For 17 years, Beth Hammer has been meeting new challenges with an enthusiasm and professionalism that has propelled her to a nurse leadership role at the VA. A nurse practitioner in cardiology, Hammer's childhood dream of becoming a nurse has blossomed into a dedication and commitment admired by her VA colleagues and recognized nationally by nursing organizations.

Among other things, Hammer stays abreast of current research and was a key figure in developing a critical pathway for patients with chest pain to the Milwaukee VA Medical Center. Using best-practice research, she co-chaired a multidisciplinary group to set practice standards and developed a teaching plan to assist nurses with implementing the protocols.

The 23-hour Chest Pain Evaluation program was piloted and soon instituted as an ongoing quality improvement program. When a patient presents to the ER with chest pains, providers are taught to follow a sequence of key decisions to determine the degree of risk for acute MI. If the risk factor for a heart attack is moderate, patients are observed, undergo stress testing, and are released in 23 hours or less. This has resulted in decreased hospital length of stays and related costs.

Hammer also is active in the American Association of Critical-Care Nurses. She feels that her involvement with the organization has provided her with an invaluable network of colleagues. She uses these contacts as well as research and protocols published by the association in ongoing program development and continuing education for nurses at the Milwaukee VA.

"I've spent my entire career at the VA and I like it because I'm able to participate in research projects and give hands-on care to patients," said Hammer, who also helped develop a congestive heart treatment protocol. "Nursing offers a unique combination of being both professionally and personally rewarding."

Hammer obtained her nursing degree from the College of St. Teresa in Winona, Minn., a program that involved clinical study at the Mayo Clinic. She joined the VA hospital as a direct-care nurse on a telemetry floor and later earned her MSN degree in the adult nurse practitioner program at Marquette University in Milwaukee.

"I've wanted to be a nurse since I was 8 years old," Hammer said. "I don't know what influenced that decision but I couldn't get out of high school fast enough to get started."

Her diligence and hard work resulted in rapid advancement at the VA as she left telemetry for a position in the cardiac ICU and later the cardiac cath and EP labs and has developed the technical expertise needed to function in critical care areas, including the OR, where she may be called to assist in a pacemaker placement.

Hammer's busy schedule includes seeing both inpatients and outpatients, consulting with physicians and staff on patient needs, and educating VA nurses on trends in cardiology. She also gives VA classes on telemetry, cardiac physiology, new medications and ethical issues in nursing and teaches the cardiac portions of advanced assessment classes for Concordia College and Marquette University.

Outside of the provider setting, Hammer regularly volunteers to staff the first-aid booth at an annual fund-raising run for the local Children's Hospital and has spent time in underserved areas such as Appalachia, where she recently provided three weeks of health care training at a community clinic. She even volunteered her services at a health clinic in El Salvador, where she was frustrated by the lack of medications and supplies.

Hammer, who has spent her professional life at the VA, doesn't regret the career choice, praising the hospital system for being in the forefront of a number of practice settings, including telemedicine. She said the VA might not have the resources of some hospital systems, but is an industry leader when it comes to having a sophisticated knowledge base and technology.

"I've never been bored and never had the feeling I've learned everything there is to know in one area, there's always something more, always a challenge," she said. "Even on my worst days, there's always been a patient who has somehow touched my spirit and made me feel that this is where I should be."