Nicole Cromwell, MSN, RN,


"The Journey to Clinical Nurse IV"


Nicole Cromwell has been a critical care nurse at Stanford Health Care for most of her career.  Her journey has been vast; encompassing the ICU, Lifeflight, and the Critical Care Response Team.  When describing why she pursued advancement through the PNDP clinical ladder, Nicole says,"My commitment to the nursing profession and my devotion to patient well-being, inspired me to enhance my professional advancement by pursuing the PNDP."


One of Nicole's exemplars was inspired by a process known as the “pause.” This was started by Jonathan Bartels, a nurse from the University of Virginia Medical Center.  After the code blue death of a patient, the “pause” allows for a moment of silence amongst the team. This allows for reflection of the patient’s life and the code team’s efforts as honorable, and not as a defeat. Taking time to acknowledge the event helps bring closure and healing, thus promoting a healthy work environment and a sense of purpose for those involved.

At the end of a particularly tragic death of a young woman in the Emergency Department, Nicole stepped forward, took a deep breath, and spoke up after the physician pronounced the patient dead.  In a crowded and hectic room and in her loudest but calm voice, she asked everyone to "please stop what they were doing and 'pause' in silence."  This pause or moment is taken to acknowledge a soul who had just died, and the hard work of the code team in trying to and save her. This patient was someone’s daughter, a mother, a sister, and a friend to many who cared about her. She and her colleagues stood in silence, bowed our heads, and acknowledged the tragic event in their own quiet way. 


Over the last year, Nicole has advocated for the “pause” many times, twice in one particularly sad day. Nicole says that it is always received with appreciation from the physicians and nurses involved.  "Anyone can initiate the 'pause'", she says,  "as it does not take any special education or training, just a bit of courage to speak up for your patient in your final act of advocacy. Our patients deserve this acknowledgement and respect in their final moment in our care."  

"Promoting excellence and encouraging growth is at the core of our profession. Talk to your peers, find out more about the PNDP process, add up your points, and attend an information session. It is easier than you may think," Nicole says.  The PNDP promotes life-long learning and excellence in the commitment to the delivery of high quality care and optimal patient outcomes.


Contributed by:

Nicole Cromwell, MSN, RN, CCRN, CNRN, CNL, CNIV

300 Pasteur Dr
Palo Alto, 94304​

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