RN Spotlight: Rebecca Guthrie, Brightening the World One Giant Illustration at a Time

If you’re a nurse on social media, chances are that you’ve already stumbled upon or been introduced to the Hopkins PICU Whiteboard (@hopkinspicuwhiteboard) on Instagram.

If not, pause right here and click that link above–you won’t regret it.

For the past 8 years, Rebecca Guthrie, RN has been bringing an extra dose of joy to her floor on Johns Hopkins Pediatric Intensive Care Unit.

We sat down with Rebecca to learn a bit more about her background, why she got started with the whiteboard project, and what’s to come in the future. Check it out in this week’s RN Spotlight: Rebecca Guthrie, Brightening the World One Giant Illustration at a Time.

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Why did you choose nursing?

I grew up in Maryland, in the greater Baltimore area. My mother is a nurse, and that is one reason that the field interested me. I like to help people and wanted something challenging that would make a difference in people’s lives.

I attended James Madison for my undergrad, and then immediately jumped into a program closer to home at Johns Hopkins. They have a pediatric intensive care unit program for new graduates, and that was a perfect fit.

I’ve now been a PICU nurse for 10 years.

Can you tell me a little more about the PICU Unit?

It is Maryland’s largest and best children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. With that said, we take referrals from other hospitals that don’t have pediatric specialties from all over the Mid-Atlantic.

It is a 40 bed unit, 12 beds dedicated to the Pediatric Cardiac ICU and 28 beds dedicated to the PICU.

Our patients have a wide range of diagnoses and we care for the sickest kids in the state.

What is a transport team?

Our team is the only dedicated Pediatric Critical Care transport team in the state. Depending on the location and the diagnoses, we’ll transport patients from all over the Mid-Atlantic area. We’ll mostly bring them back to Johns Hopkins Children’s Center, but occasionally we’ll transport to other area hospitals that have similar pediatric specialties and capabilities. 

We will take referrals from outside hospitals and other care facilities, triage them over the phone, and then go out to transport the patient. That means we will either be out there in an ambulance, or even in the Hopkins helicopter, depending on the severity and distance of the case.

There are two transport nurses on each shift. One nurse is the “intake nurse,”
and manages calls, triages, provides medical recommendations, and finds available beds. 

The second nurse will be the one actually going out to pick up the patient. Obviously each case is different, but we’re trained specifically to care for and transport pediatric patients with diagnoses ranging from broken arms to cardiac arrests. 

It can inevitably be taxing, but it is also exciting and every day is different. The transport world can be intense, especially when there are emergency situations.

What’s a day in the life look like now?

I joined the transport team in 2018, but I actually stopped working at the bedside two years ago, when we created an independent team to align with other transport programs.

It definitely depends. Although I’m on the transport team full-time, I will still assist in the PICU if it is a slow transport night.

During the RSV season, our team was receiving over 500 calls per month, at least 10 per shift. Many of those calls would require our team, but again, depending on the case it may not be necessary to have a nurse travel with our crew.

When a call comes in, the intake nurse on the transport unit will evaluate and input those details on a scoring sheet. Certain scores will require a nurse, others will not. Occasionally we’ll board a PICU fellow, but a typical call would have an EMT and the paramedic.

The thing to keep in mind is that kids are not just little adults! They require different treatments, different care and specialized units. When the RSV and respiratory cases rose, there were essentially no beds on the east coast. Anywhere we could find a bed, we were bringing patients.

If it is a really tough patient and case, we will board the helicopter with the lifeline team which can include a nurse, paramedic, respiratory therapist and fellow. In those cases, we often don’t even have the room to bring a parent back or to the unit. Our priority is of course the patient, and it’s better to bring the child with and let the parent drive to the hospital.

The furthest trip we will drive is about 3.5 hours out to the Ocean City and Salisbury areas of Maryland.

What’s the biggest difference from beside to your current role?

There are several differences, but the biggest is the critical thinking aspect while on transport. When you’re an hour to two hours away, you’re on your own out there with just the team on the transport with you. These smaller community hospitals are relying on you, and you don’t always have a lot of help.

Independent thinking and working is a requirement; there’s no doctors, nurses, or respiratory therapists to help like there would be in the PICU. 

We of course have protocols, but really the goal is doing whatever you can to get your patient back to Hopkins safely.

Now, can you tell us about your whiteboards?

I started illustrating the whiteboard in August of 2014.

There was one whiteboard that had nothing but a help number on it. It was big and underutilized with informational material surrounding it. The earliest illustrations then were really just the PICU nurses doodling throughout the shift. There was a weekly theme and everybody pitched in.

But then I noticed that it slowly started to turn people’s moods around. Even a small action like decorating the whiteboard randomly could brighten up a parent or a child’s face when they walked around.

The children and parents in this unit are often experiencing the worst days of their lives, and the idea for the whiteboard was as simple as taking their minds off of the reason for being in the unit – even if it were for a minute.

It also often brings the PICU team together. It’s a tough unit with a lot of sorrow and despair. When you’re finishing a long shift, or walking in knowing you’re about to do 12 hours, it can help lift the spirits.

How do you go about picking the next illustration?

Well, it typically takes around 1-3 shifts to actually draw it. The patients come first, always. So it just depends on the week and how busy transport or the PICU is in terms of spending time working on the illustration. We switch them out every three months or so because it takes so long to make!

Sometimes I will host a poll on the instagram, and get a sense of what the followers would pick or want to see next. But a lot of the time, if there is a cool movie coming out, or a fun topic in the realm of kids entertainment, I’ll use that. If there is a holiday coming up, we’ll do a theme around that, and in the summer, we’ll typically do a beach vibe, like “Moana.” 

At the end of the day, I pick what I think will make a fun illustration and go with it.

Do you have a background in illustration?

I’ve never taken an art class; honestly I was a terrible artist originally, but after a year or so of doing them, it sorta kicked in. I cannot draw or illustrate on any other medium, but the whiteboards have come a long way and I really enjoy doing them.

The whiteboard has definitely fostered enthusiasm on the unit. Everyone gets excited to help color after I’ve finished the outline. Nurses, doctors, respiratory, front desk, and more all like to grab a marker and help fill in some sections. Again, some collaboration to raise spirits makes it worth it.

When they’re done, families usually stop and stare–I really want them to be great so that people can enjoy them. I’m very particular about how they turn out, so typically the families or patients don’t help and I try to share my plan with my colleagues who do.

Favorite one you’ve done so far?

Definitely the “Finding Nemo” and “Up” illustrations are my favorite so far.

What does the future hold?

There’s a new-ish Disney movie named “Luca” about a little boy in Italy who becomes a sea monster. Plus, I think they’re doing a live-action version of “The Little Mermaid” so we’ll do that when it comes out too.

In terms of the Instagram account, I of course want it to grow so that we can spread some positivity around. One of my fellow nurses and I have even talked about bringing the illustrations to other children’s hospitals; we’d have to figure out the time and logistics but it’s made a positive impact here.

Oftentimes, hospitals don’t always feel like children’s hospitals. There will be a few pictures or some alphabet wall paper but we’d love to bring the illustrations and decorations to other facilities and maybe inspire some more thoughtful decor.

There’s even talk about the option to make some permanent, or like an installation. Tough to say for sure, and I’m not sure who designs all of these children’s hospitals but there is room to do it with kids in mind.