Katherine Brennan is not only an expert in her field, she also works at the first pediatric hospital in the country to achieve Magnet designation (and continued to receive the rank 4 times) – the Ann & Robert H. Lurie Children’s Hospital of Chicago.
In 1990, U.S. News and World Report began publishing hospital rankings based on extremely strict criteria. They originally called it “America’s Best Hospitals”. Today we know the rankings as the “Best Hospitals”. When a hospital appears on the list, we know that it has passed rigorous assessments in 16 specialty areas. In the words of U.S. News, the purpose of the acknowledgment is “to identify the best medical centers for the most difficult patients—those whose illnesses pose unusual challenges because of underlying conditions, procedure difficulty or other medical issues that add risk.”
One of the factors the report considers is whether or not the hospital has a Magnet rating. A Magnet rating refers to the Magnet Recognition Program® developed by the American Nurses Credentialing Center (ANCC) in order to “recognize health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice.” The program is so rigorous in its evaluations and processes that only an estimated 6% of U.S. hospitals earn the rating. The latest figures attributing only 389 US hospitals with Magnet Recognition. For the nurses who are employed by these exceptional hospitals, it means you are a part of an honorable and elite group.
Interview - Question & Answer
Katherine, would you explain exactly what an Advanced Practice Nurse in Intestinal Rehabilitation and Intestinal Transplant does?
I manage patients with short bowel syndrome secondary to a myriad of intestinal disorders in addition to intestinal transplant patients. A unique aspect of my job is that I follow this high-risk cohort of patients across the continuum, whether they are stable and doing well at home or sick in the hospital. This allows me to become an expert on each individual patient, who have unique, complex needs based on their medical history.
How did you become interested in nursing? Did you come from a family with nurses?
I grew up in the suburbs of Chicago as the youngest of three children. I’m from a family of lawyers and accountants, so I am not sure where I spawned from, but I feel I am in great hands if ever I’m sued for malpractice or the state never passes a budget… Just kidding!! But truly, I have wonderful role models for parents who instilled in me an incredible work ethic and demonstrated selfless love on a daily basis.
Did you have a mentor growing up?
A dear family friend and incredible nurse served as a mentor growing up. I recall her fascinating work stories and the work-life balance she was able to maintain with a full-time job while raising 4 children
Is that why you chose nursing?
It is funny looking back as a naive, clueless teenager starting the college application process. I never truly “discerned” or contemplated my career choice all that intently. Somehow, I knew nursing was the right path for me. From my very first day of class at Boston College, nursing felt like the perfect fit personally and professionally. I have never once questioned this profession for me, but rather have validated on numerous occasions how lucky I am to have found my calling with such ease.
In terms of the classes, courses, and labs, was college a challenge for you?
I am proud to admit that I am a nerd and actually loved school! I recall one of my professors in graduate school in my last semester saying to me, “YOU’RE the one who will end up back for your PhD before you know it!” I have always loved learning and see it as one of the biggest luxuries in life. I believe that if I won the lottery, I’d perpetually be in school – perhaps picking up degrees in philosophy, bioethics, or a master’s in public health…and traveling of course!
How did you feel when you graduated?
As I neared the end of my graduate program, I felt the weight of my responsibility as a clinician. I recognized the distinct privilege of promoting and maintaining the health and well-being of my patients. But I feared I wouldn’t have the answers; I feared looking stupid; I feared falling victim to the “White Coat Syndrome,” feeling like a phony as a new graduate NP. However, as I gained confidence and established good mentors, I realized that I am never truly alone and that I’m actually pretty darn good at what I am doing. I will always have resources, and I have also surrendered to the reality that saying “I don’t know” to patients and families is a part of the practice. It keeps me on my toes and helps maintain my intellectual curiosity.
Your career is so specialized. How did you choose it?
