How Being an ICU Nurse Prepared Me to be NLM Director

In mid-May, at their 2022 National Teaching Institute & Critical Care Exposition in Houston, Texas, I received a great honor from the American Association of Critical Care Nurses (AACN): the AACN Pioneering Spirit Award. I was delighted to receive this prestigious award, which recognizes significant contributions that influence progressive and critical care nursing worldwide and relate to AACN’s values of integrity, inclusion, transformation, leadership, and relationships. I was humbled to receive this award for my work during my tenure as NLM Director, and it’s in large part due to the work that so many NLM employees do every day.

This acknowledgement from AACN is deeply meaningful to me because critical care nursing has been a part of my professional identity for almost 50 years! In 1974, while I was still in nursing school, I was assigned to work as a nursing assistant in the critical care medical unit at Lankenau Medical Center outside Philadelphia. After graduating in 1975, I became part of the nursing team in the surgical intensive care unit (ICU) at the very same hospital.

These early experiences have touched every part of my career, including my role at NLM—the epicenter for biomedical informatics and computational health data science research and the largest biomedical library in the world.

Then: Learning from My Teachers and Colleagues

I learned from Kathy McCauley, cardiac-care nurse extraordinaire, about the importance of the scientific basis of nursing. Nurses’ deep knowledge of physiology, pharmacology, and anatomy enables the bedside critical care nurse to almost instantaneously recognize vital changes in a patient’s medical status and determine just the right interventions to rebalance fluid or improve oxygenation. My colleague and ICU nurse, Nora Kelly, modeled respect for patient dignity that, to this day, shapes my work to support patient self-management using effective computer technologies. Nora showed me that even in the midst of an often hectic, fast-paced ICU environment, there was always time to provide a patient with comfort, help a person into a more comfortable position, or complete basic hygiene and grooming around tubes and monitor wires.

Now: Serving as Your NLM Director

What stands out the most to me now are the lessons about the importance of in-the-moment information processing; interdisciplinary teamwork supported by nurses, physicians, respiratory therapists, pharmacists, social workers, and others; and personal accountability that shape my everyday life as the director of NLM. Delivering high-quality care under extreme levels of uncertainty and risk is the hallmark of critical care. I learned early on that time was of the essence—there was rarely an opportunity to pause and read an article or two as one pondered how to intervene in a physiology cascade that could lead to sudden death.

The insights from these experiences taught me that for information to truly support in-the-moment care, NLM needed to make its resources open and available in machine-readable formats. It is our job to use machine-learning algorithms to make available NLM’s vast repository of biomedical and scientific literature that drives contemporary drug management or clinical guidelines interpretation. NLM invests in research that helps ICU professionals quickly interpret patient charts so they can predict the likelihood of pulmonary embolism diagnosis or track a patient’s probable health outcome trajectory using observations noted in their electronic health record.

NLM in the ICU

ICU patients in hospitals around the country are all supported by the best interprofessional teams that understand the unique aspects of patient care, whether that’s to advance the patient’s progress towards wellness or to provide alternative end-of-life care focused entirely on comfort. Because of the diversity of caregivers and professionals across hospital ICUs, we must acquire, organize, and disseminate the literature to all biomedical professional groups when they need it most.

It is in this spirit that each division in NLM—including our Library Operations team managing our NLM Collection, our MEDLINE Literature Selection Technical Review Committee to impanel experts across many specializations, and our PubMed and PubMed Central with the tools to index and catalog records—accelerates the dissemination of knowledge from many disciplines. Clinicians are required to have deep expertise and stay abreast of new research within their specialty and to recognize potentially valuable literature from other disciplines. In support of this requirement, we organize over 34 million citations by clinical problem and physiological underpinning. That way, no matter what your specialty, each search identifies literature from a wide range of perspectives and refines our “relevance-based results return” according to those patterns most valued by our patrons, as described by NLM’s Best Match algorithm.

Patients often find themselves in the ICU from somewhere else in the health care system and are frequently discharged not to their homes, but to other less-intensive clinical care units. To understand their conditions and efficiently guide their care in a vast, complex, and time-sensitive setting, health care interprofessional teams should understand all ICU clinical information and events so they can translate and transmit that information to the responsible post-discharge teams. This information flow relies on health data standards so that events that occur in one place are well understood in the next. NLM plays an important role by forecasting how health care settings like ICUs will use health data standards to promote interoperability and by shaping the public policies that protect patient records. NLM shares its expertise in data science, health information technologies, and computer science with our fellow federal agencies and with the private sector to make sure patient records are accessible while remaining private and secure.

