[00:00:00] Welcome back to the Pulse Check podcast. I am Mandy and I’m here with a guest. He he is off today, off doing on call doula work. So my guest today is Nurse Adriane . Hey Adriane , how are you?

[00:00:15] Hi, how are you Mandy? Thanks for having me on.

[00:00:18] I have so many questions. So I thought we would just hit record and dive right in. You are a board certified patient advocate and you started to explain what’s going on with that work. But I wanted to share with the audience what is a board certified patient advocate and how do you use that with your nursing?

[00:00:40] Sure. Yeah. Private patient advocacy is a relatively new field. Not a lot of folks know about it. There aren’t a lot of us around. I don’t even actually know the numbers. I was part of I think the third or second group that tested through for the credential with a patient advocacy certification board.

[00:00:57] And if you rearrange the numbers or the letters, that’s my credential board certified patient advocate. And what that basically means is, it’s very broad. So basically means that we are somebody that a family, or a client, an individual would contact if they need additional support through the healthcare system.

[00:01:19] We don’t give advice. We don’t do medical reviews. Although I do have a partner that I work with, an NP who can do medical reviews if somebody wants to have their chart reviewed. But in essence, we are there to support people to navigate the health system, which, when I did this in 2019, this was before Covid.

[00:01:39] I couldn’t have even imagined the kind of needs there would be in healthcare and for different groups in, in the healthcare paradigm in seeking Care. And then how that would change and be evolving with the kind of shortages, deficits we’re having right now in, in the healthcare system. So for example, something that I might do is first off I’d meet with a client you know, I’d picture snapshot of what is their concern? What do they need the help most help with? It could just be, Hey, I’m have so much anxiety when I go to the doctor or my provider, I can’t remember anything. And so what I do is I do everything remotely unless somebody just happens to live really close to me and hires me, but it allows me greater latitude to reach people.

[00:02:25] So I come with people with their iPad or their phone on FaceTime and I can be there with them. If they really want somebody who’s gonna be there with them in person, then I will refer them to somebody who does that kind of service. So not all patient advocates are nurses either. And I didn’t realize that until I got more involved in the profession.

[00:02:45] Many people come out of the billing world, which is not my wheelhouse per se. But again, I have partners who do medical billing cuz that’s a whole other arena of patient advocacy. Yeah. So the other part is family dynamics. People are living farther away from their loved ones. If we just look at aging population, for example, and we don’t include anybody that’s younger, under 65, we look at that over 65, we’ve got 46 million people in America.

[00:03:16] Life expectancy has now gone down for the first time since two 1996 two years in a row. However, we’re still looking at people that are not living near their parents, not living near their grandparents. Perhaps they are the one designated by default or directly to be the caregiver or the decision maker.

[00:03:36] They may be in Dubai, they may be in the military and deployed. They may be an executive somewhere very far away or have a schedule where it doesn’t allow them to be participating, even remote in the care or decision making in the, for their family or whoever they’re designated for. So that’s another area where I come in is, hey, oh, you’re a colonel or general in the military and you know, you are in Africa or in Spain, or you just live across country. Or you are the CEO of a company, you’re in the C-suite. That’s an area where people really need help because they don’t have that immediate family. And the other component that I realized quickly after starting this was not everybody who is that designated person gets along really well with that person that they’re going to be making decisions for.

[00:04:35] And that can be a barrier. So they may be willing to make the decision, the final call, however, they may not be as interested or eager to be actually involved with that individual. So that’s another area where a patient advocate, a private patient advocate can be hired and brought in and help navigate that relationship a little bit and navigate the care for that individual and basically be a mediator media a mediator between family members or individuals.

[00:05:10] There could also be conflict. I mean, as nurses we’ve often seen, I don’t think there’s any of us as nurses who’ve worked in hospitals who have not been in the midst of conflict with families and a patient. Right. And disagreements. And that caused delays in care ultimately and perhaps not the best decisions made.

[00:05:26] Yeah, It’s a high stress time. A lot is on the line. And a lot of folks don’t know, don’t have a background, They don’t know even nurses in, in my field, nurses going in, having babies feel out of sorts, right? They say, I know a particular part of healthcare. I don’t know this part. I don’t know what to expect, or, I don’t know if I’m getting the right information or I’m getting all of the information.

[00:05:54] It’s really hard to navigate, even for folks who have a history and background in healthcare.

[00:06:00] Right. And most of us in healthcare can call somebody maybe we know we work with, you know, I don’t do oncology, I don’t do pediatrics. Right? That, that’s not my wheelhouse. So, but I know people can who know that.

[00:06:12] But if you’re not a nurse and you’re not in healthcare, who are you gonna call? You really, you’re looking up on Google, right? That’s what people do. They’re looking information up. Maybe they find an advocacy organization. There are many for certain diseases. However many people are just a caregiver for somebody.

[00:06:30] And then there’s caregiver burnout. People deal with, you know, they’re doing the physical caregiving and they’re just not wanting to do that emotional, mental component of the caregiving, of having to then, Oh, I’ve gotta decipher all of this information and maybe decision fatigue sets in. So that’s a big part, I would say, of what I do is decision support.

[00:06:54] You are on your, like on a call in appointments and what does that look like for you? Are you taking notes? Are you looking things.

[00:07:07] Yes. So in the, in the assessment with the client, there’s an evaluation that I do of, well, what is your biggest concern? It may be, well, I like my doctor, but they talk so fast. Everything’s happening so quickly. They’re in and out. Then I’m dealing with a medical staff person that maybe they’re not explaining things. So it’s really identifying what is the concern of the client. You know, is it a literacy issue? Is it a language barrier? Is it that they feel because of maybe they don’t like their provider, maybe they need a new provider. People are experiencing discrimination in healthcare also, right? There is a huge amount of discrimination reported in various groups in healthcare. So it maybe something like me just calling that office and asking them, What is your non-discrimination policy and how are you complying with the Affordable Care Act?

[00:07:55] Because there’s been a recent ruling, a lot of people aren’t aware of that sexual orientation is now included in the non-discrimination clause of the Affordable Care Act. And that has been something that that was actually one of the very first things that went into effect in the Affordable Care Act must in 2010.

[00:08:10] But the non-discrimination on sexual orientation is more of a recent ruling and they are now enforcing that. However, people are still, there’s I think somewhere around 18% of LGBTQ individuals report feeling discriminated against, having care actually refused to them, other barriers, having their partners not recognized.

[00:08:33] And, you know, I live in a state that doesn’t necessarily recognize that. if you are the same sex couple, you literally have to set up an LLC to have all of those protections.

[00:08:44] Shit.

[00:08:44] Yeah, I just looked into that.

[00:08:46] Oh my gosh.

[00:08:48] So California is great. It was great being in California, but now I’m in a different state.

[00:08:52] And yeah, so that’s more what it looks like. And when providers, hear Hey, I’m a nurse. And again, not all board certified patient advocates are nurses, but when they find out I’m a nurse, I introduce myself, It’s non-adversarial. It’s like, Hey, I’m a partner here with you to make sure that this individual gets the best care possible and that they have the best outcome and are able to make decisions for themselves.

[00:09:13] With the full picture. And it, the provider may be as frustrated. They may say, you know, Hey, this person’s non-compliant because we all know this chronic illnesses and, and how they arise is often out of non-compliance. And so they may say, Hey, can you help educate this person on diabetes, on smoking, on diet, on exercise, whatever it may be.

[00:09:34] Or, and that may just mean me going back to the individual, maybe the family and saying, Hey, can you take this person out for a walk a couple times a week. Who’s buying the food? What are the food choices being made? Who’s cooking? Do you need a food service? You know, so it’s a little bit of case management in there as well, but it’s all centered around ensuring that this person gets the best care and is making decisions for themselves. Or the person who’s making those decisions is making them with the most information and the best information they can have.

[00:10:03] This makes my nurse heart so happy. Two things. One, what you just said, like we ultimately that is what we want. We want everyone that we encounter, our family, our clients, our patients, to have the most information, understand all of their options, all of the information presented, make their best choice for them because they’re coming with their own baggage, their own story, their own history, their own wishes that none of us truly understand and they feel confident in that choice.

[00:10:40] Right. That’s the hard part too. And you said remote and I know I’m loving working remotely. You know, some days are easier than others. I have friends also who are like, Oh, I’m dying. I can’t do this, I can’t do this, I can’t do this. And they want to know about nursing options or ways to be a nurse remotely, or at least not at the bedside.

[00:11:02] It’s a great opportunity. Yeah.

[00:11:04] Are you, I wanna back up half a step. Are you talking to, in that example that you just gave, was that a time where maybe you would’ve called the office to get a little more information? Are you talking to providers without the patient?

[00:11:20] So we would typically not speak with the provider unless it was just to set up an appointment or to clarify something. If there was some clarification needed that you know about a medication or are they still gonna supposed to take this pill? Or where do you want them to get an X-ray or an mri or did you put in, did you put in for that referral? Things like that.

[00:11:45] Right. Okay. That makes.

[00:11:46] Some advocates will do, you know, the appointment setting. Again, it really varies. I know some advocates who work very hands on setting up, DME for patients, durable medical equipment. They’re very hands on. Others, again, work mostly in the billing sphere where somebody is gonna have a lot of bills coming through.

[00:12:05] And really need help navigating that. Yeah. So it really depends on the situation. If it’s just, one of the things when we talk about remote I just was out of the country for a little bit and I had the opportunity to explore doing this in another country with expats. So again, there’s a high need for families to have this service, especially families of, I would say greater wealth.

[00:12:34] There is a financial component to this that is undeniable At some point. My dream is create a nonprofit and be able to have some kind of type of foundation to offer broader services. But what I will be offering are, you know, classes on demand and free videos and, and tips on how to navigate the healthcare system.

[00:12:52] But yeah, it is private pay. So that was actually, I was approached about that by a few people when they found out what I did. And it’s not something that’s really even unique to the United States. I mean, you could do this with a family in France. If you speak different languages, that’s a huge benefit because healthcare is, it’s universal as far as the application for the most part of healthcare.

[00:13:16] Yeah. Yeah. And the need to have someone, oh my gosh, I can see so much benefit to this. The need to just have someone hear what you hear and then discuss like, did I understand that right? Well, I came up with another idea later.

[00:13:32] I wanna review that option. Do you think that’s an option? And not be alone in that process of making those decisions, receiving the information, and there’s so many decisions. It’s not just make a decision about healthcare, it’s make a decision about where to get healthcare. Are there other, should I be including, you know, a naturopath?

[00:13:58] Should I be including physical therapy with this? What are we missing? And I just am going through a very new transition into chronic illness. Is that how you say it? Hello? I now have a chronic illness that’s new and. I just have a new different perspective on it. I’ve always, I’ve always wanted every single patient that I’ve ever seen and known to have an advocate with them at all times, because I think that’s the safest way to navigate healthcare.

[00:14:30] It’s the safest way to navigate pregnancy. It’s a vulnerable time. It’s taken advantage of, and there’s abuse, abuse abounds. After our discussion on this right before we recorded, I understand your knowledge of abuse is significant inside and around healthcare in working with policy, nurses, unions, things like that.

[00:14:53] And so, you know, the risks of not having an advocate with you and how, ugh, I, how a complicated situation. I feel like pregnancy and birth is complicated, even though it’s pretty like straightforward, physiologic, usually there’s nothing wrong or there’s a few things that could go wrong, but a complicated situation with a lot of moving parts.

[00:15:20] How could folks navigate without an advocate?

[00:15:24] Yeah. And I would say from my own, just experience within a union and working for a large healthcare union of nurses, is that some of the most horrifying stories I’ve ever heard were out of from l and d nurses, you know, because the stakes

[00:15:41] are Okay, well that, that tracks, that’s validating. Thank you.

[00:15:43] The stakes are high. It’s a critical environment. There’s a lot of dynamics going on. There’s a lot of situations where people are not getting prenatal care. You’ve got younger people you know, you have a lot of different circumstances.

[00:15:55] There’s a threat of litigation that is just, it’s just a fog.

[00:16:01] It is. It is. And and the staffing, I mean the staffing of these units has diminished from the support staffing, the secretaries, the techs, the scrub techs. All of that. And when you then coupled out with maybe a charge nurse from NICU who has to then run over to the high risk birth in l and d, but also cover their unit and I mean there’s this Roan boat that hospitals do between NICU’s, postpartum and labor and delivery.

[00:16:27] That the public is not aware of that I have seen universally occur and even in California where there are staffing laws, however, it is a complete yeah. I don’t even have the word for it, but it’s something that the public is not aware of. Cause, cause hospitals do not have to disclose their staff.

[00:16:45] They don’t have to disclose, Oh, we only have one nurse in the er. We only have five, you know, two nurses. But we’re gonna let 60 patients in. You know, But come,

[00:16:53] but we’re open. We’ve got this open sign. I just heard of a it, it’s this dynamic on TikTok and you mentioned it and I just saw your profile. I cannot wait to dive into that.

