(click here to see source document)

Background: Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes.

Objective: To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet.

Research Design: Retrospective, 2-stage panel design using 4 secondary data sources.

Subjects: One hundred thirty-six Pennsylvania hospitals (11 emerging Magnets and 125 non-Magnets).

Measures: American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index.

Methods: Fixed-effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet.

Results: Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (P<0.01) and 6.1 fewer deaths per 1000 patients (P=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes.

Conclusions: In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals.


Kutney-Lee, Ann PhD, RN; Stimpfel, Amy Witkoski PhD, RN; Sloane, Douglas M. PhD; Cimiotti, Jeannie P. PhD, RN; Quinn, Lisa W. PhD, RN; Aiken, Linda H. PhD, RN

2015 is the 100th anniversary of Florence Nightingale’s Death.   And May 12th is typically thought of as Florence’s Birthday.  So pause for a moment and reflect on our profession and the legacy we offer to our communities.  We are clearly a profession worth celebrating.

For entertainment, here are some of Florence’s pledges.  The original and a more contemporary version:

Original “Florence Nightingale Pledge”

  • I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully.
  • I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug.
  • I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling.
  • I shall be loyal to my work and devoted towards the welfare of those committed to my care.

Interestingly, the pledge was not written by Florence Nightingale. The pledge was actually written by a committee at the Farrand Training School for Nurses in Detroit, Michigan, in 1893. The committee was chaired by Lystra Gretter

“Practical Nurse Pledge”, a modern version based on the “Nightingale Pledge”

Before God and those assembled here, I solemnly pledge:

  • To adhere to the code of ethics of the nursing profession
  • To co-operate faithfully with the other members of the nursing team and to carryout [sic] faithfully and to the best of my ability the instructions of the physician or the nurse who may be assigned to supervise my work
  • I will not do anything evil or malicious and I will not knowingly give any harmful drug or assist in malpractice
  • I will not reveal any confidential information that may come to my knowledge in the course of my work
  • And I pledge myself to do all in my power to raise the standards and prestige of the practical nursing
  • May my life be devoted to service and to the high ideals of the nursing profession

However a favorite comes from “the truth about nursing” and is quite inspirational:

As I care for you, it is my job to protect you from all harm. That means any harm from your illness or its symptoms, from outside forces including the care environment, and from other people if necessary, even those involved with your health care or health financing. As an autonomous health professional who reports only to senior nurses, it is my job to defend you from poor or misguided health care from any source. I am your advocate. I vow to do my best to protect you as if you are a member of my family.

So go forth and celebrate choosing profession that makes the world better. – Jim Kane



It was another Saturday night in the intermediate step-down unit where I had been working as a registered nurse for a little over a year.  I suctioned Harry and decided to bathe him because it was already 4 AM, and I thought I’d have him “fluffed and buffed” by the change of shift.

Harry and I spent many Saturday nights together.  We had CNN on and the lights dimmed while I chattered to this 69-year-old man who was far away from home.  He and his wife Claire had been driving through Pittsburgh in their Winnebago, fulfilling a dream to travel throughout the United States.

On a cool March morning, Harry and Claire stopped to “gas up” the Winnebago and have breakfast before moving on to Washington, D. C. to see the cherry blossoms in bloom.  As the two began to drive out of the gas station, Harry clutched his chest and, putting the Winnebago in park, lost consciousness.

Alone in a strange city without family or friends, Claire called 911, described their situation, and waited for help.  The paramedics arrived, stabilized Harry, and sent them to Allegheny General Hospital.  After an unsuccessful angioplasty of his coronary blood vessels, Harry was sent to the OR for emergent coronary bypass surgery.  Harry never regained consciousness.  He was put on a ventilator and his electrolytes were unstable.  The calendar changed.  Harry’s mediastinal wounds had healed, and Claire continued to sit faithfully by his side day after day, but Harry was still asleep after sixty-one days.

I bathed Harry as I continued my one-sided conversation with him about my diabetic dog.  I washed his arm and carefully in between each and every finger, because nurses often forget those parts, and then I respectfully asked Harry to hold his arm up so that I could wash under it, though I knew he couldn’t hear me.  This evening was different for Harry and me though.  This time when I asked him to hold up his arm, I could feel his arm straighten and stiffen.  I let go of his wrist and his arm stayed in the air!

