Nurses Make the Difference

Natalie and Michelle Razore

“Until Natalie got sick, I had no idea how much nurses do, and how important they are in the care of a child,” says Michelle Razore, who spent three months at Children's last year while her infant daughter fought pertussis, a dangerous bacterial infection. “Natalie's nurses were her advocates, and they treated her like their own child.”

Nurses work on the front line of patient care and are the eyes and ears of the medical team.

If everything you knew about the medical profession came from prime-time doctor dramas, you might think nurses are minor characters in healthcare, working around the edges and in the background.

That’s not a mistake you'd make after you – or someone close to you – spends time in a hospital, says Michelle Razore, who spent nearly three months at Seattle Children’s last year while her infant daughter, Natalie, beat the odds against a near fatal bout of whooping cough, a deadly bacterial infection that affects the lungs.

Administering intravenous medication? Nurses do it. Running technologically sophisticated life-saving equipment in the intensive care unit? That too. Managing a patient’s care 24/7 while staying tuned in to the physical and emotional needs of patients and families? You guessed it – nurses.

80% of patient care on inpatient units is provided by nurses. 1,300 nurses practice at Seattle Children's.

Nurses are the front line of patient care: the eyes and ears of the medical team. They are teachers, care coordinators and advocates whose clinical judgment helps steer the course of our patients’ medical care.

“I give nurses so much more credit now,” says Razore. “Natalie’s doctors were amazing, but it was the nurses who were by her side every second.”

The nursing team at Children’s – more than 1,300 strong and by far the largest segment of our work force – is among the nation’s best. In 2008, our nurses earned Magnet designation – the most prestigious nursing credential in the U.S. – from the American Nurses Credentialing Center. Only 6.6% of hospitals in the U.S. achieve Magnet status.

What makes nurses at Children’s so good? Well, there are more than 1,300 answers to that question. Here’s a glimpse at three of them.

Care for the long run

Jason Cruz and Karl Bielser

Four years after his heart transplant, Karl Bielser, right, is looking forward to college next year. Jason Cruz, RN, a transplant coordinator in Seattle Children's Heart Center, is helping him learn to be responsible for his own healthcare.

When Jason Cruz first became a nurse, he got a kick from the quick fix.

“Sick or injured patients would come to the medical unit where I worked, and in a few days they would be healthy enough to go home,” recalls Cruz. “It was very rewarding to quickly make a significant difference in people’s lives.”

A decade later, Cruz still gets a kick from making a difference – but now his care plays out over years instead of days. As one of four transplant coordinators at Children’s Heart Center, his relationship with a family starts the moment they learn that their child’s life depends on getting a heart transplant, and it doesn’t end until he helps them transition to an adult healthcare setting.

Cruz met Karl Bielser and his family six years ago, shortly after they found out that the weakness and shortness of breath they had attributed to asthma were actually symptoms of advanced heart disease. Karl needed a transplant to survive.

The sicker Karl got, the more time he spent at Children’s. His doctors worked to keep him well enough to withstand a transplant, and Cruz gave the Bielsers an in-depth education about Karl’s heart condition and guided them through what he calls the “transplant maze” – coordinating visits with specialists, keeping tabs on lab work and ensuring the Bielsers understood every aspect of Karl’s healthcare. When they were discouraged, he buoyed their spirits by introducing them to other young patients who were thriving with transplanted hearts.

“Waiting for Karl’s heart was just awful,” says his mom, Julie Bielser. “We were in a fog and Jason was our lifeline, always available to answer our questions – day or night.”

Karl waited nearly a year for a heart. After the transplant, Cruz shifted into post-transplant mode, working with his family, his school and his pediatrician in Stanwood, Wash., to plan a transition back to everyday life. Cruz helps Karl’s parents understand his continuing medical needs and stays in close touch, fielding their calls and addressing their worries. Today, Karl is a 17-year-old high school senior, and Cruz is teaching him to take responsibility for his own health.

“Providing care over time is enormously gratifying,” says Cruz. “It’s a privilege to get to know families and to support them throughout this long, intense journey.”