[00:17:04] The dynamic on TikTok where we can talk to each other, patients are talking to nurses or you know, any healthcare professional that’s inside. It can be a tech doctor or surgeon, and they’re like, We thought the open sign was on and you could take us in. And everyone on the inside is like, We would really like the open sign to not be on right now.

[00:17:27] This is not a safe situation. And there’s that barrier. No one knows that we’re speaking those two different things.

[00:17:34] You don’t know unless you’re on the inside, that there’s only one sterile processing tech and there should be five. So really, how are instruments from surgery and OB and procedures getting sterilized?

[00:17:45] How are they being procured? You don’t know there’s only one pharmacist for two or three hospitals that hasn’t had a break in five years. You don’t , you know, you don’t know. You know, the staff have just been, the, the support staff and nursing staff have been decimated. And, you know, again, when we, we’ve brought in lean technology. The lean, this lean process, you know, in the healthcare, when

[00:18:08] I saw in time right, we didn die just in time, so we took three more patients. Like that’s how it feels.

[00:18:16] Right, Right. And I’ve had this discussion with other nurses about, especially new nurses, about when patients pass, how there’s nothing, it’s like, well clean the room and here comes the next patient.

[00:18:26] And so you, you needed that full attention of that nurse and that staff. But this may have been that new nurse’s first code or the first time they’ve lost a patient and they may not even know how they are going to react or respond. And you know, I’ve been in those situations as charge nurse, where I’m like, Thank goodness I have a charge and I could give this person a little reprieve, but you know, basically it’s like, okay, you got 15 minutes and

[00:18:56] that’s not a reprieve,

[00:18:57] just go to the private bathroom because there’s no other private spot in the entire bath in the entire hospital. That’s another thing people don’t understand is right in the hospital environment there is zero privacy. Unless you find a closet that you can just go stand in for five minutes and decompress. It is just the constant onslaught of pressure and, and critical thinking and tasks and management of patients that’s happening with fewer and fewer resources.

[00:19:23] Yeah. You really get it and it sounds and feels worse and better at the same time to hear you say all that .

[00:19:32] Yeah, it’s, I mean it, I can say it does take a lot for me not to get cynical and I think perhaps. People may believe I’m cynical if they’ve worked with me in the union capacity, however, you know, I worked on a unit, we had 26 managers in 12 years.

[00:19:49] Oh. Oh, that’s intense.

[00:19:53] And so, So that takes a level of cohesiveness of staff to hold a unit together but it also created a dynamic where it was very difficult for a manager to come in, because it’s like being foster kids.

[00:20:06] Yeah. the kids are running the show.

[00:20:09] The kids are running the show. Right. I mean, we just needed somebody to sign up our pay payroll and we did all the ordering, we did everything. We did the throughput. We basically ran our own show. And you know that and watching managers just crumble and, you know, that’s a whole other topic, of course.

[00:20:24] Middle management in healthcare. The most thankless job there is. But it’s, you know, so out of that, I’m just so lucky that I had a great education as a nurse and a great team that I was able to work with in a union hospital. That made all the difference so that I could, I could be the nurse I wanted to be.

[00:20:44] I was able to be the nurse I wanted to be. At the point I was no longer able to do that I left. At the point I felt that I was no longer able to provide the care I wanted to provide and have the space to think critically about my patient needs and implement that care that was a turning point for me, and I believe that’s the case for many people, for whatever reasons it may be.

[00:21:09] Yeah. I think that’s really good for nurses to hear and healthcare staff to hear, because I hear that from them all the time. I know that I could be great. I know what my patients need. There’s so many barriers to getting that to them, and I really, I’m excited about this about your business, about trusted guardian patient advocates.

[00:21:34] I’m excited about that whole side of helping patients, but not working for a union or the hospital or a healthcare system and doing it.

[00:21:44] Yeah. I think a lot of nurses, right? We know a lot of nurses and other people in healthcare are looking for other avenues. Some of the advocates that I work with are pharmacy techs, they’re respiratory therapists, the radiology techs. They have some background in healthcare. Again, some don’t. They come outta the billing world or maybe coding. Luckily I’m a certified coder as well. I’m kinda a jack of all trades with my experience and to that, I took every opportunity I ever had to continue learning as a nurse.

[00:22:11] Because it is important to understand how the money works in healthcare, how the billing process does work. We’re often very divorced from that and don’t really understand all of that. But it is very important either for, as a nurse, how we practice and also as a potential patient or a caregiver of somebody else to know, well if you, if you prescribe that medication, this is gonna be $3,000 a month. Maybe you can think about this other medication. And I was able to do that a few times. But there are so many options out there for nurses. It is really important to not allow yourself to get into the place where you’re so low or feel so depleted.

[00:22:53] And I was there and I know, And that you just feel defeated as a human being. We talked about doing, we did resiliency courses and in, during the pandemic, I provided curriculum for that and taught courses to the members. And then that kind of led to moral injury learning about that.

[00:23:12] And then you get into trauma response. I’ve learned so much about trauma response, as a result of the last couple years. I could never have imagined, I mean, there’s so many triggering events that have happened for individuals, and yet nurses, healthcare workers have continued to show up, continued to do their job, do their best, and keep pushing themselves.

[00:23:34] And that’s just something that we do. Whether it’s the personality type drawn to nursing. I’m not sure if it’s her trauma response. Right. And it’s that trauma, like we’re maybe, you know, we, Well, there’s some statistics about that. And as a union organizer that was, you know, a part of the pep talk, I would give nurses that I never had to give housekeepers.

[00:23:54] I never had to give dietary workers, they knew they were screwed. Nurses on the other hand, you know, it would be this cognitive dissonance based on their history of cognitive dissonance from past trauma throughout their lives. And it was very interesting. You know, I’d have to say that

[00:24:12] is so interesting.

[00:24:13] You gotta crank

[00:24:14] up your deserving meter. You gotta just, I would say just imagine your life and what you deserve is this meter and just crank it up and know that it’s going to be an uphill battle against your inner voice that’s saying, Suck it up. This is all you deserve. This is as good as it’s gonna get.

[00:24:33] And this is just the way it

[00:24:34] is. My opinion is, The forever experience of being in an abusive relationship. Mm-hmm. , Right? And so it’s like, it taught us that. It taught us, What do you expect it would get better? Do you expect it to be better? Did you expect this to be easy? Did you expect this to be fun?

[00:24:53] Mm-hmm. . And then that whole, like you said, a patient dies and everyone around you is like, well, did you take, you know, did you go to the morgue or did you not go to the morgue? You’re like, literally a, a soul has left the room and I am here and my soul is still next to this body and I am processing. And everyone’s like, Do you need more gloves?

[00:25:17] Or like, what’s the issue? Like, do you not have what you need? And you’re like, I’m in crazy town. And so it’s compiles on this like abuse of, I feel, I feel a little gas lit, but no one else seems to realize it. So maybe this is normal. And then you. Scoot over to this bad side of normal and you think it’s normal and you move over, over, over, over.

[00:25:42] And like you said, you can’t even see where you’re at anymore because you’ve just been Right. It’s this cycle of abuse that continues over and over and over

[00:25:52] and over. Yeah. It’s the I was introduced to the concept of empathetic witness, Uhhuh blew my mind and really changed my life a couple years ago.

[00:26:03] Mm-hmm. Through one of your past guests. And that concept of having an empathetic witness is so key to have somebody acknowledge and say, Gosh, I am so sorry. Are you okay? And I’ve had this, these encounters with nurses in the last couple years where when I’m able to be face to face with nurses or any help anybody in healthcare really mm-hmm.

[00:26:30] to say, Are you okay? How are you? I’m really sorry you went through that. And be honest. Really be, you know, this is a genuine place. Right. And just people crumble because

[00:26:43] I was gonna say, what do they do? They

[00:26:44] can’t even breathe. They just crumble. I mean, I, I’ve hugged so many sobbing nurses that just need to hear that.

[00:26:53] Yeah. You know, it’s like, where can we soften? And, and to your, you know, this point about this abusive, codependent relationship that we then transition to as nurses. Well, and it gets reinforced in nursing school, Right. Because who’s the predator in nursing school? Right. The professors, The, I went when I, and just aside, my clinical experience was like boot camp for two years.

[00:27:16] For the most part. I, I got a great education from my school. I recall my very first week of clinical looking down the hallway and seeing two of my cohorts on the ground. Slumped on the wall crying and the teacher in our face saying, You know, I can get you out for anything. I can kick you out for anything.

[00:27:39] If we don’t want you here, we can get you out in clinical. And that’s the fact. Right. We all knew that that’s the dirty secret of nursing school. They’ll get you out in clinical if they don’t like you. And I, and I, I’ve had discrimination for being a lesbian and in my nursing school, I’ve been in California, there was, you know, racism.

[00:27:54] There was, there was a lot of bias happen. Yeah. And so there’s that. We go from that to zero. Self advocacy education in nursing school. Right. We’ve just now seen in California and Michigan, introduction of regulations, new requirements for nursing schools to include bias training in the, in the school, in the actual curriculum, which is great.

[00:28:19] But again, it’s, there’s just, there’s these really kind of written in stone paradigms, but then you get in the hospital, right? And we we’re, now we’re in a profession that has the highest rate of non-fatal injuries of any profession, right? Any profession, It’s off the roof, right? And then what happens when you get injured?

[00:28:39] You go to employee health. Your manager, they have you fill out a form and what do they ask you? What could you have done differently? What’d you do? Yeah, what did you do? Tell us how you contributed to this, and what would you do differently? I, at one point, almost set that paper on fire in employee health if, I mean, I just found that.

[00:28:59] Because I was in, I became a nurse at 39. I had never encountered that kind of question in an employment environment, really? And I thought the audacity Yeah. To ask me what could I have done differently? Well, let’s see. I don’t know. I, you know, I mean, depending on the situation right, of getting injured when Right.

[00:29:22] I would’ve not got a job here. That’s, that’s what I would write. And I had coached everybody I worked with write that down. I would’ve just got a job somewhere else. Right. I would’ve actually got a career not being a nurse, not being here. How does this even help? Because now you’re a ga you have like basically institutionalized gas line something.

[00:29:40] Yes. I

[00:29:42] distinctly remember the first time, the very first time I had a physician screaming in my face and I was getting cord gases. And I put the needle right through the cord, right into my finger. And I had someone screaming and it was dark and I was not prioritizing like mm-hmm. , bitches back up, bitches back up.

[00:30:05] I’ve got a cord, I gotta get a gas, it’s gonna clot and I have a needle. And never again was this situation like that. But the form said, Well, were you wearing a shield? I’m like, This was like 2010. There’s no shields. We don’t have shields. Right. And how would a shield have helped that situation? That sc dangerous, very dangerous situation.

[00:30:32] And it was so gas lighty, it was like, well, were you wearing Yes, I was wearing gloves. Gloves don’t, It’s not chain mail, it’s gloves. Right, Right. . It’s not gonna protect me from a needle going through a blood into my own hand. I just remember that like flush of people like, Well, what’d you do? What could you have done differently?

[00:30:51] And they were wearing me down. So that I didn’t say your situation caused my harm. Right. And you need to

[00:31:02] fix it because we can just gaslight you away to distraction from the actual issue and the source of the, the incredible speed, the pace that you’re working, the workload, having physicians yell at you.

[00:31:13] Having that pressure, having maybe physicians who are newer,

[00:31:18] Not having a space that’s safe, not having enough staff to right. Cover my other responsibilities. So I could do this for the three and a half minutes that it takes. Mm-hmm. in a safe, well lit, clean environment. There’s like people running back and forth.

[00:31:36] It was a systems issue, Right. But all of the questions were directed at, what was

[00:31:41] I doing? And the mismatch of policy, right? Like were you wearing a shield? What does that have to do with it? Right. And you know, we did a hospital foodies, I mean, they could buy puncture proof gloves. Right. But they choose not to.

[00:31:52] Right, Right. And, you know, that’s, that goes back, you know, in the issue of needles. Right. I mean, that goes back to the unions. That goes back 30 years in California. How we got safe needles. I was, you know, somewhat involved in that campaign coming out of the AIDS crisis prior to working for a union. But this was a time when nurses were getting aids, they were getting hepatitis.

[00:32:13] And the hospitals were saying, Prove it. Prove it. You got it through us. Mm-hmm. the later. And just letting people die. Letting workers die. Mm-hmm. and safe needles came outta California. It came out of unions and then it became nationwide. But I remember learning that in school. Universal precautions. Yeah.

[00:32:28] We didn’t have it before, before HIV aids.

[00:32:32] We learned about it at school, which meant we knew the hospital gave us covid. Right. The

[00:32:40] minute it happened. And that was a key component for a credit to California and to the governor is under osha. It was made preemptive I can’t remember the exact term, but basically it was assumed that in a worker’s comp case that if you have covid you got it at work.

[00:32:55] Yeah. If you were a nurse. If you were a nurse, that’s a huge difference. So there was no argument about it. You’re covered, you know, that is the same for certain other police officers have several preemptive types of injuries that are assumed to be part of the duty, but oftentimes other than, you know, firefighters and police officers, many professions don’t have that.