With tears in my eyes, I asked Harry if he could hear me, but his eyes remained shut and his facial expression was unchanged.  I then asked him to squeeze my hand and he did.  By the end of the week Harry was awake and following commands. Eleven weeks after surgery, Harry’s tracheostomy tube had been capped and he began to whisper.

Harry asked where he was, and where was Claire, his wife and best friend for 37 years.  We had been chatting for an hour when he looked at me with the deepest blue eyes I have ever seen in a man his age, and asked me how my dog was.  Stories about my diabetic dog, Marti’s little girl, Dr. Rich’s fishing trip, and details about a surprise spring snow began pouring from his lips.  I’ve had patients tell me stories that they had remembered hearing while asleep, but never did a patient remember so many different stories in so much detail.  After 77 days, Harry and Claire walked out of the hospital together to go home to Oregon to recuperate.

Nine years have passed since I met Harry, and I continue to talk to my patients about the weather, world issues, their family, and what has been happening on my favorite television shows, even though my patients may be unconscious or unable to clearly understand the words that I babble.

I know that my patients can hear me speak hopeful words.  They can feel me touch them with caring hands, and they know, for that moment, that I am caring only about them while I wait for them to wake from a sleep that cannot always end with a stretch and a yawn.

Karen A. Tarolli, RN, BSN

Allegheny General Hospital, Pittsburgh, PA

Mrs. Dundee was a 50-year-old woman with end-stage lung cancer, which had metastasized to her brain and bones.  She was from out-of-state, but she and her husband had done their homework and selected our university teaching hospital and our doctors.  I’d spoken to Mr. Dundee twice while Mrs. D was semiconscious, and had established some rapport.

Family and friends from all over were gathering to say goodbye to the patient, including her daughter who was eight months pregnant.  The room was often filled with laughter and tears, and many loving stories of good times in the past.

I visited one day, and was surprised to see the patient out of bed.   I greeted Mrs. Dundee, she began talking softly, her voice barely audible.  Her friends began interpreting her statements to me, explaining that Mrs. D was meaning this or that, and that she was confused. I continued to focus on the patient, and encouraged Mrs. Dundee to speak.  I also encouraged the family to listen to her.

Mrs. Dundee then told us an amazing story of sitting alone in her motor home soon after being diagnosed with cancer.  She described crying her heart out, overcome with fear about what the future might bring.  After a while she began talking to God, and soon felt a warm breeze move over her, followed by being completely filled with peace, a feeling which remained with her ever since.  She said, “Everything will be okay, I’m in God’s hands.  I’m so lucky to have my husband, I’m so lucky to have my family, I’m so lucky to have my friends,” and she went on and on, listing people she cared about.

She relaxed as she spoke, and her voice became stronger and clearer as we listened.  A sense of awe descended in the room.  When she became silent, I acknowledged the beautiful gift she’d given us.  One of her friends offered to write the story down and share it with family and friends who had not been present

I believe it took a nurse to recognize the potential in this situation.  This was a sacred moment in Mrs. D’s life.  She was displaying more energy and alertness than she had in several days.  She had something to say.  I modeled patience, presence and active listening for the friends and family gathered, and this empowered her to bring forth her story.  Once her story was received, its value became clear to all of us. Her daughter would write down her mother’s words for those not present, including the unborn grandchild.  Mrs. Dundee’s’ story would live on.

Ramita Bonadonna, RN, MSN 

Charleston, South Carolina


As an experienced critical care turned cardiac rehab nurse I worked with a couple who remain vivid in my memory.  They taught me about love, courage, and generosity of spirit.

John had a heart attack at the age of 52.  His risk factors were positive for cholesterol, high blood pressure, and family history.  After reviewing his chart, I went to the bedside for our first visit.  We began to talk about his symptoms, how he was feeling at the moment and what he thought the impact would be upon his life.  While we were talking, visiting hours began.  A very attractive man, a few years older than myself came into the room.  He introduced himself as Greg and sat down at the bedside.  John and I chatted for a few minutes more and agreed to meet the next afternoon to discuss discharge plans and risk factor modification.  I suggested that it would be helpful if a family member could be there to hear the information as well.

When I entered the room the next afternoon at our scheduled time, Greg again was sitting at the bedside.  We talked for a few minutes and I asked John if any family members would be joining us.  He glanced at the younger man sitting beside him, looked up at me and said, “Greg is my family.”