Connecting the Dots

I remember the enormous intimacy involved in my ICU nursing experience, often including myself and a patient, at times the patient’s family, and certainly every time the rest of the care team. But teamwork only works when each member holds sacred their responsibility to the patient and the care that they require. Personal accountability does not occur in a vacuum; rather, it is molded and shaped through conversations with colleagues, collaborative care-planning rounds, candid postmortem reviews, and quiet heart-to-hearts in the staff lounge. Even these efforts are touched by NLM, from providing literature and guidelines that lay out the various roles of professionals to furnishing our citations repository with the contact information of those authors whose work guides clinical thinking. In this way, NLM becomes a partner for personal accountability.

If only that fledgling ICU nurse from 50 years ago knew that her entire cultural and practical experience was preparing her to direct the most important health science library in the world! Because of who she was as that nurse and who we are as NLM, critical care remains a cornerstone of health care information and systems in best support of all patients. If you have ideas for how NLM can better support the critical care of YOUR patients, please let us know!

Nursing in the Headlines

Every year, we celebrate National Nurses Week between May 6, which is National Nurses Day, and May 12, which happens to be Florence Nightingale’s birthday. If you haven’t picked up a specialty journal or public newspaper in the past few months, you may not know that nursing has made it to the headlines:


Some of us might argue that any press is better than none, and others might say it’s about time that the real story about nurses and nursing become better known. While I believe a little in both perspectives, the real reason I’m glad to see them today is that they depict a much richer, more valid, and more robust story about who and what nurses are and how they serve society.

A recent article in The New York Times stated, “A Shrinking Band of Southern Nurses, Neck Deep in Another Covid Wave.” This news story brings into national view the importance of small, nonprofit safety-net hospitals and the experience of the nurses who work there. Told without romanticizing nurses’ dedication or pointing out their long-suffering compassionate nature, this article tells of the real challenges faced by nurses who want to do good for their communities but are faced with persistent shortages, significant illnesses that could have been avoided, and politically motivated, bureaucratic financial decisions. However, it also tells of the creative problem solving demonstrated by these nurses as they try to meet patient needs and the compassion they provide to their colleagues as they continue, yet another day, to address the needs of many with fewer and fewer resources.

Look at the first three headlines: together, these depict a professional field dedicated to meeting the conditions of its social contract—to provide high-quality patient care—and awash with opportunities for outstanding career growth, and at the same time at risk of losing some of its critical workforce due to unrelenting stress in the workplace. What does this say about nursing? Never has there been such opportunity, but never has the opportunity promised so little.

A beautiful story in March in The New York Times, “Confronting Grief, With Margaret Atwood, in ‘The Nurse Antigone,’” which talks about regular nurses participating with Margaret Atwood in the reading of the play Antigone, provides me with hope and vision. In this rendition, Atwood will play the blind prophet Theophanes and the nurses will be part of the Greek chorus. This story of Antigone’s determination to bury her brother, who died in battle, despite a law forbidding the burial of traitors mirrors the challenges nurses face by attending to those in need despite enormous challenges in acquiring resources needed to provide care, including sufficient time. An ethicist quoted in the article remarks that Antigone’s triumph over Creon’s prohibitions provides an apt mirror of the moral injury with which nurses cope, neither romanticizing their decision nor despairing at their deplorable conditions.

The final headline in the middle of the pack heralds nurses’ awakening to their economic power. The COVID-19 pandemic didn’t create the traveling nurse sector of our profession, but it certainly accelerated its growth across the country. Individual remuneration soared, leaving many nurses with the dilemma to remain as a loyal worker in a long-served institution or move on for financial gain. Hospitals too faced the challenge of differential staff compensation, with highly paid traveling nurse staff working next to more modestly paid existing staff. Fortunately, the perversity of this economic structure has led to hospitals and clinics improving staff nurse compensation, attending to their work conditions, and stabilizing the staffing complement.

