Top Nurses 2020: Rachel Ruhland helped transform the ICU by finding home again

Rachel Ruhland of William S. Middleton Memorial Veterans Hospital is a recipient of the practice award.
Rachel Ruhland
Photo by Paulius Musteikis

Just as the COVID-19 pandemic was beginning, Rachel Ruhland lost her father to Parkinson’s disease. Then came the statewide shutdown, pushing the funeral to July. But Ruhland had been gifted two weeks off with him in his final days on hospice, a luxury soon denied to many due to visitor restrictions. Back at work at William S. Middleton Memorial Veterans Hospital, she asked to be transferred to the intensive care unit. They were preparing for a surge, and she wanted to bring bedside comfort to the ICU setting. “After my dad passed, I felt even a stronger calling. I guess I was looking for home again,” says Ruhland, who began her career in the VA’s ICU 14 years ago but became a nurse practitioner in a less acute unit. Ruhland didn’t just return “home,” according to Chief of Inpatient Nursing Carole Borland. With the support of her colleagues, she transformed it.

“Rachel is competent, caring and willing to do whatever needs to be done,” Borland says. Ruhland was asked to develop a position for nurse practitioners in the ICU, a setting they weren’t historically utilizing. She dove in, developing a tiered staffing model and mentoring other nurses. She worked with the pulmonologist to take responsibility for admission, daily orders and discharge plans, and collaborated with the ICU intensivist on treatments like “proning” — a practice borrowed from non-pandemic times in which COVID-19 patients on ventilators are strategically turned onto their stomachs to increase lung expansion. Most profoundly, she worked with the palliative care team to develop a safe procedure that allowed contact between family and end-of-life patients. This included iPads for FaceTime, education on PPE protocols, making sure all COVID-19-positive veterans completed life-sustaining treatment plans and connecting loved ones with grief support after their goodbyes.

“Going through what I went through with my dad, that empathy swells up inside you,” Ruhland says. “You can really understand how somebody else feels.”

At the end of March, Ruhland and two nursing colleagues — with 72 hours notice — volunteered to transfer to Chicago’s Jesse Brown VA Medical Center. For four weeks during Chicago’s shutdown she worked 12-hour ICU shifts while living at a Marriott hotel, joining more than 60 other VA nurses from around the Midwest who’d come to help during the surge. “It was tough, because they didn’t have time to prepare the way we had,” she says. They were short-staffed and they’d been hit hard.

But here again, Borland says, Ruhland was “instrumental,” implementing many of the practices she’d helped develop back home: “She provided education and mentoring to the ICU RN staff and made a huge, lasting impact on critical care nursing in Chicago.”

For Ruhland, the care goes both ways. Her colleagues are passionate and supportive, and veterans are the most inspiring, grateful patients she’s ever served.

“There’s a lot of bad days in nursing, but you can find joy in the connections you’re making. There’s pain, but there’s a level of love,” Ruhland says. “Even at the worst, you can find the best.”

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