Claire Champion, MSN, APRN, CPNP - phaware® interview 482

Claire Champion is a nurse practitioner at Texas Children's Hospital, specializing in pulmonary hypertension. As a nurse practitioner, she has the opportunity to see some of the patients as outpatients, which allows her to witness positive outcomes and the resilience of children. She also highlights the need for nurses to have a support system to cope with the emotional toll of the job. Claire encourages families to be open about their ongoing issues so that the healthcare team can provide the necessary support.

My name is Claire Champion. I am now a nurse practitioner at Texas Children's Hospital working with Elise Whalen and the pulmonary hypertension group there. Previously, I was an ICU nurse in the PICU for five years and was on the floor that focuses on the pulmonary hypertension kids that are there for a long time. So I had a lot of bedside experience with this population. When I graduated nurse practitioner school, I didn't really know what I wanted to do, so I just hung out for a while. Then, this job opening posted and one of the ICU attendings, Dr. Charton, who's one of the PH doctors as well, came up and was like, "Are you going to apply?" Initially I was like, "Absolutely not. I don't want anything to do with that," because it's a very hard population to deal with. I knew it was going to be a lot of education. It's so different being an ICU nurse and being a nurse practitioner. He was like, "I think you'd be great and we will get you through the program." That's what happened and here I am. It's really been a great opportunity and experience and the education I have learned, I can't even begin to say how much it has really been life-altering.

We initially had a PICU that was not cohorted. Then, Texas Children's built a new tower called Legacy Tower that was specifically designed for the new ICUs. What they did was we have three different floors. We have the 9th, 10th, and 11^th. They cohorted it so that when consulting groups would come in, they had all their patients in the same area. I was never scared of the pulmonary hypertension kids. It didn't bother me. So, I just ended up on that cohort of the unit. And so I had a lot of experience and it worked out for me.

I think from the bedside nursing perspective, you really just have to focus on getting a good relationship with the parents and getting them to trust you, because they're overwhelmed, they're exhausted, they're constantly there. Their kids sit in the ICU for months. So, really figuring out what the parents want for their child and how they want their child to be cared for is, I would say the number one most important thing that you can do. It gives the parents that ability to feel more comfortable and they can start leaving the bedside, getting back to some of the other things that are important in their lives, their other children.

Then you just adapt to what the kid needs, because all the PH kids, no one is the exact same. There's a difference between the idiopathics that come in. They're usually not there for too long. They're usually a two-week max type of patient. Then, you have the BPD babies that are there for months. So, you just feel out what the parents and what the family is wanting and go from there.

One of the things I think is cool about transitioning to the nurse practitioner job is that now I do get to see some of these kids as an outpatient, whereas when you are an ICU nurse, you don't see them ever leave. So, that part gets really hard because it feels like these babies are just sitting here for months and months and not progressing. I think the flip side of switching to the provider role is now I get to see, wow, eventually one day we will get there. It's nice now to go in as a nurse practitioner to some of these families that are in the ICU and talk about the positive outcomes of kids that, "Oh, three years ago I had this patient who was in the same position as you, and now they're out and they're living their best life." There's a positive end, because a lot of times in the ICU, everything is so negative and just drowning. So, I think that's one of the benefits of switching to this role is seeing the fun side of outpatient world.

You have to learn to disassociate yourself from work and your real life. When I first started as a PICU nurse, I mean, that was probably one of the hardest jobs I could pick straight out of graduating from just general nursing school. It was very depressing. There were times that I would drive home and you don't turn the radio on, you just sit there in silence and are like, wow, that was a very rough day.

But then you learn to rely on your nursing friends and the people in that community, because they understand what you're going through. So, you can always vent or you talk about anything else and they get you through it. I think one of the most important parts of being in this career is finding coworkers to have an outlet to speak to. But then, I think there's a lot of positives that you learn and you get to see a lot of miracles, as well. There's so many things about children. They're so resilient. You get this diagnosis and think they're never going to get through it. I saw a kid that was on a PEEP of 24 and now he's on a PEEP (positive end-expiratory pressure) of 12 and doing great. So, there's just a lot of cool things that you get to see that I've seen in my seven years in the nursing profession. They're just eye-opening to what children can go through and what they push through.

It's a nice change to see them outpatient because we see our kids about every three months, and so you actually get to know what's going on in their life outside of just their disease process. When you're in the ICU, it's more of what are we doing today? What are we changing today? What happened overnight? Now in outpatient world, it's, "Hey, my birthday was yesterday and the whole family went to Chuck E. Cheese, and we're going to... Is it okay if we fly this summer and go to Disney World?" There's just a lot more positives that you get to see from the outpatient perspective and a lot of just different social aspects that you don't think about when you're just in the hospital. That part has been amazing to see kids have normal lives as much as they can outside of their disease process.

I have to admit, not all of it is great. Sometimes kids will come in and their walk test is worse or their echo is worse, they're having cyanosis or whatever the reason is. It does get tricky because you want everything to be so great every time you see them. There are times that there's not, and do we need to admit you? We need to change your therapy. Things are getting a little bit worse. Those conversations are really tricky. But at the end of the day, the most important part is having that strong relationship with the family where they can trust you and it all works out. It's nice to have providers and nurse practitioners and the whole team, our social worker, our nurses, our dieticians, everyone comes together for that family and we bend over backwards for them. That part has been really nice to see a whole team, because when you're in the ICU, it's really the ICU team. You maybe see the consult teams every once in a while, but you don't see the whole outside picture. Just the amount of conversation that goes on about each of our patients. I don't know how many meetings I was going to have in this nurse practitioner role and so it's really cool to see everything behind the scenes.

Just be honest and be open on what your family is going through. Sometimes we get palliative care involved and the palliative care team will come back and say, this mom is really struggling with X, Y, Z, and it has nothing to do with the child. I think the best advice is to be open about all of the ongoing issues that are going on, because even if it's not about your kid with pulmonary hypertension, we can still help in whatever way that your family is needing, because it's an all or nothing type situation. I think that piece is really important for families to just know our center really wants the best for everybody involved.

My name is Claire Champion and I'm aware that my patients are rare.

Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on social @phaware Engage for a cure: www.phaware.global/donate #phaware
Share your story: [email protected] #phawareMD #PPHNet @PPHNet @TexasChildrens