Holland America nurse explains the scope of clinical practice at sea
Nursing takes on new "heights" for those who choose to practice the profession at sea. Imagine climbing into a basket lowered from a helicopter hovering over a ship in mid-ocean. Up and away, and you're in the copter. The basket is lowered again, this time to retrieve a sick passenger, now your patient, in dire need of a ship-to-air evacuation.
The scenario is not all that unusual, if you are a nurse at sea, said Laura Vlaadingerbroek, MSN, RN, chief medical officer aboard Holland America Line's Zaandam.
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Laura Vlaadingerbroek, MS, RN, helps evacuate a wounded crew member from the Holland America Line’s ms Zaandam. |
She mentioned another evacuation at sea in recent memory: A 16-year-old girl needed immediate urgent care, and the ship she was on was too far from land to be serviced by a helicopter.
"The USS Ronald Regan aircraft carrier picked her up," said Vlaadingerbroek. "How often can you get the U.S. Navy to stop by?"
Not Just Dramamine and Aspirins
Of course, day-to-day practice of nursing on board the Zaandam is a little less dramatic, although certainly no less impressive.
"We've handles MIs, we provide lytic therapy on board , we give TNK [tenecteplase]," enumerated Vlaadingerbroek. "The nurses run all the labs. We also do all our own X-rays and we have teleradiology with the University of Texas medical branch so we can have a radiologist review our wet reads from the dock."
Some cruises are more challenging than others - Hawaii, for example.
"It's a 15-day cruise, 5 straight days at sea, going and returning, so there is no way to get anybody off the ship after about 5 hours from port. By then we are beyond helicopter range. If someone becomes sick we totally have to manage and maintain. So, we have a full ICU with two respirators. We do the full gamut until we can get to port," explained Vlaadingerbroek.
"On almost every voyage we see some type of cardiac arrhythmia that we can manage and stabilize, or passengers with run-of-the-mill MIs who we medically evacuate at the first port. GI bleeds are big - we see them quite often - along with bowel obstructions, seizures, you name it."
En Route to Hawaii
"On the Hawaii cruises the population is older... so we see a lot of chronic things. And especially going into Honolulu, we see older people making a pilgrimage out to the Arizona Memorial as one of the last things [in life] they want to do. We saw a person with bone cancer and just 5 weeks to live who had finished radiation... we saw a person get on the ship with their brain swelling. Sometime I just think, ‘Oh my gosh, your doctor actually said it was OK for you to sail?'
"We see people who come with caregivers, toting Hoyer lifts. Through the years it has gotten more amazing. We allow dialysis and we also allow hemodialysis when patients bring their own units. And four times a year our ship runs ‘Dialysis at Sea' when a company by the same name comes on with about 12-15 passengers who need hemodialysis three times a week. They bring a nephrologist and nurse and all their own equipment."
In between all of that, the ship's medical center is- comprised of a large ICU for the most critical patients, a huge exam room and doctor's exam room and exam table, three ward rooms, X-ray room, office and inventory area staff - maintains regular clinic hours, not only for passengers but for staff. ("We're the total primary care provider for any cough and cold... lab, X-rays, simple treatments.")
Throughout it all, mandatory reporting is maintained. "We report to the CDC every time we come into a U.S. port. We have to report numbers... fevers, diarrhea, unusual measles, influenza."
Preparedness Is Key
And has H1N1 raised concern on the high seas? "You bet," said Vlaadingerbroek . "With the possibility of H1N1 looming, I had to order $25,000 worth of supplies and be prepared because everyone on the ship could have it... so masks, gloves, tamiflu, you name it. We regularly carry about a $20,000 supply of medicine, and I order every other voyage."
Noting there is opportunity for other nurses with Holland America Line, she suggests interested RNs check the website at http://www.hollandamerica.com/. And if you come aboard for a vacation she says, "Come on down to the medical center and ask for a tour. Tell them Laura sent you!"
Post script: Read a recent ADVANCE for Nurses' feature story by Candy Goulette about Laura and other nurses at sea by clicking http://nursing.advanceweb.com/Article/Welcome-Aboard-11.aspx
Until next time: This blogger is signing off for a brief vacation, and yes, I'll be setting sail! When I return, I'll introduce you to an RN from the UK.