Nursing U's Podcast
Nursing U is a podcast co-hosted by Julie and Caleb. We embark on an educational journey to redefine nursing within the modern healthcare landscape.
Our mission is to foster an open and collaborative environment where learning knows no bounds, and every topic—no matter how taboo—is explored with depth and sincerity. We delve into the essence of nursing, examining the intimate and often complex relationships between nurses and their patients amidst suffering and death.
Through our discussions, we aim to highlight the psychological impacts of nursing and caregiving, not only on the caregivers themselves but also on the healthcare system at large.
Our goal is to spark conversations that pave the way for healing and innovation in healthcare, ensuring the well-being of future generations.
'Nursing U' serves as a platform for examining the state of modern civilization through the lens of nursing, tackling issues that range from violence, drugs, and sex to family, compassion and love. We will utilize philosophy, religion and science to provide context and deeper understanding to the topics we tackle.
By seamlessly weaving humor with seriousness, we create a unique tapestry of learning, drawing wisdom from the experiences of elders and the unique challenges faced in nursing today.
Join us at 'Nursing U,' where we cultivate a community eager to explore the transformative power of nursing, education, and conversation in shaping a more whole and healthier world."
Disclaimer:
The hosts of 'Nursing U', Julie Reif and Caleb Schraeder are registered nurses; however, the content provided in this podcast is for informational and educational purposes only. Nothing shared on this podcast should be considered medical advice nor should it be used to diagnose or treat any medical condition. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding a medical condition or health concerns. The views expressed on this podcast are personal opinions and do not represent the views of our employers or our professional licensing bodies.
Nursing U's Podcast
Ep #009 PT 1 - Revolutionizing Nursing Education and Practice with Brandy Falconer
Join us for a riveting conversation with Brandy Falconer, a seasoned nurse with over 22 years of experience in emergency medicine. From her early aspirations as a pediatrician to her current role as a professor and PhD candidate, Brandy shares her transformative journey in healthcare. Her stories from the frontlines during COVID-19 offer a raw and insightful look into the evolving landscape of nursing, shedding light on the intricacies and challenges faced by nurses today.
We tackle the pressing issues in nursing education, revealing shocking statistics about the competency of new graduates and the critical need for improved training methods. Brandy provides an insider’s perspective on the limitations of electronic health records and how they may be fostering a checklist mentality that hinders critical thinking. Through her experiences and our discussion, we underscore the importance of robust onboarding processes and effective use of simulations to ensure that new nurses are well-prepared to deliver safe patient care.
Our conversation doesn't shy away from the systemic challenges within the nursing profession. From the alarming rates of nursing suicide to the lack of support for nurses suffering from PTSD, we expose the harsh realities many healthcare workers face. We emphasize the importance of nurses interviewing potential employers to find supportive work environments and highlight the potential of AI in reshaping nursing education and practice. This episode is a must-listen for anyone interested in the future of healthcare and the well-being of those who dedicate their lives to it.
Okay, welcome back and welcome Brandy.
Speaker 2:Hi, yes, welcome, brandy.
Speaker 1:Thanks for joining us.
Speaker 2:Our first guest, our very first guest.
Speaker 1:We're doing new things. I'm super excited to have you on Hi.
Speaker 2:I'm Julie.
Speaker 1:And I'm Caleb. Welcome to Nursing U, the podcast where we redefine nursing in today's healthcare landscape. Join Julie and I as we step outside the box on an unconventional healing journey.
Speaker 2:Together, we're diving deep into the heart of nursing, exploring the intricate relationships between caregivers and patients with sincerity and depth.
Speaker 1:Our mission is to create an open and collaborative experience where learning is expansive and fun.
Speaker 2:From the psychological impacts of nursing to the larger implications on the healthcare system, we're sparking conversations that lead to healing and fun. From the psychological impacts of nursing to the larger implications on the healthcare system, we're sparking conversations that lead to healing and innovation.
Speaker 1:We have serious experience and we won't pull our punches. But we'll also weave in some humor along the way, because we all know laughter is often the best medicine.
Speaker 2:It is, and we won't shy away from any topic, taboo or not, from violence and drugs to family and love, we're tackling it all.
Speaker 1:Our nursing knowledge is our base, but we will be bringing insights from philosophy, religion, science and art to deepen our understanding of the human experience.
Speaker 2:So, whether you're a nurse, a healthcare professional or just someone curious about the world of caregiving, this podcast is for you.
Speaker 1:One last thing, a quick disclaimer before we dive in. While we're both registered nurses, nothing we discuss here should be taken as medical advice. Always consult with your doctor or a qualified healthcare provider for any medical concerns you may have. The views expressed here are our own and don't necessarily reflect those of our employers or licensing bodies.
Speaker 2:So let's get started on this journey together. Welcome to Nursing U, where every conversation leads to a healthier world.
Speaker 1:Brandy and I worked together for about three years through COVID and she's one of the smartest people I know and I think she is going to be a huge contribution to what we're doing and to the conversation today, thank you. Thank you very much. I appreciate that to what we're doing and to the conversation today, so welcome.
Speaker 3:Thank you very much. I appreciate that.
Speaker 1:Yeah, so do you want to give us a rundown of kind of your how you became a nurse and your the trajectory of your career?
Speaker 3:Yeah, sure. So I went the very long and convoluted route to becoming a nurse. I am going to date myself a little bit, but I knew from the time I was very little that I wanted to be a pediatrician. That's what I was going to do with my life. I can't remember wanting to do anything else, and in middle school I started candy striping. So there's the date on how old I am. Candy striping is not even a thing that exists anymore, and I followed a pediatrician and it was about 20 minutes into this shadow experience that I just looked at him and I said at what point do you take care of the kids? And he said I don't, this is my job.
