Nurse Essentials: A podcast focused on caring for you
Nurse Essentials: A podcast focused on caring for you
Specialty Spotlight: Caring for Patients in a Neurological ICU
The journey back to health is often long for patients in the neurological ICU being treated for a variety of conditions, ranging from stroke and seizures to rare disorders, such as myasthenia gravis and Guillain-Barré syndrome. A nurse in the neurological ICU at Cleveland Clinic main campus shares what it’s like to work on the unit and why he loves the specialty – one he never imagined landing in as a nursing student.
Carol Pehotsky (00:05):
One of the beauties of nursing is all the various specialties that we can lean into and be inspired by. And you never really know what will inspire you to change direction and lead you to a specialty that you feel is your own. We're joined today by David Lucas, a neurological ICU nurse to learn more about the specialty and his powerful story of how he ended up there.
(00:28):
Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate chief nursing officer of Surgical Services Nursing.
(00:48):
As the Nurse Essentials adventure has gone on, we've started to dip more into different specialties, and you've heard me in the past talk about how becoming a nurse was a later career decision for me. It was something I felt called to do after having been a music therapist and getting to see really what nurses do. I, I felt drawn to it.
(01:08):
And in terms of where I landed in perioperative care, similarly, you know, as I was a nurse on, on a med surge unit really finding myself gravitating towards surgical patients and wanting to get closer to the action and here we are 20 years later.
(01:22):
I'm so glad to be joined today by David Lucas. David is currently, we'll get into that, but currently a registered nurse in one of our neurological intensive care units at Cleveland Clinic main campus. Welcome, David.
David Lucas (01:32):
Yeah. Hi.
Carol Pehotsky (01:33):
So, so we're hoping you're going to share a little bit with us about your story, how you ended up in the specialty, what nurses can learn, and nursing students can learn about the specialty and where you're going next.
David Lucas (01:43):
Okay.
Carol Pehotsky (01:43):
So, would you be so kind to tell us what drew you to nursing and how'd you end up in, in neurological ICU care?
David Lucas (01:50):
Yeah. Absolutely. I feel like from a young age, like young ages in like middle school, high school-
Carol Pehotsky (01:55):
Mm-hmm.
David Lucas (01:56):
... I always thought medicine was interesting. You know, I like the shows. I love Scrubs (laughs) and everything.
Carol Pehotsky (02:02):
Same. Well, we'll get back to that one too. (laughs)H
David Lucas (02:05):
And kind of started, um, uh, in high school, explore the different avenues and everything and thought about being a doctor for a minute and then a physical therapist for a minute. And then my mom really encouraged me. And was like, "You should check out nursing." And I was like, "I don't know if I want to do nursing."
Carol Pehotsky (02:05):
(laughing).
David Lucas (02:17):
And then I ended up shadowing someone and really could see myself going into that field and went into nursing for school and came out and I started off in bone marrow transplant.
Carol Pehotsky (02:27):
Mm-hmm.
David Lucas (02:27):
Was there for about two, two and a half years or so. I started in 2018 and by, you know, mid-2020 or so, like right as we started to get in COVID and everything. I just kind of felt like, all right, I feel like I've seen everything I wanted to see here.
[NEW_PARAGRAPH] I, I love the patient population. I love what we did. It was great, but I was just kind like every time we, we aim at a patient, send them downstairs or whatever, I was always really interested in the atmosphere and I really looked up to and admired those nurses and the staff and everything. And so, I was like, "I think I want to go into critical care."
(02:57):
Fast-forward a little bit in September, my mom has an aneurysmal subarachnoid hemorrhage.
Carol Pehotsky (03:02):
Oh.
David Lucas (03:03):
Yeah. So really scary. She was really, really sick. She had a bolt and EVD. She had a hemicranie, all these things, was like hospitalized for roughly three months or so. Came in September, was in the ICU for about three weeks, started to kind of sort of wake up a little bit.
(03:22):
She was... We had like make the difficult decision to trach and peg her. She was then sent to an LTAC, was there for about a month, started to follow commands, wake up a little bit more, and then she got into Metro's traumatic brain injury rehab facility.
Carol Pehotsky (03:35):
Mm-hmm.
David Lucas (03:35):
Which is like the best in the state. And they whooped her into shape. Oh. (laughing) She was there for about six weeks and then she came home. So, like all throughout that time I was like, "I'm not going to, you know, like, we'll think about this career change later." And those like thoughts kind of came back. Was like, "Hey, what about critical care? What about critical care?"
(03:51):
And looked to, you know, about the job postings and there is NICU, SICU stuff in the cardiac world and everything and neuro.
Carol Pehotsky (03:59):
Mm-hmm.
