The Great Multi-tasker
A Conversation with Nurse Practitioner Eve Holzemer
Eve Holzemer, DNP, sees patients, conducts research, manages the neurology and psychology research nursing staff and teaches as an adjunct instructor at SLU’s School of Nursing. She also is one of the first three students to receive the doctor of nursing practice degree, the highest degree in the field, at Saint Louis University.
|Eve Holzemer, DNP with Susan Torretta, neurology and psychiatry|
How did you get to this point in your career?
I’ve been a nurse for over 30 years. It’s been an awesome journey. I spent 18 years in critical care. I joined SLU in 1989 and in 1998 I finished my nurse practitioner degree. Neurology was looking for someone to work with them and so they hired me. They didn’t know what to do with me at first. The fun thing was that I got to form my own job and formulate the things we’re doing now. I took over management of anti-coagulation care.
We hired other nurses to help support the research mission. After we joined with psychiatry in 2007, I became a faculty member and I was offered the opportunity to manage the nursing staff. It has been a labor of love.
And in December 2010, I was one of the first three students to receive the doctor of nurse practitioner degree from SLU’s School of Nursing.
What is a typical day like for you?
Every day is different. They call me the great multi-tasker. I work collaboratively with nurses and doctors. I see patients in clinic. I manage stroke studies. I mentor other nurses to help them develop and grow. I work with other disciplines, like psychiatry or dermatology, to bring studies to SLU. I’m teaching as an adjunct at the School of Nursing and I’m mentoring other DNP candidates. My role is also as a manager, developing budgets and looking at costs.
The thing about SLU is, they’ll give you the ball and you can run as far and hard with it as you want. I think my mission, always, is to make the place I work better. When it comes to mentoring my team, I want to elevate those around me to function at a higher level. I feel like I’ve been successful at that. I want our nursing staff to be empowered and to work at a higher level. I love to see them do things they never thought they could do.
What are some of your most memorable patient experiences?
|"Working with patients is like reading a good book each day."|
Working with patients is like reading a good book each day. I can’t approach them from my perspective, I can only approach them from their own perspective. Hearing their stories helps me understand how best to treat them and how to give them advice they’ll be able to follow.
I can say ‘You stop smoking.’ But they’re not going to do it. One lady I met drank a six pack and a fifth of bourbon each day. I wanted to know about her life. As it turned out, the alcohol was a learned behavior. Her family drank that way. As I talked with her, I asked her if she’d be willing to work with me to reduce it. She was interested in giving it a try. I said, ‘Can you cut down by one beer. The bourbon and just five beers.’ She thought she could cut back that small amount and she was right. We kept going. It took a year, but she quit drinking completely and she found a job. It was so much fun to empower her.
I have a patient in his 80s who doesn’t know when he was born. He can never remember when to go to his doctors’ appointments. He doesn’t read or write very well, so his doctors’ appointments are on my schedule so I can call to remind him to go. When he gets here, he doesn’t stop at the front desk. He heads straight back to find me.
Some of these people have touched my heart so much.
How did I end up so privileged? It’s been amazing to me. I’m in awe of the trust that our patients put in us. Even being a part of process of being with someone as they die. Some people don’t have family or anyone else there, supporting them during that time, and you become that person for them. People trust you with so much and it’s an honor.
Our patients love to come back. We really do care about them. Other places can seem like a machine. We truly individualize the care we give to our patients.
You’ve said you believe it’s vital to involve families in a patient’s care. Why?
|"There she was, wide awake, holding her baby with tears streaming down her face. It was a beautiful sight."|
Early in my career, we admitted a 24-year old new mother with a severe stroke. She had given birth about two weeks before. She was on a ventilator, on mediation to support her blood pressure, and kept paralyzed so that we could maintain her oxygenation. Her condition was so critical that she had multiple specialists attending to her. During their rounds, it became apparent that they did not believe she could possibly survive. It was disheartening to see all of the teams making rounds, shaking their heads, leaving her room, and mumbling that she was probably not going to survive. Everyone thought she would die.
Several weeks had gone by with no improvement and more complications for this young mother. I decided that our nursing team had to act. I assembled our nursing team and challenged them to think outside the box. I suggested that we had not done all we could for her and asked them to think of other strategies. I proposed that we have the husband tape record the baby crying and making noises, and we could play that at the head of her bed, which we did. Interestingly, about a week later, things began to stabilize. We continued playing the tapes for another week, and she became even more stable, allowing us to take her for a brain scan and perform a tracheostomy for her long-term ventilator needs.
At that time, hospitals did not have open visiting time and we certainly did not allow children or babies in the ICU. I was about to start that battle. I rationalized that this was imperative because if this mother survived, we were setting up this family for an attachment disorder because of the lack of bonding between mother and child. There’s lots of evidence about the importance of bonding. Even in her sleep, the baby would bond.
So I fought the fight. I got the okay of the medical teams. I called the woman’s husband with my proposal, and he enthusiastically brought the baby to the ICU whenever we asked him. Many people fought against these concepts, but in the end, whenever this mother opened her eyes, her baby was in the room with her. We would hold the baby over her and tell her, ‘Your baby is here and needs you to take care of her. It’s time to wake up and take care of your baby.’
One day I walked into the unit after several days off, and I walked past her room. There she was, wide awake, holding her baby with tears streaming down her face. It was a beautiful sight.
In the end, this patient was with us for three months until transferring to rehab, where she recovered for another three months. A year later, she came to visit us. Her only disability was weakness in one arm. Her bond with her daughter was strong, and the family survived and thrived. After this, I was able to push for opening visiting hours and including families in the process of critical care. I have always believed that patients are not admitted in isolation, but are a part of a system that is imperative to utilize and respect.
Medicine can be so cold, but it doesn’t have to be that way. We can do a much better job.
What is your research about?
I see patients in clinic after they’ve had a stroke, and I wanted to find out if we’re doing a good enough job of educating patients after they’re discharged from the hospital. After experiencing a stroke, these patients are overwhelmed and we’re here giving them information about how to reduce their risk of future health problems. There are questions patients don’t think to ask as they’re leaving to go home.
In my study, we randomized patients to receive either the typical, standard information or extensive, individualized education about cutting down their risk for future health problems. We individualized the information to be specific to their situation. We gave them report cards. I wanted them to know their numbers, like blood pressure, and what those numbers meant to them. If they didn’t have high cholesterol, I didn’t focus on that. After three months, this group did better with blood pressure, diet and exercise. The study showed me the intervention was effective. One patient in this study who had many risk factors went from a 45 percent risk of a future event to a 19 percent risk.
It was lots of fun. I did a poster at the American Academy of Nurse Practitioners. It’s important because we’re really not doing a good enough job of teaching our patients as they are discharged. You’ve accomplished a lot, earning several degrees, helping so many patients and mentoring your team.
I’m giving myself a little bit of time to decompress and use my new skills. I always leave myself open to new opportunities. I think the next opportunity will reveal itself to me and when it does I plan to walk through that door.
This is the hardest place I’ve ever loved to work. If the job was easy, I’d be bored to tears. This job has been a love affair for me.