Speaker 3:I come in, I see them, I write some stuff down, I talk to the nurses and I leave and I'm like, okay, well, I want to see what they do. And so he then paired me up with the nursing staff and that's when I got to see okay, these are the people that put hands on and take care of, and this is what I'm interested in. And so I volunteered on the pediatric unit for a very long time, and this was when we did paper charts and somebody called up from the emergency room looking for some help building paper charts and I said, well, I can go.
Speaker 3:I can, you know, staple paper charts here or there, it doesn't matter.
Speaker 2:And I went down there.
Speaker 3:And this is when EMS systems were intertwined with hospitals and the tones went off and I'm looking around, going like wait a minute, what is that?
Speaker 3:And a very, very well-seasoned paramedic said hey, kid, how bored are you right now? And I'm like I'm pretty bored and he's like, get in, let's go. And I went on my very first ambulance ride and that was it. So I did EMS for the first 14 years of my career and then decided once I had children that I needed not 24 hour shifts, that I needed stability and a bigger paycheck. So I said, okay, I'm going to go to nursing school.
Speaker 1:And.
Speaker 3:I went to nursing school, stayed in emergency medicine my entire career in some form of another. When I was going to school I was a tech. I was in EFT. A medic did all that stuff and I've been in it for 22 years. At this point I met Caleb in the PACU. The PACU is my safe space. When I get really frustrated and just kind of burnt out of the ER I go to the PACU and it's a different change of pace, a different type of patient, and you can kind of fill the cup up a little bit more and then get ready to go back to the emergency room.
Speaker 3:And I have worked. My husband spent 21 years in the Marine Corps. So I have traveled all over the country and done all kinds of levels, from level one trauma centers and urban cores to critical access hospitals that are so far out. The doc has to get in his boat and drive across the lake. He doesn't even stay at the hospital all night long, um, and just about everything in between.
Speaker 3:And I've never ventured outside of emergency medicine. It's what I love, what I always thought I would do. I used to joke around and say they will remove me and my walker from the ER. I'll never leave. I think COVID hit and that completely changed my perspective and the way I think about medicine and the way it's ran and the way that I can add value to the system changed. And so I became a professor, and I am two and a half years deep into a PhD at this point trying to figure out how can we better prepare nurses to do the job the actual job that we expect them to do upon graduation, not this fantasy that is created for them, and so that is what I am trying to figure out. That is my entire career in a nutshell.
Speaker 1:Tell us about the research that you're doing.
Speaker 3:So I do simulation, sequencing and integration, and we're using a couple different theories. We all know Benner, and she has established that in order for you to be a good nurse, you have to have experience. You have to see it, touch it, smell it, do it. You have to learn it, essentially the hard way. There is no, I can't tell you, and it makes sense.
Speaker 3:You have to do it that if we put things in particular orders, just like the way your computer works, your brain takes inputs and it decides where to store them and then it decides how easily or readily you can pull the information back out. And so I'm looking at if we sequence simulation to mirror their didactic content, so we teach them the book stuff and then they put them in an environment where they can get that experience, where they can see it, do it, touch it, smell it. Then I can put them into the clinical environment. And so by the time they hit the workforce they have taken care of a diabetic patient, they have taken care of a stroke patient, they have done all those things that we used to rely on clinical sites for. And because healthcare is now a business and there is liability in business, the first thing that happens when my students are in clinical if something goes wrong or something is going south, they remove the students. They don't let students do anything anymore.
Speaker 1:Wow.
Speaker 3:They're wallflowers and they expect this knowledge to just osmosis into their head from the wall, and anyone who is a nurse understands that it does not work that way. So that clinical site is deeply underwhelming and they're not getting the experience they need. And there are some data out there and, if you want, I can send some references so you can post, because people are going to want to know where I got these numbers from. We can put them in show notes or something, but 77% of new grads cannot complete a basic assessment of new grads cannot complete a basic assessment 77%. Now, I'm not a math genius, but that tells me that only 23% can.
Speaker 1:And that should terrify you?
Speaker 3:That's wild. 56% of new grads fail to rescue their patients because they do not understand that their status is decreasing rapidly. They fail to rescue their patients. Wow, if that's not terrifying, I don't know what is. Medical error is now the third leading cause of death and 56,. Coincidentally, 56% of all medical errors are completed by nurses with less than one year of experience. Wow, that's an education problem. Yeah, that's an onboarding problem. That's an orientation problem. That is an education problem. And we are putting new grads in situations that they are not equipped to handle. And our patients don't know any of this stuff because the only thing we put in front of them that matters is h-cut scoring. Is your water glass? There's your pillow fluffed. We don't know any of this stuff because the only thing we put in front of them that matters is HCAT scoring. There's your water glass, there's your pillow fluff.
Speaker 1:We don't measure patients, just the scores, just the satisfaction surveys.
Speaker 3:So that's what my research is in is trying to find a way that we can produce a not a smarter nurse more competent nurse. How can I get you better equipped day one to do the job? Because hospitals are not going to give you the year orientation that an ICU nurse used to get. They're not going to give that to you. You're going to get your 12 weeks and at the end of your 12 weeks you're off and running.
Speaker 2:Wow.
Speaker 3:Eye opening.
Speaker 2:I mean.
Speaker 3:And there's currently not one scrap of quantitative evidence about simulations use. No one has directly tied it to either student learning outcomes or exam scores, or board results or patient outcomes. None of that research has even been done, wow.
Speaker 1:Which makes you the world leader in this space.
