Calling the Shots

Follow Lisa Munsterman, BSN, RN, CRRN, during her shift at the VA Long Beach Spinal Cord Injury and Disorders Health Care System to get a glimpse into the daily life of an SCI nurse.

Dan Pierson is in constant pain.

Sitting in his wheelchair, the Marine Corps veteran’s back and shoulders chronically ache at the Department of Veterans Affairs (VA) Long Beach Spinal Cord Injury and Disorders (SCI/D) Health Care System in Long Beach, Calif. Sometimes, he clenches his hands together to deal with the discomfort.

Hit by a sniper’s bullet in the Vietnam War in 1969, Pierson sustained an L-3/4 spinal-cord injury (SCI). He has been in and out of VA hospitals over the past four-plus decades. He’s had dozens of nurses, but admits he’s hard-pressed to find a better one than Long Beach’s Lisa Munsterman, BSN, RN, CRRN.

He watches Munsterman swiftly walk from one end to the other, being called away and then back. Pierson thinks she should have a pair of roller skates to motor around. She’s all energy, all the time.

“She’s always apologizing for being late or apologizing for taking too much time. It’s just the opposite,” says Pierson, a Riverside, Calif., resident. “[She’s] a very good nurse, very caring. You can see it in her face and her eyes. I have chronic pain and you can see it in her eyes how she just wished she could do more. She puts in her 12 [hours] and then sometimes she’s asked to put in four more. Quite the lady.”

Munsterman cares. The VA’s mission is Integrity, Commitment, Advocacy, Respect and Excellence (ICARE). That’s one of the first things Munsterman memorized — although she admits the very first was who to call when she needs help.

“I’m dedicated to keeping up morale, making sure our patients have quality of life. The first day they’re here, we’re trying to figure out their discharge day,” Munsterman says. “That’s what I’ve always called it — quality of life.”

Nursing Is Her Calling

Munsterman admits being a nurse, especially for veterans, is her calling. Her father, John, is a World War II Army veteran and received a Purple Heart; her fiancé, J.K. Smith, an Army veteran, was exposed to Agent Orange and is a throat cancer survivor.

Before coming to Long Beach in 2013, Munsterman worked for nearly three years in staff rehabilitation at Research Medical Center, in Kansas City, Mo. A certified nurse aide, Munsterman provided care to patients who had dementia and Alzheimer’s disease, for several years in Missouri before obtaining her BSN degree from Rockhurst University/Research College of Nursing in Missouri in 2012. Though she’s only been in Long Beach the past two years, it felt like home from her first interview.

Each nurse in Long Beach works six shifts, either 7:30 a.m.–8 p.m. or 7:30 p.m.–8 a.m. (with a half hour lunch), and one eight-hour shift during a two-week period. Nurses have the opportunity to work the extra four hours on the eight-hour day and that’s included as overtime. Long Beach SCI/D nurses follow a shared governance plan, which allows them to schedule their own hours. Manager Ofelia Pasiliao, MSN, RN, developed that plan and keeps it all together.

For Munsterman, who likes to work four or five days straight each week, it’s an easy call. She works those four hours — and sometimes more — every time.

She doesn’t have any children. Her mother and family live in Missouri and she visits when time allows. She’s dedicated her life to this work and to her fiancé. She views all her patients as family.

“I will help out whenever asked,” Munsterman says. “It’s a 24/7 hospital. Even if it’s your day off, you’re always on call. That’s one thing you sign up for. If they need you and you’re on call, you need to go.”

Rex Tjoa, RN, talks with Lisa Munsterman, BSN, RN, CRRN, right, on Feb. 27 at the Department of Veterans Affairs Long Beach Spinal Cord Injury and Disorders Health Care System in Long Beach, Calif.
Photo by Jennifer Tsan

Starting A Shift

Her day begins with a review of the night shift head nurse’s report and a look at the scheduling board. As a team leader, that’s how Munsterman figures out a shift plan. The SCI/D nursing staff is usually divided into three teams. Depending on how many showers they have and what patients need more extensive care, Munsterman breaks down how many patients each team monitors.

Today, there are 25 patients, and Munsterman is Team Leader for Team III, bed numbers 20–30.

Munsterman passes the report, which details each patient’s situation/background and includes an assessment and recommendations, on to the caregivers.

Then, she’ll usually fill her cart with medications (though she had an assistant do it on this day) and make out a med sheet to remind her what patients get what meds at what times. It’s one of the most tedious, yet important, moments of the day.

Long Beach’s SCI/D Center is designed in a U-shape and has 90 total beds. Patients are grouped in three different ways — staying in private rooms, double rooms or four-person rooms. Each room has a shower and a ceiling lift. Inside the center, patients can also use a kitchen area where they can cook their own meals and laundry area with washing machine and dryer. Patients have wider hallways to move about and can also go outside in a courtyard if they choose. It’s a more open area. Even visiting hours are 24 hours a day. Family remains important.

“We wanted patients to not feel like there is a barrier between the patient and the caregiver,” says VA Long Beach SCI/D Health Care Chief Susy George. “That’s why the nurses station is very open and patients can go wherever they want.”

At 8:30 a.m., Munsterman greets one of her patients, 67-year-old Alvin Uttecht, with a loud hello, a smile and those warm, yet soft and caring, eyes. He’s already sitting up in bed, surfing the Internet on a laptop computer and watching television. She knows he’s an early riser, while another one of her patients, an elderly man with SCI, likes to sleep late.