“Okay,” I replied, being perky in that annoying, young know-it-all fashion.  “He can’t possibly be your son, you’re much too young.  Is he your brother?”

John looked seriously at me, probably astounded at my naïveté, and said, “Greg is my lover.  We’ve been together for 10 years.”

I was taken aback…I grew up in the Southern United States where homosexuality is still today not widely accepted and had not been introduced to an openly gay person until college.  I had, as far as I knew no gay friends and would not have been much more surprised had John claimed to be a Martian!  I did manage to pull my foot out of my mouth and begin the first of our discussions about cardiac anatomy, physiology, and risk factors.

In the late seventies, MI patients were routinely kept in the hospital for ten days or so.  As the days passed, John, Greg, and I spoke frequently.  We discussed risk factor modification, exercise, diet, medications, cardiac signs and symptoms.  I encouraged them to participate in the hospital’s cardiac rehabilitation program.  We got to know one another and I saw the deep care and concern that they had for one another, the gentleness that they expressed in little ways as a couple.  I was moved and enlarged as a person by observing how they interacted.  They were like any loving, committed heterosexual couple with whom I worked.

As the discharge day approached, I found myself avoiding one topic that routinely was discussed with cardiac patients.  Usually, I had no difficulty talking to patients about sexual activity.  I had discussed sex with men older that my father and twenty-something, single and married people, but never with anyone who was gay.

One afternoon, when I came into the room, John looked at me, smiled, and reached for Greg’s hand.  He took a deep breath and said, “I know this is probably uncomfortable for you, but we need to talk about sex.  What can’t we do, what can we do, and when?”

I was simultaneously, touched by their courage in pursuing the information they needed and embarrassed by my discomfort.  Their concern for my feelings should have been unnecessary.  They put me at ease with their openness and empathy.  We discussed their usual sexual practices and although I had no readily available resource materials to help, we spoke of general principles.  I promised to investigate further and get additional information.  We were able to find appropriate advice to share with them and clarify their questions.  Whenever I got tongue-tied at not knowing exactly how to discuss something, John or Greg would help me.

John was discharged in good condition with a good prognosis.  He attended our cardiac rehabilitation program for a few months and I was able to see his physical condition improve steadily.  Psychologically, John moved through the same adjustments as anyone with a major illness.  But he spoke often to me of how Greg’s support was helping him through the emotional ups and downs of recovery.  John returned to work and, the last I knew, was living well with his disease under control in the same loving, committed relationship.

I don’t believe that I was prejudiced against gays in 1978, but they were outside my conscious experience, different…unknown.  It was in a time before AIDS, when being gay was less dangerous than today.  John and Greg gave me a tremendous gift, to see individuals who were different from myself and ask, “Are these good people?  Do they care for one another and for others?  Do they harm anyone unnecessarily?”

I have met many, many people since who are “different” in one way or another, as we all are.  We are all part of the tapestry of humankind, rich with color and texture.  Although my mother, who is also a nurse, tried to explain it with words as we grew up, it was demonstrated fully by two wonderful men who hugged me one afternoon and said, “It wasn’t so hard, was it?  Thanks!”  I hugged them back and replied, “Thank YOU.”

Donna Nolten RN
Santa Cruz CA

– excerpted from Touched By a Nurse©

It was around 5:00 p.m. on a Friday afternoon when I “should” have been going home when I got a call to see a patient in the neurological intensive care unit.  As a psychiatric liaison nurse, I am called to see “problem patients” who have emotional as well as physical problems.  Sometimes, it is not the patient who has the problem, but the staff.  It was not unusual for me to get frantic consultations on a Friday afternoon, so I cancelled my evening plans and walked up a flight of stairs to the Neuro ICU.  When I entered the unit, I hear a female voice groaning and distinctly saying, “I can’t believe it.  They say that they love you and they shoot you in the head.”  Hearing someone speaking other than the staff is a strange experience in the Neuro ICU since most of the patients who enter here have a brain injury or are paralyzed, making talking impossible.  Therefore, I was curious as to who was speaking and why.