Speaker 3:I don't know about the world leader, but it's a small niche that I am trying to push, something that we have to consider Like why are we spending millions of dollars in the simulation world if we don't even have any proof that it works? Right we've been doing this for so long. Simulation started, I mean, originally in the early 1900s, but for nurses and medicine traditionally in the 70s. But we've spent all this time developing it, evaluating it, designing it, but nobody ever went and like does it work?
Speaker 1:I mean that's, that's one of the things. Like you know, when, when, when we first started, we, we ran. What were they called? Um, when we would simulate a code, the mock code, but we had a mock code, oh, where we would go through every step and you had you know instant feedback.
Speaker 1:You know you had. You had the medicines right there in your hand. You're seeing it, touching it, the. You know the. You know the. What the label looks like. You know the. What the label looks like, you know. All of that prepared you to step into that critical situation and it's almost like the questions were eliminated because you had that hands-on experience. I don't care what anyone says simulating a code on the computer is ineffective. It doesn't work the way that a master code worked. Simulating a code on the computer is ineffective.
Speaker 2:No, it doesn't work the way that a master code worked.
Speaker 1:It is A megacode. It was a megacode, remember Megacode? Yeah, megacode.
Speaker 2:Yeah, in ACLS it was the megacode and everybody was petrified about it, and as you should be, Right Because you need to know your shit and that really prepared.
Speaker 2:And now you got these. You know nurses who don't have very much experience with the code doing the acls, because you know everybody needs to be able to acls now for their very first time through the e-sim, and they, they're just trying to get to the end. That's it. They're trying to manipulate and use the technology just to get to the end so they can just be done. Because they don't. They don't know anything about it, they've never been in one, so how could you even know?
Speaker 3:could you even know it's we have created so, along with the EHR platform, that has taken the thought process out of nursing so a million years ago when I started this, if I didn't know all the parts and pieces of a cardiovascular assessment, I could not write my notes.
Speaker 3:All the parts and pieces wouldn't be there. I had to know what was involved in that. And so then we got into HRs, which were designed for billing purposes, not nursing purposes, and now that assessment becomes a box that I can check. So if I don't know that capillary refill is part of the cardiovascular assessment, when I get to that box it's going to prompt me. When I get to that box, it's going to prompt me. And so now, acls, bls that's our QI system, all of those things that put all of this on the computer.
Speaker 3:We are generating medical staff who use checklists. It is an order of operations for them. It is a as Caleb will recognize, an SOP. I do step one, then I do step twoP, I do step one, then I do step two, then I do step three, then I do step four, and we're memorizing those lists. The problem with nursing is I could have 10 patients all coding at the same time, all with the same disease process. I'm going to have 10 different codes. No two patients are going to behave the same, so I cannot put them into a box and follow a checklist. I have to be able to use my brain and say, okay, we need to go this route now, versus following the checklist.
Speaker 3:And we've gotten away from standing orders, checklists this basic knowledge being something that we do when we don't know what else to do to being the only thing that we learn. And so you cannot put them in application specific scenarios, because they never learn to apply the knowledge. They memorize the steps and they go through the steps. And what happens if the patient doesn't follow the steps? That's where we're at. And so now these nurses come out and I call them order set nurses. I'm going to put an order in and they're going to follow all of those orders.
Speaker 3:And if one of those orders says give grandma 400 milligrams of morphine, they're not going to have the application piece to think about. Wait a minute, that might be too much for grandma to handle. They just and that's that's what that computer-based learning does, because it is very well structured to mimic how your brain learns things. And you gotta remember k through 12. We teach them to memorize, take the test and dump the information. Memorize, take the test and dump the information. You can't do. Take the test and dump the information. You can't do that with nursing content. Stuff you learn on day one is just as important as stuff you learn in year 30.
Speaker 2:Yeah.
Speaker 3:And we structured their learning on a format that does not apply in our world and then, we're shocked when they can't do it.
Speaker 2:Yeah.
Speaker 1:I mean, one of the big things that's popping up for me is is just that you know, julie and I have talked about this in the past how the you know salty veteran nurses, that that you know, just. You know leathery personalities, that were so hard on us you know the, the value of of that is like irreplaceable, and because that's the only way that those nurses are going to learn is, and you know, like the the saying, we've all heard it nurses eat their young yeah like you know, there's always such a negative thing, like in this context of what you're saying it makes eating far young a valuable contribution to society, as we're essentially weeding out those who can't can't really who are going to be dangerous, I mean.
Speaker 3:I was dangerous, we're going to be dangerous and we're no longer weeding them out.
Speaker 1:Well, we, we were all dangerous day one.
Speaker 3:Well, yes, but the difference is, you know, my, my, my nursing mom, as you call I yes, yeah if she, if she's from heaven right now, you would need to see a visceral.
Speaker 3:visceral reaction. I would be like I don't, I didn't do it. I I may have, I don't know. It's not necessarily that she ate me as a youngling, but she required and demanded that I learned what I needed to learn to do the job effectively. She accepted nothing less.
Speaker 3:And you take out those you essentially separate, not those that are smart versus not smart, because that's not what we're measuring here. You are taking out those what I tell my students. You have to be smart enough to know what you don't know. If I ask you something and you look at me and you say you got it, I have to know that you really have it. Yeah, and you are. Your fear of being wrong yeah was what drove you to learn what you had to learn. You were unwilling, mediocre at it, because I wasn't going to let you do that. It wasn't going to happen and we've taken that out.
