Nomination Letter

Elise Troske-Roberts, RN is an amazing woman—and I don’t use that term lightly. Not only do her 20+ years of experience include ER Triage, ICU, infusions, L&I case review, and home health case management, but she is the mother of five (yes -5-) children still at home, an avid community theater actor currently staging Romeo & Juliet, and is working on completing her course work to become an ARNP.   Yet in addition to all that, on the job at BrightStar Care she is responsible, reliable, and hands down the best of our 6-nurse infusion team here in Seattle, Washington.

While most of our field nurses will schedule one infusion per day, Elise can see two infusion patients across the city and stop to change a PICC dressing on a third patient on the way home. She is the one we go to for the most difficult cases and she always says, yes. She is the one we call last minute when another nurse is sick and she says, I’ll just adjust my schedule no problem. She is the one we call when a nurse refuses to see a patient the second time and she says, I’ll go check it out and let you know if I can take them on as my patient.

Is she empathetic? She had a 5yo patient who had been hospitalized with a septic hip (osteomyelitis). The child was sent home with a PICC line and IV antibiotics.   Elise was seeing her twice per week for PICC dressing changes and medications even though Mom was trained to administer antibiotics q 8hrs as well. But one weekend while the child’s father was out of town and Mom was exhausted keeping the energetic 5yo safe from re-injury just being released from the clinic again, Elise was called. Mom was trying to administer antibiotics through the PICC line at night when suddenly the flow stopped. Frantic, Mom finally called Elise at 11pm for help. As Mom put it, we just can’t go back to the hospital again today! Can you come help? Of course Elise said yes. When she arrive and assessed little Violet’s PICC there was no clot, but it was fully occluded. Elise started playing with Violet. They danced, they played, they put their hands in the air and sang songs. Finally, Elise tickled Violet and she giggled inciting a Valsalva maneuver…and the PICC flipped back into place and cleared. Then Mom and Elise completed the antibiotic infusion.   Mom broke down in tears so happy for the help and miraculously easy solution.

That’s the kind of thing a nurse understands, that it’s caring for the whole family when a child is sick.

Or there’s the 10yo boy Samuel with CAPS, who isn’t quite homeless per se, but does have to be tracked down every 4 weeks for his Ilaris injections because he and his family keep getting evicted. His single Mom works for minimum wage so is having a very hard time providing for herself and three children. I really don’t think another nurse would go to the lengths Elise has to be sure he gets his medication regularly. She learned quickly within the first two visits that things had to be handled differently for this patient. Since this boy’s address kept changing, and his Mom’s phone kept being cut off, Elise had to be clever and persistent yet helpful and respectful of the family’s unique situation. So Elise made arrangements with the pharmacy to always ship to her own home address so she could be sure the boy would get his medications. She established a trusting relationship with the Mom and kept calling weekly her to be sure she could locate them each time it came closer to his 4 week injection visit. Finally Mom gave Elise her work number too so she would not miss the call even if she didn’t have cell phone service that month. Mom soon came to realize how important it was for Samuel to get his medication regularly…and just how much he enjoyed his visits with Nurse Elise.   You see, Elise quickly learned that Samuel’s favorite subject in school was science.

Whenever he saw Nurse Elise he had lots of “science” questions and she was always happy to answer his questions, teaching and feeding his curiosity along the way. To Elise this was the most important reason for her visits, just being there for him and for his Mom.   Yes, the medication is important but equally important is this visiting nurse who has become the one stable, reliable connection the family has in the community. By just being there not once, but every time, she is bringing out the best in all of them because they can count on her.

But you know it’s not just the children on Elise caseload. There are the numerous adult IVIg patients she sees every week—those who are on dialysis, those who are post transplant, those with myasthenia gravis, or CIDP.   IVIg infusion is our mainstay business in skilled nursing at the Elise BrightStar Care. IVIg infusions with Elise are what took David, an 85yo with CIDP from wheelchair to mowing his own backyard within the past year. But it’s not as easy as just going in and hooking someone up to an IV and pump and sitting back to read emails on your phone. For instance, this patient David was a very frail man with brittle BP that spiked every single time Elise started his infusion. It’s been frightening—and his infusions last 4 days every month so it’s been intense too. Luckily Elise has the ER and ICU experience behind her to meet and respond to any scenario, but still it’s been a bit frightening every infusion. So Elise has spent hours in phone calls over the past year to the pharmacy, to the patient’s PCP, his cardiologist, and his neurologist and half a dozen nurses in-between. Finally a couple of months ago, Elise hit it off with one of David’s cardiology nurses. They talked about David at length, and Elise also talked about her ER and ICU experience and that she wanted the doc to consider allowing her to utilize Clonidine during David’s infusions, that she knew the risks and promised she wouldn’t let him bottom out, but also didn’t want to continue in the current manner that might have him stroking out. I remember Elise telling me when she received the order, I must have finally said something right because one of these docs finally trusted that I know what I’m talking about when it comes to this patient. I’ll tell you, if anything happened to this sweet 85yo man during these infusions, I wouldn’t know what to tell his dear sweet wife.   Now that’s confidence, but with care and true humanity all the way.

And then, there are the bone marrow donors. These are not regular patients for us. They are donors that we see for 3-4 Filgrastim injections and then we’re done.   All of our nurses take these cases. However, the first time Elise had one of these patients she taught me that we must say “thank you”.   You see, somewhere in the bank of Elise past experience she had dealt with bone marrow recipients and donors. She called me after she had finished with her first BrightStar donor patient and asked, do we do anything for these donor patients? Do we send them a card or a gift or something?  All I could say was, no, not usually, why?   That’s when she told me that the donors don’t get any assistance. They are responsible for all their own medical costs, their own time off work, their own recovery and any complications. This is truly a gift that they provide through their donation. We must do something to say THANK YOU for doing this so altruistically. And so, she said she was going to give this first patient of hers a potted plant with a thank you card. She was emphatic about this explicit act of thanks. Talk about exceeding expectations.

That’s Elise, she always does the right thing. She serves with passion and she makes a difference. She advocates for her patients and she’s unflappable in doing so.   For instance, she has a young male patient with Fabry disease who receives infusions.   On one occasion the pharmacy did not send the proper supplies but insisted that Elise could “make do” with what was sent.   Her patient Christopher, has a port and so she required a Huber needle for the infusion, but all that came in the shipment were four 18-guage wide bore syringe needles. After 30 minutes discussing the issues with this scenario on the phone with the pharmacy tech, she finally said very calmly albeit facetiously, So am I to understand you want me to take this needle the size of a sippy straw and jam it into my patient like he’s a juice box? The next day she received a call from the actual pharmacist on duty who said, I’ve read the notes from your phone call yesterday. Did you really say “…like he’s a juice box?” You’ve got a point—we’ll be sending out the correct supplies today.  Elise is pure persistence in advocacy, and it works.

She amazes me, and if you met her I think you couldn’t help but be impressed as well. By her example we are all challenged to work smarter, care more, and be our best in service to our patients. But even though we try, none of us can keep up with Elise the Wonder Nurse.   Others should recognize this too, and recognize Elise as the BEST, The 2016 BrightStar Nurse of the Year!