Lauren Macko’s clinical expertise and passion for managing patients with stroke and other neurological conditions is showcased in her various projects and roles. Her recent involvement in the Society of Critical Care Medicine’s ICU Liberation Collaborative has driven evidence-based practice across a 29-bed neurosurgical ICU and led to improved patient outcomes, such as increased mobility and decreased mechanical ventilator hours, ICU days and delirium. ICU Liberation aims to liberate patients from the harmful effects of pain, agitation and delirium in the ICU. It also focuses on early mobility strategies that can help reduce the risk of long-term consequences from an ICU stay. Because of her involvement with ICU Liberation and her influence, commitment and leadership in leading daily multidisciplinary rounds to improve communication with patients, families and team members, Macko received an AACN Circle of Excellence award this year.
Where do you work?
I’m a clinical nurse specialist in the neurosurgical ICU at Carolinas Medical Center in Charlotte, North Carolina.
And what drew you to nursing?
Nursing is a profession that provides so many opportunities and paths, and I loved that. I was always drawn to medicine growing up and knew that I would ultimately take a career path in the medical field. Nursing allowed me to follow that path while making a difference daily in the lives of my patients. I took a different path from what I envisioned my nursing career would look like, but I love where I am now, and I look forward to furthering my career.
You recently participated in a program called ICU Liberation. Talk about your role and what ICU Liberation hopes to accomplish.
As the clinical nurse specialist on the unit, my role was to help implement the ICU Liberation bundle. In addition to educating staff, tracking compliance and fostering interprofessional collaboration, I assisted in the development of protocols and policies associated with the bundle. I also researched the different evidence-based tools to see what would be most applicable to our unit. The ICU Liberation campaign was a very large project, with the primary goal of bringing together key components of evidence-based practice into a nice bundle in an effort to decrease ICU length of stay.
How did you become involved with ICU Liberation?
The neurosurgical ICU that I work in was chosen as one of the few units to be a part of the ICU Liberation Collaborative through the Society of Critical Care Medicine.
How did you sell your biggest paradigm shift to healthcare administrators and leaders at your hospital?
In order to sell the paradigm shift to administrators and leaders of the organization, it was important for us — myself and other members of the team — to present them with the evidence. If we share what the evidence tells us, and that this is what is best for our patients, then that helps encourage them to back us behind these changes.
So how would you suggest to other nurses that they go about creating that kind of change in their units?
I would recommend to them to do their research first. I think it is valuable for nurses to come to the members of the leadership team with the evidence ready to present. Leadership wants to know what benefits the unit, the hospital and the organization are going to get out of proposed changes to policy. Even if there is little available evidence to support your suggestions, I also think there is value in coming to leadership and having a brainstorming session on how to implement your ideas. This is what ultimately leads to further advances in treatment and care.
How do you create positive interdisciplinary collaboration?
Positive interdisciplinary collaboration is the cornerstone of any good critical care unit. At the foundation, we need to treat each other as peers and embrace that no one discipline is greater than another discipline. We are all there with a common goal, but with our own area of expertise. Therefore, the opinion of the physician is equal to the respiratory therapist’s, which is equal to the occupational therapist’s or the caseworker’s. Embracing a culture where everybody is equal creates a positive environment, because everybody feels empowered to speak up and suggest changes to the patient’s plan of care.
What advice would you give to nurses trying to build communication and collaboration on their unit?
First and foremost, provide opportunities for nurses to communicate any problems, issues and ideas that they may have. Those opportunities will create space for collaboration and problem-solving. Then the nurses or the leadership team can bring in appropriate members of the interprofessional team to help the implementation of ideas or assist with problem-solving.
How do you stay current in your practice, and how do you bring your best self to work every day?
Being a member of various organizations, I think, is one of the most helpful ways to stay current, because you’re always receiving journals and articles that are peer-reviewed and already have that evidence available. Those organizations give you the opportunity to network with other experts in the field, which allows for idea sharing. In regard to bringing my best self to work every day: I love what I do. I love solving problems. I love researching to see what we can do to make those problems go away and adding to the body of medical evidence.
How did you feel when you found out you were selected to receive an AACN Circle of Excellence award?
It’s hard to put it into words. As a critical care nurse, and as a nurse in general, we tend to be very humble and we don’t feel like we deserve some of the recognition that we get. I’m so honored that my peers even thought of nominating me, because of the work that goes into the nomination process. I’ve written for several Circle of Excellence award nominations, and it makes me feel very humbled and honored.
What do you like to do when you’re not working?
When I’m not working, I am spending the majority of my time with my son, Alexander, born this past March, as well as my husband and our dog.
Find out more about the Society of Critical Care Medicine’s ICU Liberation Collaborative at www.iculiberation.org.