Speaker 3:And now, instead of them only being dangerous because they're new, they're dangerous significantly longer. It's taking them a lot longer to get their feet wet, to kind of wrap their head around what's going on. When you have a nurse who my student finds a central line that is completely uncapped, no pigtail on it at all, and she just brings my student a pigtail and says, well, you can put this on and then you can use it. And I'm like I'm sitting here and thankfully my student was either a terrified enough of me or be unwilling to make the mistake because I demand if you do not know, you asked, she called me in there and she's like hey, can I use this? And I'm like absolutely not. Yeah, I don't know how long that's been open. There could be a blood clot in that line, this big, and we're just gonna flush it into the body, right? But you're looking at a veteran nurse who's been on that floor for seven, eight years and that process didn't occur the line needs a a pigtail.
Speaker 3:Here's a pigtail.
Speaker 2:Right, that's what I mean. I think that's what's missing. Is the the new nurses coming out? They don't have the leathery you know mothers to to raise them. You know that that's. I was raised by a leathery mother. I was a leathery mother, yes, but now, as we're leaving the bedside and we become, you know, aged in our 50s and we're not doing that anymore you know that it gets watered down with like every graduating class, and and mediocre has just become acceptable and it's acceptable and it's, I think, probably built into the hospitals.
Speaker 3:Yes, risk cost analysis yes, and that's your true problem is the hospitals view it as well. If my patient doesn't know they're getting substandard care, then there's no risk for me putting these people in positions where the only thing they could possibly get done would be substandard care.
Speaker 2:Yeah, absolutely, there's not enough time and there's not enough people and they don't leave people in orientation long enough, and you know, I mean you could list a hundred things, but a big primary focus has shifted from excellent clinical care to reimbursement and and surveys and patient satisfaction, and the patients are no longer patients, they're customers. Reimbursement and surveys and patient satisfaction. And the patients are no longer patients, they're customers, clients. They're clients. Right, they're paying clients, which is funny because they don't even pay their insurance companies pay.
Speaker 3:I've never had a client in my life. No, during those 22 years that I've never once taken care of a client, not one time.
Speaker 2:And I think you know. So that's where me and Caleb sometimes we'll just sit and look at each other like, well, so you know what? What do you, what do you do? How do you do? We can we're, we can't fix this. And so then you start to feel overwhelmed and but then you know we're like, okay, come back down to reality. We can make a difference by just talking about it, bringing people on the small things that are an awareness, you know, and and things that you're doing, you know.
Speaker 3:I guess Knowledge becomes the power Cause, if I can open this world, my students up to this world. When they go in their interviews, they know to ask about staff turnover attrition rates. They know to ask about what's your department function like? How many people have more than five years experience or less than five years experience? I teach them to ask these questions of these managers when they go in to do these interviews. To ask these questions of these managers when they go in to do these interviews and, like Caleb has said previously, you interview them.
Speaker 3:There is not a hospital in this country that doesn't need a nurse. There's not a place in this country that is like, oh no, we don't need nurses. So you are interviewing them. Find the fit that is going to prevent you from losing your license down the road. That's going to set you up for success and not failure. And I think that's why I went to education, because I can't do that in the healthcare world. I can only educate the workforce. And so that they demand better, so that they demand those moms that exist on the unit that can help them. And is it difficult? Yes. Is it fun? No. But when you are on your own and you are the one that is like able to function and think and move through situations critically. It makes sense. I'm like oh, now I know why I was like that. Now I know she did these things. Now it makes sense to me, just like it is when you're a teenager and your parents tell you no, it doesn't make sense until you're older.
Speaker 3:It's the same in nursing.
Speaker 1:Yeah.
Speaker 2:I did a little stint as a manager and did some hiring. It was in the spring of 2020. So these nurses were graduating, doing the rest of their clinicals online for that year, and the system isn't set up to really allow for the nurse to interview the hospital. It's like they don't know a that they're supposed to do. They. They're just they would come in just grateful that they even got an interview. You know, no question, no questions. You know, and I was the one that was like giving them the real deal, Like I didn't want to give them a fake scenario of the unit that I was hiring them on. You know, I was like it.
Speaker 2:This is a 20 bed, very, very fast paced unit. There are a lot of discharges and admins and, and actually though but she wasn't a new nurse there was a couple of nurses that were like actually no, thank you. But you know, thank God. I mean thank God. I told them that because if I wouldn't have I mean 100% fail, they would have just failed me, and all of that would have gone to not, and all the orientation would have been not.
Speaker 2:But I don't think it's not set up that way. They just want the bodies get them in there, get them oriented so that we can have the count, the numbers. We have enough nurses on. No one can bitch, but you talk about numbers of nurses on the unit who can take patients. Then you talk about who actually can take care of the patients, because we have probably all worked shifts with, like okay, they're here, but like we need to keep an eye on all of those patients. Like they sent her to us from the float pool, but what are you gonna do? Be like actually we don't want her or we don't want him. You know what I mean.
Speaker 3:Like no, you're just like okay, I guess I have eight patients now, so I'll have to take, I'll have to watch, or you tell other people to watch it and we don't have not only we not have the nurse moms to exist, to be that like hovering person that makes sure that you're not going to do anything completely crazy. We don't give the people that are there that may even have even a little bit more experience or a little bit more knowledge, any breathing room to mentor or to help those people. That coming just a little bit overwhelmed. Because, whether we like, if you took me 22 years in emergency medicine and you put me in an ICU, I would be like, okay, everybody here is alive. I don't know what you want from me. They're all sorted, they all like. All the holes and things have been identified. Yeah, I don't know how to fix any of it. I am a sorter and a bandaid sizer, like that is it. I don't know how to fix it, yeah.
