Jennifer has been a palliative care nurse for over 10 years. She is well known for her ability to advocate for patients and families and goes above and beyond to support them. This past Saturday, there was a situation that depicts her ability to navigate the most challenging of situations to ultimately accomplish what a patient/family truly needs most.

On Saturdays, there is only one palliative nurse at the hospital triaging all of the current patients on the palliative care census and handling any new referrals that come in. She was covering for one of our other nurses by providing support to the family of a patient who had been involved in a traumatic motor vehicle accident. He was only 26 years old, and his wife, who had been in the accident with him, was also briefly hospitalized and recently discharged. The patient was critically ill, not only on ventilator support but on Veletri, an inhaled form for relaxing the blood vessels in the lungs to lower pressure (treating pulmonary hypertension). Due to the severity of the injuries to his lungs, it became apparent that the patient would require that he be placed on ECMO (extracorporeal membrane oxygenation) to temporarily take over the function of his heart and lungs to allow for further intervention and healing.

Prior to the weekend, the pulmonary NP had worked diligently to try to arrange transfer to a higher level of care at either Vanderbilt in TN or Barnes-Jewish in St Louis. When Saturday rolled around, it came to Jennifer's attention that the patient could not be life-flighted due to requiring Veletri, which can not be accommodated on a flight. He was also unable to be taken by the critical care ground transport team due to the fact that there were no other level one trauma centers along the route in case the patient would need to have care at a facility along the way. These were the obstacles that Jennifer faced: a pulmonary physician and trauma team physician that were covering the weekend so it was "Day 1" with the patient, critical care residents that did not have the experience in facilitating a transfer to higher level of care, case managers covering for the weekend that were also "Day 1 with the patient and a family that was experiencing a very high level of stress, feeling like no one was helping them get their loved one to where he needed to be. The family was even making calls themselves to try to see how the patient could be transported. Jennifer, who was also "Day 1" with this patient and family, made it her priority for the day to figure this out, so as she simply put it, "he did not die here in our hospital waiting for a plan to come together".

To be clear, her role as a palliative nurse was to offer support and education to his family, and all that she accomplished this Saturday reached far outside her expected role. She made calls to transport teams, facilitated communication between the physicians following the case, worked with the case managers and bedside nurse, and provided clear communication to the family. She took the brunt of some expressed frustration by care team members, including physicians, and did not let this affect her mission to take care of this patient and family. Ultimately, with adjustments in the patient's care interventions and medications made by physicians coming together via her coordination, the patient was able to safely transfer via life flight to Vanderbilt University Medical Center to receive the life-saving care that he needed.