Licensed independent provider

Debra Ewing-Lonczak

“My goal is to cause as little agitation or discomfort as possible to the patient while I do my job,” says nurse practitioner Debra Ewing-Lonczak. Among her secret weapons is an old-fashioned Mickey Mouse watch that plays music to distract and reward her young patients.

In Children’s pre-anesthesia clinic, Debra Ewing-Lonczak, ARNP, is in charge of making sure babies, children and teens can safely tolerate anesthesia before they have surgery or imaging procedures. She checks their hearts, lungs and airways; confirms that any chronic conditions are under control; and educates families about what to expect before, during and after anesthesia.

It’s a job that, until recently, anesthesiologists performed.

As an advanced registered nurse practitioner (ARNP), Ewing-Lonczak is what’s known as a “licensed independent provider.” Her state-issued ARNP license allows her to direct a patient’s care on her own and to prescribe medications and other treatments. Like physicians, nurse practitioners make referrals when it’s appropriate, and they collaborate with doctors and other specialists to provide the best patient care.

When Ewing-Lonczak became a nurse practitioner – as a U.S. Army nurse three decades ago – she needed advanced training to enter the profession, but not an advanced academic degree. Today, nurse practitioners must earn a master’s degree in nursing. All nurse practitioners must maintain certification by a national board and participate in continuing education.

“Open communication increases parents’ peace of mind and decreases a patient’s anxiety – and that’s good for everyone.”

Dr. Lynn Martin

Shifting the pre-anesthesia exam to nurse practitioners makes sense, says Ewing-Lonczak. It enables her to practice to the highest level of her training and ability, and it frees anesthesiologists to be in the operating room doing what they are uniquely qualified to do – safely administering anesthesia and monitoring patients during surgery.

And there are other advantages. “We’ve found that families are often more comfortable with nurse practitioners than they are with physicians. They’re more likely to ask them questions,” says Dr. Lynn Martin, chief of anesthesiology at Children’s. “Open communication increases parents’ peace of mind and decreases a patient’s anxiety – and that’s good for everyone.”

Grace under pressure

Ingrid Patnode

As practice keeps pace with the latest research, things change constantly in the intensive care unit. “I learn 10 new things every day, and that's my favorite part of this job,” says critical care nurse Ingrid Patnode.

Every time she goes to work, critical care nurse Ingrid Patnode enters a family’s personal crisis.

“For most families, having their child in intensive care is the worst thing they’ve ever been through,” she says. “Though my top priority is meeting my patient’s medical needs, helping families cope with the psychological stress is a huge part of what I do.”

“Life on the intensive care unit (ICU) was crazy,” recalls Razore, who spent more than a month on the unit while Natalie was acutely ill. “The people, noise and activity in our room were constant.”

Patnode and other ICU nurses constantly monitored and interpreted data from the life-saving equipment keeping Natalie alive, including a machine that enabled her to breathe and kept her heart working so her overstressed lungs could heal. Other machines helped her kidneys work and administered precise doses of medication.

Susan Heath

“Advocating for children and families is an essential part of nursing practice at Seattle Children's. Nurses have a strong voice in influencing the plan of care for patients, and our provider teams welcome their insights,” says Susan Heath, Children's chief nursing officer.

During that time, Patnode cared for Natalie every shift she worked – a choice the hospital makes to ensure consistent care during a long, complicated illness. Her regular presence also gave the Razores – who were stressed and overwhelmed – a trusted interpreter and guide.

“Ingrid answered our questions and made sure we knew what was happening,” says Razore. “She made us laugh when that’s what we needed. But most of all, she got to know Natalie better than any other care provider and she became her strongest advocate.”

“These kids are like puzzles – the more brains working to solve their illness, the better,” says Patnode.

Step by baby step, Natalie started to recover. “Natalie was a rock star,” says Patnode. “She was very, very sick, but she was also feisty and strong.”

She used every ounce of that strength to overcome the significant odds against her, and on Christmas Eve 2010 Natalie went home. In September 2011, Natalie’s family and friends celebrated her first birthday with a special gift to Children’s: the Natalie Razore Rockstar Fund.

“It’s a miracle that Children’s was right in our backyard with the expertise and technology Natalie needed to survive,” says Razore. “We can never repay Children’s for saving her life. But we can try to pay our luck forward to help other kids who need the type of care Natalie received.”