[00:33:15] Right. It’s like, well, you know, prove that you got electrocuted and you’re an electrician prove it was at work. Right. Or, or it’s a safety issue. But again, it’s things are often put back on that individual and, you know, sadly, going into, you know, covid, I already knew from my experience working with hospitals and healthcare for 20 years being a union organizer and a nurse.

[00:33:41] I, I knew what was going to happen. Mm-hmm. , and I was pretty spot on. I mean, I went to my, my employer of the union I worked for, and I said there’s this disease coming. The employers are gonna be terrible. Mm-hmm. , and we’re gonna lose members, and we need to figure out now how we’re going to address losing members.

[00:33:58] Mm. And it’s going to continue to be really bad. Wow. And, you know, so, and right off the bat, you know, we had nurses who were getting suspended for wearing masks. We had er doctors buying the entire ER staff, you know, bunny suits and, and suiting up. And the hospitals saying, No, no, no, you can’t wear that. We don’t wanna, We’re concerned about how it all looks.

[00:34:17] And this is again, the thing we’re now dealing with, with safety, Right. In hospitals. And again, this go, this does tie into patient advocacy and self-awareness and self-actualization about, you know, If you, if I, Are you gonna be a patient in a hospital that just had a shooting? Are you gonna, what is the safety precautions of the hospital you are going to be in as an employee?

[00:34:39] As a patient? These are things that the public needs to really get behind because there’s such a PR machine at work in hospitals and in healthcare. Is that like,

[00:34:49] how do patients even navigate that? Because so much is about what it looks like. Like you said, everyone’s getting in trouble for what it might look like.

[00:34:57] People are talking on TikTok about Well, if we have less than safe staffing on our unit, like half the people call out right now in on the East Coast we’re dealing with flu. Right. It’s

[00:35:08] horrible. The RSD flu outbreak.

[00:35:10] Yeah. And so people have to be calling out sick. They’re sick, their kids are sick, their family members are sick.

[00:35:16] Half the unit calls out sick and you get, for my case would be labor patients coming in, preterm patients hospital has to take tala. We’re not on diversion. People just show up. They have the flu, they’re sick, they go into labor Also, that happens and nurses wanna be like, you know, you’ve got choices of hospitals.

[00:35:37] I need you to know, I I’m your nurse. I’m also the nurse of four other people. That is three times the number that I should safely be taking. Like, Right. What do you, what do you do when you’re on the patient? End of advocacy. Mm-hmm. , how to, how to navigate that Cuz patients don’t not ask.

[00:35:57] Well, that’s an important component in, in the work I do with my clients, is letting them know, Hey, you know, like for example, if I were in California, I would be saying, Hey, here’s a staffing rule.

[00:36:06] Here’s, you know, title 22, and here’s the ratios. Mm-hmm. , but in a non ratio state, the rest of the United States. Mm-hmm. , then I would be asking the hospital, I would be asking some tough questions. Mm-hmm. , I would ask them, you know, what are, how many staff, how many patients are your nurses taking? What kind of support staff do you have?

[00:36:24] If there’s a choice of hospital, Right. It could be an emergency situation. Right, Right. And then, you know, you’re just sitting in a hallway or maybe you’re outside, you know, in a tent. I also have learned, and many of us probably have that it’s not always the, the best hospital, the hospital that has the greatest pr, the, the hospital in the best neighborhood that has the best care.

[00:36:45] Right. It, it’s, there’s a mismatch there on perception. But is exactly, you know, to the point of. Care safety. Is this a safe environment for care? What are the visiting policies? Those are some things that people don’t often ask actually. Mm-hmm. . So if you have a 24 hour visitor policy, well, are you comfortable with that?

[00:37:08] You know, as a patient, Right? How many patients, how many visitors are allowed? I worked in a hospital that was open door 24 7. You could have a hundred people. It, they didn’t care. And there was no waiting rooms on any floors. So everybody was in the room. Mm-hmm. or right outside the hallway. You know, you may have somebody who has an ankle monitor.

[00:37:26] You may have somebody who’s on parole probation. We often had that. We had a mixed peds med surg unit and occasionally they would forget there’s peds patients on that floor and they would run, downgrade these patients and the nurses. So if the nurses didn’t think and have the foresight to think, to call management and say, Hey, Maybe don’t put that we gotta keep this person on tally or keep them over here in this other unit because we can’t safely put them there.

[00:37:56] So there’s a lot of things that people need to be aware of as patients and and caregivers in these situations. You know the other component is also transparency, cuz now we have billing transparency. Yeah. We know that a lot of hospitals are not complying. CMS to my knowledge, is only fine, two hospitals of the 4,000 that are CMS certified.

[00:38:17] So understanding billing practices is something that advance, there’s a lot of things in advance that an advocate can do that can then bring back information to the client or the family and say, Here’s the information we have. These are, you know, I asked about these 20 procedures, labs, tests that you more likely have or you have had in the past or are gonna be recurrent depending on the disease process.

[00:38:40] And here’s what they’ve had to say. And then, you know, I’ve called your insurance to see where they’re gonna pay and the match and if there’s insurance disputes. So there’s a lot of research that goes into it. It’s, it’s so I work on a retainer. Most of us do. So most of us will work on a retainer. It’s similar to a lawyer because we know that there’s going to be, you know, at least five to 10 hours of work with the assessment.

[00:39:04] With the patient. The client if the family mm-hmm. . And then doing all the research, the background research. Right. And then we’ve gotta make sure that the patient has an advanced directive that we are listed as being able to receive information on their behalf. So there’s some paperwork and legal components that have to be satisfied as well.

[00:39:22] First and foremost, we’d wanna make sure that they have their medication list and that they have an advanced directive. Yeah. Like right off the bat. Those are very important. And that tho the people that are the decision makers for them. Are equipped to be the decision makers and have that support, and that’s kind of where the coaching comes in as well.

[00:39:39] Mm-hmm. and also the mediation services because you, you know, you, I, during nursing school I had the opportunity to be a caregiver for a company that took care of the richest people in America, pretty much. Mm-hmm. , What I discovered was the richest people in America, as they age, often don’t have close family systems.

[00:40:00] They often are geographically quite distant from their families. Okay. They basically are in the same situation as anybody else in a skilled nursing facility. They just got more money and maybe they have a private duty nurse. I did private duty. Yeah. But I was astounded at the lack of family support and infrastructure support.

[00:40:23] You know, with these folks or the detachment that their children had to them. Wow. And not judging, I don’t know their back, you know, what happened or what the story was or situation. But I was often on, you know, questioning, Well, where’s your daughter? Where’s your son? Mm. Are they, But they are making the decisions.

[00:40:40] Okay, Well, getting on the phone with them. You know? So that again, is where mediation comes in, if, if that’s desired and if there’s conflict about the care of a patient. Mm-hmm. Some of us, I, I remember a very distinct situation where I had three wives show up. Mm-hmm. and about 10 children. Mm-hmm. , you know, some of the kids were older than the youngest wife.

[00:41:01] I don’t even know who the real wife was. I don’t know if any of the, any of the marriages were legitimate. Right, right, right. But this was somebody who was in their eighties and all of a sudden family just started popping outta nowhere. Yeah. Yeah, you can’t predict those kind of situations. But if somebody is going into deteriorating health and there are gonna be family dynamics that need to be navigated, it’s always best to try and do your best to navigate those in advance.

[00:41:26] Whether you are one of the children, one of the stakeholders in that patient’s health or in their life, or you are that patient yourself while you still have your faculties. Mm-hmm. , get your thing, get your affairs in order, and get your relationships in order, and do what you can to get the family dynamics straightened out because it’s also a learning process.

[00:41:43] We are, none of us are getting out alive. We’re all gonna need this at some point. We’re gonna need these skills of how to make decisions, how to cope, how to have our discussions. Right. You know, we, we had.

[00:41:57] Validating for all of the patients that are like writing their birth plans. . Right. It’s gonna come back.

[00:42:03] Well, there’s a, So I, I’m part of a group called Pulse. They’re in Long Island, New York. They’re a nonprofit patient advocacy organization. Okay. And we had a big initiative that we were participating in to get college students to do their advanced directives. Oh. And people like, and when you mention advanced directives to somebody whose parents or, you know, like some, I talk to people I know I’ve, Cause I’m my age group, A lot of my friends have teenage or college-aged kids and they’re like, Oh my gosh, you know, we don’t wanna talk about them dying.

[00:42:30] You know, it’s so taboo in our culture. And we’re like, and I said, Well, and these are people not in healthcare, so, Well who do you think the organ donors are? Right? What do you think we call under 25 males who ride a motorcycle? Right, Right, right. We call ’em organ donors. And so let’s put the power in their hands.

[00:42:49] Mm-hmm. , let’s put the power in the hands of that young person when they turn 18, when they’re in college, because they do participate in high risk activities. Mm-hmm. , you know, whether it involves drugs, alcohol, behavior, anything, or just, you know, being out, they’re just out in society a lot. Mm-hmm. . And they could be the con, you know, have some ill effect out there.

[00:43:12] But to have those conversations at that young age is so empowering versus like just being in denial and waiting until, you know, you’re 65 or 80. Right. Well, or never. It’s

[00:43:24] great conversation to have with your family when you don’t need it. Because when you do need it, probably the parents are gonna need it first.

[00:43:38] Right. And we want our kids to have. Had that conversation with us. We want to have that open communication of we know what’s on each other’s directives. We are updating things regularly, we’re talking to each other. I want my parents to be talking to me about their healthcare. I wanna know what’s going on.

[00:43:55] One, I wanna know what’s in my genetics. I mean, there’s so many reasons to be talking to your family about healthcare. And a lot of families don’t have that. They don’t have the history, They don’t have alive families to discuss that with. And I think if you do mm-hmm. It’s kind of your, it’s a great opportunity, but difficult, like you said, very difficult.

[00:44:17] It sounds like you meet some of the folks who have a lot of privilege in our health system and need advocates. So that is validating for the families that take family members with them. To healthcare appointments, to inpatient procedures, because you’re following your intuition that you’re gonna need an advocate.

[00:44:45] And to have someone kind of built in that already loves you, thinks about your perspective, asks questions on your behalf, remind you of things, writes things down for you, is crucial. And it’s construction. Breaking up the street. I can’t, I can’t hear anything, so you Oh, good. Good, good. It’s so loud over here.

[00:45:06] But it’s crucial. It’s crucial, especially for folks who are not the most privileged in our, in our society and our healthcare systems who are receiving and experiencing those biases, those discriminations, and maybe don’t have access to an advocate that they can hire.

[00:45:24] Right, Right. And, and that is why we, there needs to be more of us, and there needs to be, It looks like what’s happening is.

[00:45:35] The insurance industry is going to start paying for us. There is some movement there. Whoa. I say that with a caveat because I have that little part of me that’s cynical about what are the ca, you know, what’s the catch gonna be? Right now there are patient advocates built in. So if you’re a pediatric patient, you know, kids with cancer, for example, they get a patient advocate.

[00:45:54] There are certain diagnoses that more or less come with advocacy, a little more built in. The VA has a, has a patient advocacy program. So you might hear that term in other realms within your healthcare system. It does not mean the same thing as what I do, so I wanna make sure people understand that, that yeah, for sure.

[00:46:14] It’s not the same. I am not beholden to anybody but my client and I’m gonna fight for my client’s best interest. So it’s like having a lawyer almost, you know, it’s somebody who’s gonna be on your side, who’s impartial and can just deal with the family dynamics, the, the doctors, the providers. Medical equipment, billing and being impartial about things and objective.

[00:46:37] And that’s really important. And also, you know, because of my, my experience as a coach and my training, I’m able to bring some other therapeutic skills for forward. Like all of us as nurses, I mean, we, we are coaches, we all have that, you know, basic training in some way, shape or form as educators as well.

[00:46:57] But to bring those family dynamics together, to bring hard conversations to the forefront. And I would say that for people who cannot afford these kind of services, which are gonna be a lot of people, is that they’re go to Pulse, go to find the patient advocacy, you know, organizations, National Greater Advocates is a big one out of, I believe Chicago.

[00:47:21] They are directory of all patient advocates. People do char, it is all private pay at this point. So there are different. There’s a big range of what people may charge. I will say it’s gonna be anywhere from $75 an hour to $500 an hour. So and again, I work on retainer unless somebody has a really super clear one and done kind of situation, which is rare.

[00:47:46] But I’m gonna work on, you know, somewhere around a 10 hour retainer that then I’ll work off of. And then we’ll figure out what I anticipate or what the expectation is of the length of our relationship based on, you know, different factors at play. So given that, But I do see that more of us are putting out content.

[00:48:06] I’m really pushing my colleagues to put out more content on social media, more educational information. If you go to Pulse’s website, they have an entire checklist. That’s great. It’s a downloadable, it’s free. I would suggest everybody go there and download that checklist. Basically, what do you need to have before you go to the doctor?

[00:48:26] What are your medications? What is your history? What other information that you need to know? Because it, even for myself, I mean, I go to the doctor and I’m like mm-hmm. , Oh wait, but I had this question. I had that question, which is why Concierge medicine is taking off. Yes. But this whole, I did a whole episode on another YouTube channel about concierge medicine.

