Within seconds of post-operative recovery from brain or spinal surgery, the patient takes the next step on the recovery journey - the Neurointensive Care Unit. Each patient has a private room, and is observed continuously by telemetry, and rounding by nurses, neurosurgeons, and when appropriate, by physical therapists, and speech and language pathologists, medical social workers, and other care providers.

It's important to maintain quiet in the NICU's low-light environment. In the first 24-48 hours post surgery, it is critical to keep stimulation at a minimum. Families are encouraged to be part of evaluations and consultations that can offer their loved one the most optimal recovery possible.

Neuroscience nursing requires nurses to have specialized knowledge, experience, and unique skill sets in order to provide a high level of quality care to this very special population.
Ronda Cunningham, Clinical Nurse Specialist at BRMC, has worked closely with the nursing staff, physicians, therapy staff, management and administration to develop order sets, protocols, and clinical pathways to ensure that best practices and standards of care are attained.

Through collaboration with a variety of professional organizations, including the American Association of Neuroscience Nursing (AANN), American Stroke Association (ASA), Michigan Hospital Association (MHA), and the Michigan Parkinson's Foundation (MPF), many educational opportunities have been offered to staff and the community.

The stroke performance improvement team has worked diligently to create, develop and streamline our processes in delivering stroke care. Bay Regional has earned awards from the Heart & Stroke Network for community efforts in stroke education and prevention.

Although many new and exciting changes have occurred in a short time, the nursing staff has embraced these challenges, and has taken the initiative to pursue the necessary education and expertise to care for this population.

Jan Tardiff, BSN, has been at Bay for 37 years, and is Nurse Manager of the Neuroscience Inpatient Unit. "We set high standards for ourselves, so there is a proper nurse to patient ratio. It's fast-paced, and our nurses have to respond in seconds if a patient experiences any difficulty. Our nurses are attuned to notice subtle changes in a patient that might not even be picked up on telemetry.

"Because our patients are usually bed-bound for some period of time, we are very particular about keeping patients turned to prevent skin breakdown. Nurses take part in patient rounds with the neurosurgeons. Nursing assessments are critical as the neuro team decides 'next steps' in the plan of care. We have found our care practices, under the physician's direction, have shortened lengths-of-stay for some patients."

Joyce Baudino, RN, is a nurse with specialized training in neurological care. She has been on Bay's NICU for many years. You can see the compassion in her face, with a touch of humor so important in the intensity of care required by NICU patients.

All patients are monitored continuously, and nurses respond in seconds to subtle changes that may occur. The post-operative recovery process is individual to every patient, as recovery is a gradual process.

Families are included in patient care and are educated on the surgery and how they can best help their family member to achieve the best possible outcome. "A multidisciplinary team approach in which all care providers work together is absolutely necessary to attain the highest optimal outcomes for these neurologically challenged patients.

"I find it very rewarding to take care of neurologically-challenged patients, because every gain is like a gold medal in the Olympics. I've always found I get back far more than I give because I've seen miracles happen. That's the reward: to see patients start to get back their lives.