The Dr. Big Guy Podcast
"The Doctor Big Guy Podcast" offers listeners expert advice on injury prevention, healthy living, and longevity, all aimed at helping you avoid chronic illness and the need for surgery. Join Dr. Caleb Davis, AKA "Dr. Big Guy" as he shares insider tips from his experience as an orthopedic surgeon, provides a behind-the-scenes look at the life of a surgeon, and answers questions about health and medical careers. Whether you're interested in staying fit, curious about the medical field, or just want to live a healthier life, this podcast has something for you!
The Dr. Big Guy Podcast
Episode 5: Nursing Careers: Personal Journeys, Emotional Challenges, and How Nurses Overcome Them
Discover the fascinating world of nursing through the eyes of Rachel Davis, a seasoned registered nurse who has navigated the complexities of cardiac step-down units and travel nursing. Join us as we explore the crucial yet often overlooked role nurses play in healthcare, from education to the daily grind of specialized units, revealing the hidden challenges and triumphs of this noble profession.
Rachel and I tackle the journey from aspiring nurse to seasoned professional, shedding light on the variety of nursing degrees and the hurdles faced by newcomers to the field. With insights into the notorious imposter syndrome and the limited clinical exposure in nursing education, we underscore the importance of nurse residency programs in bridging this gap. Reflecting on our own paths, we share anecdotes from the demanding environments of hospitals, discussing the critical thinking required in high-pressure situations that define both nursing and medical education.
Finally, we invite you into the emotional side of healthcare, where empathy and vulnerability can transform patient care. From the cultural quirks of different nursing specialties to personal stories of emotional connection, Rachel and I celebrate the profound impact of openness on both caregivers and patients. Learn how embracing emotional intelligence can forge deeper connections and lead to more rewarding healthcare experiences. Tune in next week as we continue this enlightening conversation with Rachel, unraveling even more insights into the world of nursing.
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Hey everybody and welcome back to the Dr Big Guy podcast, a place to discuss injury prevention, optimizing health and living a better life. My name is Dr Caleb Davis, but you can call me Dr Big Guy. As an orthopedic surgeon, I love to fix people after an injury, but my true passion lies in helping you stay fit, healthy and out of the operating room. On today's episode, we have an amazing guest who I really admire. She is a registered nurse, she has her bachelor's degree in nursing and she has extensive history working in the cardiac step-down unit and she's also worked all over the country as a travel nurse, and she just so happens to be my sister.
Speaker 3:Our guest today is Rachel Davis. I invited Rachel here today to discuss her education as a nurse, her career as a nurse and some of her more memorable moments, both good and bad. My hope is that this interview will give people a deeper understanding and appreciation for nurses, the schooling that they've gone through and what they do for us every single day in the hospital and other clinical settings. I've really been looking forward to this interview, so let's dive right in.
Speaker 1:The information shared on this podcast is intended for educational and entertainment purposes only. The content of this podcast should not be considered medical advice, nor is it a substitute for professional consultation with a qualified physician. The views on this podcast do not necessarily represent the views of Dr Davis's medical practice group. If you have health concerns or conditions, it is recommended that you seek the advice of your own physician, who knows your medical history and can offer you personalized recommendations.
Speaker 3:Rachel, welcome to the show and thank you so much for being here.
Speaker 2:Thank you very much for having me.
Speaker 3:I've been really looking forward to having this interview Ever since I even thought about starting the Dr Big Guy podcast. I thought you'd be a perfect guest. Before we get into the main part of the show, I have a couple little segments of the show that I like to do, and one of them is called Fractured Facts. It's a little bit of trivia on orthopedic knowledge, so we're going to get into that first. Rachel, did you know that you are taller first thing in the morning when you wake up, compared to when you go to bed at night?
Speaker 2:I did.
Speaker 3:I figured you would. You know, the thing I worried about having Rachel on the podcast is, I think that she might be smarter than me, and that's a big problem because I try to keep people around me who make me look smart. No, that's a joke. Obviously, nicole's already shown me up on the show many, many times when I try to stump her with orthopedic knowledge and I don't think I've ever been successful. So I figured that wouldn't work for Rachel. I'm going to lay out this fact and she's going to tell us her experience about being taller in the morning.
Speaker 3:So the cartilage between your bones compresses throughout the day due to activities like walking, sitting, standing or, for some people, powerlifting. This can compress you and can actually make you up to half of an inch shorter by the end of the day. During sleep or some other activities like spinal decompression, your spine actually lengthens and elongates, allowing you to regain some of that height, which is why you wake up slightly taller every morning than when you went to bed. You don't get taller every morning. I think you know what I mean.
Speaker 3:The phenomenon of being taller in the morning occurs primarily because of the way the discs in your spine interact with the force of gravity.
Speaker 3:The spine is made up of multiple vertebrae that are cushioned by intervertebral discs, which are composed of soft gel-like substance surrounded by a tough outer layer, and those discs are filled with water and they act like shock absorbers and give you some cushioning for your spine.
Speaker 3:Throughout the day they start to flatten and the water content starts to decrease a little bit, and that's why you actually start to shorten. It's not really perceivable unless you actually measure it, but it is actually happening. Throughout the day. As you stand, sit, move around, the weight of your body and the force of gravity compresses these discs and compresses the water out of the discs a little bit, and then they start to get thinner and when you sleep that starts to come back. Interestingly enough, astronauts experience an even more pronounced version of this because they're not having nearly as much gravity affect their body, and some studies have shown that astronauts can actually get up to two inches taller when they are in space, but they don't get to keep that height when they come back. So, rachel, you have a story about this, don't you?
