There's been an accident on I-95. The parents arrive
at the hospital, believing their child has broken an arm.
Next thing they know, they're ushered to the pediatric
intensive care unit to discover their child is fighting
for his life. Furthermore, they're in a strange city.
They have no money and can't afford the parking or even
the hospital food. It's the kind of situation that's made
to order for social worker Dawn Warfield, who knows how
to help families navigate the turbulent waters of the
Warfield is a quiet, unassuming person until it's time
to advocate for her patients, says Claire Beers, nurse
manager of the PICU. "Then she's a bulldog."
What Warfield likes about her job, she says, is that "when
I come to work, I have no idea what I'll find." Over
her 14-year career, she has tracked down a place for a
father and long-distance trucker to drop off his rig,
planned a graduation ceremony complete with "Pomp
and Circumstance," and arranged for the back seat
of a van to be Federal Expressed overnight for a family
afraid of flying home.
There also are more subtle ways she looks after the families
in her care. Have these parents, under such inordinate
stress, understood one thing the medical team has just
said to them? Are they making sure to take their own medications?
"I love it here," she says. "We see on
this unit the strength of the human spirit, and among
the staff, there's the feeling that we're all in this
Respiratory therapists Chip
Custis (left) and Tom Musselman.
On any given day, two respiratory therapists are at work
on the PICU. Responsible for ventilator management and artificial
airways like endotracheal tubes, they administer oxygen
and mixed medical gases. They operate and maintain a blood
gas lab right on the unit, and they're responsible for transports
within the hospital.
Most of the 34 respiratory therapists in pediatrics are
certified in extracorporeal membrane oxygenation (ECMO),
a complex stand-in for a heart and lung. A one-on-one therapy,
ECMO requires the RT to remain at the patient's side for
the duration, which can be as long as three weeks. "The
ECMO specialist is responsible for the whole system. He's
trained to deal with emergencies with the circuits, the
system and the patient," says Anthony Bilenki, technical
director of respiratory care service.
"It takes a special person to be a respiratory therapist
on this multidisciplinary unit. Not only do you have to
be able to deal with moment-to-moment changes, you also
must be able to work with children in their worst time.
And that," says Bilenki, "takes real compassion."
From Neophyte to PICU Nurse
PICU nurse manager Claire Beers
When the Johns Hopkins Children's Center had difficulty
recruiting experienced pediatric critical care nurses, it
decided to try an experiment. What if the PICU targeted
brand new graduates, and trained them according to the unit's
own rigorous standards? They would be assigned a mentor,
a senior nurse to support and teach them. The goal was to
get the neophytes over the six-month hump, the crucial time
when a nurse is made or broken.
It may not sound revolutionary today, but the idea was practically
heretical in 1987.
"It was not accepted practice to recruit new grads
into an intensive care unit," says Claire Beers, who
created the program 16 years ago as a clinical specialist
and is now the PICU's nurse manager. "Certainly none
of our adult colleagues were doing it."
The program started out tentatively, but soon was fine-tuned
into a structured, 16-week orientation held twice a year
(February and August) to coincide with nursing school graduations.
Because they require such intensive instruction, the nurses
are hired in groups. "Plus, that creates instant peer
groups for support," says Beers.
Beers has a remarkably loyal staff; 50 percent of PICU nurses
have worked here more than five years. "People develop
a passion for taking care of children," she explains.
Yet she knows that circumstances being what they are-a spouse
gets transferred, someone has a baby-she will lose staff
during the year. Then her pool of new grads is her salvation.
By the time the nursing shortage hit nationwide, the PICU's
system was running like clockwork and being emulated in
other intensive care units throughout Hopkins Hospital.
"It's come full circle," says Beers.