As we celebrate National Nurses Week this year, please join me in recognizing the vibrant, rich picture of our profession. We are not unbuffered by these challenging times, and as a profession, we are responding in a way that serves our patients while preserving our profession. Accepting new models of care, innovative career trajectories, and an expanded understanding of how to create compassionate workplaces promises a future in which all nurses can work to the top of their licenses. Let us know how we can help you do this, too!

Partners on the Health Care Team: Librarians Collaborating with Nurses

Guest post by Annie “Nicky” Nickum, BSN, MLIS, AHIP, and Rebecca Raszewski, MS, AHIP, faculty and nursing liaison librarians at the University of Illinois Chicago.

Occasionally we focus on the intersection between libraries and special clinical practices. Librarians are important partners for nurses who seek to improve their practice within their workplace and continue to be indispensable as nurses start their professional and academic careers.

There are many ways librarians contribute to nursing education with the ability to provide expertise on evidence-based research and research strategies for clinical questions. Librarians collaborate with nursing faculty by conducting literature reviews, collaborating on manuscripts, and teaching students. Our patrons range from students just getting started in nursing to faculty and practice leaders within the field, all having access to our library’s resources. We teach them how to search the literature for projects contributing towards completion of their degree whether it be Bachelor’s, Master’s, Doctor of Nursing Practice, or PhD.

The support and partnerships librarians provide to nurses is nuanced and varied. It is dependent on the type of relationship the library has with the given hospital and the nature of their clinical query. At the University of Illinois Chicago, we have a teaching hospital.  Within hospital settings, librarians may also be involved in educational initiatives within nurse residency programs for new nurses or specific programs for nurses who want to conduct evidence-based practice or research. This goes hand in hand with preceptor support for nurses mentoring students. Librarians may provide orientations and collaborate with residency directors and preceptors to develop quality improvement projects.

Hospitals that are pursuing or have Magnet status (the highest credential for a nursing facility within the United States) will usually have a shared governance model in place where nurses of all educational levels advocate for nursing’s role in patient care. Nurses are involved with reviewing updated hospital guidelines and protocols, providing an opportunity to make sure nursing practice is reflected.

Librarians may be members of nursing- and hospital-wide councils — supporting quality improvement initiatives conducted by nurses or other health care professionals by providing the latest evidence. Examples of literature searches that have been conducted at our institution include:

  • Interprofessional patient rounds,
  • Delivery of care in labor and delivery for obese pregnant women, and
  • Examples of the SBAR Tool (Situation, Background, Assessment, Recommendation), which is a technique used for communication and often used in electronic health records. 

The literature that librarians provide lays the foundation for improving patient safety and contributing to staff empowerment.

At the University of Illinois Chicago, we’ve been involved in an external collaboration with nursing faculty. The NExT Project has provided free continuing education to public health and school nurses since 2014. In 2021, the modules were expanded to include ambulatory care nurses. Nurses can go through the modules created by library and nursing faculty on the evidence-based practice process, which involves how to find evidence, appraise the evidence, translate the evidence, and disseminate what they found. These modules give nurses from workplace settings with limited resources the opportunity to learn about evidence-based practice, exemplifying that searching for and implementing evidence-based practice(s) is possible in any work setting.

Librarians are critical to the success of health care teams. Throughout your career how have librarians helped you?

Annie ‘Nicky’ Nickum currently works as an Information Services and Liaison Librarian and Assistant Professor at the University of Illinois Chicago where she supports the College of Nursing and the University of Illinois Hospitals. Her research interests include consumer health literacy amongst nurses and supporting the translation of student health literacy to nursing practice. Before coming to UIC, she worked at the Library of Health Sciences at the University of North Dakota as the Nursing and Biomedical Sciences Librarian. She obtained her MLIS from the University of Wisconsin-Milwaukee in 2013.

Rebecca Raszewski, MS, AHIP is Associate Professor & Information Services & Liaison Librarian at the Library of the Health Sciences at the University of Illinois Chicago. She has worked with nursing on the Chicago campus since August 2008. Her most recent publications have focused on data management education in graduate nursing programs and nursing faculty’s awareness of information literacy standards. She is involved with the NExT Project, a library and nursing faculty partnership that provides free continuing education on evidence-based practice.

Imagination – The Cornerstone of Innovation

Part 1 of a series discussing the importance of imagination.