Speaker 2:Yes, I gain more than half an inch throughout the day. Yes, I gain more than half an inch throughout the day. When I am up in the morning, I am nine and three quarters inches, which I'm five, nine and three quarters inches, but by the time I go to bed at night, I am just under five foot nine. Now, if HIPAA wasn't a thing, my doctor would tell you that I've never followed a textbook in my life, so that's no surprise.
Speaker 3:So you're saying it's more than half an inch for you and you've measured it. Recently You've seen this happen.
Speaker 2:Yes, actually within the last few weeks we were just measuring at home for fun and I was just below 5'9 in the evening and by the morning I had gained almost an entire inch 5'9,.
Speaker 3:that's pretty tall. Yes, because I guess most of the women in our family are pretty tall.
Speaker 2:Yes, the national average according to the CDC for men is 5'9, and women are supposed to be just under 5'4".
Speaker 3:Now I've seen some people actually do active spinal decompression during the day because they say it helps some of their back pain and neck pain. Have you ever had any of your patients talk about that?
Speaker 2:No, and patients have not mentioned spinal decompression to me, mostly if a patient is talking about spinal surgery, unfortunately they're telling me that they don't like it very much. They haven't liked the outcomes.
Speaker 3:Yeah, unfortunately there are a lot of horror stories out there when it comes to spine surgery. That could be a whole different episode, so I won't get into that too much, but we could talk about that sometime. But there are a lot of things that you can do with a chiropractor or a physical therapist or even just on your own as simple as hanging from a bar and letting gravity pull your pelvis down and kind of elongate your spine. Whether or not it gives you any sort of durable, lasting outcomes is hard to say, but it's something that I've heard a lot of people trying, that they actually do enjoy and can give them some, even if it is temporary pain relief. But that wraps up Fractured Facts, so we're going to get into the main body of the show. So, rachel, what inspired you to become a nurse? Can you name some things that were really pivotal in your life that led you down that path?
Speaker 2:Unfortunately, there's no glory story to how I started nursing. Really, the main reason I went to nursing was because I was bored after high school. There were some inspirations along the way. Although no one ever told me you should be a nurse because your mother's a nurse, I'm sure it influenced me to some degree. But also I wanted a career that would have a difference and make a difference in people's lives, and when I was in my late teens you had already moved out. Grandpa moved in with us and helping mom manage his health. I found out I was very good at it and he was quite sick A lot of different disease processes going on. He needed a lot of help and I found this is something I can do.
Speaker 3:So you felt like you just had a natural inclination to caring for sick people. It was something that was just easy for you and felt natural.
Speaker 2:Especially working with elderly people. Some people find that quite difficult because elderly people can be difficult to work with, but I had a knack for it.
Speaker 3:Did you feel like it gave you satisfaction? Did it make you happy to do it, or did you just say, well, this is easy, so I'm doing it?
Speaker 2:There's a lot of satisfaction to working with people, especially if you can make a tangible difference in their lives. People who are sick they're usually in a bad mood, they're in pain and at least once you're in the hospital setting they're at the worst moment of their lives. And if you can make them laugh or at least the very least make them less miserable, you've done something positive for them and that's a really good feeling.
Speaker 3:Do you have any stories? I know we have to be really careful about any specifics on terms of where treatment took place or patient identification for privacy rights, but do you have anything that sticks out in your mind as though that was a really good moment where I know I did some really good, lasting good for this person?
Speaker 2:As I was working as a travel nurse in a clinic, I was taking care of a cancer patient who had to come in for his treatments regularly and they were very hard on him. Just by the time he was done because these are very lengthy treatments to get all the medication into him he would go home and he was just wiped out and he would sleep and sleep and it was just. It was really hard on him. But he and I were able to connect and have a good therapeutic relationship so that when he would come in he would ask for me personally for his treatments and he just felt like I made his day a lot easier on him.
Speaker 3:So not even necessarily the physical care you were giving him, just your presence and overall demeanor and conversations you had had a healing factor.
Speaker 2:Yes, the conversations in particular, because we're both Christian.
Speaker 3:Okay, so you were able to make a religious connection with this person. That brought him comfort.
Speaker 2:It brought him a lot of comfort in a very difficult time.
Speaker 3:That's something really easy for clinical medical people to overlook that emotional connection. It's taught and I think all of us know it's there. But sometimes we can get so caught up in the nuts and bolts of medicine and the textbook answers it can be easy to get disconnected sometimes. So it's nice to be reminded that that can give a really tangible, or maybe intangible benefit to patients. So you alluded to this already that our mother was a nurse and is a nurse. Actually she took time off from nursing to raise all of us and then, once we got out of the house, she became a nurse. Do you think that was an inspiration at any point to drive you through nursing school and get you through that?
Speaker 2:I think a major inspiration to get me through nursing school is that I hate to fail and nursing school was absolutely the hardest thing I have ever done. But looking back, I can say that I really admire our mother's bravery, because she was out of the field for 30 years. Everything had changed by the time she went back, but she still did it and did it excellently. So, yes, it's inspirational. I don't know how conscious I was of it at the time because I was so wrapped up in my own difficulties of nursing school.
Speaker 3:Yeah, I can imagine that it's similar to med school, that you just sort of lose yourself when you're in school. Everything else just goes out the window and you just have one positive focus on getting through school. But yeah, that's a great point, I'll have to have her on sometime, because to raise seven children and then go back to nursing and have to get reaccredited and do all these things when the world it's literally just completely changed the culture, the science, everything's different, that it that's quite a monumental task. So we've already talked about that. You went to school and got your bachelor's in nursing. I don't want to go through every single thing you had to do to apply, but can you kind of give me a rundown of what it looks like, just for people who are listening, who maybe would be interested in considering a career in nursing? What does it look like to apply to get in and kind of get a job after, just in your own words?
