In good hands

The St. Jude ICU: In good hands

In a unique ICU devoted solely to pediatric hematology/oncology patients, dedicated employees care for the hospital’s most vulnerable children.

Julie Huggins, RN, pumps a dollop of hand sanitizer into her palms and gives them a brisk rub. By the time the cool tingle fades, her gloves and gown are intact for the start of her 12-hour shift in the Intensive Care Unit (ICU) at St. Jude Children’s Research Hospital.

She and the staff of nearly 70, including physicians, staff nurses, nurse leaders, nursing care assistants, health unit coordinators and respiratory therapists, provide lifesaving care to more than 300 patients admitted each year to the eight-bed unit—a unique ICU devoted solely to pediatric hematology/oncology patients.

Members of the ICU staff are not immune to the demands of the job, and some say they would be wealthy and retired if they collected a dollar for each time someone asked, “How do you do it?”

“It gets emotional at times because I have two small children of my own,” Huggins says. “I find myself complaining about getting up in the middle of the night because my 3-month-old is fussy, but that’s small compared to what these families are going through.”

Matching the critical need

An impressive nurse-to-patient ratio, staff longevity and improved patient outcomes from best practices in critical care are hallmarks of the St. Jude ICU.

Because of their weakened immune systems from treatment for cancer and other catastrophic diseases, St. Jude patients are at high risk for developing life-threatening infections that require a higher level of care. In the ICU, the critical care team administers antibiotic and fluid therapy and provides 24-hour monitoring to prevent the spread and severity of infections. In some cases, patients require life-supportive services such as mechanical ventilators, renal replacement therapy or other high-level, multi-organ support.

To provide the best possible care, St. Jude offers a staffing model unmatched in most ICUs: a 1-to-1 nurse-to-patient ratio; 2 to 1 when treating the most severe cases.

“Long ago the St. Jude leadership decided that the acuity for these children with cancer is high enough to staff at these ratios in order to provide optimal care for our patients,” says Ray Morrison, MD, St. Jude Critical Care Division chief. “Our ability to staff at a level that gives us a dedicated nurse educator and clinical nurse specialist is essential to nurse retention, job satisfaction and the ability to involve them in critical care at a level that’s commensurate with their expertise.”

The model also underscores the longevity in the St. Jude ICU. Many employees tally their service in double digits. For instance, Michelle Mosby, RN, and Barbara Taylor, RN, have each devoted more than 30 years to St. Jude patients with critical care needs.

“This job is not cut out for everybody,” Taylor says. “I’ve served in several nursing leadership roles and have worked on all shifts. I love bedside critical care nursing and using the technology to provide the best care for our patients.”

Partners in the journey

The ICU staff is sensitive to the uncertain journey that families face during treatment.

“When children are sick, many times parents feel as if they have lost control of caring for their own children. So we partner with them in decision-making and honor family preferences, which is the essence of family-centered care,” says Nan Henderson, RN, an ICU nurse manager. “This gives parents that sense of control back at a time when they feel like there’s nothing they can do to make things better.”

A sign hangs on a wall near the nurses’ station celebrating those caught in the act of caring. This exceptional care has been recognized internally and in the larger medical community.

The nursing staff recently received the prestigious Beacon Award for Critical Care Excellence from the American Association of Critical-Care Nurses. Less than 3 percent of the estimated 6,000 ICUs nationally have received the honor. Most recently, the critical care team was recognized among peers at St. Jude with the Outstanding Clinical Care Improvement Award for significantly improving clinical infrastructure to support the hospital’s mission.

Even these accolades pale in comparison to the greatest reward they receive when they witness miracles in the unit.

Witnesses to miracles

Barbara Robinson, RN, a St. Jude critical care nurse for 16 years, recalls many times when children facing the gravest situations beat the odds.

 “I once worked in an adult ICU and saw many of them face end-of-life issues, but it’s different when children face the same prognosis,” she says. “Coming to St. Jude really opened my eyes. The families are grateful, and the children—many of whom are wise beyond their years—have taught me to appreciate life...”

Before Robinson can continue, an impromptu visit from a 2-year-old underscores the miracles that occur in the ICU. The boy once spent six months in the unit. Now in remission from a stage IV brain tumor, the child and his parent visit the team between clinical appointments.

Pheraby Witham, RN, remembers the early years of critical care when children who received mechanical ventilation after undergoing bone marrow transplantation had a survival rate of less than 1 percent. Many children were not admitted to ICUs because further treatment was deemed futile.

“St. Jude physicians continued trying regardless of the odds,” Witham says. “I remember caring for one patient who was in that less-than-1-percent category. Years later, he ended up being my waiter at a local restaurant. I’ve seen miracles many times when others said there was no way that these children would survive.”

With improvements in critical care medicine, many St. Jude patients in ICU now experience long-term survival.

Pass it on

The ICU nurses share their expertise by participating in clinical studies, implementing practices that improve patient outcomes and publishing their findings in leading nursing journals.

“Much of the existing literature is not geared toward our unique patient population,” explains Yvonne Avent, RN, clinical nurse specialist. “So we review practices in general pediatrics and adult care that have been proven to work, modify them to fit our patient population and monitor our progress.”

Current critical care research includes evaluating outcomes of two diagnostic procedures to examine lung infectious processes in leukemia patients and evaluating the effect that the hospital’s Rapid Response Team has on ICU patient outcomes.

“The Critical Care Division works closely with nursing to evaluate outcomes for children we have discharged, for patients who received and later came off of mechanical ventilators, and for patients who have had critical events,” Avent says. “Our data show that we’ve done very well in all of these areas.”

As St. Jude continues to help set the worldwide standard for pediatric critical care medicine, one ICU veteran plans to devote several more years to the journey.

“To see the many changes and successful patient outcomes that have taken place over the years is truly amazing,” says Barbara Taylor, who has worked in the unit for 36 years. “People always ask me when I plan to retire, and I say, ‘Ooh—not for another eight to 10 years.’”

Reprinted from Promise Autumn 2009

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