She greets Uttecht with a “hello” and chit-chats with him in her slight Southern drawl — she used to be a professional singer, writing gospel music, playing guitar and touring the United States — before checking his blood pressure to make sure he’s stable. Sometimes, she does that; sometimes she follows up with caregivers on it.

“Caregivers help do that [too],” Munsterman says. “If you have eight patients, you can’t just continuously focus on one patient. You have to have your eye and the caregiver’s eye on that patient.”

An Army veteran and Paralyzed Veterans of America member since 1970, Uttecht, is a T-9/10 paraplegic. A professional bowler who has won 113 championships, including 12 national titles, he is recovering from surgery after having a flap closure early last October.

“When I got first into surgery … I had two positions — flat on my back and on my side. I wasn’t allowed up, so the caregivers give you a bath. I washed what I can and they washed,” says Uttecht, who lives in Anaheim, Calif., and is in the United States Bowling Congress Hall of Fame and American Wheelchair Bowling Association Hall of Fame. “The nurses just bring the meds and sometimes the nurse is your caregiver because of the amount of patients and staff.”

Munsterman moves on from Uttecht to other patients, following her list of who needs to be fed, who needs Accuchecks done for diabetes and who needs to have their food/fluid checked to make sure they don’t have too much or have any urinary tract infections.

And with nearly every patient visit, Munsterman puts on a new gown and new gloves. Munsterman estimates she goes through at least 30 pairs of gloves — sometimes as many as 40 pairs — and at least 20 gowns a day.

Patients Are Like Family

It’s patients like Erik Kimes who value her help most.

An Army veteran and firefighter living in Pocatello, Idaho, Kimes had just recovered from being sick in October 2014 before he unexpectedly developed transverse myelitis, a neurological disorder caused by inflammation of the spinal cord, which later turned into Guillain-Barré syndrome, a disorder in which the body’s immune system attacks the nerves. He was only weeks away from moving and joining his wife, Crysta, who was attending school in Las Vegas.

“I got sick, felt better after being sick, then I was paralyzed,” Kimes says.

Now, instead of fighting fires and saving others, he’s trying to fight and save himself.

Muscle function, gone. Motor function to his limbs and core, gone. His life — turned upside down.

He’d spent the past six weeks at Long Beach, slowly trying to get his muscle function back. He has three kinds of therapies, ranging from occupational (upper body and working on everyday living movements like brushing teeth and combing hair), physical (whole body) and kinesio (exercise/movement).

Munsterman has served as Kimes’ nurse on and off during that time. Her care always puts him in good spirits.

She jokes with him, telling him it’s time for the “moment of truth” as she prepares to take his blood pressure. It’s where it should be.

Then, she scans his armband, gets his medication and brings him his water bottle. She squeezes the medication from a small paper cup into his mouth and he sips water from a large plastic straw to help it go down. He has physical therapy up next — and it’ll help. She checks his heart rate, looking for even pulses on his arms and legs. He tells her he’s gaining strength in his hands.

“She’s awesome,” Kimes says. “She has a good attitude, comes in and just, I don’t know how to describe it.”

Crysta knows how to, though.

“She’s very caring,” she says of Munsterman “She’s always making sure that he’s comfortable and that he has what he needs.”

Staying Busy

What Munsterman relies on are her heart and a pair of comfortable shoes.

Standing. She spends hours on her feet — hours documenting on her tall, computerized cart. Documenting medications, documenting what type of pain her patients are in, documenting when her patients took their medication.

This is when Munsterman is actually busiest. Nearly half her day is spent checking and verifying orders, inputting and updating medicines into her portable computer with a United States flag taped to the back. She’d planned to take a lunch, but was delayed by inputting a couple of new medications doctors had prescribed to her patients. She’s used to being on her feet now. In fact, she still tries to get in a 5-mile run each day.

Reassessments are just as important to her, too. She’s constantly reevaluating patients’ pain levels. Before she gives patients their pain medicine, she asks them on a scale of 1–10 how bad their pain is and asks them again when she returns. It’s her job to find a way to help manage their pain.

“I know therapeutically about their pain levels and make sure their pain is managed,” Munsterman says.

When Munsterman first started at Long Beach in September 2013, she worked as a night nurse for a year. She experienced that shift, which she admitted was quieter and a bit less hectic, but you could study the medical information more if you wanted. And she took advantage of that.

“With the experience of day shift, you know more what’s going on. [But during the night shift] you could really read about the patient and learn more about them,” Munsterman says. “Day shift is phenomenal because of that, but without night shift, we couldn’t do our jobs.”

A Big Help

Each patient is different and no care is the same. No one checks in the hospital for a week or so. Lots have been there for months or a year.

Michael Forte, 58, needed to get away and move about. He’s had plenty on his mind after having spinal-cord surgery Jan. 21. The Army veteran with a T-10/11 injury wanted to try to regain some of his independence, so he decided to do some of his laundry. But it’s taken him weeks to finally get to that point.

“It’s humbling. You have to have somebody to clean you, dress you, feed you. You don’t have to do nothing. It’s hard. It’s humbling. I have a different appreciation for nurses and doctors. I like the fact I have a team of people here caring for me,” Forte says. “People don’t realize how invaluable their care really is. You don’t realize how important and how invaluable their service is until you’re paralyzed and then you realize how important they are. I couldn’t have survived without nurses like Lisa. They love what they do.”


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