David Lucas (03:59):
And I was like, "No way." (laughs).
Carol Pehotsky (03:59):
Really?
David Lucas (04:02):
And from the get-go I was like, "No." Like it's, it's, it's too close to home right now. I think I'll burn out and everything.
Carol Pehotsky (04:02):
Okay.
David Lucas (04:08):
And applied to some other jobs. And I ended up not working out and there was neuro still.
Carol Pehotsky (04:13):
(laughs).
David Lucas (04:13):
So, I think it was intentional that those all didn't work out and everything, but I was like, "All right. I'm going to, I'm going to look into it."
Carol Pehotsky (04:13):
Okay.
David Lucas (04:20):
So, I went and applied and just instantly fell in love with the culture. Little later on fell in love with the patient population 'cause neurology and endocrine and nursing school is like my least favorite. (laughing).
Carol Pehotsky (04:31):
(laughs).
David Lucas (04:33):
I still don't really like endocrine, but... (laughing)
Carol Pehotsky (04:36):
(laughing) Nothing against endocrine, but yes.
David Lucas (04:39):
Yeah. (laughs) Yeah. And so, I applied, they offered me a job. I accepted it. And then as time went on, I fell in love with that patient population and was able to really see what my mom went through and just how-
Carol Pehotsky (04:49):
Mm-hmm.
David Lucas (04:49):
... incredibly lucky she was and how miraculous her healing was, and everything compared to, you know, the size of her injury and stuff. And so that's kind of long story short how I ended up in neuro. And I, I feel like I've kind of found my, my niche there and I like it now.
(05:03):
You know, I, (laughs) my neuro patients are fun. They're, they're kind of quirky, they're kind of weird, but, uh, not in a bad way. (laughs)
Carol Pehotsky (05:08):
Never a dull moment and probably no two days (laughing) look even a little bit the same, huh? (laughs)
David Lucas (05:09):
Oh, yeah.
Carol Pehotsky (05:14):
So, the full scope of, right? Stroke care, cancer care, more variation probably than not, right?
David Lucas (05:21):
Sure.
Carol Pehotsky (05:21):
Can you talk to us a little bit about some of that variation in, especially in critical care, what types of patients are you serving?
David Lucas (05:22):
Mm-hmm.
Carol Pehotsky (05:28):
And what type of diagnoses or diseases are you treating?
David Lucas (05:32):
Yeah. We have like a handful of the same things that we see pretty frequently.
Carol Pehotsky (05:32):
Yeah.
David Lucas (05:37):
So ischemic strokes, hemorrhagic strokes, brain tumor, seizures, and then kind of more of like your zebra patients, if you will. So, your Myasthenia Gravis, Guillain-Barre.
Carol Pehotsky (05:47):
Mm-hmm.
David Lucas (05:47):
And we at one point had like three patients on the unit and two of them were catatonic and one of them had tardive dyskinesia. So, like-
Carol Pehotsky (05:47):
Oh, gosh.
David Lucas (05:54):
... we just kind of see like those, you know, uncommon things that we see every now and again. In that case, it was, you know, (laughs) three in one week. But those are kind of the things, and then from there, you know, we manage all of the, the complications that can occur. So neurofevers, neurostorming-
Carol Pehotsky (06:07):
Mm-hmm. Mm-hmm.
David Lucas (06:08):
... increased intracranial pressures, cerebral salt wasting, like you name it, seizures can be the complications from all these. And then also just the, so to speak, normal ICU complications that we see.
Carol Pehotsky (06:19):
(laughs) Yeah.
David Lucas (06:19):
Sepsis, pneumonia-
Carol Pehotsky (06:21):
Okay.
David Lucas (06:21):
... AKIs, you know, all those fun things. So yeah, but it keeps you on your toes because there's, you know-
Carol Pehotsky (06:21):
Yeah.
David Lucas (06:25):
... you have like the few things that we see and then just like a number of things that can happen from that. So, it’s kind of, kind of keeps you ready.
Carol Pehotsky (06:31):
So, yeah. That, that's a lot. Right?
David Lucas (06:32):
(laughs)
Carol Pehotsky (06:33):
So different patient populations, different presentations, and you'd mentioned words like EVD and hemicranie.
David Lucas (06:34):
Sure.
Carol Pehotsky (06:40):
So, talk to us a little bit about what your education has looked like, what, what technologies you're interacting with?
David Lucas (06:40):
Mm-hmm.
Carol Pehotsky (06:47):
And, and like I know what an EVD is, but-
David Lucas (06:47):
Yeah. (laughing).
Carol Pehotsky (06:49):
... like what that is and what that does to help our audience even-
David Lucas (06:52):
Yeah.