[00:48:46] Yeah. And really, you know, Is that you know, why is, why is there that need for that and that desire and that’s actually rather affordable. I’ve used online services mm-hmm. prescription, and I was shocked at the follow up by this doctor. It was $35, I think, online or something. Wow. And you know, they text me back, Hey, do you have any other questions?

[00:49:07] Hey, there was an issue with the prescription not going through. I text, I was kind of freaking out because in normal life you’re like, Oh my God,

[00:49:15] it’s over. You have to pay again. You have to go .

[00:49:18] Right. It’s, I’m just gonna, you know, like this is why people use the ER for primary care. Yeah. Right. Yeah. And it was no problem.

[00:49:24] It was like, Oh my gosh, I’m so sorry. Let me get this. Yeah. I was a service. I was

[00:49:29] like, I’ve had a similar experience. Yeah. And, and I’m relatively young, educated. Relatively healthy. And now that I’m not relatively healthy, I have like pages and pages and pages and pages, I cannot assume that people know who I am and that my chart is correct.

[00:49:47] And it’s often not. Right. Right. And it’s not that complicated. Right? I haven’t seen that many specialists. It’s been in network, it’s been with the same group. And I’m like, y’all, I was just here a couple weeks ago. Like I remember you. It’s so scary. So scary. And it

[00:50:06] is, and it’s really important that everybody, I mean, one thing everybody can do, especially now that you get pronounced when you go to this physician, your provider, ask for a copy of your chart.

[00:50:14] Ask for, you know, take a look at what that says, cuz it typically will have your history. So whatever diagnosis that they’re putting on there. And again, diagnosis or money, right? The coding is money. The type of visit is money. For example, where I live for a good part of my life. Before I moved here, I used the county health system.

[00:50:34] My provider was through the county. They moved to an EHR at some point, you know, when I was living there and I get the printout, I look, it says depression. Hmm. And I said, I don’t have depression. Why would they have put depression? It took me about eight hours to get through of various calls and emails to somebody in their ehr.

[00:50:53] Now, I was actually an informaticist at the time when this happened. I was working for my own organization as an informaticist. And so I knew exactly what had, I had a feeling what had happened. So I finally get through to somebody and I said, You know, I need to get this removed one. Yeah. But I wanna understand how did this get on there and do you know what they told me?

[00:51:13] This woman very honestly said, you know, we had, we were working like round the clock for two weeks, converting all the patient records. This is a county facility, Uhhuh, to me to electronic. And we, it, the system required, we put a diagnosis in. So we gave everybody in the county depression. No. So they put, yeah, they put depression on every patient’s chart because they had to put a diagnosis, they had to fill in the bubble.

[00:51:41] Right. Fill in the bubble. Right. To link to the money. And I was like, well, I may be going for like a security screening. Yeah. And I may, that may not be good. Did they? Or like insurance

[00:51:54] reviews or something like, like couldn’t you

[00:51:56] think of something better than depression? I mean, something a little less

[00:52:00] Aller, seasonal allergies, maybe ,

[00:52:04] Rh.

[00:52:05] Rhinitis. I lived in a capital she rhinitis capital. Right. With

[00:52:08] rhinitis, a red inflamed left pinky finger. Anything besides that?

[00:52:14] Right. So again, and I mean I found this with my mother. So my mother had MS actually which I hadn’t shared with you earlier, but, so that was a very good teaching experience for me.

[00:52:23] Yeah. As a young person in healthcare, I grew up in hospitals. I grew up in healthcare with both my parents and it taught me a lot learning from them before I had any notion that I would ever become a nurse, cuz I never wanted to become a nurse. And then one day I did . And it just showed me so much how when you are the squeaky wheel, when you do ask questions, you know you are gonna get the best care.

[00:52:50] You just are.

[00:52:52] Yeah. Sometimes, sometimes you’re mistreated even

[00:52:55] more harshly, but then you have that choice to move on. You have that choice to. And one thing that I learned, you know, part of the coaching services I do is about also perception. It’s about how do we frame ourselves, right? So, and it occurred to me, and I never really noticed this cuz my mother had this resilience about her with dealing with her ims.

[00:53:13] That was really amazing. And she was extremely positive person. And when I become a nurse, you know, I would have these patients, Oh, I’m diabetic. And I said, Well what if you change that Instead of saying I’m diabetic, what if you just said, I’m a person who has diabetes. Does that change things for you in your mind?

[00:53:30] Does that give you empowerment? You know, because if you say, I’m a, you know, I’m a diabetic, or I’m this, you’re not your disease, right? That disease is just part. What’s happening, It’s going on. Or you know, it’s, it’s come along for a ride in your body for a while and maybe you can, you know, drop it off somewhere at a train station or maybe you’re gonna carry it with you the rest of your life, but you’re gonna manage that.

[00:53:54] And it’s just a little component of who you are. But we allow because of, you know, and I really believe this is an American thing because we allow healthcare marketing, we allow drug marketing. Yeah. Advertising. You don’t see drug ads in other countries, by the way, folks. Mm-hmm. , you do not see drug ads in Canada.

[00:54:11] You don’t see them in Europe. People do not go to their doctors and say, Hey, I saw this pill and this magazine ad and I’d like you to prescribe it for me, like to buy it. Right. This, you don’t have, we pay for the r and d, right? This is all r and d for research and development for pharmaceutical companies and or equipment companies.

[00:54:28] You know, all this stuff. So it’s really important how people frame themselves within their own health, Right? Like, I’m, Am I, I’m asthmatic. or do I have asthma? Right. There’s a difference in our identity and how we treat ourselves and how we see ourselves and how we perceive our health status and our wellness status.

[00:54:50] So there’s, that’s, that’s a whole topic under itself. Mm-hmm. , but it’s so important that people are empowered through that. And, you know, we just sometimes over-identify with a disease. Mm-hmm. . Mm-hmm. , because that’s a way to get attention. It’s a way to get something that maybe we’re not getting somewhere else in, in life.

[00:55:07] People aren’t taking it seriously or you feel like you have to center it because you’re the only one that Right. Knows all about it. Remembers it. You have to prioritize

[00:55:17] that. The hyper vigilance. Right? Yeah. So it’s, it’s the collapsing with the hyper vigilance about it. And then there’s like that lae faire, Right.

[00:55:23] We all, I mean, I worked in telemetry, so it would be those patients have dialysis and they’re just like, Yeah, I’ve gone into end stage renal failure. And you’re like, This was completely preventable. Oh, . You know, and, and you see patients and you’re like, this is not, you know, but it becomes part of their life.

[00:55:41] Right. And, and there are some healthcare situations and illnesses that do require a lot of care. Mm-hmm. . And really people who do the best, I believe, are people who really frame it as this is part of them, but it’s not their life. Mm-hmm. , and it may be for a while, right? Mm-hmm. , when you’re coping, you’re dealing with something new.

[00:56:02] I’ve had horrendous injuries. I mean, I basically got injured out of nursing. Mm-hmm. , I just couldn’t continue. I couldn’t, at my age, take another injury. Mm-hmm. . And you know, I feel, I mean, like we come outta nursing, like we’re linebackers or something in the

[00:56:15] nfl. A friend was just talking to me about a patient she had.

[00:56:18] I’m like, My shoulders can’t hear any more of this story. I’m already hurting. Just imagining being there. My father, we live in chronic pain,

[00:56:26] right. We live with chronic pain, always in pain. Yeah. Yeah. I mean, I, I have, I just started doing Pilates, which has been amazing. I highly recommend Pilates for anybody

[00:56:34] But yeah, I mean, I’ve spent most of my career as a nurse. I, I had three major injuries hurt. Wow. I think I was, you know, probably out a total of at least two years. Wow. Several years of, of, you know, physical therapy. Mm-hmm. and continuing to take care of myself. I’m very diligent about that. But yeah, I mean, it’s, self care is really important in, as a healthcare worker and as a human being.

[00:56:58] I mean, we have to take responsibility for our bodies and our health and our wellness and how we frame, you know, is this life in alignment with the life I wanna live, right. Is, is being a nurse. It’s great. 12 hour shifts, you get four days off, you oak soup. I can pick up all the overtime I want. But, and I have time off to travel.

[00:57:18] But then well, if I’m too sort to travel and you know, we all know about that one day of recovery you need where you’re just a vegetable. Yep. And don’t anybody talk to you. You become the couch. Yep. Right. You become the couch and you know, only cats allowed and Right. No humans allowed in the cats and cookies.

[00:57:34] That’s it. Yeah. And so it’s, it’s about living that life that’s aligned with what our vision, our goals are. Yeah. And creating that and through the advocacy work that also allows people that opportunity, you know, for people who are the caregiver, I’m selling back their time. Mm-hmm. for that person, you know?

[00:57:50] Cause I realized through my mom in my career field prior to being a nurse, that I had spent so much time taking care of my mom and flying back home, that it had really impeded my career advance. And if I could have gone, you know, paid somebody to help me navigate some of those moments where I didn’t panic and have to leave and get on a plane, you know, I, or I would’ve maybe been able to live a little farther away, take on a greater responsibility in my organization.

[00:58:17] You know, that would’ve been a huge difference in my, Yeah. In my life now. But we’ve got this sandwich generation right now that’s really, the sandwich is getting thicker and thicker. Mm-hmm. , you know, people are being caregivers for their, almost their whole adult life. Right, Right. Of old, older parents or grandparents, Their kids.

[00:58:36] I mean, I have a friend who’s 74, taking care of her, 102 year old mom. Oh, wow. So really, I mean, her entire retirement has been that caregiving and, you know, so it’s, it’s how do we navigate that and take care of our own health because then, you know, we’re. Gonna have health issues at some or deal with the healthcare system at some point ourselves.

[00:58:56] Right. Yeah.

[00:58:57] That’s an important, I think reminder for nurses as well, that we are, we are the human and then we’re also a nurse. We’re not labor nurses are so married. This may be unique about labor nurses. I think it’s unique about ED and ER or ICU nurses sometimes, sometimes oncology, where they’re like, No, but this is who I am.

[00:59:20] Right. And it’s really hard, like I still say I’m a labor and delivery nurse. It is who I am. I don’t work at the bedside, but it is infused in everything that I do. It is incorporated, it is related it, everything I learned there is used in every aspect of my work and every aspect of my work is infused with the fact that I’m also a nurse, but I’m not a nurse.

[00:59:42] Mandy. Right, right. I am Mandy and I’m also a nurse, and I think that. I think it’s important for nurses to continue to hear it, and I think our audience likes to hear it and give you permission to expand in whatever capacity you need to in order to be whole and healthy. and Human first. And I love learning about this work, Adriane .

[01:00:04] I’m so excited. I, every time I, I have a guest just like this, I’m like, I have to tell all my friends, You can do this too. You don’t have to be mistreated. . Yeah. I we’re really,

[01:00:17] and and honestly, any nurse can pass the exam. Let me just tell you that exam is basically some common, if you’re already in healthcare, it’s a lot of common sense.

[01:00:25] Things that we already know in healthcare ethics. Yeah. A lot of ethics questions. You know, I went ahead and, and did the mediation, arbitration training. Those programs are available and if people wanna message me, they, I’ll let them know where I’m, you know, did the program and, and it’s very affordable.

[01:00:40] And, you know, there’s, it’s, it’s about taking that risk and envisioning something greater for ourselves of what are we gonna be? Cuz we get so much into the do, do, do, do, do. And it’s about being, if I’m being something, it’s reverse engineering what we want. And it starts with a beingness, not with doing this.

[01:00:58] We think if I do this, do this, I’ll be this. No, we have to be first, I have to be courageous. And then from courage Act. That’s really

[01:01:10] hard. . Its,

[01:01:12] it’s, but it’s, and it’s possible. It is, it is so challenging because we’re so wired, you know, we’re just wired so we get to. You know, like I like to say this season of, of autumn and fall is a season of shedding a season of change.

[01:01:25] And where do we get to soften? Where do we get to? What am I gonna release? Because there’s no way, and I wanna make this really clear to anybody, no matter what you’re doing, if you’re listening to this, when you are reverse engineering your vision and your goals in your life, there is no way you’re gonna just get there without having some release.

[01:01:45] Yeah. You’re gonna be letting go of people. You’re gonna let go of ideas about yourself. You’re gonna be letting go of who you are, maybe your identity in part. And that takes courage and, and a level of bravery and boldness that, you know, may seem overwhelming, but it’s just one step leads to the next.

[01:02:05] That is hard. It’s hard, but it’s good to hear. And thank you for the reminder and thank you for sharing your story. This is so exciting. You’ve done so many things in and around nursing and you say that you haven’t been, you were a nurse later in life and it’s inspiring to hear your story and hear how you are still an advocate and doing it in a, in a different way.

[01:02:34] I don’t really think it’s a different way doing it out of the healthcare system. Yeah.

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[01:02:39] Thank you. Thank you. Do you work for yourself? So, yeah, I work for myself, so I have my own business and I did give myself some time off, like many nurses and, and I miss my patients. Let me tell you, I, I wanna say I do miss bedside.