Speaker 2:Well, I always would call that a tasker. You can do the tasks, yeah, when they would send a med surgeon or stand out, I see you, I can tell you the tasks, you can pass the meds, you can do that, but you have no experience in clinically judgment of what the situation is or how to fix it Right. And so that to me falls on administration. When and many ICU nurses would say you can't send us just anybody, icu nurses would say you can't send us just anybody, you can't count that person as a full staff. So now you know we might have the numbers of what these patients call for, but it is. It is very, very dangerous still and none of that ever matters. None of that matters to anyone because a administration and they all leave at night, so they don't, they're sleeping, they don't care, and they can say they care, but you don't.
Speaker 2:Because if you did, you wouldn't allow it to be that way. You would demand. It's just like sending a nurse into surgery, yes, but that would never happen. Or how about labor and delivery? You would never send a med surgeon or so over to deliver a baby Never, that never happens. You might send someone over who can answer call, lights and task and you see an a work, but so, but it's allowed on all units. So if you go to a specialized unit and you're in the float pool or you're floating from this floor, that's low census. I mean you're screwed.
Speaker 3:You are and you're totally set up for failure. And then there's not enough people to where that person who's coming to help cannot take a team who can just relieve some of those tasks that need to be done. It would be the craziest thing to put me in an ICU and then give me a team of patients and I can be like well, I can check the boxes and I can do the things, but I am ill-equipped, even with all of my experience, to genuinely fix this person and we do that. And then we take med-surg nurses or OB nurses and we did this during COVID. They would send them to the ER and they're just like losing it because they don't understand and at some points the concept of triage like this one is still technically breathing on their own.
Speaker 3:So we're moving on to this one and you just get into all of these not only logistical problems but how, if you're in labor and delivery and 99% of your experience is happy, how do you then switch to go to an ER where 70% of your patients that come in in true arrest die? There's no, there's way more terrible outcomes and there are happy outcomes in the emergency room and and then you can. You can see that bubble break. We all know the personalities of nurses. We can, you can, we can have three or four minute conversations and I can probably peg what unit you work on based on your personality and we're. Just the psychological aspect of doing that to nurses is impactful, let alone the logistics and the patient outcomes and all the other things that happen. It's you're getting hit from all sides.
Speaker 2:Yeah. Yeah, I mean the psychological impact is it. It's so big, but I think it's the least looked at and it's the least noticed, even by the person. You know they, they just will be like I just feel like a failure. I mean, you know they're, I've consoled many med search nurses who came to the icu who were crying, you know, and and it and it's not their fault.
Speaker 3:You know they're, they're put in, they're put in that position against their will, literally and there's no way that even if they were willing that they are set up to even be successful yeah, that's a moral injury yeah, it's, it's huge.
Speaker 3:Yeah, as if it's nothing, yeah, there is no downside or no impact to that. And even if that med surge nurse, let's say that she survived her one 12 hour shift, you know, I worked one 12 hour shift in the ICU, right, and the patients that I got when I came in were alive and when I left they were alive. And I was like I can offer you nothing else, like that is it. They were alive when I got them and they were alive when I left them.
Speaker 3:Right, I'm an ER nurse, that's all I know how to do and we're not even considering when we do that to a med search nurse or labor and delivery nurse, they don't go back to their unit with a loss of confidence, with some sort of negative connotation about their ability to perform, and we are. I think nurses are notoriously perfectionist or we are constantly striving to move forward and they're not going to accept that there was no way they could be successful. It is always going to be I should have known how to, or I should have done, or I should have seen. And so all of that just gets sit right on top of your shoulders and, whether we want to admit it or not, it's going to start practice. It's going to affect the practice that you are comfortable with doing.
Speaker 1:That's the moral injury element of it, which is like, like I've said before, like the, the fundamental element of nursing is of nurses. The fundamental elemental level of what makes up a nurse is that they care. It's their caring that is actually hurting them, because they're putting themselves, or we are putting ourselves, in positions to do things that, like all of the things that you're describing, put us in situations where we are incapable of actually doing the care. You know, when you don't have the tools to do the job, it hurts your soul, it hurts that part of you that is truly good, which is the caring part yes yeah yes, and it damages it, and damages with it.
Speaker 3:It typically goes one of two ways they leave, they're going to exit the profession altogether because at some point I mean it typically goes one of two ways they leave they're going to exit the profession altogether because at some point and I think we have all been there, you get to it is literally them or me.
Speaker 1:Yeah Well, the other thing, like you know, last week I mean I have done a lot of research. You know, after my breakdown I think I've talked about this before how you know, I called the state board of nursing. Both of the states I was licensed in called them and they had nothing for PTSD for nurses. So I often, you know this is part of why I'm doing this work. You know, I'll do a lot of research on nursing suicide because I've had lots of friends that have taken their own lives. You know, and I think you know, last week I did a search the NIH, everyone is talking about nursing suicide. I mean that's where.
Speaker 1:That's where my mind is going, listening to you guys talk. This is why nurses are killing themselves. Talking about nursing suicide. I mean that's where my mind is going, listening to you guys talk. This is why nurses are killing themselves an element, and it feels like having this conversation. I feel like this conversation will help heal some of these nurses that are really suffering right now, and I don't think I've said this before. One of the things that really, really pisses me off is the every month the state boards will put out. They send out the newsletter and they've got all the nurses that have been arrested for something Not paying your taxes Publicly, it's like, like yes, all the nurses that have been arrested for something publicly.
Speaker 1:It's like, like it is so. It makes me so mad Like I. I I could have been on the back of that newsletter so easily.
Speaker 2:Well, it's like it's public shaming, it's like it's like how they used to go out and they used to hang the people in the courtyard. That's what it is.
Speaker 1:I'm bringing that up because maybe someone will know a nurse that is not set up for you to successfully navigate it.
