I WILL NEVER FORGET the anguish on his face, his anger, and his pain. DM was one of my patients during my first nursing job on a medical telemetry unit. He had been found after falling in his shower. Having been immobile under the running water for days, he was diagnosed with rhabdomyolysis and had developed a stage 4 sacral pressure injury.

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DM's need for complex nursing care continually challenged my clinical and critical thinking skills. However, nursing school did not teach me how to interact with such an angry patient who spewed hateful words at the staff. Many days I hid in the breakroom bathroom crying. Because I wanted to scream at this patient for being so hateful, I often left the hospital thinking I was not fit to be a nurse.

However, one morning I had an encounter with the patient that I will never forget. The pain medications prescribed for DM were not adequately relieving his pain. As I turned him to care for his pressure injury, he grabbed my arm and looked me straight in the eyes. My heart sank. His facial expression and the pain in his eyes changed my perception and ultimately my nursing career.

In spite of the difficulties I was experiencing caring for DM, I vowed that day to advocate on my patient's behalf. He deserved better pain relief, better care, and more empathy than we were giving him. I began that crucial conversation with the physician, who was initially irate that a nurse would dare question his orders. I was intimidated but refused to back down. After discussing DM's clinical status and his refusal to participate in therapy, the physician thanked me for being an advocate for his patient and for speaking up.

That single day on that medical telemetry unit, in Room 313, I advanced from a novice nurse to something much more as I reevaluated why I had become a nurse in the first place. It was a turning point in my career. After that experience, I walked in every day ready to advocate for my patients and to employ compassionate bedside care no matter what.

That single act of standing up on behalf of my patient left a permanent mark on my career. That day transformed my practice and laid the foundation for me to be a leader. As Florence Nightingale said, "Never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself."1

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