Speaker 2:So applying to nursing school is like any college application. You have to find a school that has a nursing program. You need to apply to that school and be accepted to get your prerequisites out of the way. Different nursing schools have different prerequisites and they do have different requirements to graduate in general. So you got to do a lot of research. You would think it's a national accredited exam at the end of this program, but every school is different and that's really interesting to see the nurses that come out of the different schools.
Speaker 3:Can you go straight to a bachelor's of nursing out of high school?
Speaker 2:or do you have to do something first? No, you can go straight to a bachelor's program out of high school.
Speaker 3:And are there other types of nursing degrees out there? Are there associates or graduate?
Speaker 2:Yes, there's an associate of nursing, a bachelor's, a master's and a doctorate of nursing. You can get a doctorate of nursing without becoming a nurse practitioner.
Speaker 3:Okay, so you can go straight to school for that, without doing the clinical nurse practitioner role.
Speaker 2:I'm not 100% sure. I believe that is correct.
Speaker 3:Okay, so what's the difference in terms of roles and responsibilities and privileges for associates versus a bachelor's of nursing?
Speaker 2:There is no difference A nurse who qualifies by passing the national exam and collects RN is an RN, whether he or she has an associate's or a bachelor's.
Speaker 3:You all say take the same test at the end, yes, okay. And is there a difference between an RN and an LPN?
Speaker 2:There's a big difference between an RN and an LPN, Although honestly I would rather have a really seasoned LPN than a new grad RN. They know everything and you need to listen to them.
Speaker 3:We'll have to remember that. That's a great point. I want to talk about that a little bit later. The difference between book smarts and getting good test scores and then just that seasoned clinical knowledge that those veteran nurses have, it's really something to behold. I want to get into that later, but go ahead and continue.
Speaker 2:So an LPN is limited in his or her practice. They are a nurse. They did have to go to school and pass the national licensure exam. It is the NCLEX LPN, I believe is what it's called, versus an NCLEX RN. They are limited in that they usually can't do the first assessment upon admission. They can work with an RN to do a skin assessment. They can work with an RN to do administered blood, but they're more limited. Some states require them to take additional education in order to do IVs to give IV medications limited. Some states require them to take additional education in order to do IVs to give IV medications. At least in the state of Kentucky they're not allowed to give certain IV medications at all.
Speaker 3:So they're limited in some of the clinical things that they can do, and they also have to have more oversight.
Speaker 2:Yes.
Speaker 3:Would you say that kind of sums it up.
Speaker 2:Very much. Different states have different rules.
Speaker 3:Well, that's a pretty good rundown. So the takeaway here is that lots of different programs have different requirements and you just have to see what school you might be interested in and what they have, because it's so varied. So after you got started, a lot of doctors are have imposter syndrome. I think I've mentioned that briefly. But you know, you've gone through all this education, you've got this degree, you've passed all the tests and then you're like is it real? Like am I really the doctor? Is it similar for nurses? Do you feel that sort of am I ready, am I ready to do this? Are people going to think that I'm not? I'm incompetent? Like tell me a little bit about that when you first started.
Speaker 2:I was, I was pretty sure I was incompetent. I felt dumb as a box of rocks. I had textbook knowledge. I was a walking encyclopedia. I was very good at school, but practical knowledge was lacking. As I said, nursing schools are different. In my nursing school I wish we'd had a lot more clinical time. I had a lot of classroom time. I had a lot of knowledge, but my hands-on skills were seriously lacking.
Speaker 3:So would you say that there are some nursing schools that have a lot more clinical time with patients than others?
Speaker 2:Yes, I would say that I know some have full 12 hour shifts. You're with the nurse the entire shift and I think that would be a really good idea for all schools.
Speaker 3:How many years is the average nursing school for bachelors?
Speaker 2:The bachelor's program will be four years, but I don't think all those four years are clinical. I think two of them would be spent with all your regular class time.
Speaker 3:And an associate's is shorter.
Speaker 2:An associate's nursing program is only 18 months.
Speaker 3:So if you could go back, you would have had more supervised clinical duty before getting out into the job, but you obviously did okay. I've heard stories that you were a phenomenal nurse. Thank you.
Speaker 2:What really helped me was I worked in a hospital where they had what's called a nurse residency program. So for 13 weeks I was paired with another RN. My RN I was working with had been nursing longer than I'd been alive, so she whipped me into shape.
Speaker 3:So you got stuck with a veteran for a good chunk, yes, and that really got you up to gear and gave you that sort of safety net and confidence to help you practice. Yes, okay, so that was a big buffer for you.
Speaker 2:Not all hospitals have that, so if you're considering nursing and considering a job, I highly recommend nurse residency programs.
Speaker 3:That's a good tip. So you said nursing school is one of the hardest things you've ever done in your life. What made it so difficult?
Speaker 2:What made it so difficult for me was that I had absolutely no background in healthcare whatsoever, and healthcare is its own language, it's its own culture, it's its own ecosystem. Almost. You have a whole new way of thinking, of acting, and there's politics involved and I had no idea what I was getting into. And there's politics involved and I had no idea what I was getting into Also. But nursing when you're taking nursing exams, whatever the question is, every single answer is right. In nursing, you have to figure out what the most right thing is, because you might have only 30 seconds before somebody's dead and you have to do the best possible thing.
