1. Livesay, Sarah

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I distinctly remember the first time I recognized a unique role that I, as a nurse, played in patient care. I was a new graduate bedside nurse in the neuroscience intensive care unit at St. Luke's Episcopal Hospital in Houston, Texas. I was attending a family meeting for a patient with a devastating brain injury.


The physician was trying to communicate the direness of the situation. The patient-my patient, the families' loved one-would not likely survive. The physician was using terms the family didn't understand. I clearly saw the breakdown in communication and began to help translate for both parties. Medical terms need to be translated into layman language for the family. I also had to translate ideas and questions that the family was struggling to express into words so the physician and I could address their concerns.


After the meeting, I continued to translate and facilitate communication between the family and physician team. Throughout the day, all while continuing to care for the critically ill patient, I moved seamlessly through different roles. What I now recognize is that I was operating in an in-between space-a facilitator, a translator, and a clinical expert, all at the same time. I felt like a chameleon as I moved between the patient, medical team, family, and other hospital staff-always changing my language, my approach, and emphasis as I moved through the in-between spaces.


Years later, working as an advanced practice nurse in stroke and neurocritical care, I had a similar awareness as I was getting ready for work one morning. I had 3 key meetings that day. My first meeting was with senior hospital administration considering a significant investment in technology for our neurocritical care program. Another meeting was with our physicians to evaluate our order sets. My third meeting was to work on an educational program for our staff nurses. It was a busy day ahead that required some planning.


As I planned my day, I recognized my practice spanned several worlds. Hospital administration relied on me to interpret literature and physician requests to justify financial investments. The clinical team asked me to bridge the gap in understanding between medicine and nursing. The staff nurses needed to feel my presence and support. Once again, I floated through the in-between spaces that day-once again feeling like a chameleon as I entered each world, changing my colors to meet the needs of the situation.


Throughout the day, I interacted with multiple stakeholders. I felt responsible for different parts of every meeting. I felt accountable to everyone and, in a way, for everyone-accountable to our collective patients first and foremost, but also responsible for, and accountable to, my fellow nurses, advanced practice nurses, physician staff, and hospital organization. This is a great burden to bear and, I suspect, a key reason many nurses struggle with exhaustion and burnout.


We often refer to someone who changes his/her colors to match the situation (like a chameleon) as inauthentic or untrustworthy. Not me. I believe the ability to change and adapt to multiple situations is a unique nursing skill that we should embrace. We walk in multiple worlds and frequently operate in the spaces in between. It's hard to quantify, but it is at the core of nursing practice. We are chameleons, using our rainbow of colors to impact our patients and each other every day.