[01:02:53] There is a component of being with those patients I do miss. Right? Yeah. Yeah. And, and so it’s not without some sacrifice of Oh, I really like that, but you know, I had to figure out what could I do that was gonna reach more people and have the impact and be aligned with the life I wanna live right now.

[01:03:10] Yeah. It’s fitting into what’s the life you wanna have? What’s the life you’re gonna create and what works for that? And be courageous about that and think outside the box. Because I, you know, if I didn’t hear about this certification process and I literally don’t even remember how I heard about it, and I thought, that’s me.

[01:03:28] That’s what I’m going to do. And I didn’t know how long it would take. And of course, Covid happened. Yeah. So again, these are, this is a long game. This was 2019. I got certified. I’m really just launching the business fully now. Really? But it’s been in the process and I’ve been doing the work along the way.

[01:03:46] Yeah. So think long game. It’s okay. Think five year plan, think three year plan. It took me a while to figure out I needed to take a year off. I knew I was gonna take a gap, like a gap year, a sabbatical year. Mm-hmm. , and because I could not do it. All right. That’s the other thing. You hear nurses, Oh, I work three jobs.

[01:04:04] I’m getting my master’s degree, my PhD nurse practitioner, and I have five kids and I got all the baseball games and this and that, blah. Right.

[01:04:10] Nursing, three of ’em and one’s in

[01:04:12] college. Yeah. Right. It’s like, what? No. Take the time and figure it out. And I put the time on the front end. I knew I was gonna take some time off.

[01:04:21] I didn’t know it would be a year. And it’s been a beautiful experience for me at this point in my life. And I highly encourage people to take time off. We just don’t give ourselves that gift of time and grace because we cannot soften ourselves under that pressure cooker. No. There’s, you know, we can be beaten down, right?

[01:04:42] under down, but we are not gonna soften ourselves from within under that pressure cooker of all the burdens that we choose, that we put on ourselves and our lives. And so I really, you know, my best words to anybody is really, you know, practice self forgiveness, self-awareness, and where can I soften and what can I let go of and what’s, and really be real, be honest.

[01:05:03] What’s it going to take to live the life? I wanna live it. It could mean a lot of big things, but trust me, when we create that space, the possibility so much comes in because possibility could be knocking on our door, but it will not, it will not enter. If there’s a bunch of garbage in there, we can’t even hear it.

[01:05:23] Right. Right.

[01:05:25] Yeah. We’re busy , we don’t, we don’t really have the space. Right. We can’t, because some things just aren’t, are not gonna live in that space of like being added on, added on chaos. Right, right, right. Yeah. Right. Exactly. Exactly. Oh, thank you so much,

[01:05:38] and on this episode of Therapy with Nurse Adriane , I love it.

[01:05:44] Thank you

[01:05:44] so much, Adriane . Thank you. Appreciate being here. Helpful.

[00:00:23] We have Brigitte Sager today of Integrative Nurse Coach Academy. Thanks for coming Brigitte.

[00:00:31] Oh, totally. I’m super happy to be with you guys and talk about this.

[00:00:34] Oh, I’m so excited. So for our listeners who have been with us for a little bit, they will recognize Sarah Collins’s name as a previous guest that was just here.

[00:00:46] And she has so much energy and I love emailing because I can see her face cuz I watch her on TikTok and she’s like, I’m so excited. You’re gonna love this. I have someone for your podcast. It’s Brigitte. She’s really different than me. It’s gonna be so great. And like you just said It’s gonna be more upbeat.

[00:01:03] And Sarah was like, Wawa, here’s what’s going on and what you need to know if you’re, if and when you’re going to press charges for retaliation or file motions against retaliation of your hospital, which is extraordinarily helpful, in my opinion.

[00:01:18] Absolutely and unfortunately necessary

[00:01:21] and necessary and kind of like, geez, I did not expect. I did not expect that, but she gave us a lot of good information and connected us with other nurses. So I’m so grateful for that. So you and Sarah are close and you both are in the West coast.

[00:01:35] Mm-hmm.

[00:01:36] And I saw on your site, so what I know about Brigitte, we don’t have to do like a whole long intro, but I did see a lot of letters behind your name.

[00:01:45] Y’all are gonna see her blogs and podcasts in the show notes. You wanted to be a midwife.

[00:01:52] Mm-hmm. Yes.

[00:01:54] Hehe, I thought you would like that part. You wanted to be a midwife because your website says you empower people wanted to empower people to believe in their own bodies.

[00:02:01] So we can totally get down with that. And you became a critical care float nurse. Followed the medical model, followed the algorithms, chase the disease process. No one was getting better. Then you became a family nurse practitioner and you became what you call manager of disease.

[00:02:19] Mm-hmm.

[00:02:20] And you felt like you went to school and you’re like, I know about great nursing care. This is me putting words into your mouth. I know about great nursing care. And you went to work as an advanced practitioner and then you were what your blog says, not practicing in a way that you knew would be the most helpful in the way that you could help the most people. And so then after that, what happened?

[00:02:47] So yeah, I would call that standard of care. I was practicing in the way that my corporate model was pushing me and the way that I was trained. What I found is when you go to a nurse practitioner school, you leave behind a lot of the nursing and you learn how to diagnose people and which medication they’re gonna get for it, or which surgery they’re gonna get for it.

[00:03:05] So once I started to practice in primary care, I had had this vision of being a healer and that was you know, my goal and I just kept feeling that wasn’t where I was at and so it all culminated into a conference I was at and I, it was the same conference I’d done like two years before.

[00:03:20] But I was really excited for new content on IBS, cuz that’s a really challenging thing to treat. And so it was the same speaker and I was sitting there with a hundred other providers, probably at least and he pulled up the same slides from two years before and they were the same interventions that haven’t been helpful for my patients.

[00:03:38] And so I was really bummed. So instead of listening, I was scrolling through my phone looking for something different. And I’d looked before, but I hadn’t found what spoke to me. And the Integrative Nurse Coach Academy was having a nurse coach’s the intro to their course in live near my house.

[00:03:54] And so it was an hour away and I was like, Oh, this sounds like more aligned with what I wanna do. So I went to that and it was like a immersive intro and then a six month program, and then you go back and you’re together again at the end. So it was really great. I became a nurse coach, which means that I do the opposite of nursing almost.

[00:04:12] It’s really interesting because I, I help people figure out, What they wanna work on and what’s in their way. And so it’s a lot of open ended questions and helping people meet their own goals rather than in nursing I feel like we do a lot of teaching and preaching to people about what they should be doing.

[00:04:31] And so coaching was really cool to flip that on its head and say, Wow, I’m gonna help people figure out what they want to be happy and healthy and what they, what their intuition is about their own bodies and, and create some awareness for them. So nurse coaching, super cool. And then at the same time, I was kind of starting to learn functional medicine and the more I integrated it into what I was doing in primary care, the more frustrated I got because it takes time and it’s hard to do.

[00:04:56] And at the same time, my corporation was asking me to work faster and faster, seeing more clients quicker. And so it was detracting for my ability to do that. And I was getting pretty broken-hearted about it. So the more I was learning functional medicine, the more I realized I just needed to take the leap and practice it.

[00:05:12] And then while I was doing my training and I started working on my doctorate and I was doing consults from home with my clients, Karen Aino, who’s the director of Education for Inca, the Integrative Nurse Coach Academy. She reached out to me and asked me if I wanted to make the functional medicine course.

[00:05:28] And so I was a little intimidated by the whole idea, but I agreed to do it, and now I’m so thrilled. It’s really exciting.

[00:05:36] Oh, that’s awesome.

[00:05:37] That is awesome. I’m really into, into this. Okay. So I, I have a thought. It’s not so much a question. I’d love to hear your thoughts about my thought. I imagine that with your model of care of allowing patients to choose their goals, you must have an incredible follow through rate. They must have this intrinsic self-motivation to achieve these goals because they chose them versus a medical provider telling them what they should and shouldn’t do, which is obviously going to create in a lot of people resistance.

[00:06:10] Absolutely. Yeah. Even if you end up aligning in the same place, is what you might wish for them when it comes from their own desire to make a change. It’s just like, I always say like how often do nurses tell people they should quit smoking, right?

[00:06:23] And then you have to hear it until you’re ready to hear it. That’s like a really classic one. And with this, it’s people that come to me motivated, they’re ready, they’re excited. With functional medicine, I do do the teaching, right? It’s not just open ended questions. And so for me, now, I have clients that come to me super motivated.

[00:06:38] They’re ready for change, they wanna heal, and they sometimes find out that the thing that is in their way is different than what they expected it to be and it is challenging and that’s when I get to use my nurse coaching more. It often ends up being something about their lifestyle or healthy boundaries and relationships and things and we have to work through that, but that isn’t my job, right? I just ask them the questions to help them uncover that, you know. So it’s super helpful when I’m practicing functional medicine. Absolutely.

[00:07:05] Yeah. It’s like congruent to therapy like you should be having a functional medicine doctor and also a therapist, and I feel like that will improve your life so much.

[00:07:16] Absolutely.

[00:07:17] HeHe, have you been to a functional medicine provider?

[00:07:20] No, but I am on a wait list here in Boston for someone who had an 18 month wait list, and I’m like in town to like seven months now. So I should be seeing her next year sometime. Yeah.

[00:07:28] Oh my gosh. Oh my gosh. That’s wild.

[00:07:31] She is like the best in Boston apparently. I’ll be driving a little bit to go to her like 45 minutes, so when I have, I have doctors literally like down the street for me. I live pretty close to the city, so yeah. Functional medicine, I’m into it.

[00:07:45] It’s interesting that I think I wanna go back to kind of how you realize that this was for you because I think a lot of our listeners are in a place of resistance, confusion, frustration, and we have more than nurses in our audience, but I know we have a lot of nurses that are listening and nurses are in place of frustration, as it sounds like you were. So, you were even learning more and more and more to try to feel more aligned with what your role as a nurse practitioner more aligned with your patients.

[00:08:23] Yeah. You know, I teach adjunct sometimes at an associate’s degree nursing program. And it’s the same program that I did a long time ago. And when I started to teach I was like, Wow, we are really focused on teaching nurses how to go to school to work in a hospital.

[00:08:38] And when I asked nurses, and I often do this cuz it’s kind of a passion topic for me, is like, why did you become a nurse? Most nurses went to nursing school they’ll say it was like me to the midwifery thing was to empower people about their bodies. I wanted them to know, to believe in themselves and that we have this incredible ability to heal.

[00:08:56] And that gets taken away from you when you’re a woman in labor walking in a hospital setting in a lot of cases. And so that broke my heart. So as I went to nursing school, I learned that it’s more than that. It’s like I didn’t just wanna do moms and babies. I wanted to do the whole picture because it’s, everybody needs to know that.

[00:09:13] So when I ask other nurses, their stories are similar. They’re, I wanted to help people, I wanted to heal people. I wanted to teach people about their bodies and we aren’t really afforded that opportunity when we go to school and learn how to just work in a hospital, how to work at the end of the story.

[00:09:28] And, you know, it’s when people have had a problem going on for a really long time and we’re like putting out fires for them. So for me, I kept being hopeful or optimistic that when I got to the next step of my goal, I would be in that place where I was gonna heal them. And I thought primary care was gonna do that and it was unfortunately not the case. So with functional medicine, the whole point is the why, figuring out the why. And a light bulb went off one day where I was like, Oh my gosh, this is fundamental nursing. It really is like when you peel back the layers of functional medicine, it is what we learn in nursing school.

[00:10:02] And then in the course I teach, I add in the how, like how do I use what I already knew as a nurse to truly heal people because that was my calling and it is incredible and I just like, it fills my heart to see the comments, my students and when we talk together because they are having that same moment that I had where they realize they finally get to live their calling.

[00:10:20] And a lot of my friends that still work in the Alopathic model are so broken hearted right now in the role that they play, and so I am so excited that more and more nurses are looking towards this.

[00:10:31] I love that you say that and I think I had read your bio. I had looked you up. Sarah spoke so highly of you and I was like, Who is this person? I need to go see where they started, where they are, what they’re doing, what is all this coaching? And I was getting it, but I didn’t read your blog posts. You sent us some links, but I read ’em today and I think timing is so funny, isn’t it? Yesterday we just, I am one of the creators of a trauma informed birth nurse program, and it’s for perinatal nurses working to learn trauma informed care, and we say all the time in trauma informed care, this is nursing. This is the type of nursing you got into nursing for. And I know that because many of us share these universal beliefs that we can support folks to be better. We can walk alongside people.

[00:11:28] We want to see them grow and improve, and we wanna be there with them for that, either teaching or medication or assessment or whatever. The human to human connection is what like poof goes away.

[00:11:44] Mm-hmm.

[00:11:44] And like you’re saying, your timeframe with seeing these patients is getting shorter and shorter and shorter and shorter.

[00:11:51] And you talk to a nurse in a hospital and they say conveyor belt imagery. And patients also, because of social media, we’re able to tap into a lot of a lot more patient experiences outside of our own experience. And so we hear patients telling stories about, I felt like I was being taken care of by robots and no one was answering my questions.

