DOME: PICU Experiences

CENTERPIECE

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CENTERPIECE

-	Room Enough for the Sickest Children
-	PICU Experiences

NEWS REPORT

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CLOSE-UP

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WHO / WHAT

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LETTERS

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PICU Experiences

Family Aid

Social worker Dawn Warfield

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 PICU.

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 together."

Breathing Lessons

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.