#acrn

http://thinkingmonologue.tumblr.com/post/64555534569/a-rant

and http://thinkingmonologue.tumblr.com/post/99966202923/an-update-on-an-old-rant

So now here I am four years later and tonight I think I can finally claim a small victory. Tonight at the same hospital that four years ago was going to turn away my PEP patient, my colleague and I delivered not only one but two brand new HIV diagnoses. 

In four years time this ED went from a place that would turn away a PEP patient and refused to do any HIV testing in the ED to paging me to deliver an HIV result that was outstanding since November. I can’t claim all the credit single handedly....I have had mountains of help along the way, but I still can’t believe it.

I guess I need to provide some semblance of context as to how this came about. After working in a local small community hospital ED the hospital ended up closing....yes that does still happen. At that point I was unsure what I should do with my nursing life and began exploring the option of going back to work at the hospital where I had been a student...that top tier one...in the ED no less. Well by some stroke of fortune at the time my hospital closed and I was looking to transfer to another ED a position opened up in that same swanky top tier hospital’s infectious disease department. So for the past two years I have been working at one of the top hospitals in the country as one of 5 infectious disease nurses. 

I slowly began to push out all of the nurses who needed to retire and hire some of my old colleague and even a couple of new faces. I started working on initiating substance abuse treatment programs in the HIV clinic and started, with one of my best friends, an HIV retention to care program that makes all previous attempts at moving the 40% engaged in care numbers of the HIV cascade look like a joke. Then with the help of a compassionate doctor, supportive leadership, and a team of some of the best nurses I have ever worked with we were able to convince the ED at that fancy hospital to do rapid testing on select patients. 

There was one caveat....they wanted back up if anything came back positive. Reasonable enough right...so myself, my best nursing colleague/friend, and the ultra compassionate doctor are taking shifts in case they test someone and get a positive result. Any of us are then dispatched to the ED to not only deliver the result, but to help actively engage the patient in care and offer a different kind of support at what is a pretty terrifying moment in most people’s lives. 

The program has been set up for a few months now and it has taken a while to get people on board about testing as they seemed hesitant that it would actually work. Then tonight we got out first page for a 20 yo white girl with absolutely no obvious risk factors beyond recurrent pneumonia. My counterpart and I were dispatched to the ED and while she was supporting the patient I spoke with the medical team (nurses, doctors, and PA) about how to support the patient, how to keep the diagnosis confidential from the patient’s mother until she was ready to disclose, and how to navigate the assessment process prior to admission. I was encouraging to them because they were able to not only recognize the risk but the team actually had the courage to order the test. 

We had barely finished with the first patient when we got a call from another doctor telling us that someone who had not received his positive HIV test result from a provider across town (another big hospital) was in the ED and could one of us go down and help with diagnosing the patient. 

I was up...and in the same area of the ED (the one nurse and 20+ patients) where my PEP patient was almost discharged without a rx, I was given a room and all the time I needed to diagnose someone with HIV, assess their mental health, and create an action plan for next steps. 

It’s really funny how everything comes full circle eventually. It may have taken four years and a lot of weird twisting turns, but somehow but by the grace of God it happened. I have started to change the culture in one of the major EDs....the next step will be even more of a challenge, but I have never been more encouraged that it is possible. 

By Julia Leiby, Contributor [Domino; 2016] Rating: 4/5

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Told Slant - Algae Bloom