks on him, eliciting a half smile from the still-sleepy toddler.

Stubblefield graduated from nursing school in 2012 and has worked in the recovery unit — technically called the post-anesthesia care unit — since July. She’s relatively new on the job, but when it comes to patients, she already knows it’s often the little things that count the most. Patients and their families are particularly stressed out on the day of surgery, when Stubblefield sees her patients. So doing something as simple as keeping patients informed about when their rooms will be ready or chatting with them about where they are from can make the difference between a good day and a bad one.

“I just try to make people comfortable with me and let them know I am there for them, and that I am not just here to work,” Stubblefield says. “Your patients recover better if they connect with you and if they feel comfortable. They relax.”

In fact, according to a 2007 review of 28 studies in the journal Medical Care, increased nurse staffing rates were strongly linked to reduced mortality and rates of adverse events in hospitals.

In the world of health care, it takes a team of professionals to care for each patient, from physicians and nurses to technicians and the support staff who provide food and clean rooms. But it’s the nurses who are on the front lines of each patient’s struggle, who are there to assist with every need and to advocate for patients and coordinate their care.

Given the transformative changes happening in health care in the United States and the growing health needs of an aging population, the importance of nurses will only continue to grow. According to a 2010 report from the Institute of Medicine and Robert Wood Johnson Foundation, ensuring that nurses are supported and able to contribute all of their training to a health team is a crucial aspect to improving health care in the United States.

“Nurses have an ability to impact patients’ lives and outcomes in simple ways,” says Sandra Citty, Ph.D., R.N., ARNP-BC, a clinical assistant professor of nursing in the UF College of Nursing. “Good nursing care can improve outcomes, get patients home quicker, help them get better faster and stop them from having adverse problems.”

Jesse Stubblefield, a nurse in the recovery unit, checks on toddler Myles Cobb after his minor surgery.

Jesse Stubblefield, a nurse in the recovery unit, checks on toddler Myles Cobb after his minor surgery.

With a leading College of Nursing and as one of only 19 health systems that has received Magnet designation from the American Nursing Credentialing Center three times, UF Health is poised to not only provide superior nursing care but also to educate the next generation of nurses and nursing leaders.

In this month’s issue of The POST, we show you just a few of the ways UF Health nurses, nursing faculty and nurses-to-be are changing the face of health care one patient at a time.


The advocates

The mother was sick — very sick — and her baby would be born premature. It wasn’t the picture-perfect birth scenario most new mothers imagine. But there was one way UF Health Shands Hospital labor and delivery nurse Anna Walker, R.N., thought she could make a difference — helping the mother feed her child.

Because both mother and baby were sick and located in different intensive care units, Walker teamed with Lindsey Vlaardingerbroek, A.S.N., R.N., and Ashlee Noorthoek, B.S.N., R.N., from the neonatal intensive care unit to hand-express the mother’s milk and deliver it to her baby. The Adult ICU nursing team also assisted the nurses with the request. The effort earned Walker, Vlaardingerbroek and Noorthoek the hospital’s first-ever DAISY Award. The DAISY Foundation created the award to say thank you to nurses for their contributions to care.

“I think that situation highlights the kind of care all third floor nurses provide,” says Jan McKenzie, R.N., the nurse manager for labor and delivery at UF Health Shands Hospital. “Many of our moms are high-risk and are not going to have that birth center experience, but that doesn’t mean it can’t be beautiful. That is where our nurses shine — in stepping out of the box and helping them have the best birth experience possible.”

Advocating for patients when they can’t advocate for themselves is just one of the many things nurses do for those in their care. It’s an example of the types of relationships nurses build with patients during their shifts. As a nurse in the mother-baby unit at UF Health Jacksonville as well as a recent graduate of the College of Nursing’s nurse-midwifery program in Jacksonville, Kristen Lewis, M.S.N., R.N., spends her days building relationships with moms-to-be and new moms.

“With bedside nursing, you are a consistent face your patient sees for 12 hours,” she says. “You really get a chance to bond with them, help them and advocate for them.”

During the fall semester, one of Lewis’s patients was hoping to have a vaginal delivery even though her previous child had been born by cesarean section. Because uterine rupture can be a risk, many women who had a cesarean section for their first child opt for a repeat procedure, but trying for a vaginal birth the second time around has become more common. During the woman’s long stay in the hospital, Lewis stopped by to visit her and encourage her.

“I let her know we were supporting her and advocating for her and keeping her informed,” Lewis says. “She had a beautiful delivery. I caught her baby and it was fantastic.