Carol Pehotsky (06:52):
... more understand the variety.
David Lucas (06:54):
Kind of feels like our bread and butter sometimes.
Carol Pehotsky (06:56):
Sure. (laughing).
David Lucas (06:56):
Um, extraventricular drain-
Carol Pehotsky (06:58):
Yes.
David Lucas (06:58):
... is an EVD. So, we use them for cases of like hydrocephalus, especially with our bleeds and everything where something's obstructing the CSF from flowing correctly. So, we throw the drain into help us drain that CSF as well as we can monitor the intracranial pressures in the head as well.
(07:15):
So, we use, um, a device called the Natus that they hand drill at the bedside, the neurosurgeon staff does, and they put it in. And then from there we hourly check those pressures. We, we check the output and all those things.
(07:28):
We have other devices that we are kind of rolling in, ones we've used for a while, but it's a just a new, a new brand that we're utilizing that is a bolt. So, it's that same catheter that, or not the same catheter, but it's still a catheter that goes in-
Carol Pehotsky (07:28):
Mm-hmm.
David Lucas (07:41):
... that just continuously measures that pressure in the head.
Carol Pehotsky (07:41):
Mm-hmm.
David Lucas (07:44):
So, we're having a patient that's having, you know, ICP crisis and their pressures are always high. We put those in so we can be on top of it and know if we need to, you know, do we need to, do we need to further sedate? Do we need to administer hypertonics? Do we need to do something to help bring these pressures down right now? Because yeah, as that pressure in the head increases, you know, your head's a, a finite space-
Carol Pehotsky (08:04):
Yeah,
David Lucas (08:04):
... it can only swell so much or allow so much pressure to occur. Yeah. (laughs)
Carol Pehotsky (08:08):
So, so much to learn. Talk to us a little bit about... Yeah. I'm just trying to wrap my head around because it can be so many things.
David Lucas (08:08):
Mm-hmm.
Carol Pehotsky (08:13):
So certainly, you're learning critical care skills, but when it's time to learn about neurology, what did your onboarding look like? How do you continue to educate yourself-
David Lucas (08:22):
Mm-hmm.
Carol Pehotsky (08:22):
... and expand your knowledge with all of the ever-evolving patients you're serving and technologies you're bringing in?
David Lucas (08:27):
Sure. My onboarding was great, firstly. And the nurses that I precepted with the, the different education we had like a neuro boot camp, we called it, (laughs) that they just kind of go over all these things-
Carol Pehotsky (08:27):
Okay.
David Lucas (08:36):
... that we're going to see and everything, which was super helpful. But just, yeah, the knowledge of the nursing staff on the floor was super helpful, as well as just like picking the brains of the nurse practitioners-
Carol Pehotsky (08:44):
Mm-hmm.
David Lucas (08:44):
... the attending providers, our neurosurgery staff and everything, being like, "All right. What are we doing? Why are we doing it?" And they're all just, you know, quick as a whip like great to pick their brains and everything. And if they don't know, you know, they're like, "Hey, like I know that they just released this study so like let's take a look at it together."
Carol Pehotsky (09:01):
Okay. Fantastic.
David Lucas (09:02):
I mean, I haven't had that happen before too, which is cool so-
Carol Pehotsky (09:02):
Mm-hmm.
David Lucas (09:02):
... yeah.
Carol Pehotsky (09:04):
So, you mentioned your mom and I'm sure plenty of other patients. Thank you for sharing her story.
David Lucas (09:09):
Yeah. Absolutely.
Carol Pehotsky (09:09):
Really appreciate it. Probably a lot of patients spend some time with you but then have a long road ahead knowing that at least in the neuro ICU, you're a portion of that journey. What are some things that you and your colleagues can do to really help support the patient knowing that that journey is long-
David Lucas (09:25):
Mm-hmm.
Carol Pehotsky (09:25):
... or how do you provide support to that family?
David Lucas (09:27):
Yeah. Great question. Like you said, we, we see them from like their sickest.
Carol Pehotsky (09:32):
Mm-hmm.
David Lucas (09:32):
So we, we treat them, we get them stabilized, and then we send them off to, whether it's the step-down unit or it's an LTAC to help wean off the vent or it's a rehab facility to start trying to work on the deficits that they've occurred and everything. Physical therapy and occupational therapy work from the rip.
Carol Pehotsky (09:50):
Mm-hmm.
David Lucas (09:50):
So like patient comes in, as long as they're stable enough to work with, we try to work with them because you know, typically the, the sooner we start to, to get patients up and, and trying to, you know, use the arm that doesn't work anymore or, or, you know, work on the language skills that were here yesterday and they're gone today or whatever the case is, just we found like the better it becomes.