The nursing staff saw me enter the unit and motion me to a secluded corner.  The nurse asks me to see Chrissy “over there in the corner; the one who is talking”.  She continues to tell me Chrissy’s history of what brought her to the hospital.  Chrissy is a 21-year-old woman who works as a waitress and was shot in the left side of her brain by her ex-boyfriend.  Her ex-boyfriend shot Chrissy and then shot himself.  He died on top of her and when she awoke, she had to crawl out from under him and walk to the neighbor’s trailer for help.  The nursing staff’s dilemma was that Chrissy kept repeating the story over and over again.  Chrissy was unaware that she was saying the same thing again and again and again.  What I noticed almost immediately was that most of the nursing staff in this unit were young, (in their mid twenties) and unmarried themselves.  Hearing Chrissy reveal how her boyfriend professed his love and then shot her was too much for the staff to bear.  In the meantime, Chrissy is having difficulty believing this horrible incident has happened to her.

When I approached Chrissy, I was struck with how small she was.  Her head was all wrapped in a large white bandage, her dark brown eyes were filled with sadness and disbelief.  I asked her how she was doing today. Her voice was shrill and defensive as she spoke, “How would you be feeling if your boyfriend shot you in the head?”  All I could think to say was, “I would be sad and scared if something like that happened to me.”  She immediately calmed and said, “Yeah… I can’t believe he did it.  He told me that he loved me and then he shoots me in the head.  You’re not supposed to do that to someone you love.  Are you?”  I asked her if she could remember what had happened that night and she told me the story.  I sat there a long time that night listening to her repeat her story until she fell asleep.  The nursing staff were so relieved to have another person (me) talking to her so they would not have to listen to the terrible details of betrayal from someone whom you have loved.

With Chrissy’s particular gun shot wound to the left temporal lobe, she was unbelievably alert and could recall the events leading up to her hospitalization.  She knew who she was, how old she was, what year it was, and that she was in the hospital.  However, she could not remember that it had been three days since the shooting and that she kept repeating herself to the nursing staff, telling them the same story over and over and over.  Her repetition of the story was wearing the staff’s defenses down; they wondered privately if the same thing could happen to them.  At the time that I saw Chrissy, she was not depressed; she was in a state of shock and suffered from delirium from the swelling in the brain caused by the gunshot wound.  Both the staff and Chrissy needed me to talk and listen to Chrissy as she retold her story in an effort to resolve her trauma.

I worked with Chrissy throughout her hospitalization and afterwards when she went home to live with her parents.  Chrissy met with me on a weekly basis for three months in an effort to restore her life.  During the first month after discharge from the hospital, Chrissy looked at me and said, “You know, what happened to me was the pits.  I still can’t believe it. But, you know, I don’t think that I would ever be able to go on if you hadn’t been there for me.  I know that I don’t always say much and that I repeat myself over and over, but I got to do it over and over right now.  None of my friends and my parents  want to hear it any more.  I think that it scares people too much.”  I thought to myself that she indeed needs to continue to talk about her trauma and how perceptive she had become.  Chrissy did recover significantly from her gunshot wound.  She went to a local community college and took accounting courses.  Math was never her best subject; however, since the shooting, she was able to better grasp the concepts.

Jane Bryant (Neese), RN, MS, CS
Charleston, SC

I was working as a psychiatric liaison clinical nurse specialist in a department of medicine when I was called to see Anne.  Her attending physician had requested that I talk to Ann because “she was not dealing appropriately with her diagnosis of pancreatic cancer.”  As I listened to his discussion of Anne’s history, I kept thinking to myself, “How does one deal ‘appropriately’ with being told you have cancer, especially pancreatic cancer.”  The reason I was perplexed by this situation was that pancreatic cancer is known to be deadly and has a year to two years of survival after being diagnosed.  From Anne’s history, she had been having symptoms for at least a year.

As I entered Anne’s room, I noticed a thin, frail woman whose eyes spoke of merriment and life.  I told her that her doctor had wanted me to talk to her because she had been diagnosed with cancer and he was concerned how she was dealing with the diagnosis.  She looked at me and said, “Not well. I mean, is it normal to be thinking about your funeral and how you want things done?”  I shook my head and continued to look at her because I did not think that she was finished saying what she wanted to say to me.  “You know, I’ve done a lot of reading about the pancreas.  I’ve gone to medical school libraries to check out books and read journal articles about the different pancreatic disorders.  You see, I’ve had these pancreatic symptoms for a year and a half.  The doctors haven’t been able to find anything definitive until today.  This was my third CAT scan and the cancer finally showed up on this scan.  So, you see, I know that I don’t have much time to live.”  As I sat listening to her talk, I kept thinking to myself that this lady knows herself and knows what she wants to do.  Now, whether the doctors or her family will allow her to do what she wants in another story.  And, I also knew that she was correct about not having long to live.