Speaker 3:So even if you are the best at what you do and the most mentally stable and you have, your entire act is together. Ducks are in a row. If we put you into this healthcare system, whether we all want to admit it or not, the system itself is going to start sending those ducks in different directions and you cannot successfully get across the pond navigating that system the way it is designed yeah so you either leave or you figure out how to survive within a system that is meant for your destruction.
Speaker 3:And I say mint and I mean that word, I. That is not a misstep, it is meant for your destruction why Explain that?
Speaker 1:Because last week we talked about pharmaceutical industry and how it became what it is, and Julie brought up the idea that there was a malicious intent and I pushed back and I said how it became what it is. It's logical, it makes sense how it became such an efficient tool. And I'm not saying that there isn't terrible unethical, immoral acts done by pharmaceutical companies Absolutely no question. I mean, the opioid crisis in so many ways was fabricated to make money. I mean they're doing documentaries, they're making movies about it. That stuff is like okay, I feel like choosing to say that this whole thing is designed to hurt you. I think that. I think that that. So one of the things that I like to think about is is how other industries are giving care. So like the financial advisor that prevents someone from making a financial mistake, that saves their life, like that's caregiving they're giving only if they are a fiduciary and they are required to, and there's nothing in it for them.
Speaker 1:True, true.
Speaker 3:So, even in something as innocuous as the finance industry, the people who are designing the system. So whoever builds this hedge fund company, if they choose to be good, then they're obviously going to be a fiduciary, but that system as a whole is only as good as those people making that decision. And any system that we have and all health care systems are this way across the board, nurses have all of the responsibility, none of the authority responsibility, none of the authority. And if hospitals are trying to claim that we are not the cog in the wheel that they are willing to routinely break, the system is designed so that the nurse is the one that routinely breaks. That's what I mean by it is meant to happen that way. If you look at the way the healthcare system is designed, everything if the room isn't cleaned, that's me.
Speaker 3:If the sink is clogged, that's not a plumber. That's me that has to take care of that. If the patient needs transport, that's not a transport service, that's me. If the patient doesn't have a house to discharge to, I'm coordinating that. So everything about this system is designed to fall on one person, and that is a nurse, and one of the things I teach my students is if it exists within the four walls of that institution, it's your job, whether that is housekeeping, dietary plumbing, physical therapy, transport it doesn't matter, that is your job.
Speaker 3:It's designed that way. It is meant so that all of that weight, and none of the authority, falls directly on the nurse. She is the expense on the budget sheet yes, expendable.
Speaker 2:It is designed so that that weight sits right there and I know you know the people. You can say you know the CEO, the nursing director. You can talk about those individuals, and I don't think that those individuals are maliciously doing that. They are also in the system. The whole system is making it no matter. You know, you can have the greatest CEO and I've worked under a couple but they only have so their constraint, and they're then working with what you are, which is an expense. You are an expense and in a business model, you have to manage your expenses, and so to give nurses what they deserve, what they should have, how to treat them as humans and part of the like. If we had investment in the company and we were part of all of that, we would be treated differently. We don't have a seat at the table.
Speaker 2:We are a worker bee. Yeah, yes, it's just how it is. It's just how it is, yes, and it's just how it is. It's just how it is and that is a huge thing that in our lifetime was never going to change. But I think what we can do is bring awareness that this is the system that you're going into as a nurse and bring awareness to what is moral injury so that it can be identified when it happens.
Speaker 2:So when you go into a situation as a nurse unprepared and you start feeling the feelings and the flushed face and the tight chest and tingly, and you're going to cry because your mind is like you are not safe, this is not safe, you don't know, and whether the charge nurse is yelling at you or whether she's like you're going to be okay, I've got, I've got you. It doesn't matter. She might look after your patients and they may be alive when you leave, but the feeling of being unsafe, that someone, you're not doing that to yourself, they're doing it to you. So if a nurse can recognize that that she's not safe and either refuse the assignment which that is another whole situation or just do the things for herself whether she needs to breathe through it, things for herself, whether she needs to breathe through it, whether she needs something, and even after the shift, to debrief with someone, with herself, with journaling with a group, with going into her nurse's group, talking about it, venting about it, being angry about it, but knowing that it has nothing to do with who she is as a person, the human being, the soul that she is and the education that she still is a very good nurse in an environment that supports her to do that. And so maybe that's the little piece that we're able to bring, which is awareness to what you're actually getting into, like I did with the interview.
Speaker 2:Yes, the unit, like I'm not joking, you might have eight total patients this shift, three discharges and three admits, along with your other two. So that that's the truth. And, in my opinion, one thing that healthcare does is they're not true. They're, they're, don't, they're, it's not, they're not telling the truth, they the truth. They hide the things that are. Probably they don't look good and people would be like why are you doing that to them? Why are you making that nurse go there? Why are you doing so? It's just part of the staffing, that's just how we do.
Speaker 2:And they don't ever really have an answer. Because I was the one who chimed up in the meetings and I'm like we're not putting another thing on the nurse and we're not putting another thing on the supervisor, we're not doing it. And you know all the looks at me and I'm just sitting there like yeah, I didn't laugh, I didn't last, I didn't last long.
Speaker 3:I couldn't take it. And I will tell you the first time I was ever charged in the ER, we had 24 beds. There were three nurses and we're talking about a freestanding facility, so I run my own labs, I transport my own patients, I triage from triage to disco. There are three nurses in that building Three One doc, one x-ray, ct and one tech. That is it. And we got 24 beds and there are typically 40 or 50 deep in that waiting room.