“That is the biggest part of what I do, helping women and making sure they have what they need on an individual level.”


The guardians

Before last fall, nursing student Joseph Doromal had never seen a patient who was dying. Most of the patients he’d met in the hospital were recovering or at least had hope of getting better. But that day during one of his clinical rotations, working under the supervision of a nurse, he assisted in an assessment of a woman in severe pain. In pain and emotionally distraught, the woman had no friends or family by her side. Although the nurse he was working with that day had other patients to tend, Doromal stayed with the woman, comforting her.

“The nursing staff became her family,” Doromal says.

As part of his education in the UF College of Nursing, Doromal has learned that the most crucial aspect nurses provide to patients is comprehensive care, covering all patient needs, even the emotional ones at times.

“Before she died, she wanted to thank us for all we did for her,” he says.

Kristen LewisFor patient Steven Blackmon, 23, hospital stays would be nearly unbearable without the constant support of his nurses. For the past two years, Blackmon has been in and out of the hospital with a heart condition. The days can be long, sitting in a hospital bed, he says, reclining in his hospital room during a recent stay. Nurses make a patient’s days better, he says.

“Some nurses I have seen from two years ago,” he says. “We just throw jokes at each other. They get to know you and your sense of humor; you joke around all day long. It’s just fun. I like making people laugh. You can’t just sit around and feel sorry for yourself. It’s not going to work.”

Some studies have even looked at humor and the benefits it can have for both patient and nurse, particularly in relieving stress.

The relationships hospital nurses develop with their patients can also assist with what is arguably their most crucial role on the patient care team — monitoring and evaluating their patients and watching for even the most subtle changes in a patient’s condition. Think of each patient as a unique world, with its own issues and problems and a delicate ecosystem to manage. The nurses are the guardians of these worlds.

“Hospitalized patients are undergoing physiological stressors that affect their hemodynamic (blood flow) stability and there can be significant variability in vital sign measurements throughout the day based on the medications they take, the food/fluids they consume, the activity they do,” Citty says. “Smart computer systems can help R.N.s give safe care, but they have limitations. For example, a computer will prompt nurses to document blood pressure before giving hypertension medication, but it may not ask about other things that need to be addressed before giving particular medications. Nurses need to be have excellent critical thinking skills to anticipate threats to patient health and well-being.”


The leaders

Of course, bedside nursing isn’t the only type of service nurses provide, and the UF College of Nursing is a national leader in producing not only the next generation of staff nurses, but also nursing leaders, researchers and nurse practitioners.

The college is home to a Doctor of Nursing Practice program — the highest level of clinical education a nurse can receive — and offers several tracks for students looking to pursue advanced nursing practice, including the nurse-midwifery program.

With nursing being such a crucial component of UF Health and the care and education it provides, nursing leaders in the hospital and in the College of Nursing have been working to build a stronger relationship between the two entities. The College of Nursing and UF Health nursing are strengthening their collaboration in keeping with national recommendations to build academic/practice partnerships. Effective partnerships can create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, and provide mechanisms for lifelong learning. New College of Nursing dean Anna McDaniel, Ph.D., R.N., and Irene Alexaitis, M.S.N., R.N., vice president of nursing services for UF Health, have been working closely together to achieve these goals.

“The partnership with UF Health and the College of Nursing is great,” Citty says. “It helps improve patient care and promotes strong collaboration. We have faculty who teach in our college who are also clinicians at UF Health Shands Hospital. That really helps on both sides of the fence.

“Our students really enjoy working in the hospital, and they learn a lot. We have a lot of sick patients and expert clinicians to care for them. They get to see a lot and do a lot. Educating them is a big responsibility.”


Jesse Nurse_MBF_IMG_0084A few months ago, Jesse Stubblefield got a surprise when she came back to work after a couple of days off — a bouquet of flowers for her, sent by a patient who had spent a long time in the recovery unit while waiting for a room. Stubblefield kept the woman and her husband informed and checked in on them frequently, bonding with them so the wait wasn’t so bad. For her efforts, she also was nominated for a DAISY Award. Stubblefield tries to shrug it off, downplaying her role that day.

But having these types of interactions with patients is exactly what drew her to nursing in the first place. She was a land surveyor prior to entering nursing school. Listening to her mother, also a nurse at UF Health Shands Hospital, talk about her patients convinced Stubblefield that she wanted to be a nurse, too.

“People remember you,” she says. “On a scary day, they know they had someone there they trusted.”