Speaker 3:That's a really good. I'm glad you brought that up because it's similar in med school too, where you have a vignette or a paragraph talking about a scenario that you're taking care of a patient and then they give you four multiple choice options and you read those like all of these are reasonable things to do. None of them are horrible, but, like you said, well, which one's the most right, and that's often hard to do and in the real world you don't have a multiple choice. You have to figure out right away. So I can relate to that in a big way. Do you look back at nursing school like with horror, like oh man, that was the worst thing ever, I hated it. Or do you kind of look back and it's like, yeah, it was really hard, but I'm glad I did it?
Speaker 2:The second one, definitely, it was really hard and I hope to goodness I never do it again. But if I had to, if I had to go back, be 19 again and enter in college.
Speaker 3:I'd do it. You said you were bored after high school. What did you do between high school and going to?
Speaker 2:nursing school, I worked in a restaurant, I worked in a factory and I was I didn't. We lived in the very rural area. There wasn't a whole lot to do.
Speaker 3:I didn't live in that setting very often. It was a strange juxtaposition. I don't want to get into our personal family life too much, but right after I graduated high school I went to college to be a musician, a professional cellist. It was my dream. And then shortly after that, my parents around that time my parents moved out into a rural area of Tennessee and there really wasn't a whole lot of opportunities for jobs. There was there.
Speaker 2:No, when I worked in the factory, I think I drove at least 30 minutes to get to work.
Speaker 3:I also had a similar story where I was on a completely different path to do something completely non-medical. I had no real medical experience and I decided just out of the blue one day I wanted to do something in medicine. And here I am. It took me over 10 years to do it, after I said I wanted to be a doctor, but that's just the path it takes to become a surgeon. So nursing school it sounds like a very difficult, rigorous process. If you could change any part of the process of the application the education, the clinical training, the onboarding to becoming a nurse what would you change?
Speaker 2:Well, from my experience, like I said, I would change the clinical how much clinical time you get, and I think it might help some nurses if there was more standardization. Yes, we have the standard test at the end of the program. Everyone has to take that to be licensed. However, nursing programs are so different. My program didn't require chemistry at all. Well, chemistry is so valuable in nursing.
Speaker 3:Yeah, I can imagine you're dispensing so many medications and understanding.
Speaker 2:Osmolality. Understanding the whole process of how the kidneys work. And electrolyte balance. Understanding acid-base balance. How are you going to take care of a diabetic ketoacidosis patient if you don't understand those things?
Speaker 3:Medical school is a lot more standardized. I don't know a single medical school where you don't have to take physics one and two, chem one and two, bio one and two and all these other things. So it's interesting to know. So you think having a little bit more of a rigorous prerequisite would be a good thing.
Speaker 2:Very much so. I was fortunate that I took advanced chemistry in high school so I did well, but some people in my program might not have had that opportunity.
Speaker 3:Did you do really well in school? Yes, yeah, did you have a 4.0?
Speaker 2:Yes, I did.
Speaker 3:Okay.
Speaker 2:Yeah.
Speaker 3:I was afraid to ask that in case. The answer was no, but I was pretty sure that you were a perfect student in nursing. Like I said, pretty sure she's smarter than I am. So you got out of nursing school, you did your residency in nursing, your 13-week program with supervision. You're out, you're on your own, so to speak. What does a typical day as a nurse look like for you at this point?
Speaker 2:At that point, a typical day I was working in a cardiovascular cardiothoracic surgical step-down unit.
Speaker 3:So that means patients who have had cardiothoracic surgery are taking care of them after surgery.
Speaker 2:Or I am admitting them to the hospital, prepping them for surgery and sending them to surgery.
Speaker 3:Okay.
Speaker 2:Either one. We were an excellent unit, well-known throughout the hospital for how well we did patient care, and because of that doctors would send other patients to us who weren't appropriate for it, but they knew they would get good care. So they came to our unit, which was very educational for us.
Speaker 3:When you say not appropriate, do you mean that's because that unit had a specific diet admissions criteria? It's not that they were too sick for the unit, it was more like they didn't meet standard criteria.
Speaker 2:They weren't cardiovascular patients.
Speaker 3:I see.
Speaker 2:They might have been nursing home patients, they might have been cancer patients. So it was very educational for me, but it kind of overflowed our unit with patients who shouldn't have really been there from a specialty standpoint.
Speaker 3:What I'm getting is that you guys were a bunch of studs, and so they sent you the troubled patients who needed extra help, because they knew you were going to do a good job. That's exactly what happened, and you, so. Most of your time was spent in in cardiac correct.
Speaker 2:That was my home unit, and unless I was floated somewhere else, I was always there.
Speaker 3:Do they float you a lot? Did you have to go to other specialty areas?
Speaker 2:towards the end of my time at that hospital. Yes, that would happen more often. I would be sent to another step-down unit. That hospital, I think, had five step-down units.
Speaker 3:Do you think that's hard to adjust if you have to go to a unit you're not as familiar with? Or is it just easy to switch back and forth?
Speaker 2:It's very hard to adjust. Different units have different cultures. We had a cute little nickname for one of the other units. That isn't very appropriate, but I won't say it. But they had a very unwelcoming culture. Very appropriate, but I won't say it, but they had a very unwelcoming culture. They weren't. They didn't have a great teamwork, which is absolutely crucial for nursing care.
Speaker 3:I think culture in nursing is a could be a three hour episode Probably. I have a lot of friends who are nurses. Obviously I spend a lot of time with nurses in my career, so I get to hear about a lot of the struggles that they have in the workplace. So I'm sure it's interesting to hear that every single different subspecialty of nursing has different cultures. Like you said, it's an ecosystem of different types of people. How do you manage that workload? I mean I hear that nurses can walk up to five miles a day and I hear people talking about they're understaffed, so you're taking care of more patients than you should. How did you cope with all that?
