“We just need to try.”
Beth Melanson, MSN, RN, CWON, ACNS-BC, CCRN, gently encouraged her interprofessional colleagues to follow a patient’s care plan and remove her ventilator, despite their hesitation. It seemed likely that if the patient remained on the ventilator, she would be discharged to a long-term care facility, rather than home to be with her family as she hoped.
Melanson is known as a champion for her patients and for her ability to “mobilize the entire team to get the ball rolling until there is a definite track the patient achieves – progressing towards recovery to a rehab facility, transitioning to a step-down unit, discharging to home or dying with dignity,” said Nursing Director Hasna Hakim, DNP, MSN, RN, CCRN.
In this case, Melanson was thinking about her patient’s quality of life and her wish to go home when the attending physician suggested trying her off the ventilator (prior attempts to wean had been unsuccessful). In addition to helping other team members feel comfortable with the idea, Melanson checked in with the patient who agreed she would like to try. Melanson explained to the patient that she would be by her side the whole time, with a full critical care team at the ready if needed and that this could be a step toward going home.
Following the removal of the ventilator, the patient did extremely well and was even able to speak for the first time in months, amazing her loved ones and herself. She would eventually be discharged home.
Melanson advocates for all of her patients in the same way, caring for them with expert clinical skills and forming relationships that help her understand their goals. For these reasons, she received the 2018 Kurlat Essence of Nursing Award, the highest honor bestowed upon clinical nurses at BWH. She was nominated by Hakim, who says that Melanson “never gives anything less than 100 percent.”
Carol Daddio Pierce, MS, RN, CCRN, professional development manager, agreed.
“Beth manages every patient assignment she receives with the utmost dedication and total investment of self to attain the highest-quality outcome each patient deserves,” she wrote in a letter of support.
Making a Difference for MICU Patients
Melanson begins every patient interaction the same way.
“I always talk to my patients and ask them to tell me about themselves before I begin to provide care,” she said. “If a patient is intubated, I talk to their family, asking them what I should know about their loved one. It puts them at ease and creates a connection between us.”
This is especially important in the MICU, where patients are critically ill and may feel vulnerable and anxious.
“Many of our patients have reached the terminal phase of their multiple comorbidities,” said Daddio Pierce. “Not only does Beth identify and implement the critical resuscitative interventions required for the clinical situation, but she also creates a calming environment, providing the necessary pause for patients and families to evaluate the goals of care.”
Melanson, who joined the MICU in 2005, appreciates the relationships she has formed with her nursing and interprofessional colleagues through the years, as well as the support of the entire MICU team.
“If I’m struggling, I know someone will come to help,” said Melanson, who works evenings and weekends. “The physicians who care for patients in the MICU collaborate with nurses and truly want our input during rounds.”
Expertise in Skin Care
Melanson also works as a certified wound, ostomy and continence nurse (CWON) at BWH, performing inpatient consults on a per-diem basis and teaching a class on pressure injury prevention.
Regarded as a mentor, coach and teacher, Melanson is dedicated to sharing her knowledge and expertise in skin care with her colleagues.
Fellow MICU nurse Maria Paz Schaller, RN, appreciates Melanson’s input on her patients, even when Melanson is not formally working in her CWON role. “She has always stepped in to evaluate and see these patients,” Paz Schaller wrote in a letter of support. “She does this because she truly puts our patients’ needs first.”
Several years ago, the MICU was experiencing a high rate of pressure ulcers. Melanson became an integral member of the group that was studying the unit’s practice and identifying a response.
Unit champions received grant funding from the American Association of Critical-Care Nurses (AACN) to develop their project and provide staff nurses with knowledge and support to lead their peers in creating unit-based change that is scalable hospital-wide. They reoriented staff on all shifts to use the same terminology, measurement tools and standardized treatment, reducing pressure ulcers in the unit by 68 percent.
“We were able to present at the AACN National Teaching Institute (NTI) and Critical Care Exposition, and our work was cited in Forbes magazine,” Melanson said.
This experience is one example of why she enjoys working at the Brigham. “People stay at the Brigham for a long time; that says a lot,” she said. “We have the opportunity to grow and do so many things here as nurses.”
Getting to Know Beth Melanson
Family: Husband and three sons, ages 14, 12 and 9.
Education: MSN, BSN, and BA in Psychology from the University of Massachusetts, Boston
Favorite music: “I have a bizarre fascination with the BeeGees.”
On becoming a nurse: “Nursing is actually a second career for me. I had a degree in psychology and worked on an adolescent child pysch floor at Cambridge Hospital in my 20s. Once I saw the roles of nurses, I knew that’s what I wanted to do.”
When she’s not at the Brigham: You’ll find her traveling to her sons’ soccer, hockey and baseball practices and games or working part-time as a nursing supervisor at Cambridge Hospital, where she began her nursing career.
Reaction to learning she won the Kurlat Essence of Nursing Award: “It’s very humbling, and it feels good to be recognized by your peers. I’m thankful to be part of a team of great nurses who deliver exceptional care to our patients.”