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How Can You Not

It was a normal day on my favorite unit— an inpatient oncology unit that specialized in liquid oncology. I was completing my summer fellowship and it was my last day. It was 7:15am— the busiest time in the hospital, and I was greeting my four patients for the day. Four was the maximum one nurse was allowed to have, so I knew it was going to be a busy day for my preceptor and I. By the fourth patient, I felt like I had some time to relax into my day. I was getting in a groove and I had a few spare minutes so I chatted with my patient. A middle aged woman just a little older than my mom who had a nasty form of leukemia. She was taking chemo like a champ and we chatted about her fuchsia pink nail polish. I took her vitals and everything was normal— easy day I thought to myself.

About 45 minutes later, I came back into the room to bring her some water and the air was drastically different. She was struggling to breathe. Counting her respirations thirty one, thirty two, thirty three— I started to panic even though I’ve been trained for three years for situations like this. You allow yourself five good seconds of panic and then you start to think about what you need to do. I quickly bumped her O2 up, threw a pulse ox on, and sent my preceptor a message to come immediately. I did not feel comfortable leaving the room. My preceptor comes gliding into the room, she covers her concern nicely and again raises the O2. It’s time to elevate to the next level now and as we leave the room I’m quietly shaking in my clogs.

Just this morning, we were joking about fashion, and now she is having a clinical emergency. I slide back into the room as the attending and his entourage arrive, and the conversation takes me back. “Honey, I don’t know how to tell you this, but this could be the end for us”. He speaks succinctly but with overwhelming kindness. She’s spiked a fever and is put on high-flow oxygen— they think she has a bug. This is my first family meeting. My goggles fog up as I try to hold back tears. Her husband asks several questions about hospice and the decision is made. Immediate transition to comfort care. Within hours, her family is flowing in and out like a revolving door (we had a visitor limit because of COVID so the family had to take shifts at the bedside) and all orders are switched to measures to keep her comfortable. Her breathlessness increases and she begins to drift into a gentle sleep. We give her medications to keep her calm as breathing becomes more difficult. I bring her daughters coffee and let them tell stories about their mother. She loved to garden, she liked to play with her grandchildren. She wakes up only briefly and asks for a lemon icee. We were out on my unit but you better believe I tracked down this water ice for her. She ended up passing peacefully at the end of my shift with her two daughters at the bedside.

After an experience like this, people often ask me “how can you do oncology?” and my answer is “how can you not?” I had the privilege of caring for this woman and her family at the lowest point they had ever experienced. I had the privilege of holding her daughter’s hand and explaining how we were keeping her mom comfortable. It is really hard for lots of people to understand, but the end of life can be just as beautiful as the beginning if you work hard enough. In oncology, this will certainly not be my last patient death, but the goal is to bring people peace when none is around. Even though this was something that I didn’t feel prepared for and I was really scared about, I feel very privileged to be able to uphold the nursing values of caring for the vulnerable and feel so much gratitude for the experience.

 

Nursing Students are Innovators 

People are usually confused when I tell them I’m a nursing student passionate about entrepreneurship. The typical question I get is, “Why aren’t you in Wharton then?” I usually just want to roll my eyes, but instead, I respond by saying, “Nurses aren’t just at the bedside, we are CEOs, legislators, researchers, and more.”

Nursing students are one of the most powerful minds for innovation on Penn’s campus. As the frontline provider, we have a vital perspective into healthcare and the many challenges that patients face. Within this perspective comes an opportunity to be innovative and creative. This drives the power nursing students have as innovators and entrepreneurs.