Speaker 2:Well, we were fortunate that our hospital had a better ratio than some of the surrounding hospitals. I had five patients per shift, which is incredibly difficult because they were high acuity. I'm talking drips, blood thinners.
Speaker 3:Can you tell us what drips are? I don't think a lot of my listeners will know what a drip is.
Speaker 2:Sure. So a vasoactive drip is an IV medication that's running through an IV pole on a bag and it's going into a vein. We call them drips because they're running continuously and vasoactive means it will affect their heart rate, it will affect their blood pressure. So since we were a cardiac floor, we'd have people come in with heart arrhythmias, meaning the heart was not beating appropriately, sometimes quite dangerous and even deadly arrhythmias, and those drips, as we call them, would run continuously and we'd have to try to fix whatever the problem might be.
Speaker 3:And for everyone listening. It's not like you just hang a bag of IV fluids and you just wait for it to run out and then you're done. You would have to adjust the rate. If they have an arrhythmia, their heart's beating way too fast. You have to adjust the rate Like if they have an arrhythmia, their heart's beating way too fast, you have to up the dosage and the rate at which that drip's coming down. Oh, and then their heart's being too slow and you have to lower the rate. So we have to have constantly monitoring these very sensitive drugs. It's not like you just give the dose and walk away. It's something that's constantly changing up and down.
Speaker 2:Are you allowed only certain medications that were less, that needed less monitoring, which is why we would have more patients perhaps.
Speaker 3:Fortunately, as an orthopedic surgeon, a lot of my patients aren't critically ill, although sometimes they are. Sometimes it says if this medication is ordered they must be in intensive care unit. So there's certain medications that they have to be in the ICU.
Speaker 2:Yes, that was also the case where I worked. However, sometimes what we have admission criteria, meaning if a patient has certain lab values that are too far out of whack, too far from normal, they could not come to our unit. Or if their blood pressure was too low or they needed a certain medication, they couldn't come to our unit. But those rules were not always followed.
Speaker 3:So there's a little bit of wiggle room there.
Speaker 2:For the worse. Yes, yeah. So how did we manage that? Unfortunately, the way you manage it is to let go of some care. Some care just doesn't get done because if you have to choose between your patient breathing or your patient getting a bath, they're going to be breathing. That's what I'm going to do, but that's a problem, because if a post-surgical patient doesn't get a bath, their wounds can become infected, they have prolonged stay. They can end up with very serious complications.
Speaker 3:So what you're telling me is that if criteria were ignored, sometimes patients suffered for it.
Speaker 2:Absolutely.
Speaker 3:Did you have a specific way to cope with this? Did you have a strategy, or is it really just I'm going to buckle down and do it?
Speaker 2:That's really the only thing you can do If you have that many patients and some units would have seven patients 10 patients per nurse. The only thing you can do If you have that many patients and some units would have seven patients 10 patients per nurse the only thing you can do is keep everyone alive at that point.
Speaker 3:So sometimes you're just running on pure adrenaline, aren't you?
Speaker 2:That and coffee.
Speaker 3:The things nurses and doctors have to do are very different and yet very similar. So the level of care that a doctor offers in a hospital setting is not often as personalized. So you took care of five patients. I think my highest census that I took care of by myself was a hundred. I took care of a hundred patients, but that's with a team of nurses taking care of all of those hundred patients, but across three hospitals.
Speaker 3:I'm the person all those nurses are calling, so that's like an upward tree and I'm there and so you're, and you, just when you get, when you you get one page and you call that nurse back, or whoever it is, and you're answering them, and during that phone call you receive 10 more pages. You just want to cry and but there's nothing to do except I'm, I'm, I have to get this done. My strategy was to all right, I got this page. I write down the tasks that I have to take care of. Based on that page, I'd answer the next 10 pages and then I'd have 30 things on a list before I could start going and doing them. But those were dark days.
Speaker 2:I can understand that very much, because I would say that I guess the best way to say it is for the strategy. I used a pseudo-triage system. If all my patients are trying to die at the same time, because that happens, I might have a patient with delirium tremens tied down in one room. Delirium tremens is when you're withdrawing from alcohol and it's very bad. You can have seizures and die. This really happened to me. I had a patient tied down with delirium tremens in one room. I had a patient with active chest pain in another room and other patients trying to do something horrible in another room. I don't remember all the details. You have to figure out who's going to die first and take care of them first so just for the, the delirium tremens, the alcohol withdrawal.
Speaker 3:It's not only just seizures, although that's the sort of the horrible end result that we try to keep from happening because it can be lethal. They're hallucinating and they're trying to get out of bed and walking away. They're pulling IVs out, they try to leave their room. It's really horrible to deal with for the patient and whoever's taking care of them, because they don't know what's happening there. As the name would indicate, they're delirious.
Speaker 2:So I didn't mean to interrupt your story but well, the thing is, you have to figure out what's happening in every room and decide who's going to die first and take care of that person first. But the second thing to do is call your charge nurse because they can be in another room trying to keep someone else from being dead. The problem with our unit was our charge nurse also had her own five patients to take care of. Some units are really good. A charge nurse does not have a patient assignment, but we did not have that luxury.
Speaker 3:So some units have a nurse. That's sort of the backup for when someone really needs an extra set of hands, but not all units have it. Yes, yeah, what's one of the most rewarding things that you've ever done as a nurse.