(10:08):
So, I feel like we've seen kind of like the two different types of patients who are like the, the stubborn person who's done (laughs) everything for themselves all throughout their life and now they, they can't-
Carol Pehotsky (10:08):
Sure.
David Lucas (10:18):
... and it's really frustrating-
Carol Pehotsky (10:19):
Yeah.
David Lucas (10:19):
... and they're trying to get up out of bed, and those moments, like, just nurses need like a lot of patients to be like, "Hey, like listen, I love the enthusiasm, love that you want to get up and, and work and everything, but like, we need to make sure that you're safe first."
(10:29):
So, like setting those boundaries of being like, "Hey, we're going to work with physical therapy now-
Carol Pehotsky (10:29):
Mm-hmm.
David Lucas (10:33):
... and then after that we're going to rest."
Carol Pehotsky (10:35):
So, they can channel it?
David Lucas (10:36):
Exactly. Yeah. So, like save your strength for that and everything. And then on the flip side, you get the patients who are just really bummed.
Carol Pehotsky (10:42):
Yeah.
David Lucas (10:42):
Like they're just like, "I can't move, I can't do anything anymore. Like, what's the point?" And so that's when we kind of turn into cheerleaders, so to speak, and it's really trying to encourage as much as we can. Like, "Hey, listen, you know, physical therapy might be hard, occupational therapy might be frustrating, but you know, when we work at these things, when we do these things, you know, that's how you get better. You know, that's how you hopefully are able to get back to close to your baseline or whatever the case is."
(11:05):
Again, you want to be realistic and everything too, but so yeah. And then families are great, families can be challenging. We're kind of seeing them at their worst and everything.
Carol Pehotsky (11:05):
Yeah. Yeah.
David Lucas (11:13):
But something that I always just try to encourage, and this, this might take time and everything for them to, to feel like they can trust you as a provider.
Carol Pehotsky (11:13):
Oh, yeah.
David Lucas (11:22):
And also, the staff too, to be like, "Hey, listen, we have a policy in our unit like you can stay as long as you want, but you can't sleep at the bedside."
Carol Pehotsky (11:29):
Hmm.
David Lucas (11:29):
If you, if you want to sleep, you either have to leave or, you know, some people go in the family lounge or whatever, and so because if we need to get in there in like a pinch-
Carol Pehotsky (11:36):
Yeah.
David Lucas (11:36):
... like we can't be waking you up and everything. So you get to a point where it's like, "Hey, listen, you've been here all day long, you've been here all night, like go home, shower, go to bed, like, take care of yourself because there's going to come a moment when your loved one's ready to come home and they're, they might require quite a bit of care and we need you to be on your A game, like tip-top shape and everything."
(11:54):
So even just like encouraging the family, yes, be involved in everything, but also take time to take care of yourself. Make sure you're eating, make sure that you're bathing, like make sure like you're sleeping and everything-
Carol Pehotsky (12:04):
Mm-hmm.
David Lucas (12:05):
... because before you know it, I'm looking at you and I'm like, "You don't look great." (laughing)
Carol Pehotsky (12:09):
Yeah. You're really, you're really treating the family along with the patient-
David Lucas (12:11):
Exactly.
Carol Pehotsky (12:11):
... and assessing them too.
David Lucas (12:12):
Yeah. Exactly. And like I said that takes time because, I mean, they don't know me. I don't know them. They need to, to see that, you know, that our eye care, that our staff cares and are going to do a good job at taking care of, which I, I fully believe our, our staff is great and our, our nursing care and everyone is awesome. (laughing)
Carol Pehotsky (12:29):
Yeah. It's the most stressful but I, I can only imagine how relieved family members must feel to hear you saying like, like, "We've got this."
David Lucas (12:37):
Mm-hmm. Yeah.
Carol Pehotsky (12:37):
And, and giving them permission-
David Lucas (12:38):
Mm-hmm.
Carol Pehotsky (12:39):
... to take care of themselves.
David Lucas (12:40):
Yeah. Exactly. Especially like if the, the patient's not with it because then they're like, "What if they wake up and I'm not here and they're going to be mad at me?" And it's like, "It's okay. Like-
Carol Pehotsky (12:48):
Yeah.
David Lucas (12:48):
... we'll let them know." (laughs)
Carol Pehotsky (12:50):
You'll, you'll be back before you know it.
David Lucas (12:51):
Exactly.
Carol Pehotsky (12:53):
So, you mentioned trust, so building that trust with the patient, building that trust with the family, knowing that, again, it is so incredibly stressful, patients may or may not be able to communicate. What are some techniques that you've used to try to build trust with both the patient and the families?
