Champion Series: Being 'the Consistent'

For this glimpse into the typical day of a nurse practitioner at Arkansas Children's, we spent time with Jennifer York, APRN, MNSc, CPNP-AC. She's been a nurse with the general surgery and trauma team at Arkansas Children's Hospital (ACH) for five years and is this year's APRN of the Year for Arkansas Children's. By the time we caught up with Jennifer at 9:30 a.m. on a Friday in June, she had already been at work four hours. Her shift begins at 5:30 a.m. and ends at 7 p.m. It's difficult to describe our time with York as "a typical day" because ATV accidents and appendicitis don't happen on a predictable schedule. Every day is different for a nurse practitioner on the trauma team, but there are some consistent elements.

Rounds, Charts, Tertiary Exams, Education

When she arrives at 5:30 a.m., York prints the patient list she'll carry around and make notes on for the rest of the day. She checks for changes in feeding schedules or whether labs have been ordered or completed - all prep work for rounds at 6:15. During rounds, APRNs meet with residents, fellow nurses and physicians outside each patient's room to review treatments, lab results or changes in patient behavior or needs. These meetings look like informal gatherings but are packed with useful patient information:

• Is the patient eating or drinking too much or too little?
  
• How have they responded to different medications?
  
• When do dosages need to change?
  

These details and more are taken to a meeting with the attending physicians at 7 a.m., where they "run the list," which means making and adjusting treatment plans individualized for each patient. After completing formal rounds, York and fellow trauma nurse Brianna Gammon, APRN, are scheduled to do a tertiary exam on a trauma patient. On the way to the exam, York is asked to talk to a patient's family about a brief delay in surgery.

“We are the communication between the nursing staff and the patient,” York said, which means sometimes they deliver news families aren’t excited to hear.

Requests to talk to caregivers, like trauma patients, can come anytime during the shift. Responding compassionately and professionally on short notice is one of the defining traits of APRNs. Having a sharp eye for detail is another.

Tertiary exams happen the day after a trauma patient is admitted because less obvious or minor injuries, like a broken finger, can be overlooked during the initial treatment of a severe injury. Nurse practitioners ensure all necessary imaging (X-rays, CT scans, MRIs) has been completed and reviewed. York said common injuries seen at ACH are spinal fractures, head injuries, broken bones and bowel injuries, including those that happen when a child is in a car accident while not wearing their seatbelt correctly. Details from the exam are entered into the patient's chart and factor into treatment plans.

Tertiary exams are one reason nurse practitioners have the most thorough knowledge of the patients. Time spent doing exams or educating patients and their caregivers on the proper use of medications or how to do daily activities while wearing a cast strengthens the relationship nurse practitioners have with patients and caregivers.

"The most rewarding part of my job is getting to know the families and taking care of patients," York said. "We can ease some minds, calm some fears. I think that's my favorite part of the job. It's fun to see them get better and be an integral part of that."

Some days, being a part of the recovery process means taking a patient to the atrium or answering questions from parents. On other days, it means responding to four traumas within 30 minutes of each other. York and her colleagues bring stability to unpredictable days. "We are the air traffic control of trauma," she said. York also described APRNs as being 'the consistent.'

In addition to the constant influx of new patients, cohorts of interns and residents also regularly cycle through ACH, because it’s a teaching hospital.

"[Nurse practitioners] are the consistent," York said. "We are always here. We know the patient inside and out."

APRNs like Jennifer York champion children by spending time with patients every day. Knowing patients inside and out is one way Arkansas Children's delivers compassionate care and excellent outcomes.