On Jan. 16, 1988, 11-year-old Tina Workman was suddenly handed her two-and-a-half-month-old baby sister Abby, who was “not breathing, limp, blue, and lifeless.”
In a blind panic, Workman’s step-mom kept screaming, “Tina, CPR! CPR! CPR!”
Workman remembers that moment, “I froze and went blank. I tried to perform CPR but wasn’t able to move any air. The panic became terror. Then my dad was able to get Abby’s heartbeats back, just in time for the ambulance to rush Abby to the hospital.”
Abby was born with a congenital heart defect and survived open heart surgery shortly after birth. Unfortunately, the hospital declared her brain dead due to prolonged deprivation of oxygen.
“She died in my father’s arms shortly after her life support was removed. On that fateful day, a scene was deeply engraved in my mind.” Workman continued, “I knew exactly what to do in the years to come.”
Now, 30 years later, Workman is pioneering a new lifesaving procedure at what one of the most prestigious nursing schools in the United States. Her simulation program teaches nurses and physicians how to assess a patient in an urgent situation and perform an emergency intubation that enables patients to continue breathing.
“As you all go about your careers, there will be challenges, and you will get frustrated.” Workman told a group of medical and nursing students at Johns Hopkins University, in Baltimore, MD on June 26, 2018.
“Please always remember what inspired you to go into this field. Don’t lose your compassion. Never forget that each patient you treat is someone’s mom, dad, brother, husband, wife…or sister.”
Workman, now an adjunct faculty and designer of “Unanticipated Emergency Intubation in the Hospital Setting,” dedicated the simulation held at the university’s School of Nursing to her baby sister.
The simulation features a hypothetical patient who is named after Tina Workman’s sister, Abby Workman. (Photo courtesy of Tina Workman)
“It brings my soul such joy to see what began as a personal tragedy morph into something so positive, that is now improving outcomes for other human beings. This is not just a job for me. It’s a calling and my life’s work.”
For the Workman family, the few years after Abby’s death were a financial nightmare due to uncovered medical expenses. Workman experienced bankruptcy and homelessness during high school.
Yet what Workman remembers are the kind-hearted people in her hometown, Tombstone, AZ, who “believed in my potential and refused to let me fail. In particular, the guidance and mentorship of people like Mike Roane, Jim Lindsey, Francis Calderon and Sandra Wendt, were key.”
After she finished nursing school, Workman entered the area of nursing she’s been ruminating since the day her baby sister died. “When Abby died, I promised myself that never again I would freeze like that in an emergency situation.”
For seven years, Workman worked as a “critical care float nurse” in the ER, trauma bay, cath lab, OB, and ICUs.
She then went to obtain a Master’s Degree in Nursing Science with a specialty in Anesthesia from Virginia Commonwealth University (VCU), where the nursing program was the first of its kind to use high fidelity simulation training in anesthesia.
By that time, Workman was already married to an active duty military heart transplant surgeon who also did trauma surgery for the Army. When the Iraq War broke out, he was sent to Iraq for nearly a year.
Meanwhile, Workman started to contemplate about her experience in critical care. “I’ve been in nearly every single type of unit in every single type of hospital setting in this country. As a military spouse, I’ve practiced in seven different states. I’ve been fully immersed in critical care medicine for the bulk of my career and have been in the shoes of both the hospital nurse and the airway provider, and I began to see a trend emerge. Over and over again, I’ve witnessed how poorly we function as a team during emergencies, even in monitored units like the ICU.” She felt a sense of responsibility to improve the situation.
Setbacks and Triumph
However, life took an unexpected turn after her then-husband returned from Iraq. “He came back from the war a completely different person. He was angry with me for whatever happened over there. He brought all of that pain back from the war and transferred the pain all onto me.”
They had a painful divorce, which brought Workman’s personal and professional life to a heartbreaking halt.
“But just like when my sister died, or when I was sleeping in my car, anytime I found myself at rock bottom, when all seemed lost, the only thing to do is to pick myself up, dig a little deeper, focus on something positive and carry on.”
As a result, Workman went to Johns Hopkins during the worst time of her divorce. “I needed a distraction and a place for advancement. So I decided to just go for best. I walked into Hopkins and started introducing myself. That’s how it began.”
Workman enrolled in the Nurse Educator Program at Johns Hopkins.
A year into the program, Workman needed to do a capstone project. Under the guidance of her mentor Sandy Swoboda, Workman decided to address the unanticipated respiratory arrest in the hospital environment through a simulation program.
“I spent an entire semester immersed with the simulation program at JHUSON, with world-class clinicians and educators like Maggie Neal, Sandy Swoboda, and Nancy Sullivan.”
Tina Workman (L) and Sandy Swoboda, a Senior Research Program Coordinator and Simulation Educator at JHU. (Photo courtesy of Tina Workman)
“Sandy and I designed the simulation originally with a hypothetical patient (J.S., 62 years old), a mannequin that can realistically simulate the medical emergency, including vital signs that respond to the team’s interventions. A team of students is tasked with accurately assessing the patient, calling for advanced care and performing an emergency intubation.”
What makes the design unique is that it is truly interdisciplinary team training. It breaks the boundary of specialties and is a chance for medical students, nursing students, residents, currently practicing physicians and nurses of all levels to train together as a team.
Dr. Henry Fessler watching a simulation in progress at the Johns Hopkins University School of Nursing. (Photo courtesy of Tina Workman)
Dr. Henry Fessler, a Professor of Medicine and Public Health, Director of the Fellowship Training Program in Pulmonary and Critical Care and Assistant Dean for Undergraduate Medical Education at Johns Hopkins, recognized this simulation as “a unique and valuable opportunity for his medical students and fellows to gain lifesaving airway skills from an expert while simultaneously learning to lead a team of professional nurses.”
Dr. Fessler now recommends participation to all of his pulmonary critical care fellows, and it has become popular among the medical students and Internal Medicine residents, space permitting.
In addition, every Masters level nursing student graduating from Hopkins is required to go through the simulation.
Also because of this simulation program, JHU has formed Rapid Respiratory Response Teams, who utilize the same concept taught in the simulation.
This brings us back to the opening scene on June 26, 2018. On that day, the hypothetical patient was officially named after Abby, Workman’s baby sister, who would be 31-year-old had she lived.
The simulation project is a gift to her entire family, who can now face the tragedy with gratitude. “With this, she lives.” Workman’s father said.
Power of Compassion
The scene that was engraved in Workman’s mind happened in the ER waiting room on that fateful day.
“I remember being in the ER waiting room with my siblings, all of us obviously traumatized. The ER nurses were amazing. They brought us food and blankets. One of them even held me in her arms while I cried. She assured me that it wasn’t my fault, that I had done the very best I could. I’ll never forget her kindness and compassion… I remember thinking that I wanted to be just like her someday.”