Speaker 3:As you know, anybody who knows the system, I got to have somebody at triage, so now I've got two nurses, 24 beds and one tech. That is, can get nothing done but run labs, run labs yeah that's just. She's stuck in that lab. I can't get her help with anything. The first time I ever took charge and I said, okay, how many nurses do I have? All right, we have a four to one ratio. So of these 24 beds, I'm opening eight, and the heads that rolled oh yeah.
Speaker 3:I mean they lost it. My, my manager showed up at 11 o'clock at night because I am sure that the waiting room like they used to watch it was meditech. They used to watch that system. You'd watch it from home and instead of being our usual 40 or 50 deep, we're 80 something deep at this point and he wants to know why we're not moving patients. Well, we only have eight rooms open because I only have two nurses available and math tells me that's all that I can take. And he lost it and just me putting my foot down and saying if you want 24 beds open, then I need the staff to run 24 beds. And man did he only let me charge when he had no other stuff, because that's the first thing I did.
Speaker 1:Yeah, he's got a hand tied there. He can't fire you.
Speaker 3:I'm like you have it after your name. Come on in. I'll open four more rooms. Come on in. Yeah, I'll open four more rooms. Come on in.
Speaker 2:Yeah Well, and you know why they get so uncomfortable is because then they have to go to the either hospital owner or the whoever's above them and say what's the deal here? Or you know, 79 of the people out there send a shitty survey back about how long they had to wait and the wait times and the throughput times and all that the left without being seen just skyrocket.
Speaker 3:And they have to explain all that.
Speaker 2:Yeah.
Speaker 3:And the answer is never. I didn't have enough staff to run this unit efficiently, effectively or safely. That's not what they want to say.
Speaker 2:Yeah.
Speaker 3:They want to say well, the nurse wouldn't open all the rooms, yeah, they're not going to include why the nurse won't open all the rooms. Yeah, they don't want to put any of that there, yeah, and so it's. It becomes the only power. We have to change this is to educate those who do the job to be effective at dealing with the things the system is going to pile on you because there is no other method to change it, right?
Speaker 2:This is it. Yeah, yeah, yeah, and I know a lot of nurses are talking about it and you know, I I really do, and and have been, and there's no change, nothing ever changed. I worked at the same hospital for 24 years, nothing ever changes. And but I do think that that that is preparing the nurses and educating the nurses who currently work to to be able to navigate that kind of environment and then, yeah, and take care of their own selves and their own mental health, rather than taking it all on as failure and stress. That is nobody should have to deal with because you don't, you think that you should know, but you don't know, you're, nobody's prepared for that.
Speaker 3:And one of the things I teach my students is like guys, you cannot compare your performance to my performance. I've been doing this as long as some of you have been alive. Now, if you want to pause and then we revisit this topic in 22 years, then we have a fair comparison. At some point, somebody taught you to use a spoon, so it is my job as your instructor to teach you these things. You are not going to magically or instinctively or intuitively know these things until you have been taught it and when you graduate. One of the things I teach them is you find the people who are willing to teach you. You find the moms of the units and, yes, they are more difficult to deal with and, yes, they are not going to let you slack, not even for a minute. But if you find those people, you will be successful. You cannot go into it thinking that, okay, I passed nursing school, I have nothing left to learn, Like, yeah, you passed nursing school, but you don't know anything.
Speaker 2:You don't know anything you literally don't.
Speaker 3:Nothing. I think we've all had that moment in our careers where we're like for me I was five years in and I'm in the back of an ambulance treating an MI and I make it through all the things that I'm supposed to do for the first time before I get to the hospital. I'm just kind of sitting there going like okay, I did the oxygen to the morphine, we got a line, I drew the blood, like I've got it. I'm like I did it, you know. And then this overwhelming just fear, like hold on, wait a minute, this is not the first m I have taken care of. Does this mean that all the MIs that I treated for the previous five years I didn't do it? And you start to look back and realize that that progression of just being in it and kind of learning and having a deeper understanding versus that surface level knowledge that you come out with and you're like how did I kill anybody? Yeah, like how did that not happen? And you're just you kind of have that epiphany.
Speaker 3:And so we as educators got into a better job of getting students to realize you don't know what you don't know and you have to be willing to learn it. And in the way this system is designed. No one's doing that for you, no one's making you do it. They are going to leave you on your own. So you have to seek out these mothers of these units who are going to say come here, let me teach you, let me show you. You're doing this in 47 steps, when it can be done in three. Come here, let me, let me help you. And we just don't do that in school, nor do we do it in orientation, and we just your orient. Your person that you orient with could be a different person every single time, or it could be somebody who graduated six months ago.
Speaker 3:I'm just over here like, oh, I'm not even Catholic. Let me give you one of those. I mean, how is somebody who graduated six months ago charged on a unit Orienting nurses?
Speaker 1:And this is where that system has led us, because all of us who finally realize we're out so I, I want to, I want to shift gears just a little bit and I feel like that's a a good segue, because I do, I do feel like the system is changing and, and you know, like we talked about before we started recording, you're kind of on the cutting edge of technology and the application of AI. I mean, I've said this before just us doing this podcast and talking about the trauma of nurses and everything that's placed on us is, in some, in some way could be viewed as an advocacy for technology, for, for the implementation, because if, if ai can, if ai can somehow replace us in as in that cog, then it is saving a tremendous amount of human suffering on the side of nurses. So, and I mean, it's just, it's the time that we're in and you know, I've said it before, I don't like AI, I don't like, I shouldn't. It's just there's so much, we're moving so fast. We haven't even figured out how to keep data breaches from happening.