Speaker 2:Most rewarding things I've ever done as a nurse is when I can make really good connections with a patient, whatever the connection might be. For example, the patient who was having such a difficult time with his cancer treatment, helping him through that, helping him maybe not dread it so much, it so much. Or a patient who was having a bad home life and also in the hospital getting blood and having all these problems and couldn't get home and just miserable. But we can connect. I sang to her because her favorite genre and just helped her through a really hard time, held her hand while she cried.
Speaker 3:So for you it wasn't so much. The patient had a disease process and it was fixed and you saw them leave the hospital discharge. It was really the most memorable thing for you, consistently, was the emotional connection.
Speaker 2:Yes, because working in cardiac, these patients are what might be what we call frequent flyers. They're back a lot. Cardiac disease is so hard to work with. You often have fluid restrictions or you're not allowed to drink very much. You have diet restrictions and it's hard to handle for patients because often families show love through food and they eat the very wrong things because they don't want to offend their family members. And they're back in the hospital with all these problems and getting to fix them isn't always an option. It's more of a maintenance.
Speaker 3:We're, we're. We're really getting to the trenches of medicine in this conversation, which is something I was hoping to do with Rachel. So it's I'm not upset about that, but we're kind of getting into the down and dirty aspects, and sometimes it's all about managing expectations and understanding that some of our patients will always be sick and it's about optimizing them and getting them as healthy and functional as possible in any given scenario and helping improve their quality of life and not necessarily fixing all their problems. And that's a tough balance to find sometimes.
Speaker 2:And I think nurses will see it a lot more often than surgeons will, because a surgeon might just get to fix the thing and send them home, whereas nurses, we're on the floors with them and we're going to see them again and again and again, because cardiac disease doesn't happen in a vacuum. You see kidney disease, you see liver disease, it all goes together.
Speaker 3:So we may have touched on this a little bit, but with your achievements, what was, what's your favorite thing about being a nurse?
Speaker 2:If you had to sum that up, I don't have one favorite thing, it's two favorite things. So the one favorite thing is the emotional connection and the incredible positive outcomes you can see. Even if the physical tangible isn't there, the emotional connection and the way you can change a person's life is just incredible.
Speaker 3:I'm seeing a theme here with the emotional connection. Do you do you think there's any connection to emotional wellbeing and physical health?
Speaker 2:Oh, absolutely. I have seen a patient who I thought would die and he looked like death, warmed over, but his wife pulled him through. If it wasn't for her he wouldn't be here.
Speaker 3:So you've seen that play out in real life.
Speaker 2:Absolutely.
Speaker 3:And I agree with you. By the way, I was actually planning on doing a whole episode on part of. My slogan when I sign off is be humble, be happy, be healthy, and there's multiple meanings to that slogan. I haven't really got to explain that to everybody, but part of that be happy is actually surrounding yourself with positivity and good people, and having that support structure can actually lead to health, so I'm glad you brought that up. What was your second favorite thing?
Speaker 2:My second favorite thing is all the doors nursing opens. You can go very far with nursing and you can just stay in your one specialty and never learn anything else, and if that's what you like, that's fine. But I found that nursing is so diverse and you can learn almost limitless things, and I love to learn.
Speaker 3:So there's a lot of upward trajectory in nursing and different career paths you can take to suit your interest.
Speaker 2:Absolutely.
Speaker 3:Like nurse anesthetists or nurse practitioners. I know a lot of nurses seem to get into hospital management too after they've had some clinical experience, and I feel like I've seen a lot of nurses sort of leverage their degree to get into things like podcasting too.
Speaker 2:Yes, you can be a legal nurse. Writer.
Speaker 3:You can do anything really. Do you have any friends who've taken that route, where they were a more?
Speaker 2:traditional nurse role and they did something with it. Yes, I know several people who went to nurse practitioner school.
Speaker 3:Do they like it?
Speaker 2:I don't know if they like school so much yeah.
Speaker 3:The school's always the tough part, isn't it?
Speaker 2:Yeah, but you have a more. You have a better scope of practice as a nurse practitioner. It's difficult as a nurse. You have so much education, so much experience, but your hands are tied by legal issues. I know what medication I need before I call a doctor, which is great. I can suggest it, but I'm not allowed to order it. And if the doctor doesn't call me back in a timely manner or disagrees with my assessment, I have had a patient code. Because of that, the doctor disagreed with me. I was right. The doctors are human. It's fine because we got the patient back. The patient survived.
Speaker 3:I have no problem with you being critical of doctors. Remember, be humble is part of my slogan, so it's okay.
Speaker 2:It's just if I had nurse, if I was a nurse practitioner, I could have ordered what I needed. I could have prevented a code which is, when the patient's heart stops beating, they stop breathing. You have to beat on their chest, give them medications. It's really traumatic, both for the patient and for the nurse, because I knew this was happening and it wasn't stopped.
Speaker 3:Yeah, I'm sure that's really difficult. I'm sure you probably coded more patients than I have have being a nurse in a cardiac step-down unit. But I've coded several patients too, and the thing that always haunts me is when I've had to code a patient in front of their family and seeing them crying and screaming while I'm on top of their loved one. It almost makes me emotional just thinking about it right now and just thinking about how tremendously traumatic that is for everybody. So having to do that so often, that's got to take a toll.
Speaker 2:I personally have not coded many people. I was famous on my unit. My patients don't code.
Speaker 3:Oh, so you're just that good.
Speaker 2:No, I was famous on my unit where I knew when my patients were what we call circling the drain, getting worse and worse and worse, I'd get them to the ICU. No one's codes on my watch.