My career as an RN started at Children’s Memorial Hospital (the former name for Lurie Children’s) in the newborn ICU where I worked with a variety of patients, including neonates with short bowel syndrome secondary to necrotizing enterocolitis, gastroschisis, intestinal atresia, and motility disorders. I subsequently moved out to Washington DC where I worked in the Pediatric ICU at Georgetown University and picked up invaluable experience with pre- and postoperative solid organ transplant patients, including liver and intestinal transplants. It was always a dream of mine to come back to Lurie Children’s and work as an APN. When the job hunting began, I saw the posting for an intestinal rehab/transplant APN and felt I not only had the credentials, but also years of experience working with this very unique, complex patient population.
What is a working day like in your life?
My day begins at a reasonable adult time in the 6am hour. I am far from a morning person, but thankfully I truly enjoy what I do, so the anger at the alarm typically dissipates quickly! I live within the city of Chicago and thankfully have an easy commute to work via the “L,” taking only 30 minutes door-to-door.
My work day begins at 8am, which first involves reviewing the Gastroenterology and Liver Service sign-outs in order to read updates on my patients who are hospitalized. I will prepare for rounds by reviewing inpatient charts and developing a plan for the day. A lot of what I do is more of an art than a science really, since each patient has a unique history and set of needs. Many of the patients require hospitalization for rule-out sepsis, surgical procedures, endoscopies, feeding intolerance, or malfunctioning feeding tubes or central venous catheters.
Rounds start promptly at 9am. I will work alongside attending gastroenterologists and hepatologists; pediatric and transplant surgeons; pediatric residents, GI fellows, pharmacists, dieticians, and social workers most days. I will see all of my hospitalized patients and visit with parents at the bedside to provide updates to the plan of care for the day.
Many of my patients are Spanish-speaking. I speak Spanish, so it is very nice to be able to communicate with the patients and families in their native tongue, but I also utilize our fantastic interpreting services as needed for complex medical jargon to ensure parents fully understand.
On various days of the week, I also see intestinal rehab and transplant patients in the outpatient clinic. I see patients on my own template and also in TPN clinic, which involves the additional oversight of our Intestinal Rehabilitation attending physicians. TPN clinics feature the majority of our patients requiring IV nutrition, who are the highest-risk population I care for. All clinic visits are comprehensive, including nutritional consultation and when necessary, surgical or perhaps social work support. Gaining good rapport and establishing trust with caregivers is crucial for the patient’s success in our program. We get to know these patients and families very well!
Additionally, my day may include consultations. The intestinal rehabilitation program takes consults from outside hospitals in the community, and on other units within our institution. The majority of our consultations are infants in the Newborn Intensive Care Unit. Once the patient is established in our care, we will provide recommendations at least once or twice per week and will then see them regularly in clinic upon discharge. An important aspect of establishing a relationship with a new patient and family is providing an abundance of education regarding our program, our plan of care, and trying as best we can to set expectations from the beginning.
When I am not seeing patients face-to-face during the day, I am back in the office managing our 30+ patients on IV nutrition (total parenteral nutrition), triaging sick phone calls, and addressing the multi-faceted needs of the approximately 200 intestinal rehab and transplant patients within our program. Once 5pm rolls around, I am off the hook! Due to the structure of the GI department, our hard-working GI and Liver fellows take any calls or urgent needs for our patients overnight and on weekends. We work very closely with these attendings-in-training who get to know our patients very well.
How does your position at the hospital affect your work-life balance?
My position allows for a healthy work-life balance. Since starting this job as a nurse practitioner nearly two years ago, I have maintained a manageable and very sustainable Monday through Friday schedule with no on-call or weekends. I’m lucky that my entire immediate family lives in the Chicagoland area and I am able to see them with great frequency! I also have a great crew of friends from all chapters of my life that I am able to catch up with on a regular basis.
What personal interests do you have outside of work?
In addition to leaving work by 5pm most days, Lurie Children’s provides around a month of PTO for full-time employees. Travel and a healthy lifestyle are very important aspects of my life. In the past two years, I have been lucky enough to travel to South America, Indonesia, and Portugal as well as around the United States.
In the last several years, I have also sought out medical volunteer opportunities abroad, including trips to Haiti and Guatemala and am planning on another trip within the upcoming months to Central or South America. I also practice yoga regularly, in addition to climbing, running and biking. I have a 100-mile bike ride around the corner and I am signed up to run the Chicago Marathon as part of the Lurie Children’s Hospital Team this fall.