As I nodded my head in agreement, Anne continued to say, “How do you tell your husband that you love that you are dying?  How do I tell my two daughters that I won’t be here much longer?  Am I insane to be thinking about my funeral?  You know, they (her husband and daughters) won’t know where to begin.”  I looked at Anne and saw how much concern she had for her family and said, “No, it’s not insane to be thinking about your funeral.  Remember, though, you have been reading about the pancreas and its disorders for a long time.  You have been worried that you had pancreatic cancer all this time and now have found out.  However, your husband and daughters haven’t had the same amount of time to deal with this.  It will be a shock to them.  Let’s progress slower with them.”

We discussed how she would talk to her husband and daughters that evening and that she would just talk about her diagnosis and that she did not have long to live.  I returned the next day to find her in better spirits, but still worried about her family.  Anne said, “They don’t want to believe that I don’t have much time.  They keep telling me that everything will be O.K.  I guess they feel they have to do that for me.”  We talked about giving her family time to deal with her diagnosis of cancer and when would be a good time to talk to her husband about funeral arrangements.  She decided that while her family was dealing with her diagnosis, she would write down directions for her funeral and what she wanted done.  During the week that she was in the hospital, we talked daily about her and her family’s progress.  On Friday when she left the hospital, she decided to tell her husband about her funeral arrangements.   I found out that Anne died six weeks later.  I’m glad that she was able to have the time with her family and plan her funeral for them.  It was her last gift to her loved ones.

Jane Bryant (Neese), RN, MS, CS 
Baltimore, MD

– excerpted from Touched By a Nurse©

The specifics of my story take place on New Year’s Eve in Maimonides Medical Center, Brooklyn, New York.  While this special time was shared this night, a longer tale of “touched” was ongoing for about five months prior and continued for ten months after that evening.

I was a new grad in August, having been working on a Surgical Specialty unit for six weeks. I was 19 years old at the time.  Sal was admitted after surgery during the day shift.  He was 16 years old, and had been working a construction job with his father when he fell off a high ladder.  He sustained a broken spine and was paralyzed from the neck down.  The prognosis was somewhat hopeful for slight recovery but pretty bleak for full functioning.  We were told he would recover some abilities over the course of a year and that it was not clearly predictable what his condition would be at the end of that time.  The entire staff was particularly taken with his youth and extent of his disability.  Sal came to us in a full body cast, asleep from anesthetics and pain medications.  I vividly remember thinking, “How awful!  What a tragedy, he is so young.”  Actually, the reality of how close in age we were was particularly disturbing.

Sal was a GREAT patient, he rarely complained, he was almost always in a good mood.  When some awful and ugly medical procedures needed to be done, or some routine but pretty uncomfortable physical needs were cared for, he was quick to set the way for humor and a sense of decorum.  Sal, at 16, had wisdom and wit that had style.  People might think this was a “New York” style.  He was raised in Brooklyn, one of four children to a poor-middle class blue- collar father and homemaking mother.  They were of Italian decent, Catholic by religion. Sal said, “I’m not much of a student, I like working with my Dad, as soon as he’ll let me quit school I will.” For 16, he seemed somewhat mature, certainly flirtatious and a bit precocious.  He had a girlfriend who visited frequently when he was admitted, but after a few weeks, slowed her pace.  His mother, father and three sisters visited every evening initially and after a couple of months, they too slowed their visiting to once or twice a week.

Sal put up a good front, but the reality of his situation was very obvious to us, his caretakers and “new” family.

I loved being a nurse, I loved working with the patients, the feeling of ‘helping’ people and doing some good.  I loved “talking” with the patients.  I felt a strong need to listen to them and let them share with me their feelings as they encountered physical hurdles that left them emotionally unbalanced.