Everyone is talking about the “new normal” now — the post-pandemic space after we return to the physical location of work, school or play— and asking, what will life be like? There are many calls for innovative thinking. One of the best things about a library is that it provides a foundation for innovation, but building the pathway between great science, good ideas, and innovative products and services takes imagination. NLM is a springboard for innovation in health care, from describing previously not-well-understood biological processes to creating new drugs and therapeutics. Even taking the leap from this springboard requires imagination!

Imagination is a process of the mind somewhere between cognition, recall, and play, that allows a person to create novel ideas, sensations, and visualizations. Somewhere between play and wool-gathering, imagination is the capacity of an individual to conjure up ideas that can be pleasing or frightening, phantasmagoric or peaceful. Sometimes the experience of imagination is a self-contained pleasure; other times it becomes a catalyst for new ways of living or new products and services that can help the public in different ways.

Imagination is the starting point for innovation. It stimulates innovation through the experience of a mental what-if, unconstrained by the realities of physics or finance. Imagination is a talent that can be learned and refined over time, benefiting from the reinforcement of envisioning that which might be, and using that vision as a test case for that which can be. Everyone can exercise imagination, and through this practice, make the world around them a better place!

Nurses are pretty good at applying imagination to complex patient care situations. Take, for example, Marie Van Brittan Brown an African American nurse living in the Jamaica neighborhood in the New York City borough of Queens. In the early 1960s, she and her husband Albert, an electronics technician, imagined a way to help people feel and be safe in their homes.

Figure 1: Diagram of the original 1966 patent request filed by Marie Van Brittan Brown and Albert L. Brown courtesy of the U.S. Patent and Trademark Office.

Being and feeling safe at home is particularly important for homebound individuals. Many homebound individuals live alone and are isolated. They may lack the physical ability or strength to investigate a strange sound outside or answer a ringing doorbell. Ms. Brown and her husband imagined that homebound people would feel safer at home if they had a way to see through the front door and interrogate a visitor and, if necessary, activate an alarm to alert the police that help was needed. Envisioning a set of peepholes, microphones, and a closed-circuit television, they created the first modern home security system. A monitor installed in the home or bedroom of the resident allowed ease of viewing and enabled the resident to speak to someone outside the door. Ms. Brown and her husband were awarded a patent in 1969 for this system.

Like many people who use imagination to stimulate innovation, Ms. Brown found herself far ahead of her time. In the 1960s, closed circuit TV was considered a military application, and home builders found the cost of the system to be too high. However, having the forethought to register their design and seek a patent, they provided the “prior art” that later stimulated over 30 patents.

What helps build the pathway from science to imagination to innovation begins with an idea that addresses an important problem. Imagination complements science, making it possible to see what science enables. Achieving the full promise of innovation again requires a dose of science because leveraging what is already known to what could possibly be is what brings an imagined future into an innovative reality. It takes imagination to sketch out a future, and even more imagination to find (or build) the elements needed to make that future real.

NLM stands as a partner in your imaginative journey. Keep practicing and let us know how we can help you innovate the future you can imagine!

To the Nurses Today… And The Nurses Yet To Be

In early May, I had the pleasure of giving the virtual commencement speech to the graduating class of the University of Illinois College of Nursing. It was an honor to speak to the next generation of nurses as they step into a world forever changed by the COVID-19 pandemic. In a normal year, it takes hard work to complete a nursing degree; during a pandemic, it takes extra dedication to pursue your studies online.

As a nurse myself, I’m proud of the accomplishments of these 400 new nurses and look forward to providing them with resources and information as they start the next phase of their career, and for many years to come.

Please join me in wishing a warm welcome to these new graduates as they enter a world that needs and appreciates the hard work of nurses more than ever.

Video Transcript (below):

I’m Patti Brennan, Director of the National Library of Medicine. I want to add my congratulations to the choruses of friends, families, and colleagues on your accomplishments being acknowledged this day of the graduation at the University of Illinois College of Nursing.

Almost 200 of you are entering the profession for the first time, and another 200 are receiving graduate degrees in recognition of your advanced education in nursing specializations.

I want to speak today to the nurses who you are right now, the nurses who you will become, and the nurses who you will need, and finally to the nurses,  yet unborn,  who will serve society in the future.

