Thursday, December 31, 2015

Neuroscience nursing

Neuroscience: a branch of the life sciences that deals with the anatomy, physiology, biochemistry, or molecular biology of nerves and nervous tissue and especially with their relation to behavior and learning

Today is the last day that I can call myself a Certified Neuroscience Registered Nurse (CNRN), a credential I have held for 20 years. I can't renew my certification because I no longer work at the bedside and do not have the required number of hours of neuroscience nursing practice.

My interest in neurology and neurosurgery began when I was working as a nursing assistant in a long-term care facility. Many of the residents I worked with had neurological deficits from strokes and I was fascinated by the differences in deficits the residents had depending on what part of the brain had been affected.

After my first year of nursing school, I worked as a nursing technician in the rehabilitation unit at Harborview Medical Center in Seattle, the regional level I trauma center. Most of the patients I saw there had spinal cord injuries (paraplegia, quadriplegia, central cord syndrome, Brown-Séquard syndrome), but there were also patients with traumatic brain injuries and stroke.

After graduating from nursing school, I worked on the Neurology/Neurosurgery acute care floor at Harborview. It was there that I achieved neuroscience nursing certification. I spent most of my clinical career working in intensive care units (ICU), including neuro ICUs, in Philadelphia and Memphis.

"I hate neuro!"

I don't know how many times I've heard that from other nurses.

Neuro nursing is challenging. Patients with injury or damage to parts of the brain can be confused, their behavior can be unpredictable and even violent – and yes, although I've never been seriously injured, I have been assaulted by patients. People with neurological insults can have language deficits; they may not be able to speak or their speech may be nonsensical or difficult to understand. They may not understand what is said to them. There are also challenges in assessing neurological deficits. A subtle change in a neurological examination can signal an impending catastrophic event (e.g., transtentorial herniation).

Neuro nursing can be heartbreaking. Lives are shattered by neurological injuries and disease. Families struggle with changes in family roles and the loss of income from a person who can no longer work. A person's behavior can change so dramatically that it disrupts family dynamics. Both patients and families must learn to cope with neurological deficits. A person who was completely independent may become completely dependent on others. Imagine not being able to even scratch your own nose, much less feed yourself, dress yourself, or take yourself to the toilet. Often, the most productive members in a family or in society are those most likely to be injured. Men in their 20s are the demographic most likely to suffer a traumatic brain injury, men like my bother-in-law, Seth, who, more than a decade after his diffuse axonal injury, remains in a minimally conscious state (I met Holly, my wife, while I was taking care of Seth).

Neuro nurses have to learn to communicate with patients who cannot speak or understand spoken language. We have to anticipate the needs of someone who cannot communicate those needs to others. In collaboration with other health care professionals, neuro nurses teach patients and their families how to rebuild their lives and achieve the highest level of function and quality of life possible. We also have to anticipate our patient's frustration and anger. Sometimes, that frustration and anger is directed at us, so we have to learn to take care of ourselves. Sometimes, we hold the hand of a dying patient and comfort that person's family.

I love neuro!

One of the things I love about neuro nursing is that there is always something to learn; a rare neurological disorder or the name of an agnosia I had not seen before. I used to see a lot of gunshot wounds to the head. I spent many hours reading up on ballistics; what happens to a bullet when it penetrates the cranium and what happens to brain tissue when a bullet passes through it (you probably don't want to know).

Neuro was my first love in nursing. Even though I don't practice neuro nursing any longer, I suppose I'll always consider myself to be a neuro nurse. Working in Tanzania last year gave me an opportunity to step back into my role as a bedside neuro nurse. Since becoming a nurse in 1992, I've always looked for ways to challenge myself; to gain knowledge and learn new skills. Neuro nursing provided me with a wealth of opportunities to grow both professionally and as a person.

It's hard work. It can be physically, emotionally, and intellectually challenging. For me, the rewards were knowing that I made a difference in someone's life.

I thank my friend and mentor, Karen March, who was the Neuroscience Clinical Nurse Specialist at Harborview when I worked there, for nearly a quarter-century of guidance, support, and inspiration.

Karen at Haydom Lutheran Hospital in Tanzania
Karen, Holly, and me on one of the happiest days of my life

One last time,

Matthew Rollosson, RN, CNRN

Happy New Year!