David Lucas (13:08):
Hmm. Yeah. First thing that comes to mind is just trying to get both of them involved in their care as much.
Carol Pehotsky (13:13):
Hmm.
David Lucas (13:13):
So, I, I really like to just explain everything that I'm doing. "Hey, I'm coming in, I'm doing this, this is why I'm doing it. Great." You know, there's been times where I've asked, you know, even if it's just like, "Hey, can you hand me that, like, that pillow?" It like makes them feel like, at least like in the family, like it makes them feel like they have-
Carol Pehotsky (13:13):
Yeah.
David Lucas (13:30):
... you know, purpose or whatever. I've, (laughs) I'll throw IVs in and I'll, I'll like hold up the dressing that has like the little plastic piece on it to reveal the, the sticky side and I'll have the patient, "Hey, can you pull this off for me?"
Carol Pehotsky (13:30):
Yeah. Yeah.
David Lucas (13:40):
Like it's little things like that where they're like, "Okay, like I'm not completely helpless and like I am, I'm helping in my care." And I don't know, at least that's how I rationalize in my head. (laughing)
Carol Pehotsky (13:51):
Clearly every little bit helps.
David Lucas (13:52):
Yeah. And, and I've noticed that too, where it's just like, if I come in and I just start doing something, especially in a family who's already maybe, maybe a little mistrusting, maybe they've been burned in the past or whatever the case is-
Carol Pehotsky (13:53):
Mm-hmm.
David Lucas (14:03):
... you can physically see it, brings them down a notch from being kind of like, um, like this defensive front of like, "Ah, what are you doing?" To like, "Okay. Cool. No. That's okay." And that just makes everyone's lives better at the end of the day so.
Carol Pehotsky (14:15):
That's great advice for everyone.
David Lucas (14:15):
Mm-hmm.
Carol Pehotsky (14:16):
I hope you were all listening to that. (laughing) So even if you're like, "I don't think neuro is for me." That's fantastic advice for all of us. I can only imagine the, the moral and the ethical dilemmas that sometimes-
David Lucas (14:27):
Sure.
Carol Pehotsky (14:28):
... come to your unit and your areas. What resources have you engaged? How do you help manage through that?
David Lucas (14:34):
Hmm. Yeah. That's excellent question that I, I wish I had like that ace answer that's just like-
Carol Pehotsky (14:35):
Mm-hmm.
David Lucas (14:41):
... this is how you do it every single time.
Carol Pehotsky (14:41):
Mm-hmm.
David Lucas (14:42):
But it's, it's just so different for everyone. I think, sounds a little cliched, but like clarity is kindness. So, like-
Carol Pehotsky (14:43):
Hmm.
David Lucas (14:48):
... if, if a patient comes in and they're, they're really sick and they have a, a brain injury that's, that's devastating and beyond recovery, instead of like being kind of wishy-washy, being like, "Well, you know, well, we could, we could maybe do this, maybe do that."
(15:01):
Just being like, hey, listen, like in, in a, in a, not like a blunt way, but a factual way saying, this is what we're seeing, this is, you know, typically the prognosis, recovery, all these things that we've seen from injuries like this, or whatever the case is. Just giving the family all the information that they need to make the decisions that they need to.
(15:19):
That doesn't mean that every patient that comes in we're already thinking like, "Hey, change the code status.
Carol Pehotsky (15:19):
Yeah.
David Lucas (15:24):
Like, make them comfortable." I think that's what sometimes people kind of might think we're trying to do and everything, but if we're not like wishy-washy, but we're being able to convey information in a factual way, I think it, it equips the families to make decisions, better decisions for their family members and that's something that I always try to bring up if they're processing through things or whatever.
(15:43):
Just like, yeah. What, what would your loved one want? So, like, you know, there's, there's a chance that your loved one will live through this. Like, but would they want to live wheelchair bound? Would they want to live where they can't communicate? Would they want to live where they're being fed through a feeding tube?
(15:59):
Like really, really think through that. Not, not trying to use scare tactics or anything, but like, just consider that. You know, and sometimes people are really receptive of that. Sometimes they're like, "No."
Carol Pehotsky (16:10):
Hmm.
David Lucas (16:10):
Like I'm, you know, I think they would want everything and I, I would like to think they're telling the truth and everything, but I don't really know. I'm, I'm thinking of like two different scenarios recently where we had a lady who had previous strokes and was perfectly content living her life. I think she was wheelchair bound, but she was happy in her life.
(16:29):
And so, she had another injury and we talked to family and they're like, you know, we kind of explained, you know, things might be a little different, but we think we can get her close to where she was. You know, hopefully if all things work, work right. And they're like, "Okay." Like, "Yeah. She was, she was fine with the deficits she had before." Great.
