Kerri Jeppson, RN, BSN, CCRN

What is your philosophy of nursing? This is a question that is not frequently asked. To answer
this question I had to think about my career as a nurse and what that meant to me. Where has my
journey brought me and what have I learned along the way?
My journey began at the young age of 4 years old. Tragedy stuck our family with the death of
my father from a myocardial infarction and the death of my sister, at age 18, from Combined Immune
Deficiency. Their deaths were within 8 months of each other. As I grew up I wanted to learn the why.
What led up to their sickness and how did my mother deal with such emotional tragedy? I watched my
mother survive and continue to care for others selflessly. Before I could even recognize it, I had
developed an integral part of my nursing philosophy, caring for others. I also learned that nursing is not
just about the patient, but includes the family as well.
I went on to receive my BSN at the University of Minnesota and began my career as a nurse. It
started at Hennepin County Medical Center in Minneapolis. As a novice nurse I worked on a very busy
Neuro/Surgical/Trauma Unit. The first 6 months were a blur. I remember at about 6 months realizing
that now I had time to actually think a bit more. I had spent most of my time thinking about how to
hang an IV, prime a bag of tube feeding, or look up an unknown medication for the 100
th
time, I hadnt
had time to notice that there was a patient there as well. I developed my skills there, working up to
taking care of more difficult patients on the Intermediate Care Unit. It was on this unit that I became
more competent as a nurse and began developing another part of my philosophy, understanding. It was
there I began to really see people. As a county hospital we saw all different types, races, and classes of
people. I learned that it didnt matter; everyone deserved the best care I could provide. I learned to
respect that there are so many different cultures and beliefs out there and to understand their point of
view.
I now had a new sense of competency and with this I wanted to move on and try new things.
So, I decided to become a travel nurse. During this part of my journey, I learned to adapt. I didnt
receive much orientation and I was frequently thrown into new situations. While taking care of as many
as 7 patients at a time I learned how to be organized and then honed the ability to multitask, which is a
blessing to a nurse. I began to gain experience and be more precise in my skills. I began looking at
clinical signs that a patient was starting to deteriorate. I might not have known yet what to do, other
than finding a more experienced nurse or calling the doctor. I remember a patient I had whose
condition began to change. Her skin began to become mottled in her lower extremities and I took that
as her being cold. She began to become more lethargic, which I attributed to the Vicodin I had given
her. Then, her heart rate and blood pressure became unstable and I had to call the MD. He gave a few
orders over the phone, but refused to come in. I did not say anything to him, but I remember feeling
this patient needed more attention. I found a resource in the charge nurse. The charge then assisted
me in speaking with the doctor and bluntly saying if he did not come in we would be coding this patient
soon. It ended up the patient was in renal failure and had an elevated potassium level. The patient was
then determined to need a higher level of care and was transferred to the ICU. I learned that you are
the one accountable for what happens to your patient. You need to advocate for them. This is where I
began to understand the importance of being a patients advocate.
While I was in Colorado as a travel nurse, I met my husband and decided to make Colorado my
home. This is when I decided to advance my nursing career. I applied for an ICU position at University
of Colorado Hospital. It was here I found that there was so much more to learn! I went back to feeling
less than competent. Had I really understood what was going on with my patients? Was I really thinking
about the physiology of what was going on? Did I really understand the relationship I had with the
whole person? No! It was here I began to pull my nursing philosophy together and put it to good use. I
began to think critically and appreciate the autonomy that a nurse can have. I began to make
suggestions and work as part of a team to creatively make solutions. My philosophy not only was caring
for the human being, understanding and developing a relationship with them, but individualizing care
for each patient and integrating their family as well. Recently, I had a patient who suffered a
subarachnoid hemorrhage. Her interventional radiology procedure was complicated by a right sided
stroke. This left her weak on one side, but she had no other deficits, thankfully. During my first
assessment of her I realized she was on an inappropriate device for the amount of oxygen she was on,
which was 10 Liters. As I go to know her and her family I became more and more determined to keep
her from being intubated. I looked at her whole picture, labs, Chest X-Ray, Intake and Output and
worked as a team with the MD and Respiratory Therapists to strive to keep her from being intubated.
As the day went on she became more unstable, but I still was able to find the time to explain to the
wide-eyed family what was happening and made sure they were also ok. In the end I was working side
by side with her Attending to strategize her situation. She did not get intubated on that shift, but did
eventually need intubation. This is an example of how I have become an expert nurse. I am able to look
at the whole picture, come up with suggestions, work as a team, and integrate the family in my practice,
all while still managing to care for another ICU patient as well.
As an expert nurse I am always looking to grow and advance my knowledge. I truly appreciate
evidenced-based care and using it to better patient outcomes. Two years ago I attended a conference
where they mentioned the use of a non-invasive cardiac output monitor. Instead of thinking that this
monitor could benefit our patients and then dismissing it, I took the opportunity to bring the monitor
into our Neuro ICU. We trialed it, I took it through products, and we are now using it to try and better
our patient outcomes. I see myself as a leader on the unit. This is during not only my roles of relief
charge and preceptor, but also on a daily basis. I assist other nurses with questions or concerns they
have about their patients. I also work in assisting the residents in taking care of our specific population
of patients. I recently had a patient with a gliomultiformblastoma. She had undergone a resection of
the tumor a few days prior to me taking care of her. She had become somnolent post-op. They had
performed multiple tests, such as an EEG and a CT to figure out what was causing her somnolence. I had
received in report that the day before she had received mannitol, a medication that decreases swelling
in the brain.. The patient had awoken and began to follow commands during the previous day shift, but
at 1400 that day she once again became somnolent and required bipap to maintain adequate
oxygenation. At that time a light went off in my brain on where I wanted to go with this patient. During
rounds that morning with the MD I suggested giving more mannitol. This was received by some push
back from the resident, but I strongly encouraged trying the medication. I stated that yesterday at some
point after the mannitol she had awoken and quite possibly the medication might help her again. The
resident grudgingly ordered the medication. The nurse I was precepting and I administered the
medication and a short while later the patient began to follow commands again. The MD then
scheduled mannitol around the clock for this patient. We were able to wean off the bipap and work
towards getting the patient out of bed and having speech therapy work with the patient.
In conclusion, I feel I have reached a level of nursing I am proud of. I think as ICU nurses there is
a point where a lot of us go through a stage of over confidence. I feel I have surpassed that stage and
can see my nursing career as a whole. I am humbled. I have integrity and use that to take the best care
of my patients possible. I now see nursing as a career, not just a job. I am looking to develop my career
further as a nurse. I will never stop striving to be better; not only intellectually, but emotionally and
socially as well. I can now push those around me to do the same. I am passionate about my career and
look forward to continuing to evolve over the years.