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  • brandy0208

20 Years as a Critical Care Nurse: A Journey to become a Testifying Nurse Expert Witness

Updated: Feb 16

Being a critical care nurse is an extraordinary profession that demands dedication, expertise, and empathy. Over the past two decades, I have had the privilege of working in various critical care units, specializing in surgical critical care, cardiac surgery, neurology, and neurosurgery.

It has been a challenging yet rewarding journey, filled with professional challenges, life-saving moments, complex medical procedures, continuous learning and profound connections with patients and their families.

In this blog, I'll take you on a glimpse into the world as a new graduate nurse, when their was high competition due to low needs, highlighting the key areas and experiences I have encountered throughout my career that enhance my role as a critical care nurse expert witness.

Nurse Externship: One of my earliest and most profound experiences that helped shape the nurse that I am today was derived as a nurse extern (which meant I was in my senior year of nursing school in a baccalaureate program and paid to learn at the bedside while I was in college). I held this position at Emory University Hospital in the surgical critical care ICU that commenced the summer of my junior year and ended after I took the NCLEX exam.

Honestly, looking back, I found this experience to be the most valuable in my career. I consider this to be the role of an integrated observer. I was not labeled as a nurse extern and used as a patient care tech. I was assigned to be with an experienced nurse. This nurse had no obligation to train me for employment, no need to ensure I was aware of the policies and procedures as a nurse while being accountable for educating me in that regard.

What I did not realize at the time was that these nurses were transparent and showed me who they were as professionals and how they were able to best care for their patients autonomously and as individuals with varying strengths. These nurses were not burdened with teaching me the protocols and the precise policies behind their rationale for providing care in a critical care setting. I was merely an observer and I intentionally noted every interaction and only asked questions to those who genuinely wanted to share openly.

I witnessed patients disguising their contributions to their own health disparities, manipulating their providers to get outcomes they intended, hiding mental disorders and denying thoughts of suicide or drug use. I witnessed a variety of family dynamics and the benefits and disadvantages to overall patient wellbeing and outcomes,

I observed the celebrations and frustrations nurses expressed due to peer relationships, personal views of how they are permitted to provide care under different circumstances and delicate conversations with patients and their families.

I witnessed nurses who felt intimidated when obligated to address an issue with a provider who they knew would brush off their concerns and nurses who spoke up without any regard for how their concerns might be perceived. I enjoyed observing the varying dynamics of collaboration at all levels of care and the impact on overall patient care both in general and in various specific categories. This nurse externship was where I constructed my intention to learn how to communicate effectively to provide my best nursing care and positively impact the lives of the patients and families I served both in the moment and over time.

My First Job: As a new graduate in 2004, I was told by my peers and all of my PhD instructors that I would never be hired in any critical care unit as a "new grad." Perhaps they were right, if I was the type of person to wait for opportunities to come my way and stay limited in my view of how I could best contribute to providing the best care possible to those patients I wanted to serve.

Ironically, I never knew that my applications were denied and rejected by HR before ever having the possibility of reaching any of the nurse managers as I did not have the minimum required years of experience as an RN. Luckily, I had contacted the managers myself and advocated for how my skills would be best utilized and they handled the rest from there.

My first job as a licensed RN was in the Cardiovascular Intensive Care Unit (CVICU) at Emory University Hospital, where I witnessed the incredible resilience of patients recovering from open heart surgeries, including lung and heart transplantation. I became an ECMO Specialist, which included taking care of the full spectrum of population including from the neonate, newborn, pediatric, adolescent, adult to the geriatric age groups. During that time, I learned from such dynamic environments as they demanded both precise, urgent and emergent management. I became familiar with advanced technologies such as ECMO, ventricular assist devides, and Intra-aortic balloon pump (IABP), supporting patients in critical condition within a short period of time.

Expanding Expertise: Transitioning to a different area of care was uncomfortable! The field of neurology and neurosurgery brought a new set of challenges and opportunities for growth and I ensured that leaders in my new role understood that I was a novice prior to employment. In the Neurosurgical Intensive Care Unit (NICU), caring for patients with varying neurological conditions such as stroke, traumatic brain injury (TBI), and post-operative recovery after neurosurgical procedures allowed me to be less bias to one health disparity and become well-versed in neuro and neuro-surgical ICU nursing care.

Advanced certification as a CCRN and NIHSS helped me to not only to understanding the nuances of neurology and the National Institutes of Health Stroke Scale (NIHSS) allowed me to collaborate effectively with the healthcare team to provide total care for patients.

Leadership as a Nurse Coordinator, Educator and Clinical Instructor: Part of my journey involved taking on a role as a nurse educator and clinical instructor. Guiding and mentoring new nurses provided a sense of fulfillment, knowing that I was passing on valuable knowledge and skills to the next generation of critical care nurses. I shared my experiences, helped develop hospital policies, and participated in emergency response protocols to ensure efficient and coordinated care during critical situations.

My First Role as an Expert Witness:

Thirteen years after graduation, I entered the realm of expert witnessing, consulting on a defense case involving nursing standard of care in response to alleged cardiac tamponade. Recognizing the value of my experience and analytical depth, I contributed unique insights that challenged inaccurate expert report conclusions. This role highlighted the importance of my perspective as a nurse expert in legal matter.

Looking back on my 20 years as a critical care nurse, I am grateful for the diverse experiences and knowledge gained. From surgical critical care to neurology and neurosurgery, each phase brought life-saving moments, exposure to advanced medical technologies, and the privilege of caring for patients during their most vulnerable times.

As I continue to grow in my profession and contribute to justice as an expert witness, I intend to carry on the legacy of inspiring fellow nurses on their own critical care journeys. The lessons learned and insights gained throughout this remarkable journey serve as a testament to the resilience and dedication required in the field of critical care nursing.


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