Sal and I shared many touching moments over the long span of his inpatient stay on my unit, but New Year’s Eve stands out as somewhat special.  I regularly worked the day shift, but during the holiday week, Sal asked if I would work New Year’s Eve.  I considered his request against the possibility of attending a friend’s party as well as my general dislike for the night shift.  I decided, oh well, what the hey, and switched with a grateful co-worker to work that night.

Arriving on the unit at 11 PM, I took report and found us full as usual.  There were no untoward events occurring, and all patients were resting comfortably.  Many would be discharged the next day.  Making my first set of rounds, Sal was awake and asked me to make sure to come to see him before Midnight and wish him a Happy New Year.  After managing my routine duties, I checked on Sal, thinking, “What a New Year for this kid, what is his future, what is his hope?” I got back to him at Midnight, after rounds, Sal smiled brightly and displayed a bottle of Champagne.  Whew, I thought, this is not ok. Sal is under age, he’s a patient under my care and shouldn’t be drinking and it sure isn’t ok for me to be drinking champagne with him.  He told me I was a “fuddy-duddy”, he assured me he had no sleep nor pain medications, (confirmed as true) and reminded me that- “Well, what the heck, life is short!” His father had bought him the champagne as a gift for a NEW, New Year, “Make a wish”, he said, “and it will come true!”  Sal asked me to help wish him to walk again in the New Year.

Despite all my reasonable concerns my “gut” told me Sal needed to do this. So, we shared one glass of champagne for me, and frankly I’m not sure how many for him.  We wished for his walking power.  My rational brain told me this was not ok, but my heart said, yes, this is how to touch a person who happens to be a patient.  Sal was touched by a nurse, but I was touched by a patient.

At the end of a very long stay, Sal, at 17 was discharged to a rehabilitation facility.  He had the ability to stand with assistance, but not walk as yet.  I think of him still.  He would be about 45 years old now, I hope he can walk.  Sal taught me that my true talent is in the “talking” field and I have worked in Mental Health for the past 25 years, hopefully touching others with my heart as they continue to touch me with theirs.  The talented science of nursing is a phenomenon but the “touching” art of nursing is our true talent.

Marlene Nadler  (Moodie), RN
Maimonides Medical Center

– excerpted from Touched By a Nurse©

The recovery room had been very quiet for the last 3 hours.  I was the “charge nurse” for the 3-11 shift, which meant I was by myself.  The hospital justified having only one nurse on duty at this time because there was not supposed to be any scheduled surgery during this shift.  The key word here is “scheduled”.  I was working in an inner-city teaching hospital in a large city in the south.  All the trauma cases arrived at this hospital at all hours of the day and night.  I was busy getting ready for the patient that was due to arrive from surgery any minute.  I was sure I knew everything and had been trained to handle any and every emergency that might come my way.  I was 22 years old and had just completed my Bachelor of Science degree in Nursing.  I had been working in this recovery room for the last 2 years as a “professional student nurse”, and I knew it all.  This night would be different and my view and understanding of nursing and healthcare was about to be changed forever.

The call from surgery, telling me my next patient was on his way up, came around 10:00 PM.  When I asked for details about the patient, I was told he was a white male in his early 30’s who had attempted a jail break that afternoon.  He had jumped out of an 8th story window to gain his freedom.  What he had gotten was a fractured pelvis and both legs shattered.  He had been in surgery for hours and was coming to the recovery room in a full body plaster cast from his chin to his toes.

A few minutes later, Clyde rolled in.  He was indeed in a full body cast and because he was a fugitive, his leg, in the cast, was handcuffed to the bed.  At the time I remember thinking how absurd this seemed.  The man was barely conscious, and with his cast he certainly wasn’t going anywhere!  After checking him in and giving me the report of how the surgery had proceeded, the operating nurses left me to go back downstairs.  I was left alone with my patient.  I jumped into action taking his vital signs, asking him if he was in any pain, and trying to make him comfortable while he breathed off the anesthesia, and so I was surprised to hear a noise at the door.  At first it sounded like a tentative knock, which I ignored.  No visitors were allowed in the recovery room.

The next thing I knew a white male was standing beside me with a gun pointed at my face.  He looked more frightened than I felt.  I stood there wondering which drugs this man wanted to steal.  My mind was racing with the thought that I had not been taught how to deal with a robber, and I was indignant that this man was in “my recovery room”.  I did not want to get hurt, and I was not stupid.   I was prepared to give him whatever he wanted to take, except the one thing I was amazed he requested.