[00:12:09] They weren’t even like listening to me and they just did all these tests, like things happened and I didn’t even know what was happening. I was drawing so many parallels to trauma inform nursing care. I mean, you say that nurses become nurses to be healers, advocates, and empower our patients. We don’t want them to need us forever.

[00:12:33] Right. We’re not like on call. We don’t have a phone nurses at the bedside, like RNs or in that level. We don’t have a phone, we don’t have an office. Don’t call me. I’m gonna give you information that you’re gonna then go use or let’s talk about where you’re at and then go figure out where you wanna be.

[00:12:50] But what you are saying is The same with functional medicine as content was the material you had learned in nursing school, but the topics are rarely given any priority in modern healthcare. Is that not the most like biggest freaking bait and switch you’ve ever seen?

[00:13:08] Right.

[00:13:08] Come on in the water’s nice. You’re gonna be an advocate. And then you’re like, Who am I an advocate for? I’m an advocate for the hospital, their legal team, their bottom line, which is money, and then the hierarchy the latter is providers who make more money for the hospital’s bottom line.

[00:13:27] I’ll give you a great example. That’s like, So basic, but it’s like, oh my gosh, how did I not think of that? The example I love to use is we learn about our sympathetic parasympathetic nervous fit system, right? And like fight or flight. And that like an animal, if something’s chasing you, you’re running for your life. Our body, whether that’s stress or a lack of sleep or whatever that stressor might be, our body doesn’t know the difference.

[00:13:50] It thinks we’re running from an animal and then we have our resting and digesting phase, and we learn that in nursing school. And that is when we can actually digest our food and have healthy absorption of nutrients that we need for every cell in our body. But we are rarely in that state, and nurses are the best example that work in a hospital is like, from the time they get up and think, Oh my gosh, my patient’s from yesterday, you know, I’m going back and, you know, and then what about my kids and what about the five other things I need to juggle, Get their clothes on, get to work, run in the break room and eat something really quickly and leave, and, and, and then there’s huge rates of infertility and high blood pressure, like all these things that are happening to the public at large are happening to hospital based nurses on a huge spectrum. Most of the nurses that I worked with in the hospital developed health conditions, you know, at a faster rate than maybe our peers that work in a more peaceful setting. And it’s, you know, how are you supposed to digest the foods you ate and absorb the nutrients in them?

[00:14:50] And what were those food choices to start with, to even have those nutrients in them. So that is just so basic and that changes the course of health for a lot of my clients. Just teaching them how to take the time to get into that state and the awareness that being there is essential.

[00:15:06] I love it. I love it. It’s such institutional betrayal because I, I mean, I go to the doctor and I’ve been to the doctor a lot recently. I’ve been going through some stuff, some surprising stuff, and I’m like, I’m a nurse. I’ve been to a functional medicine doctor. She’s like, Wow, what have you been eating? I’m like, I don’t wanna tell you.

[00:15:25] I know what I’m supposed to eat. I teach people, you know, and in, in birth we’re alongside and we’re like, Nope, nope, nope. That contraction’s over. We’re back to relax. We’re sleep. We’re like the, the monkey that fell out of the tree we’re just cool. Calm. We’re fine. We don’t have a contraction. Meanwhile, I’m being chased by a lion.

[00:15:44] You are fine, and you’re like our bodies literally know what’s happening. You know, I’m not fine, Like I am not a safe person to be in your birth. I’m being chased by lion. I’m at work. I have another patient. I didn’t eat lunch. I have to pump, I have to pee, and the provider is on my ass.

[00:16:02] And the unit culture sucks

[00:16:04] just to name five, right? I’m being abused. I’m being bullied. I’m being manipulated. I’m underpaid. My feet hurt. I don’t have enough fingers for the number of lions that are chasing me. And I’m supposed to be like, I teach childbirth ed. Right? And I’m like, rest and digest is how you connect with your baby and oxytocin and relax to let your baby out.

[00:16:24] I’m not safe. I’m gonna be over here behind this two way mirror saying all the things because my body literally is charged. You’re so right about that and acknowledging it is. First for nurses and I think the speed at which they can acknowledge that has hastened since Covid. And I think our social media and our online platforms at the same time as Covid, I think like hospitals showed their hand a lot, very obviously in ways that like they didn’t need to hear it from us being.

[00:17:05] Or having experienced it in the hospital, having that light bulb moment that we’ve had, we’ve had to have on our own. They, they saw it and they were like, No, I literally know mask can save my life, but I can’t have one what’s happening right now? So, yeah, I think the parallel to trauma informed nursing care.

[00:17:22] I think what another parallel, you’re asking the why and you’re listening more. You moved into a space where you can have time to do that. Do you think you are shedding some of the taught saviorism out of your nurse history?

[00:17:41] Yeah. You know, for me that that exactly what you just said about The, the pandemic kind of hastening the process. What happened for me was like the clinic was like, Okay, everybody, you know, we’re gonna do virtual right? And so while we figure out what to do in the first couple weeks. And so I was at home and I would go outside and walk through my greenhouse and play with my dogs and eat a salad cuz I had time to chew when I was eating.

[00:18:07] And I realized it was the first time since I’d become a nurse a really long time ago, that I felt calm and not stressed out all the time. And it was a unique opportunity that created that awareness for me. And that was when I started to think about leaving my position, but I was still teaching adjunct at the hospital through the pandemic.

[00:18:27] And so we would go into the hospital and I’d see all my great friends cuz I, I did float and so I knew people all over the hospital and so I was so excited to go in and get to see everybody I hadn’t seen in quite a while. And they would just start crying, you know, I would be, they’d be like, How are you?

[00:18:41] And I’m like, Oh, I’m great and I’m, you know, this and that. It’s going on. And I felt bad even saying that, but then they would just start crying and it broke my heart. I feel so bad for everybody that’s still living in that land and not, And it, it’s, the thing that you’re talking about is like with nurses is like, it’s almost this mentality in school that you’re supposed to suffer to care for others.

[00:19:01] And it’s remarkable how it’s ingrained in our culture. And it gets talked about a lot in the course that I teach. Just this idea of, wow, I have to take care of myself so I can take care of other people and I don’t have to live in this. You know, I took a total leap like jumping off the like corporate income situation to do what I do now, but I totally believe it’s my calling and I have faith in that and we live in that idea as nurses of like the hospitals where it’s at to like make a great income. And then you have to suffer through your career and develop health conditions to be a sacrificer, to save others. And I really feel like that needs to change because I don’t think that most other jobs have that level of stress and responsibility that we do.

[00:19:47] Doesn’t make any sense. You’d kill all your workers. Even like in a business model, it doesn’t make any sense. Like you’re a business. All three of us own businesses and have teams like Second up is is our team.

[00:20:03] Yeah. But I think that’s indicative of how they view nurses like replaceable, right? Like if one gets sick and can’t come to work, we’ll just hire more. We literally saw that in the pandemic. They did not care. They were like, Okay, quit if you want to. We’re hiring them right outta school. They’re in that funnel of medical industrial complex.

[00:20:21] So preparing them to work in the hospitals and the hospitals, understand who cares? We have an endless supply of nurses. We don’t think about our people like that cuz we know our people are not replaceable. We know the people who help us run our businesses are far and few between. Hospitals don’t view their workers like that, I don’t think.

[00:20:43] Yeah, for sure. How do you think leaving, taking that risk, you’ve gotten all this education through the medical industrial pipeline. If that’s not so hurtful to identify, because I can identify that way too. Pay a lot of money to that pipeline. Pay a lot of time to that pipeline. A lot of breast milk to that pipeline. you can tell I’m like, not over that part.

[00:21:09] Yeah, I hear you.

[00:21:11] And you know over it enough, but like, that’s some shit. How has leaving helped your burnout or how doing this other side of medicine helped your burnout?

[00:21:21] You know, I always, like, I used to say, Oh, if I get a doctorate, it’s gonna be in nutrition because I don’t want to go further in nursing. Like I don’t. That whole thing going through the NP program kind of showed me what that would be. Right. And so now I am getting my d and p because I’m like, Oh, because I can take research and disseminate it into practice in a way that could change healthcare.

[00:21:46] And so for me, it’s like I find, yeah, I, I totally feel like I was raised, My dad was like this kind of like, White collar, hippie, sorta, you know? And so I always wanted to like fuck up the system ever since I Yeah, yeah, yeah. Got into healthcare. That’s, And, and I don’t like how the corporation that bought up our local hospital has treated my friends and my community.

[00:22:07] And so I’m kind of tearing it up because, you know, I’m teaching all the nurses in my community at the, you know, the school that I went to at like, and, and all the nurses through the country that take my program and through the world that take my program, that That we can figure out why people have chronic conditions and it’s different.

[00:22:26] Everybody’s problem in functional medicine is unique. The cause is unique to them and that’s why it takes time cuz we have a lot of questions for each person to uncover that and heal it. But when you do that, they don’t go to the hospital anymore. Right. So I feel super thrilled about that. And you know, one thing you just said that I thought it was, I was reading a student’s assignment this morning and they said that they felt more aligned with who they were holistically before nursing school, because once they went to nursing school, we get taught, like you just said, you go onto the conveyor belt of following the protocols to meet the goals of a corporation in most cases. And so she was excited that she was flipping that over and looking underneath and seeing, like remembering who she was before she became a nurse. I thought that was really cool.

[00:23:12] Yeah, because you’re creating a space that’s safe for them to do that. It’s safe to be like, Well, shit. This is what I spent so much time doing, so much energy doing. I thought this was the key. I thought it was the answer. I was told all this, this was a scam, and I am this other person and I’m not okay with these practices. I’m not okay with these priorities. I’m not okay with telling me one thing and then doing it differently in practice and having that resistance all the time and those new nurses smart, aware. That’s who we’re trying to get. That’s who we’re trying to talk to. We’re like that inner voice. That’s the smart one. The new nurses, the younger generation is exactly. I think you’re exactly right. Like what’s your gut saying? Go with that. How do you find that? If it’s not in nursing, go through your grief. If it’s not in the hospital, like, not that nursing can’t do it, nursing teaches you so, so, so much.

[00:24:14] I think we get a great foundation of so many good things. But what I’m hearing from you is it can look all different kinds of ways and feel better to use your nursing and your system fucked with the wrong bitch. I am so excited for your community.

[00:24:32] And, you know, I’ve done two really big training programs for functional medicine and ours is the only one for nurses because I, of my realization, oh my gosh, there’s so much of this is just what I learned in my ADN program a long time ago. And then I add in the how. So I, I realized when they asked me to teach the course, like, One of the programs is two years long and, you know, you could buy a car or you could take that program, but it has health coaches in it.

[00:24:59] And so they’re getting, they’re, they’re not healthcare practitioners. They don’t, they’re, you know, so, so they’re getting a ton of the basics from nursing school and then on top of that. So I’m like waiting right in my class when we get the part that I don’t know already from nursing school. Oh, and it’s the end.

[00:25:13] It’s the how. Yeah. And so this program is how. It’s the how from nursing school, right? Yeah. And so my hope, I mean, I’m really excited to teach my course, but my hope is that that realization comes across in healthcare in the next decade. And this isn’t necessary anymore because it’s that last bit of connection that nurses don’t need to work for a physician and wait for a prescription to talk their patients into. A lot of my students are there.

[00:25:44] It’s right there. Yeah. We’re not that person for you hospital medical industrial complex. We’re not talking our patients into anything that’s against everything we believe in.

[00:25:55] And RNs and nps like that take the course are like, they have their own businesses and it, and it takes a while. You know, we have these Zoom sessions and we talk through the course, and nurses come from every modality. They have other skills like, you know, massage or reiki or something that they incorporate or doulas. Like they, they have things that they’re using with their nursing, and then we add in functional medicine and maybe they take the coaching course or we have like a cany nurse course.

[00:26:19] So maybe they’re learning about cannabis and connecting that in and so, At the end of that, it’s so fun to see everybody’s ideas cuz they’re like, Wow, I didn’t realize how powerful toxins and detox is. That’s my passion now. I wanna teach people about that and how it affects fertility or how, you know, risk for chronic disease and people get into hormones and, and that topic.

[00:26:40] Ultimately, I’m really optimistic that that can align in nursing programs, but in the meantime, it’s very cool to see nurses finally seeing like, Oh, this is what I wanted to be a nurse and this is so exciting and I can go have my own business. And it has nothing to do with prescriptions.

[00:26:56] It has nothing to do with surgery. I have them research their scope of practice. There’s nothing in scope of practice about getting directions from a physician to teach people how to be healthy. We’re educators. And that is totally in everybody’s scope of practice that’s a nurse.

[00:27:11] Exactly. Wait, can I ask, I know people listening are like, I’m ready, I’m ready, I’m ready brigitte, just tell me the secret sauce. Do I have to go get my master’s to do this?

[00:27:20] No, no, not at all.