Additionally, I love to read, cook, practice my Spanish, and play the guitar.
It certainly seems like you achieve balance in your life! It sounds like your hospital encourages this well-rounded lifestyle. Would you agree with that assessment?
In addition to direct patient care, I love picking up side projects and taking advantage of the tremendous culture of learning Lurie thrives on. Having worked at other institutions, I can confidently say that at Lurie, the voice of the nurse is valued, and educational opportunities are endless. There are physician and nursing-led grand rounds, Morbidity and Mortality meetings, Journal Clubs, APN Council Meetings, an APN mentorship program, just to name a few. I personally provide lectures for new and experienced nurses on the GI/pediatric surgery floor. I am also now getting involved in the APN Education Committee and helped plan and moderate our last Lurie-hosted APN Conference last fall. I am also helping some new graduate RNs with an Evidence-Based Practice Project as part of the new grad program through the hospital.
What characteristics do you think allow someone to thrive in your specialty area?
Compassion, self-awareness, cultural competence, patience, intellectual curiosity; detest for complacency; drive to do mission-based work.
It is obvious that you love your job. Why?
I love feeling like an expert in what I do; I like being in a specialty and getting to dive deep. I also love working with a high-risk, medically-complex, dynamic group of patients. Things tend to go “wrong” dealing with a group of pretty sick kids, so I like needing to re-prioritize and being adaptable every day – they’re good life skills! It is so rewarding to get to know patients and families; it is a special bond that many specialties do not have.
Will you name the qualities a "perfect" nurse possesses?
- Team Player
What would you say are the most important changes that have happened in nursing and in your specialty in the last few years?
On a broader scale, the movement as a nation towards the recognition of health care as a universal human right with the passage of the Affordable Care Act – the negative impact of living in a state without a budget and seeing the repercussions on Medicaid patients (majority of my program).
Within my practice, earlier referrals to intestinal rehabilitation centers; expansion of intestinal rehab programs; significant drop in intestinal transplants nationwide; kids being able to live long lives with good quality of life on TPN.
If you could choose one thing to change in your practice area, what would you choose?
While it is great that we are avoiding transplantation in about 95% of the patients in my program, we do have patients on the transplant waiting list in serious need of a new intestine and/or liver. I would love to see continued growth in organ donation awareness nationwide in order to provide a better life for those actively listed in desperate need of a transplant.
What would you change within the nursing industry?
On the national level, I would love for the advanced practice nurse to gain universal, full autonomy, in order to better utilize the mid-level provider. Our country is in dire need for more mid-level clinicians as we shift the focus of medicine towards preventative healthcare.
What do you hope to have accomplished by the end of your career?
I do not have high ambitions of filling my resume with “accomplishments.” I want to continue to do fulfilling, challenging work. “Making a difference” to me is in the small acts of service which fill my days. I do not seek praise or recognition; a simple thank you from a parent or smile from a patient reminds me that what I do matters and that’s enough for me. I want to continue educating my fellow nurses and help continue to grow awareness in the medical field of the role of the advanced practice nurse. International medical work abroad will also continue to be a regular part of my career. I like getting back to primary care and connecting with the communities.
What advice would you give someone who wanted to follow in your footsteps?
First, ensure your career speaks to your authentic self…which leads to – Know thyself: Recognize your biases and how your past experiences affect your interactions with your patients and colleagues.
Second, self-care is KEY to a long, healthy, sustainable nursing career!
Third, know you will make mistakes: one of the most courageous things you can do is recognize your limits, remind yourself you are human, and be kind to yourself.
Fourth, make sure to surround yourself by people that inspire you, challenge you intellectually and professionally and perhaps most importantly, advocate for you.
Firth, work hard… it will pay off! And finally, carry with you a healthy sense of fear and humility in the fast-paced, every-evolving field of healthcare – it will prevent complacency and help maintain perspective on how unique and rewarding a career as a nurse is.
Subscribe to EveryNurse
Useful tips, advice, and inspiration for nurses. Sent twice a month. You can unsubscribe at any time.