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The Sky’s the Limit for AANN Rising Star Kris Machingo

While caring for an aneurysmal subarachnoid hemorrhage patient, Kris Machingo, RN RDMS, of Mission Hospital in Mission Viejo, CA, noticed a change in the patient’s brain tissue oxygen. Although the charge nurse had mentioned a possible problem with the catheter, Machingo, a neuroscience nurse of just 2.5 years, thought of the advanced hemodynamic monitoring principles she had recently learned and of her experience with transcranial Dopplers (TCDs), and something just didn’t feel right. So at 2:30 am she rang Mary Kay Bader, MSN RN CCNS CNRN CCRN, the hospital’s neuro/critical care clinical nurse specialist, for a consultation.

    “Her assessment was correct,” Bader later recalled when she, along with Mission’s Neuro Intensive Care Unit (NICU) Manager Margie Whittaker, RN MSN CNRN CCRN, nominated Machingo for the AANN Rising Star in Clinical Practice Award. Indeed, the patient had developed significant vasospasm of the distal variety, which is often hard to detect, and a neurosurgeon was contacted immediately.
    Another time, a practitioner conducting rounds reported no changes in a neurological exam of a patient, despite having been told by Machingo about a change in the patient’s motor speech earlier that day. Again, Machingo trusted her initial assessment, and she again sought consult from Bader, who confirmed her assessment. “We notified the neurosurgeon and took immediate intervention to increase the blood pressure with fluids, and the symptoms resolved within the hour,” Bader said. “I believe this patient’s good outcome was directly related to [Machingo’s] persistence, knowledge, and clinical judgment.”
    Machingo’s exceptional critical-thinking ability is one reason why she was chosen as this year’s AANN Rising Star in Clinical Practice. Her probing intellect and astute clinical judgment earned her immediate respect in her hospital’s NICU. “At 9 months, she began caring for complex traumatic brain injury and aneurysmal subarachnoid hemorrhage patients with multimodality monitoring,” said Bader. “She was always quick to ascertain variances in her patients’ conditions and would call [the NICU staff] to consult about her patients and the needed intervention.”
    Beyond this, Machingo also possesses superior leadership skills. Bader said that shortly after completing her new graduate preceptor program, Machingo acclimated effortlessly to the NICU. She organized study groups and sought mentoring from the neuro clinical nurse specialist, Whittaker, and senior nurses. Within months of joining the unit’s education council, she was selected as its cochair. She planned new educational strategies for her peers and created a monthly neuro-educational offering, which was scheduled during unit call schedule sign-up to increase staff participation.
    Meanwhile, Bader took notice of an in-service Machingo conducted on TCDs and encouraged her to submit an abstract for AANN’s 39th Annual Educational Meeting in 2007. “She gave her first national presentation on TCDs to a packed room!” said Bader. Today, Machingo lectures at hospitals throughout Southern California and will give a presentation in May at the American Association of Critical-Care Nurses’ National Teaching Institute.
    Even with her busy schedule, Bader stresses that Machingo makes time to contribute to both her unit and hospital by holding education classes and by serving on various education councils. Moreover, she recently took on the duties of trauma response nurse, a role usually reserved for more experienced nurses, and has already contributed to the early management of traumatic brain injury and stroke patients.
    But it’s Machingo’s personality—and her compassion—that makes her such a draw to patients and their families, as well as to her peers. In a letter to the hospital’s chief executive officer, a family member of a patient wrote, “If you were to believe in angels here on Earth to care for people, you would have to believe that she is one of them. [Machingo] was my mother’s nurse, and even when Mom was unconscious, she treated her with such dignity and respect.”
    “She enters the NICU and the unit lights up!” Bader said. “Her smile and enthusiasm are contagious. She is a beacon of light.”