[00:27:22] Like bachelors nurses that are like. I love what I do, but I can’t do it anywhere else. And you’re like, maybe you could do it better and you don’t pay anyone while you’re at it. Like you don’t make other people ugly money while you’re at it. I’m thinking pharma, big pharma. Do I have to go back to school? What is the hurdle that you’re not telling me?

[00:27:42] So, so zero. I mean, I’m trying to think of a number because I’m not the numbers person at all, but like for Inca. But I, I would guess that 75% of my students have a RN bachelor’s degree, and the other 25% either are masters in nursing or a master’s and they’re a nurse practitioner. For me personally, what my visits look like is my patients do this really huge intake. I tell ’em, you know, get a cup of tea or coffee and sit down and plan to tell me what you’ve, No, you’ve been frustrated, nobody else has listened to, you know, I wanna see it.

[00:28:14] And so then I spend time before their visit looking at labs from the last few years. And I teach the RNs how to do that too, cuz there’s a lot inside a reference range that we can use to see cues for maybe poor digestion or, you know Lots of examples. I’m not gonna go down that tunnel, but,

[00:28:29] oh yeah. Mine found like all kinds of shit. I mean, she was like, Well we could try 16 things to begin with cuz I’m like, acne, hair loss. I came up with like the craziest and it was like right before Covid and I was like, Fix me? She’s like, Yeah, alright. And all my labs are like green, right? I was like, Oh, don’t tell me, don’t tell me I’m a mess. And she’s like you’re a mess, but we got you. Yeah, for sure. It was hours.

[00:28:55] Yeah, cuz they say, you know, you go, That’s the story that we, we hear all the time from people is everybody told me everything was normal and their A1C was 5.6 for four years and their, you know, fasting blood sugar’s been around or over a hundred and it’s like, that’s not optimal. That person has been in a state of inflammation for years and everybody told ’em they look great. I have no idea why you’re tired all the time you.

[00:29:18] I can’t prescribe you insulin now, but come back in five years and we can absolutely help you.

[00:29:22] Mm-hmm. Mm-hmm. in the meantime, try to do better.

[00:29:25] Right. Could you lose 10 pounds? Ooh. Makes you not wanna go back.

[00:29:30] So, so I uncover that kind of stuff and, and more questions I wanna ask when they come. And then we have the visit and we spend 90 minutes together and go over all that. And I get to ask more questions and make connections, and then I give them some education.

[00:29:43] So, The thing that a lot of nurses get hung up on when they’re entering the course is, or if they wanna take the course is, I can’t diagnose and I can’t prescribe. We don’t prescribe anything. I don’t teach anything that we would prescribe, and we are not diagnosing anybody with anything. We actually go back to nursing diagnoses, which drove everybody crazy in nursing school, but functional medicine is that, it’s like caregiver role strain and like these, you know, it’s, it’s the basic things about people. We’re not saying they have hypertension. We’re saying that maybe they had an exposure to something, or they have a nutrient deficiency that’s causing that, or they have sleep apnea that’s causing that. So You don’t have to diagnose anybody to work in functional medicine, and you don’t have to use lab work to diagnose people, But nurses look at labs every day at work, right?

[00:30:31] We go, When I worked at the hospital, I went in there every day and looked, and then you go in the room and tell the patient, Well, actually, your leg cramps are from your low potassium, and here’s some foods that are rich in potassium, and here’s your supplement of potassium that you’re gonna take. Yeah, exactly.

[00:30:46] Yeah, so, so for sure. I think when nurses start to go through that road of, well, I need to learn more to do better, which is messed up, and we could have a whole episode of just that phrase, you know, that mindset, they go down the road of learning more, I’d be curious about how long they spend asking questions of their patients. Just, you know, this hasn’t been studied, but we’ll just go with you and me, and our friends who did the same thing of like, Well, I’ll just get this and I’ll just learn more and no one can just get this other cert certification and I’ll just do that.

[00:31:20] And then we go in and we’re like, Okay, let’s look at their chart real quick. Boo boo, boo boo. Oh, this is interesting. Let’s go talk to their whole, whole room whomever’s in there and get a picture. And then, well, how do you sleep? Okay, who do you sleep with? Show me like, Like this way, Or you sleep like sometimes it is like we know them . And that’s when you’re trying to be a nurse that feels good and you’re trying to help the whole human and your whole self is trying to help the whole human. You need the whole picture. It’s not just labs. Oh, I see that your blood pressure’s up. No, that person was super scary. That’s why my blood pressure was up.

[00:32:02] And then you believe them and you take it again and you’re like, Oh, thank you I am a kind person. Like that’s what your blood pressure’s telling me. It’s a whole different ballgame, a whole different relationship with these humans when we’re trying to get out of that, pipeline off the conveyor belt.

[00:32:17] But then, you know, we don’t have enough time to really do that. So then we get in the weeds, like you said, the frustration of wanting to do better, knowing you can do better, having it in you that you could do better. That’s what drove me out too though. That like the frustration is killing me like it’s moral injury, honestly.

[00:32:36] It’s traumatic stress. Secondary traumatic stress. It’s these like, who am I working for? What am I doing here? All these like questions start spinning because you’re seeing example after example, after example, and it’s very helpful to hear you say that that was your journey because I think so many people can resonate with and you have ways for nurses to get back to nursing the way you did.

[00:33:04] Absolutely. Yeah.

[00:33:06] We can do online learning now. Everybody. How wonderful is this ? We can, we don’t have to like go back to college, pay that, pay into that system. That’s also, you know, questionable. And then Do something on our own. And I think a lot of nurses are, I know I’ve been sending my friends all of the side hustles I can find for them because they’re like, like you said, they’re just limited in the fact that they think that they have to do it this way because we’ve been told that we can’t pay for our house. We can’t put food on the table if we don’t do that.

[00:33:41] And you know, that scope of practice question and the believing that we can’t, you know yeah, the, it really comes back to that I mentioned the educator part is that nurses are educators. And when a lot of times like students will say, Oh, how can I, I don’t know if it’s in my scope of practice in my state to be able to do this on my own.

[00:34:03] And I say, How often have you had in your nursing career? Somebody say, Oh Hey, Mandy, I sprained my ankle last night. I’m wondering if I should go to urgent care and they send you a picture or, you know, whatever. How many times do we tell people, go grab alternate ibuprofen in Tylenol and ice and heat and elevate, You know, so those are more harmful than most supplements that in functional medicine, our goal is to not need any, right?

[00:34:27] It would be awesome if we were just getting everything we needed from our food and our life and our relationships, but sometimes we need supplements. Like, I live in Washington, so we need vitamin D. Right? Like, we’re not getting it anywhere. How often as a nurse do we say, Oh, I see on your lab work from your primary care provider that your vitamin D is low.

[00:34:45] Did you know that that can contribute to depression and chronic health conditions such as autoimmune diseases and here’s a target range for you. So all of that is educating and that when that light bulb goes off for nurses, that’s when they start talking about their own businesses. Cuz they’re like, Oh my gosh, I can look at labs that they’ve already had done. Teach them about that. I can teach them about resting and digesting. Even before this, when I saw people for depression, anxiety, my first question was always, how much sleep are you getting? If you’re not getting seven to eight hours of quality sleep how are you not going to have a health condition from that ultimately? So when you shine a light on things for people. You educate them. They get to go home and make choices for themselves. We’re not their bosses, we’re not responsible for their health anymore. We’re helping them.

[00:35:32] That sounds so good.

[00:35:35] We shouldn’t, We’re not, Anyways, We’re just Saviorism. Saviorism. We’re told we’re responsible and we are. Misguided that we’re out of scope. In our program, one of the biggest questions is, how do I chart this to reduce liability? And so we have to teach about whose liability and who’s holding all of the risk and it ain’t us. And those two things are, the things that I think hospitals use to disempower nurses. Fear specifically fear around our license, fear around litigation, those two things. Those things will take us right outta that barely making it, paying for childcare realm in to can you even support your family. All of these internalized fears that we have and I love hearing you just knock ’em down.

[00:36:26] No excuses. We can do this. You’re not doing anything unsafe. You’re not doing anything illegal. You’re not doing anything to lose your license. That’s empowering. We don’t hear that very often. Your license is powerful and what you can do with it is impactful now the way it is without adding another license to it.

[00:36:47] Yeah, because, you know physicians practice functional medicine also, but they still approach things from a medical model. And even the training that I’ve done, So Inca and the Institute for Functional Medicine have partnered for my course to like endorse it. And that’s huge because they’re like, The parents of functional medicine.

[00:37:03] They’re like gospel. They really focus on quality research. But you know, I’ve done all their training and it is a physician led training that is very, Evidence based and it’s amazing and I’m glad that I did it, but I don’t think that nurses need to do two years of training to have a huge impact because they teach higher level, they go into prescriptive opportunities for treatment, and they go into more advanced testing.

[00:37:31] And I teach testing in my course to the extent that nurses want to know what it is and how to interpret it, but not to the level of go have all your clients do thousand dollars tests for every symptom they have, because the bottom line is what has increased the prevalence of all our chronic diseases is not a lack of a prescription medication or a lack of a surgery.

[00:37:52] It is our lifestyles and our food choices and stressors. Over half of US adults are deficient in magnesium. And that is one of the leading causes of hypertension, actually. So you can throw three full highest dose prescription hypertension medications, antihypertensive medications at somebody, and it’s not gonna fix them if their real problem is they’re, they’re not getting nutrients that every cell in their body needs. So I think that like, you know, nursing as a whole, recognizing the influence that we can have on the path that healthcare has taken and revert it to a place where we’re the foundation of that and take over. Right? Because, Yeah, because else nobody else has this training, right? and all we have to do is understand that the things that we already know, Are the actual things that are gonna help people get better. We’ve been blindly following this medical model that is for money, it’s for profit, and then also, you know, it’s also led by a lot like the American Medical Association makes a lot of decisions that suppress nurses. Very frustrating because meanwhile you have nurses over here that are the ones that have the time, generally more than a physician to say, How many vegetables are you getting a week? You know, like, just to talk about.

[00:39:09] Yeah. Yeah. the trajectory of healthcare today, man. I’m gonna send some postpartum geared nurses your way.

[00:39:17] Awesome.

[00:39:18] My, my community needs it. Ready to shake shit up. Oh, that’s so exciting. My wheels are spinning. Thank you for sharing this, Brigitte. This is absolutely inspiring.

[00:39:30] Yeah, it really is, man. This is, My wheels are turning, imagine if, imagine if this is required in medical school. We would have any doctors left in the system, but maybe that’s what we need.

[00:39:43] Maybe everyone goes outta the system and that’s how we take it down. But yeah, what if this was the course? What if these were the conversations? What if these were the questions that we were asking in medical school in the education that we were giving, what would the American Health, not even healthcare, but like, what would our United States health look like?

[00:40:04] It would be totally different. People would once again, wanna be coming to this country because we had a good lifestyle to, to offer. Right. People were healthy here, people were happy here. Now I feel like so much of our country is just unhappy and stressed and we just run like hamsters and wheels, always going, always on.

[00:40:26] We always want our patients in perinatal medicine, but I know in all types of medicine and all types of areas where nurses are working. They know that their patients have power. They know their patients can make lifestyle changes, but they can also make choices and decisions that impact their health that nurses feel like their hands are tied inside of say the hospital, or even outpatient, anywhere. They give ’em a little information, but those patients are the ones that have to say and speak up and advocate for themselves. We wish we could like whisper all of the things to them. Give them the information they need because we know a lot is on their shoulders. Imagine nurses teaching communities just like this, how to do just that.

[00:41:12] Those are our voters. Those are our committee members. Those are our community leaders. Those are our teachers. Those are our parents in our community that are like, Oh, wait a second. This is what it feels like to be listened to and heard and I can make a powerful, positive impact.

[00:41:29] And it didn’t hurt. Like that’s the next generation saying. Mm-hmm. I don’t have to, I don’t have to suffer for this. Mm-hmm. , I can help you without losing anything.

[00:41:39] One of my students in this cohort is a school nurse, and we were talking as a group last week about the power that she has to change the trajectory of health for children.

[00:41:53] You know, because who she’s seeing in her office all day long, they’re coming in with diabetes and asthma. She has the ability to educate them and their parents and maybe change the course of their whole life. Maybe add 10 years to their life by teaching them the impact of maybe food and gut health on asthma or food choices and diabetes. it’s so incredible to think about the impact you can have when you get involved in the community and even reach out to a younger demographic. It’s pretty exciting.

[00:42:23] I was thinking school nurse and school teacher, while you’ve been talking, I’m like, Man, talk about people who are ready to unleash.

[00:42:31] Nurses and teachers are ready to just get unleashed. Oh, thank you so much, Brigitte. We would love to hear comments from our listeners on what you’re thinking. Any responses, questions, comments you have about this episode? You can also on our Instagram at Pulse check dot podcast, and you can also find Brigitte in a few of the links that I’ve posted below.

[00:42:50] you have some great blog posts that speak just to nurses that I found really, really helpful and inspiring. but at mandy irby.com/pulse check podcast, you can drop us a voicemail with your comments and questions and we’ll play them on our next episode and respond to whatever you have in that voicemail and we won’t answer it.