Speaker 3:By the way, if you're picking up, there's a lot of lingo in medicine. What do we say? Death warmed over circling the drain, frequent flyer. There's a lot of that sort of lingo that you get familiar with. So Rachel had mentioned previously it's a whole new language and culture that that's part of it. Something I forgot to mention was how it really is medical. Medical terminology is its own language. I call it anatomies, like speaking in anatomical terms, like medial, lateral, proximal, distal things like that it's. It's hard, to hard to keep up with. So I think you kind of alluded to this already. You talked about the frustration of because you have really good clinical judgment having to not have you didn't have the authority to do things you knew were right. Sometimes I was going to ask you what's, what was the some of the least favorite things you had to deal with or aspects of your job.
Speaker 2:Probably the number one least favorite thing that any nurse has to deal with is health insurance. We hate it. We hate the fact that a doctor will order a medication, a test, a therapy, and we know the patient needs it, but the health insurance refuses to pay for it and you're just stuck because the patient cannot afford it and they don't get the medication, they don't get the therapy and their quality of life suffers because of it. It just is infuriating.
Speaker 3:An obvious answer, but the right answer, I think. Yeah, you're absolutely right, and unfortunately I have to deal with it all the time too. I'll order an order, a test, a lab. Most commonly for me it's an MRI. I'm ordering an MRI for something and the insurance company will call me and say that's not appropriate, we're not paying for it, and I'll actually have to get on the phone with someone and argue with them about getting it approved. It's infuriating and it really does limit patient care, unfortunately.
Speaker 2:Yep, In the cardiac world we'll order medications, especially blood thinners. They might cost $400 a month. No patient, unless they're Bill Gates, is going to afford $400 a month for one medication, and in the world of cardiac you're on a lot of medications.
Speaker 3:Sure, so we talked a little bit about the different cultures of nursing and I imagine that this could take sort of a comical side turn or it could be more serious. But can you tell me? You know I'm going to preface. I'm going to preface this by saying I don't generalize. I don't like to generalize people or stereotype people, but it is funny. I saw different cultures in the ICU versus the emergency room, versus med surge versus CCU of the nurses. Can you tell me briefly some of your impressions of different cultures in the different areas of nursing in the hospital?
Speaker 2:ICU is very organized. That's a blanket statement, but they have to. I don't know if ICU can handle everything that we do on step down. We don't have the luxury of being organized Because ICU they might have if they're having a bad day they might have three patients, or if they have patients who are on a ventilator that's a machine that breathes for you they might be on some extremely high acuity, which means very sick Patients who need a lot of those drips again that need a lot of very close monitoring. They might have one patient.
Speaker 3:So in general the patients there are sicker, but sometimes, because they're sedated and have a mechanical ventilation, they're not asking for as much stuff.
Speaker 2:They're not hitting you, they're not spitting on you, they're not urinating on you, they're not screaming at you and throwing things at you. But the reason that ICU nurses are so organized is all those IV lines, all those tubes, the chest tubes, the ventilator tubes, crrt continuous renal replacement therapy for people with kidney failure all these tubes and lines. You have to label them correctly and have them in a certain order, because if you push the wrong medication in the wrong line, someone could be dead real quick, right right.
Speaker 3:My experience is that they're also very fastidious and very orderly, and we are speaking in generalizations, so please don't give me any angry comments that, oh, I had five patients and they all hit and kicked me and urinated on me, like, yes, icu is very, very hard and it's a very challenging area and every subdivision of nursing is required. So I don't want any angry comments. We understand that we're just talking little generalizations here for just to kind of see contrasts. What about the emergency room? Did you have any experience there or worked with people there?
Speaker 2:My emergency room experience is pretty limited. I have been there when I worked in a procedural area as an endoscopy nurse. We might have to go down there. Someone might have food stuck in their throat, for whatever reason a lot of reasons and we would just go down there to take care of it and let them go home. Emergency room is classified as the wild west of medicine, and that's true.
Speaker 3:Yeah, I was going to say that.
Speaker 2:Absolutely Anything can come through those doors, and usually does. Very funny and very sad stories can go right side by side. So nurses have to be able to switch from comforting someone who just got the worst news of their life to trying not to laugh their head off to someone who's done something very stupid.
Speaker 3:Yeah, and in that regard, it's hard to stay organized when you just never know what's coming to the door, and it's more of. You have to be prepared for anything and things that you couldn't possibly think of.
Speaker 2:It's a lot of fun, though I've been a triage nurse in a walk-in clinic. It's a lot of fun.
Speaker 3:Yeah, I've spent a lot of time in the emergency room when I was an orthopedic resident, because when you're the night resident taking care of every single trauma that comes in a level one trauma center, you're just having disastrous accidents come in nonstop. So I've gotten to see all of the other things that aren't orthopedic related to when I'm down there. It's pretty wild, and so the impression I've had is that those nurses tend to be a little bit more wild and free and a little bit more laissez faire with some of the rules and regulations. Because they have to, because you just you have to improvise. Because you have to improvise, you've got to improvise. It's not going to be by the book, because the book wasn't written about this.
Speaker 2:No, there's no chapter in a textbook written about some of these things.
Speaker 3:So, looking back at all this, would you do it again? Would you go back to nursing school if you were 19?
Speaker 2:And if you, could go back and talk to 19-year-old Rachel, what would you say? I would promise her that's going to get a lot better. The first year of nursing is famous for being the worst. You have all this knowledge and no practical ideas of what's going on and nothing is happening the way it's supposed to be happening and all the rules don't work and it's really quite scary because you know if you mess up, someone's going to be dead. So I would tell her that it gets better.