To the nurses who you are today:  

Your nursing education experience was like no other over the past 100 years!  You’ve learned how to learn via Zoom and TikTok, transform nursing interventions into telemedicine delivery, and develop novel skills engaging patients not only as informants but as partners in care. One of the few positive outcomes of this coronavirus pandemic is the societal recognition of the essential value and contributions of nursing. So, you are entering a world that both needs you greatly and is readily accepting of the contributions you could make. 

I hope you will take with you the joy of friendships you made during your educational time here at U of I College of Nursing: the excitement of learning, the meaningful contributions of patients who accompanied you on your learning journey, and the hope that suffused your faculty members as they guided you on your journey. I trust that the foundation of your education here will give you a firm basis, grounding you in trust, supporting your explorations.

You are entering a world that needs nursing more than ever before. I urge you to use the professional education you have had to support doing the urgent tasks in front of you while remaining true to nursing’s social contract. The hallmark of a professional is doing a task that looks like something someone else could do, but is done with the sophistication of specialized knowledge and skill that grows from the deep foundation, the future vision, and the broad perspective that we draw from our profession. It’s not enough to act, we must BE nurses.

To the nurses you will be in 2031:

What do you see when you look back across the decade since graduation? Have you achieved pay equity? Did you accomplish the next level of education that you envisioned as you completed your degree today? Did you find satisfaction and depth in the area of nursing you originally selected, or did you explore several areas before finding your niche? Or maybe, did you find a way to express the values and knowledge of nursing through another profession such as law or design? Wherever you are in ten years, I hope you look back in wonder, awe, gratitude, and satisfaction.

How does the world around you look in 2031? Has our treatment of Mother Earth improved so that the UN’s 17 Goals for Sustainable Development have actually been met? Have we achieved social equity and removed health disparities engendered by structural racism? Was the coronavirus pandemic the last pandemic of the decade or was it the start of a pandemic decade? Has someone made driverless cars practical or figured out how to get rid of all of those cords on our computers?

To the nurses you will need in 2071:

Right now, I’m just about the age that you will be in 2071. I am so confident of the importance of our profession to society and of our value to it that I am sure there will be nurses out there in the future ready to serve society.

These are the nurses who will be there to care for you—I will be long gone by then. So, I’m going express my hopes for the ways nurses approach patient care and knowledge discovery with some personal reflections. 

I hope that these nurses will remember that confidence is often accompanied by uncertainty, and that nurses must consider both as they diagnose and treat the human response to living.  

I hope they will remember that many of my age want nurses to know that we feel like we did 30 years ago, think we look like they did 20 years ago, have had meaningful and interesting career and life contributions, and bring the wisdom of aging and the freedom of age. All of this makes us even more desiring of good nursing care. Nurses should let us know how to find them, how to recognize them, and how to benefit from their expertise.

I’m less afraid of dying than I was earlier in my life in part because I feel like I could live forever, or at least another 30 years, in good health with the love and support of my friends and family.

I want the nurses who care for you when you are my age to respect that goal of mine and use it to shape their practices. Like the future you, know that even now I want your guidance to help me live as fully as I can.

I don’t want nurses to be afraid to bring up hard topics—social disruption, social isolation, loss, loneliness, hopes—because all of these shape how we approach my health. We can be better partners if nurses are as brave as we need them to be.

To the nurses of 2121 yet unborn:

These are the nurses who will be there to bring nursing into the future. What legacy will you leave them? How will you help shape the future nurse? What can you do to create in them the very excitement that you feel today?

Can you share your experiences, remove barriers, open pathways of influence, give them shoulders to stand on? Can you help those nurses yet unborn know that it is better to ask a question than to answer any single question?

Can you inspire them to discover and not just remember? And more importantly, can you help them build partnerships and pathways with people who bring the best of nursing to complement and extend the best that is in that person?

What can you do to prepare the world for nursing? To make the very best practice environment for nursing? What ways can you engage with architects, home builders, city planners to make the world not only a place that nurses LIVE in, but is livable because of nursing? Over 30 years ago, a great nurse thinker identified that it is a critical function of nursing to create an environment that supports development. What will you do to build that environment so that the nurses of 2121 can live as nurses, being nurses?

Congratulations and celebrations to all of you—faculty, students, administrators, family, and friends. Another journey is complete, and another is starting.

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