Carol Pehotsky (16:29):
Okay.
David Lucas (16:44):
And then we had other ones where, you know, they come in with a pretty bad injury and you kind of ask, "Hey, how were they before this?" "Oh, they're energetic, independent, you know, they're, they're driving, doing all these things." "Okay. Well, this is what we're expecting their life to be afterwards, you know, maybe not being back at that place or whatever. Would they want that?"
[NEW_PARAGRAPH]"Well, no, but, you know, we're just not ready. We're just not ready."
Carol Pehotsky (17:06):
Sure. Yeah.
David Lucas (17:07):
And that's when it gets really sticky, and so we utilize, you know, ongoing goals of care and, and family meetings pretty frequently. So, we usually call on all the teams overseeing the care.
Carol Pehotsky (17:07):
Yeah.
David Lucas (17:18):
So, you know whether that's neurosurgery, neurology, stroke, Pal Med's an excellent resource just to kind of introduce them and, and kind of offer their services and what they can do to help in this point in their care. And, you know, unfortunately we've had to get bioethics on board, but they're also a great resource.
Carol Pehotsky (17:34):
Yeah.
David Lucas (17:34):
Um, they help us navigate those conversations really, really well and everything. So, it's probably the, the hardest part of the job-
Carol Pehotsky (17:41):
Yeah.
David Lucas (17:41):
... is, is navigating these, these ethical dilemmas and stuff.
Carol Pehotsky (17:44):
And how do you... I'm going to say take care of yourself, right? Because these are hard conversations. Sometimes family make decisions that you in a similar situation might not make. What advice would you have for nurses or what do you and your colleagues do to sort of make sure that that's not burning you out and adding a burden to your ability to take care of patients?
David Lucas (18:04):
When we've had really, really hard days, we've, we've had kind of like, like little debriefs where it's like-
Carol Pehotsky (18:04):
Mm-hmm.
David Lucas (18:09):
... "Hey." Like, we've had management come around and be like, "How are you doing?" Like, you know, this is your third transition to comfort care this week like-
Carol Pehotsky (18:10):
Yeah.
David Lucas (18:17):
... you're doing all right. And it's just even being prompted that to like talk through that and just talk through that with your colleagues, with your management and everything is, is helpful.
(18:26):
Yeah. We've, we've done code lavenders before too, where they bring in, you know, the staff just to kind of, again, create an atmosphere where, you know, we can kind of talk through things as need be or, or whatever the case is, which can be helpful too. But yeah, I know like for myself, like sometimes, you know, I get home and I, I talk with my wife and, and kind of process through it that way.
(18:47):
Sometimes I'm like, I just, I just need like a minute.
Carol Pehotsky (18:47):
Yeah.
David Lucas (18:50):
Like I need like a couple days to kind of just like-
Carol Pehotsky (18:52):
Yeah.
David Lucas (18:53):
... figure out how I'm feeling about it in the first place. But yeah, I have, I have colleagues who go to like talk therapy and stuff too, which I think is, I think is a great resource that should be utilized-
Carol Pehotsky (19:03):
Mm-hmm.
David Lucas (19:04):
... you know, more so and everything.
Carol Pehotsky (19:05):
So, you'd mentioned earlier, neuro isn't for everybody, right? Patients can present with a variety of symptoms, but we also know that no matter what type of nurse anyone is, they can absolutely be in a position where they need to identify that somebody's neurological status is changing.
(19:20):
So talk to us a little bit about some of those assessment skills and what really any nurse should be able to, to pick up on and when they should be calling for help even if they're not a fan of neurology either (laughing) and not really, not really as familiar with it.
David Lucas (19:34):
Yeah. Man, you gotta have a loud speaking voice in neuro. (laughing)
Carol Pehotsky (19:38):
Okay. Tell me more about that.
David Lucas (19:40):
If you're just trying to like wake your patient up, sometimes they're just (laughs) so grousing, and so we're screaming, like, "Open your eyes. Show me two fingers. Wiggle your toes." Uh, like when we float to different units, people are always (laughing) like, "Who, who is that?"
Carol Pehotsky (19:51):
Quiet down. (laughs).
David Lucas (19:52):
Yeah. (laughs) Who's screaming? Oh, he's from neuro. (laughing) No. But man, I just think like having a, a really keen eye for, for detail is really, really important because it could be the slightest change. Like you, like you mentioned, like, you know, you have your patient lift their arms and all of a sudden, their left arm, even if it's just a little bit is starting to fall, you know?
Carol Pehotsky (19:52):
Mm-hmm.