Speaker 1:Of course, we're going to push forward and integrate our entire world with this technology. It doesn't make any sense. We haven't even problem-solved what we have. You're already using AI, us, I, I, I don't know how ai, I mean, I know, in radiology. I've talked about that, I think, on the podcast. You know ai can more accurately diagnose diseases than the human. I I've talked to a radiologist about that and and she said that she's a long way from losing her job, like it's years away from her job being eliminated and I think with ai integration into education, we we as nurses are never going to be replaced, I think.
Speaker 3:As far as the education side goes, this allows me. I use ai in an adaptive sense. So our NCLEX questions that we use are adaptive. Now it's not just a set of questions. If my student can start out and they answer the first three correctly, well then the fourth one will be harder, and if they get the fourth one correct, the fifth one is harder. And so we are stretching and pushing that knowledge base by. Instead of everybody answers the same hundred questions at the same level, we're pushing you until you get to that point where you can no longer answer the questions successfully.
Speaker 3:And that's my gap. And if a certain percentage of my students land at the same gap, then I'm going to look at discriminating factors. Is it the top half of my class or the bottom half of my class? Does this mean that my lecture on flood and lights was lacking in this area? So that's how we're using it currently, and then I use it for part of my virtual simulations, and the reason I use the AI is because they can't treat it like an ACLS checklist that they go through. It's never going to be the same simulation twice, so even if they check the same interventions or do the same things, it's going to adapt to make them think you can't memorize your way through what I do.
Speaker 3:I won't allow it, because I don't care if you can memorize the content, I care if you can think.
Speaker 1:So it kind of sounds like to me what you're doing there is countering all of the negative effects that you were talking about nurses coming out unprepared yes I mean there's still, there's still like the wildly unprepared I mean, yeah, you're gonna be wildly unprepared, like no one.
Speaker 1:Like you can't stimulate the first time that you do chest compressions and you break the sternum in half. You know this way and like every rib, like how it feels on your wrist when you, when you compress, and the trauma of that just has to be lived and nobody, like nobody, tells you that you're going to experience that.
Speaker 3:Like you can't simulate it no, you can't simulate it, although I do have mannequins that have all of these physiological features and I can, in fact, disconnect ribs oh, wow you, you can do.
Speaker 1:I mean you can feel that, yeah, wow, okay, yeah does it feel like it does on a human? No, no, but at least there's the awareness. I mean, it was so traumatic. It was so traumatic the first time that I pounded on a 103-year-old woman's chest, the first time I did end-of-life care and I rolled the person and air was pushed out of the lungs.
Speaker 2:Yeah.
Speaker 3:It was a heart attack that I remember to this day, and so you can. We can get not an exact simulation, but with some of that high fidelity stuff that's out there, I can at least make them situationally aware so that their first reaction when this happens to them in the actual clinical practice is not panic. And that's part of what we have to try and avoid, and that's the reason why we have to integrate in sequence simulation to expose them to everything that I possibly can before the real world does it. If you don't teach your toddler boundaries, the real world will.
Speaker 3:If we don't teach our nursing students these things, the real world will Absolutely. And when I do it in a simulated environment, no one dies. Your mistakes don't kill anybody. Your mistakes don't injure somebody. Your mistakes don't injure you beyond your mistakes don't injure you beyond your ability to recover from it, because you're the one that made said decision. So there's.
Speaker 3:I think AI has a significant place, not only in education but in the nursing world, and I think we could use AI to route some of that housekeeping, to route some of that staffing, to route and adjust some of those things on the fly that don't necessarily take the job of the nurse, but perhaps improve all of those ancillary processes that the nurse is responsible for, so that we can get the nurse back to just being the nurse, being the nurse. I would venture to ask every single nurse that's ever left the profession if I put you back into an environment where you had to do nothing but be the nurse, would you go back? I would. I would go back in a heartbeat if all I had to do was be, the nurse yeah.
Speaker 2:And an appropriate staffing level. Right, right, yeah, I agree, yeah, yeah.
Speaker 3:We could get those 150 to 300,000 nurses that are just bailing out as fast as they possibly could within five years. We can keep them, and so AI we yes, it's a scary thing, and yes, we can't secure it, and yes, it's brand new, but if we get on the cutting edge of it, then we can dictate how it's implemented, instead of allowing what we've always done is somebody else who operates in a C-suite or owns a healthcare company or you know who doesn't do the job. If we don't dictate it, they will. It's coming whether we like it or not, so we might as well control that implementation and make it take care of the things that don't replace us, because we all know that AI is not going to be able to look at the 90-year-old lady who comes into the emergency room at 9 in the morning and she looks at you and she says well, honey, I just don't feel good and she is that classic heart attack. Gray, I didn't say adjust her, but I'll meet her too, I see you right now?
Speaker 2:Yeah, we can't, we're never going to be able to replace that.
Speaker 3:But if we can take some of that ancillary weight off and get back to just being nurses, couple that with maybe improving a couple other things and teaching people how to navigate, we could use AI positively. So don't be scared of it. I don't like it, but it's coming one way or another. I use it to benefit my students, and how can I dictate what that process is?
Speaker 3:And not that I'm the end all be all authority, but and by I I mean how can educators dictate how that's implemented so that it does benefit our students? And it's not another checkbox, it's not something that we just have to complete because we're in nursing school. We can make it truly beneficial.
Speaker 1:We hope you've enjoyed this week's episode.
Speaker 2:Remember, the conversation doesn't end here.
Speaker 1:Keep the dialogue going by connecting with us on social media posted in the links below or by visiting our website.
Speaker 2:Together, let's continue to redefine nursing and shape a brighter future for those we care for. Until next time, take care, stay curious and keep nurturing those connections.
Speaker 1:And don't forget to be kind to yourself.