Speaker 3:And that you're going to have a long, rewarding career.
Speaker 2:That you're going to have a long, rewarding career, that you're going to take care of some amazing patients and it's going to be really great.
Speaker 3:That's a good message to remember for people who are just starting off too, and maybe people who want to go into it. If you ask me if I could go back into residency now if you're talking to 24-year-old Caleb, when I started yeah, I could do it. If you ask me to go back now, 35-year-old Caleb, to go back and start over, I don't think I could do it, but I'm talking the hours I worked and the amount of work I had to do. I'm not sure I could go back and do it, but that's two different questions.
Speaker 2:Yes, it is. There's a big difference between 30-year-old Rachel and 19-year-old Rachel. 30-year-old Rachel wouldn't do it again.
Speaker 3:Yeah, see, that's a totally different question. The amount of physical toll it takes on your body to go through that training and the clinical training, I don't know if I can even properly describe it to people, but I can tell you, as someone who's a practicing surgeon now out in the world and doing what I love, it's totally worth it and I love it's totally worth it and I love doing it. I'm so glad that I did do it. I just don't know if my body could take it anymore. So with that, I'm going to go into lessons I learned with residency.
Speaker 3:For this segment, rachel's really inspired me with all of her stories about opening up and being emotional with patients and praying with her patients and singing for her patients, and that's really inspired this segment of Lessons I Learned in Residency. Today, hearing her tell those stories reminded me of all of the experiences I've had, one of the most memorable experiences I've had and I have to be careful with this for patient privacy. I won't say the place it happened or the type of person that happened or the exact situation, but somebody had just a horrible, horrible accident, traumatic accident that left them with both of their legs amputated, unfortunately, and this person was suffering from horrendous phantom pain and they were crying every night and their pain was very poorly controlled. And I remember as a student taking care of this patient and rounding on the patient and being up at night and being called on this patient by the nurses to come take them to try and manage their pain, and nothing I could do could comfort her and she was obviously in a massive amount of emotional distress. Her life had just been changed overnight by losing both of her legs and I remember the thing that finally comforted her was me asking if she was spiritual or religious and she told me she was a Christian and I prayed with her and that and she hadn't stopped.
Speaker 3:I don't, I couldn't remember the last time she hadn't cried until that moment when I held her hand and I prayed with her and that moment taught me the importance of opening up emotionally to your patients.
Speaker 3:And it can make you vulnerable and it can be very uncomfortable and it can take a toll on you too when you open yourself up so emotionally like that. But the effects that I've seen and the changes I've seen in people's lives because that they had their caretaker, their healthcare caretaker, open up to them like that is, you can't define it, you can't calculate it, but I've seen just such a change in them and I hope that that's had a lasting impression in that person's life. And you have to be selective, you know. You have to be able to read the room, you have to know when to do that. But I've had multiple occasions where I've felt that moment where you needed to be vulnerable and cry with the patient and pray with the patient, and sometimes I think it's more successful than anything else I've done in medicine. Rachel, what are your thoughts on that?
Speaker 2:it's true that probably the emotional health of the patient is more important than unless it's an absolute trauma where they're bleeding out right, then the emotional support is going to mean more to them, physically and emotionally, than anything else that you can do.
Speaker 3:I think that the emotional health really does affect physical outcomes. It's so hard. As Western medical professionals, we want to focus on numbers and quantifying outcomes for patients, and that's good, that's all well and good and I think that we should do that. But sometimes you can't quantify outcomes but you can feel in your gut what has happened to somebody.
Speaker 3:I do plan on doing a whole episode on this and seeing what data I can come up with to quantify and sort of try to put a number on what this does for people, because I'm pretty sure that data is out there to an extent but it's hard to measure because it's all subjective. So there's so much of this is subjective, but it this can apply to people that aren't in medicine either. It, especially for men. I think it can be very hard to open up emotionally, but it can really lead to really valuable relationships and insights for people. If you feel that you can do that, so take that as you will. Take it with a grain of salt, take it and apply it to situations where you find appropriate. But I do encourage people to try to be a little bit more emotionally vulnerable and available to people when the time is right.
Speaker 2:And I would add to that, if you aren't that way especially, naturally, if you're very private, it is something that you can learn, Because when I started nursing, I was a closed book. I didn't read, I didn't connect to people. Well, it's kind of surprising that I became a nurse, but I learned to do it. I learned to read people, I learned to feel what they were feeling and I learned to connect to them. And it takes time, but you can learn it and you can actually become very good at it.
Speaker 3:I'm really, really glad you said that, because I was the same way. In fact, I did a lessons I learned segment on another episode about empathy and learning to become empathetic and this sort of tags off of that. And I was the same way. I didn't. I felt like connecting and being emotionally vulnerable with strangers was completely foreign, a completely alien idea to me that I would never have thought that I'd be capable of in the way I am today.
Speaker 2:And remember, as you're learning, you will mess up, you will choose the wrong time and you will say the wrong thing, and it's going to teach you, so don't give up.
Speaker 3:I think that's a great way to wrap up lessons. I learned with residency, so I don't know about you guys, but I've really enjoyed this interview so far, but we're going to have to split this up into two episodes again. As usual, I've covered a lot of content with Rachel, but there's so much I want to get to with her next week. Don't forget to like, comment and subscribe and check us out on social media at Dr Big guy podcast and also check out the brand new website Dr Big guy podcastcom. Doctor spelledD R, so it's D? R bigpodcastcom. Hopefully we'll see you next week. To wrap up the interview with Rachel, and remember be humble, be happy and be healthy. We'll see you next week.