David Lucas (20:12):
All right. Maybe, maybe something's happening and they're reoccluding the stent that we just placed, or whatever the case is, or, you know, I, I ask them to move their eyes around and all of a sudden they can't, they can't move their eyes, you know, past midline going to the left.
Carol Pehotsky (20:26):
Mm-hmm.
David Lucas (20:27):
Like, oh, that's a change that we need to, to be serious about because time is brain, you know?
Carol Pehotsky (20:27):
Yeah.
David Lucas (20:31):
Every minute, every moment that passes that we don't do intervention, and if we can like that brain tissue doesn't come back.
Carol Pehotsky (20:37):
Right.
David Lucas (20:38):
So yeah, definitely having that keen eye of things that are different from what they were before, as well as I think just like organizational skills in general are just super-
Carol Pehotsky (20:38):
Hmm.
David Lucas (20:47):
... I mean, for, for any ICU, but a lot of our patients require some sort of hourly intervention, whether it's the EVD that I talked about, or being super strict on our I's and O's or hourly assessments, sometimes every 15 minute assessments.
Carol Pehotsky (21:00):
Yeah.
David Lucas (21:00):
Like you gotta be on top of it-
Carol Pehotsky (21:01):
We're good. Yeah. (laughing)
David Lucas (21:01):
... everything. Yeah.
Carol Pehotsky (21:01):
Good.
David Lucas (21:01):
Yeah.
Carol Pehotsky (21:03):
Really key neurological assessment skills are important for any patient. And, and you'd mentioned earlier it's, it's also about knowing their baseline.
David Lucas (21:11):
Mm-hmm.
Carol Pehotsky (21:11):
You know, if, if a patient is in for colorectal surgery, but suddenly is, is showing things that are not the way you saw them an hour ago where the family says my loved one wasn't like this.
David Lucas (21:21):
Mm-hmm. Exactly. Yeah. That's super important. And we, we ask that like when patients come in too, where it's like, "Hey, does their speech usually sound like this-
Carol Pehotsky (21:31):
Mm-hmm. Sure.
David Lucas (21:31):
... or is it, does it sound a little garbled? Even like patients themselves like di- do you sound normal to you? And they're like, "No, I, (laughs) I don't." Like my speech does sound more garbled or whatever the case.
[NEW_PARAGRAPH] So yeah. That's definitely important to know like that baseline. That's like our, our bedside reports, it's so important to, to make sure that like our, our exams are lining up. So, a lot of the times we'll do assessments together-
Carol Pehotsky (21:31):
Oh, sure. Yeah.
David Lucas (21:53):
... that shift change should be like, "All right. Hey, and he's doing this," or, oh no, that's new. Maybe we should tell a provider or whatever the case is so.
Carol Pehotsky (22:00):
Well, and, and great advice to any nurse that, again, the patient might be there for something totally different, but make sure that in that handoff, you know, what their neuro status is, what their baseline is, so that, that when you're meeting that patient for the first time, it's going to jump out at you if something's different than we were told.
David Lucas (22:00):
Sure. Absolutely.
Carol Pehotsky (22:16):
So, you've talked about, you know, you've got to neurology eventually, (laughing) and we're so glad you did. For our listening audience, especially, I think about nurses that are either curious about switching specialties or we have nursing students in the audience.
(22:29):
Looking back, any sort of checklist in your head of - if I'd considered these things I would've gotten here to neurology. What, what should people be curious about-
David Lucas (22:40):
Mm-hmm.
Carol Pehotsky (22:40):
... questions they should ask themselves that are considering this as a specialty?
David Lucas (22:43):
Yeah. First thing that pops to my head is just experiencing it firsthand-
Carol Pehotsky (22:48):
Mm-hmm.
David Lucas (22:48):
... because you learn about it in the textbooks, or you float to a different unit, and you take care of a stroke patient. It's really hard and really challenging and everything, and you're kind of like turned off to it where you're like, "Ah, this is, this is complicated. You know, not for me or whatever."
(22:59):
But then for me, it was, it was getting in on the unit and seeing the culture, seeing the patient population and everything that really solidified it where it's like, "Yeah. Like this is actually, this is, this is cool. I enjoy this." Yeah. Nothing beats hands-on experience and everything.
Carol Pehotsky (23:15):
So, you were telling us before the mics started rolling that you're so passionate about neurological care that you are soon to be a nurse practitioner.
David Lucas (23:24):
Yeah.
Carol Pehotsky (23:24):
Tell us more about that.
David Lucas (23:26):
Yeah. Summer of '22, I enrolled at Case for their adult gerontology acute care nurse practitioner program. And, um, I just graduated in December so, uh-
Carol Pehotsky (23:36):
Congratulations.