He looked around to be sure we were alone and then he demanded that I hand over Clyde!  He told me he had come to break Clyde out and finish the job that Clyde had attempted that afternoon.  I could not believe my ears.  This man was going to kidnap my unconscious patient!  I calmly told him that his friend was in a full body cast and was handcuffed to the bed.  The man came to the bedside to examine Clyde.  Clyde was not awake enough to acknowledge his rescuer and I told the man that he was more than welcome to take Clyde and the bed, which he was going to need to transport Clyde.  I even volunteered to help disconnect Clyde from the monitors and push him out the door to the elevators for the ride to the first floor and the door to “freedom”.

As soon as the door to the elevator closed I walked back into the recovery room and called the policeman who was sitting at his usual station at the entrance to the hospital.  I informed him that a man had just robbed me at gunpoint and had taken my most precious possession at that moment, my patient.  I told him the patient was stable, barely conscious, in a full body cast, and handcuffed to the bed.  I also stated that his friend was obviously stupid, unstable, armed, and headed his way.

Thirty long minutes later, my patient was returned to me.  He was now awake, in pain, and visibly upset.  His friend was on his way to jail.  The police officer assured me he would be staying with me in the recovery room and Clyde would have a full time guard until he was returned to jail.  Many hospital policies were created as a result of this incident.

Today, nobody would believe it could have happened, and I’m sure this story could win a spot on America’s Dumbest Criminals.  When I think back on this incident now, I just laugh.  I have forgotten how afraid I was at the time, and how angry I was that I had not been trained to deal with this kind of situation.  I often wonder what ever happened to Clyde.  He is not the only patient I have ever lost, but he was my first, and luckily the only one to leave at gunpoint!  He never knew the role he played in my growth as a person and a nurse.

Renee P. McLeod BSN, RN
City of Memphis Hospital

– excerpted from Touched By a Nurse©

Billy Holland was a tall, gangly 21-year-old guy from the inner city who was admitted frequently to our chronic ward at the state psychiatric hospital. He had a diagnosis of schizophrenia but even more tragic, he was often violent and aggressive. Whenever his behavior was violent, he would be restrained by two or three physically strong security guards. If the behavior was repeated frequently, he would be sent to the psychiatric prison down state, a facility for the criminally insane. Billy was terrified of this place and would cry and wail painfully when being transferred there. He reported abusive treatment by both guards and other inmates. When he was violent, the staff would often threaten him with being sent to the prison, but these threats did not influence his behavior even though he was afraid and intimidated by the place. He did not seem to be able to control his violence, even with the help of anti-psychotic medications.

Working as a psychiatric clinical nurse specialist on the unit, I was very distressed whenever Billy was sent to the down state psychiatric prison. He was such an appealing and friendly guy when he wasn’t violent and I liked him a lot. One day I decided to talk to him about controlling his violent behavior. I asked whether or not he could tell me ahead of time if he thought he could not control himself. He asked what would happen if he thought he could not control himself. I told him, “We’ll help you.”

“Are you strong, Jackie?” he asked.  I thought a minute and then said, “Yes.”   “Strong as a bull, right?” Again I hesitated and then nodded.

He squeezed my biceps muscle and then pronounced, “Yep, strong as a bull.”  I was more than a little embarrassed by my concurrence with this description, as I’ve never been known for my muscle strength or my size and I am actually a great deal smaller than Billy.

Every day when I came to work Billy would ask me if I was strong and every day he would squeeze my biceps and I would agree that I was strong as a bull. The ward lost its tension for a couple of weeks as Billy laughed and talked and helped out with other patients, occasionally shouting out “Are you strong, Jackie?” During this time he gave us the gift of his joy, his spirit and friendship.

I went away for 2 weeks and when I came back Billy had been sent down state again. We didn’t see him for months, and then a year passed. Finally, we heard that he had died while at the down state facility. His mother came later to pick up some of his things and she confirmed his death. She said he was troubled and afraid and “maybe it was for the best.”  She thought he died of heart failure. We all wondered and missed him in our lives.  I know I was able to influence him in his time with us; he has continued to influence me.

Jacquelyn H. Flaskerud, RN, PhD
UCLA School of Nursing

– excerpted from Touched By a Nurse©