I’ve been fortunate to utilize my nursing lens within the entrepreneurship ecosystem at Penn. Through my entrepreneurial projects outside of clinical and studying for anatomy, I’ve learned a lot - especially about the incredible power nurses have to be innovators. And here are some reasons why:

  1. With our ability to empathize with people and view situations in holistic ways, nursing students are primed for being incredible entrepreneurs, who like nurses, need to be able to understand problems, empathize with stakeholders, and find solutions.
  2. Nursing students have a powerful entrepreneurial spirit. We don’t just take orders; rather, we utilize our critical thinking skills to find unique solutions to complex problems.
  3. Nursing students understand people, and we have seen them, interacted with them, and cared for them in their most vulnerable times.
  4. Clinical hours provide us a chance to learn clinical skills, but they also provide us the opportunity to investigate challenges and network with healthcare administrators/nurse managers.
  5. Amid the COVID-19 pandemic, nurses have finally begun receiving the recognition and gratitude they deserve. Now, more than ever, companies such as Johnson & Johnson and Microsoft want to support nurses in their innovative pursuits.
  6. We handle pressure and stressful situations with composure.
  7. We are compassionate people and are driven to make an impact.

In a report issued by Penn Nursing and the consultant group BDO, LLP entitled Unleashing Nurse-Led Innovation, leaders surveyed from both clinical and business sectors agreed that nurses have the greatest opportunity to utilize innovation to transform and improve care for patients by 2025 (BDO, LLC, 2019). While innovation and nursing have not always been coupled terms, it is time to realize that entrepreneurship/innovation has been incorporated into nurses’ daily work since the nineteenth century. As nursing students, we cannot underestimate our innovative ability.

You may be asking yourself, “How am I supposed to balance a heavy course load, clinical, and startup?” and trust me, I ask myself that a lot. However, there are incredible resources on-campus to help you so that pursuing your innovative ideas is not such a burden and can be balanced. Resources like the Penn Nursing Innovation Accelerator, designthinkingforhealth.org platform, the Innovation in Health: Foundations of Design Thinking Case Study course (Nursing 357), the Weiss Tech House, VIP-C, and more!

I encourage you to reach out to your professors, ask patients what is wrong with their care experience, interview nurses and managers about what is challenging for them during clinical — We have the power to truly transform healthcare, and it’s time we start speaking up about it.

If you want to learn more about how to participate in innovation/entrepreneurship on campus, feel free to email me at antsl@nursing.upenn.edu.

Anthony Scarpone-Lambert is a senior and Hillman Scholar at Penn Nursing. Additionally, he is the Co-Founder and CEO of Lumify Care, a startup currently participating in the VIP-X on-campus accelerator.

 

Finding the Positives 

This summer, I had the unique opportunity of working at Curative Inc., a COVID-19 detection laboratory. At Curative, we provided the community with precise oral fluid tests, maintaining a turnaround time of getting results within 24 hours of arriving at the laboratory. Oral fluid tests reduce pressure on the medical supply chain; the test is performed by the patient — a quick and easy 3 step procedure. 1.) for 2 minutes, swab around the walls of the mouth, under the tongue, and the roof of the mouth 2.) place the swab into the tube 3.) gently swirl the swab.

Each day, I worked with up to 1,000 patient samples, utilizing a single-channel pipette to precisely extract fluid from patient tubes into a 96 well plate. This procedure took extreme stability because of its high possibility of contamination. Through my time at Curative, I was able to perfect my pipetting skills thanks to the high volume of tests I encountered daily. I had the opportunity to learn how to operate the Hamilton Microlab STAR Liquid Handling machinery, an machinery for automatic extraction, tripling output rate. These were skills I never would have never had the chance to develop during nursing school!

This experience taught me persistence; we were constantly working tiring 8 hour shifts, filled with 4:30 am wake ups, back aching work from pipetting all day, and difficult breathing conditions due to wearing N-95 masks the whole shift. However, this was worth our efforts in order to insure patients had their results as soon as possible. Even though I was exhausted, I knew that the work I was doing was helping to aid the current global pandemic - lives were being saved.

During my time at Curative, I was able to witness many milestones. After operating for only 5 months, the company hit one million tests analyzed. Two weeks later, we hit 2 million tests analyzed. I am happy I was able to have the opportunity to be a part of a company and have been inspired working here, as Curative finds new ways to improve, learn, and grow every day in order to slow the spread of COVID-19.

Vanesse Tan is junior in the traditional BSN Program