My Specialty
Critical Care CNS, Tammy Ludwig, PIH Health Whittier Hospital
An evolving role that combines mentoring, education, and patient care
Tammy Ludwig, RN, MSN, AG-CNS, CCRN
Critical Care Center Clinical Nurse Specialist and Educator
PIH Health Whittier Hospital
What led you to nursing?
When I was 19, I worked as a home health aide. I would see nurses coming and going from patients’ rooms, and began to realize that I could learn more, do more, and accomplish more as a nurse.
How did you choose critical care?
When I did my final clinical rotation in the ICU, I knew I wanted to be a critical care nurse. As a new grad, I worked on a complex medical-surgical unit for nearly three years until I felt ready to transition to critical care.
The learning curve was still very steep. I remember thinking, “What have I gotten myself into?” I’ve always believed that a healthy sense of fear helps you stay alert, but it took me three or four years to not feel overwhelmed.
Critical care settings offer life-and-death scenarios requiring split-second judgments and interventions. It takes a great deal of hard work to become a proficient ICU nurse. It took me almost six years before I felt like a relative expert at the bedside, and close to a decade before I felt like an expert at all my duties, including charge and supervisory roles.
What led you to choose the CNS track?
Before attending nursing school, I planned to become a nurse practitioner focused on women’s health. However, a year before starting my graduate studies, I became a critical care educator, which taught me how to develop lesson plans and how to manage large organizational projects.
While developing my skills as a clinical educator, I discovered that the CNS role combined hands-on care, consulting, mentoring, and education within a clinical setting. I realized I could become an advanced practice nurse while also continuing to assist in other nurses’ growth and development.
What are your main responsibilities as a critical care CNS?
My main responsibilities are to continually develop and refine my critical care expertise to lead and guide nurses in delivering safe, evidence-based care.
A CNS influences patients, families, and nurses, as well as nursing practice, systems, and organizations. I get the best of both worlds: My office is located inside the CCC, so even though I may be working on a project or writing reports, I’m still close enough to assist with patient care. I keep all of my clinical competencies current so I can jump in at a moment’s notice.
Almost daily, I participate in our unit’s multidisciplinary rounds, talking with physicians and nurse leaders about clinical questions and standards of care.
I often roam the unit during and after these rounds. If I observe nurses having challenges with clinical aspects of care, I provide education on the spot. Interacting with nurses and patients is the most rewarding part of my job.
How has your CNS role evolved?
The CNS role is always evolving. As a CNS, I’ve even gone out to some of our ambulatory clinics when they’ve requested education on topics in my wheelhouse.
I’m currently my facility’s only adult-geriatric critical care CNS. This affords me the unique opportunity to work closely with other clinical nurse specialists and educators in other adult inpatient settings. If another CNS or educator has a patient with a complex medical situation that’s outside their purview, they call me to consult.
I also provide education for graduate nurses and serve as a CNS and nurse educator preceptor.
Could you share a patient story that illustrates your work as a CNS?
Recently, a critically ill patient experienced cardiac arrest due to massive blood loss, which led to the activation of the massive transfusion protocol. I showed up to the patient room, as did a newer critical care nurse I’d previously guided through a massive transfusion simulation.
She had never used a rapid infuser during an actual massive transfusion, and she asked if she could do it. I immediately agreed, and calmly talked her through each step. She followed my instructions completely and correctly. Afterwards, she thanked me for the experience. I was more than grateful to help build her confidence and skills while supporting lifesaving measures.
What are your career goals now?
I’ve considered pursuing further higher education, but decided it would take me too far from the bedside. My passion is in remaining close to patient care and sharing my experience and knowledge with others.
KEITH CARLSON, RN, BSN, NC-BC, has worked as a nurse since 1996 and offers expert professional coaching at www.nursekeith.com
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