David Lucas (23:36):
Thank you. Yeah. Um, past my boards, all those fun things and now just, you know, I need like a lot of information and everything to go to the approval board and everything, so I'm just waiting on that process.
Carol Pehotsky (23:37):
All right.
David Lucas (23:47):
And I should be starting in a couple weeks or so, so.
Carol Pehotsky (23:50):
In the same unit?
David Lucas (23:51):
Same unit. Yeah. So-
Carol Pehotsky (23:52):
That's fantastic.
David Lucas (23:52):
Yeah.
Carol Pehotsky (23:53):
And what does the role of a nurse practitioner look like in your unit?
David Lucas (23:56):
Yeah. So, you know, right now, I, as a nurse, I'm seeing a couple patients each, we have a two to one ratio in, in, uh, neuro ICU. And so, I'm seeing the orders, I'm executing the orders and everything. And as a nurse practitioner, I'm more guiding the care.
Carol Pehotsky (24:09):
Hmm.
David Lucas (24:10):
So, I'm, I'm seeing and saying, "All right. You know, this is, we need to restart. You know, our, our oral antihypertensives, you know, that they take at home or their electrolytes are, are messed up, so I'm going to order the, you know, the replacements for that," or, or we're keeping a really close eye on fluid status, so I'm going to assess everything.
[NEW_PARAGRAPH] You know, you're kind of running the show, so to speak, with your attending over top of you, kind of helping you in that process and everything too. So exciting, kind of scary, really scary. (laughing).
(24:40):
You kind of like, feel like you get to a place where you're like, "Yeah. I'm hitting my stride." And then you're like I'm back at the bottom again. (laughing)
Carol Pehotsky (24:44):
Just kidding. Yeah. Yeah. Now I'm in office again.
David Lucas (24:46):
Yeah.
Carol Pehotsky (24:47):
Well, it's super exciting and we wish you nothing but the best.
David Lucas (24:50):
Yeah.
Carol Pehotsky (24:50):
What, what an asset to, to your team-
David Lucas (24:52):
Yeah.
Carol Pehotsky (24:53):
... to have you there growing alongside them and being able to share with them in a different way.
David Lucas (24:53):
Yeah. Thank you. I appreciate it.
Carol Pehotsky (24:57):
Yeah.
David Lucas (24:58):
Mm-hmm.
Carol Pehotsky (24:58):
So, you've given us a lot to think about. Gosh, sorry about the pun, everybody, (laughing) but, but we're, we're running close to the end of time. Hoping you'd humor me and answer a few fun questions in our speed round-
David Lucas (25:09):
Absolutely.
Carol Pehotsky (25:10):
... so, our audience can get to know you a little bit better in a different way.
David Lucas (25:12):
Let's do it. (laughing)
Carol Pehotsky (25:12):
So, let's see. What is something you do for you to recharge? You have a stressful role; you want to be present for your patients?
David Lucas (25:13):
Yeah.
Carol Pehotsky (25:20):
What do you do for you?
David Lucas (25:20):
Let's see. I like to hike, rock, climb. I have a dog that him and I will (laughs) go on hikes together, play, or whatever the case is. Yeah. Spend time with my wife, with friends is definitely a way that just kind of makes me feel like, all right, cool. Like my batteries are recharged. I'm, I'm refueled, ready to go.
Carol Pehotsky (25:37):
Yes. And if you weren't a nurse, what would your career be?
David Lucas (25:41):
Ooh. Probably an architect or a woodworker.
Carol Pehotsky (25:44):
Really?
David Lucas (25:45):
Something like that. Yeah. I've always liked Legos so I'm like- (laughing)
Carol Pehotsky (25:49):
(laughing) There you go. So, it's building blocks of brain, the building blocks of Legos.
David Lucas (25:52):
Yeah. There you go.
Carol Pehotsky (25:52):
All right.
David Lucas (25:54):
Yeah. Just I have like a little tiny wood shop in my, my garage that I'll-
Carol Pehotsky (25:57):
Cool.
David Lucas (25:58):
Well, I made a cabinet, like over the, over the winter and stuff so it's like-
Carol Pehotsky (26:01):
That's impressive.
David Lucas (26:02):
It's kind of cool. Yeah.
Carol Pehotsky (26:02):
Yeah.
David Lucas (26:03):
Yeah. It's fun, it's fun to create. (laughing)
Carol Pehotsky (26:05):
Very cool. Well, David, thank you so much for joining us today.
David Lucas (26:07):
Yeah. Absolutely. It's a pleasure being here.
Carol Pehotsky (26:12):
As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you.
(26:22):
Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.
(26:46):
The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.