[00:43:09] Don’t worry. You just talk it records and then you hang up. All right, Brigitte, is there anything else that you wish to impart on nurses and healthcare professionals and consumers that are listening today?

[00:43:20] I think the bottom line of functional medicine is asking why, and I just think that the pandemic in a one positive of it is that it has made all of us question the practices of healthcare and recognize there’s different answers.

[00:43:33] And so asking why more is a huge thing that I think that patients can try to find a practitioner that is asking those questions and nurses can be. Providers for them, which is really exciting. And live our callings. Right. For us to be teachers and healers and empower people.

[00:43:50] Oh, yes. Thank you so much, Brigitte. This has, this has been incredible. Thank you y’all. Thank you.

[00:43:57] We’ll see you guys next time. Thanks so much, Brigitte. This was awesome.

[00:44:00] Thank you.

[00:44:00] Bye.

[00:44:01] Bye Bye.

[00:00:20] And so many people were tagging you, people were saying how great your, your session was and you looked like you were having a ton of fun. However, when you got back here and you and I started to debrief. Womp womp. It kinda, it fucked you up real good is what you said. Those were the words you used. You were like, man, it fucked me up, but in a good way.

[00:00:42] And there were just so many parallels between bedside nursing and nursing within the hospital system that were mirrored. I mean, they were just so similar once you got to working with this national organization to be a speaker. Some of the things that popped out to me was really a lack of communication.

[00:01:03] We see that bedside and you experienced it being a speaker. Unpaid labor. I mean, that is like the whole MO of the hospital system, getting nurses to work for free and, or doing all of this unpaid labor. And that was similar in your speaking engagement as well. And then finally, just the smoke and mirrors of it.

[00:01:22] All things feel oftentimes very performative in the hospital system, especially from nurses, you know, it kind of comes down to past episodes that we’ve done of like, why did you gimme a rock with squiggly eyes when you literally could have given us all a $50 gift card and told us to do something nice for ourselves that smoke and mirrors idea or 

[00:01:42] Yeah, performative. 

[00:01:43] Right. Was part of this too. So let’s dive into it. I think a lot of nurses right now are in this pivotal place where they’re trying to leave bedside, maybe not all the way, but at least halfway. And they’re trying to find other streams of income. They’re trying to find other things that fulfill them and help them, you know, still use their nursing degree and reach people in a way that makes them feel happy.

[00:02:05] How do we do that? When everything in the nursing world seems really permeated with these ideas of no communication, unpaid labor, smoke and mirrors, performative performances. How did it fuck you up? Real good. 

[00:02:22] That sounds so silly now. Yeah. Yeah, it was, well, I knew it would. And you and I talked about it a little bit.

[00:02:28] I didn’t want to do this. I mean, I chose to do it and I’m happy I did. And it was an honor to be, you know, get accepted, you know, you have to apply to be a speaker or be a presenter at a conference. And even if you’re asked to by someone or like referred to as a speaker, you still have to send in your outlines, you have to send in a bunch of information.

[00:02:50] And so that was cool. It was very validating to be like, oh yeah, my shit is good. And it is aligned with nurses and it is at a national level and it is important and it is what people want to hear. That was really validating. But I had said no to speaking at this conference for years other friends had asked, let’s do it together. Other friends had gone and done it and said, I’ll be there speaking, why don’t you do it? I’ll help you with the process. And I said, hell no, am I gonna pay to play? Because I had just been doing that at the bedside. I had just been giving and giving and giving and giving and not getting paid a fair wage and not getting treated fairly, not having any sick days.

[00:03:30] Sick days, holidays were the same thing. That’s fucked up. That’s not okay. That’s unethical. It’s unethical to not be able to nurse your baby and provide milk for your baby while you’re growing your family as a nurse and then teaching other people how to do it. And Ugh, just so many things. I was, I am still recovering from that and I said, no, I’m not gonna pay to go.

[00:03:54] And you asked me that this morning, right. When we got on and I was like, Hey, push record. Because also like, maybe I wanna cut it because I’m not proud of the fact that I, I went and paid for my hotel room. It was reduced, but I had to pay to get in.

[00:04:10] What?

[00:04:11] I know. I didn’t wanna tell you 

[00:04:13] oh man.

[00:04:15] I know. And it’s not, I, I feel good that you feel bad. That’s not really what I mean, but you’re shocked because maybe you don’t see me as someone who would even do that. Right. I. I don’t think that that’s okay. You know, I have created a trauma informed business model in the years that I’ve left the bedside and developed an educational business from scratch. And I, I get excited when money moves through my business to other educators and parent educators and my team of women and gender expansive folks. I’m excited to grow in that way and to move money through and to be a conduit for good and change. And it is not on brand to be like, please, can I speak for you for free?

[00:05:06] And also here’s a partial ticket fee to get in and like go to all of the other presentations, which you don’t really do as a presenter, right? Yeah. You’re not really you’re. I felt like I could be one or the other. I could be an attendee or I could be a presenter, but it was really hard to switch my brain into learning and like being, I had two presentations.

[00:05:29] At the conference and it was hard to switch in between. So I, I would love to hear from listeners on Instagram, if you are presenting or want to incorporate that into your nursing resume. You’re like away from the hospital gig or grow your way from the hospital gig. I wanna hear about it and like where you’re going and how does it feel to be, to be asked to provide your own way there?

[00:06:00] When I bill for educational services, I include travel right? As do all physicians, all lawyers, all consultants, all coaches, they all do that. And it was a huge discussion within my team, the trauma-informed birth nurse team of, of like, this is how nurses are treated inside the hospital and outside the hospital.

[00:06:29] This is how people think it’s okay to treat nurses. I said, nowhere else do I do this? Nowhere else would I think it’s okay. And nowhere else would I expect anyone to come to me for something like this and pay their way, or they wouldn’t put that in the fees. And we had to really like wrap our heads around that and process through that because we also sell content to nurses.

[00:06:54] We also sell educational packages to nurses. We also sell whole unit packages of education to hospital systems and like quality collaborations within states, like health departments. And they also have a hard time wrapping their head around fair compensation for nurse education. They wanna send like a couple nurses to do it and then bring back the education for everyone else, which puts those nurses who are getting educated, which this happens at conferences also. I would meet nurses and they would be like, oh, they sent two of us. So those two now have a responsibility, not just of learning this information for themselves, but being able to learn it so well that in a few days they can regurgitate some of it to colleagues in like in like a professional way in like a, we’re gonna have a staff meeting and you’re gonna present this.

[00:07:49] Like, how is that learning? That’s not learning. That’s like an orientation where you’re like getting oriented and then you learn how to do it, and then you do it. And then you try to teach like pseudo teach your preceptor. This is how I would do it so that you can really begin to work through those like higher level learning of the process yourself as a learner, but that’s not, you don’t like learn it and then like take a student and then could fully be able to articulate everything. Like you just don’t have it integrated yet. Messy. It’s messy. 

[00:08:26] It’s just so indicative of how they view healthcare. I mean, Just hearing you say, you know, that they wanna use a fraction of their budget. Reminds me of one time. I was approached by the state of Massachusetts and they wanted to do this pilot program at one of our local hospitals and local being the, the hospital was about an hour away from our entire team. And I had sat down with them to create budget. So I knew what budget they were working with and I had drastically reduced our team’s price in order to be able to maximize the number of patients that we were gonna be able to utilize and serve through this program based on the budget that they had. And I ended up turning in a proposal for right at $800 per patient. And I was estimating that our team would spend about 30 hours per patient. Wow. For $800. So that breaks down to an hourly rate of about $26. Do you know that they came back to me and said, we need you to work for about $300 per patient bringing our hourly rate down to $10 an hour.

[00:09:42] And unfortunately that program wasn’t able to get kicked off, or at least not with our team, because there’s just no sustainable way that our team could work for $10 an hour. For all of these people, even if it was a pilot program, even if it was, you know, in hopes that more money would come down the pipeline, even if it was serving an underserved population, it doesn’t do any good for me to serve an underpopulated population at the expense of my team, because then we serve nobody.

[00:10:11] And it just reminds me of this is what do you think this organization’s budget was for this conference? Astronomical. It was huge. They probably have a ton of money to spend, and they wouldn’t even help their people who were speaking, putting this conference on, get out there mm-hmm they wouldn’t help them house themselves. That is crazy to me. And it’s just so indicative of how low on the totem pole valuing healthcare in our country really is. 

[00:10:42] What’s the word that is in Atlas of the heart. That is not guilt and it’s not shame, but it’s like being wronged by somebody else. That’s how I feel.

[00:10:54] Transgressions. I don’t think that’s the word. That’s not the word, but but transgressions against you for sure. 

[00:11:00] Yeah. I was done wrong, but I also accepted it and I also like agreed to it. And it also, still felt gross. But. Like you said, that program didn’t go forward because you know that you are teaching others how you are going to be treated in some ways.

[00:11:23] So you weren’t gonna say we can do it for 10 and then later have to say, but we’re only gonna do it for 10 until a hundred patient, you know? Yeah. 15 patients go through and then we’re gonna do it for 26 and then we’re gonna do it for 36 and then we’re gonna do it for 56. That’s just, that’s just not realistic.

[00:11:42] Like people aren’t going to respond well to that. And you are probably never gonna see that money. Mm-hmm so I, that was part of my like argument of not wanting to do this was like, I am saying it’s okay to present for this crazy like I’m, I’m okay to say I pay to play and I was not okay with that. And I did not wanna be that person, but we decided that it was beneficial in certain ways.

[00:12:10] And we were excited about it though I still feel like it was wrong and they shouldn’t have programs like that. They were exploiting. Yeah, the presenters, I hope they paid panelists that they invited cuz I went to a panel and I planned to ask because I, I want to continue that conversation with this program, but I hope they paid panelists who were there was a trans man who was talking about giving birth. There was a trans woman who was talking about transitioning and healthcare support. And then there was a physician who runs a Euro office, like they work with trans health and she was, I think, at a university, they were doing studies and collecting data. And she was a physician. I hope they were paid . I hope the money that they were gonna pay me, went to them because I, I don’t want them to be Out by teaching me what I learned at that conference. And I know nurses think that it’s done differently. The fact that you were surprised means that this is a secret , this is not well known and it should be well known because I don’t think nurses should stand for it, but that would’ve taken like 25 30 presenters to say, mm, you can go to hell.

[00:13:32] Right. And so I don’t have access to those 30 presenters. They don’t let us know who’s been accepted ahead of time, maybe so that we can’t talk and be like, what’d you get? But in my trauma informed business model, I think that that’s okay. It, we should be able to be transparent about that stuff because it should challenge me as the business owner to be ethical and fair. Isn’t the word I want, but fair, ethical and fair. And yeah, sometimes we need to be checked about that and also That usually promotes excitement. If folks are paid fairly and they should be excited about what they get paid. And that’s what I share with the folks that I pay is I want you to be excited.

[00:14:20] I don’t want you to be doing this and resent it. Just like you would’ve resented that program in Massachusetts. That resentment would’ve crossed it into your client care. Totally. Right. Just like just like biases do, like, we don’t want ’em to, they do mm-hmm so yeah.

[00:14:34] That was a downside, but I have a new perspective going in I’ve never had in a conference before and it’s so it’s, it’s fucked up. I mean, it’s cool to see like these different parts of it. Like, I was an attendee to conferences when I was a student. I think I went to like small ones, local ones when I was a nurse. And then. The pandemic was like a perspective shift for everyone. And now as a business owner, a trauma informed business model business owner, as I’m trying to be, I have made changes in my business that have not been modeled to me and done that with a team where we’ve had to like, figure it out and think like, how do we be transparent?

[00:15:21] How do we be ethical? How do we be fair? And I didn’t see a lot of that. But like, I went to go talk about trauma-informed care, so I shouldn’t have expected to see it. I just saw that there were missing pieces of information, like you said, communication. 

[00:15:39] And, there was no welcome committee. There was no meet and greet. There was no communication about where you should check in, who the other speakers were, there was no camaraderie around helping speakers actually meet other speakers. So all your speakers are your change makers in this industry. These are the people who have the goods. These are the people who are talking about these progressive subjects that we want to be on the loud speaker. Yet this organization being a national organization, having national reach didn’t take the opportunity to intentionally put all their change makers in a room and say, here’s your magic dust that we just sprinkled on. Go change the world. Right. Instead it almost seems. And who knows if this was, you know, really behind kind of their actions, but it almost seems intentionally they kept you apart. Maybe they didn’t want you to talk about who was getting paid, what maybe they didn’t want you to talk about X, Y, and Z. But in my opinion, a better approach would have been to put all of your change makers and your speakers in a room at least a couple times throughout this conference to say, You guys are the go-geters you guys are the golden child.

[00:16:52] You guys are the people who have the means and the resources and the willpower and the brains to do this and to move our industry forward. We gave you no agenda. We just wanted you to have three hours to talk amongst yourselves, to network, to get to together, to get to know one another. And that mark was really missed, I think, with this conference.

[00:17:14] Yeah, for sure. And the magic sprinkle is like food just feed us. Just, just like put some food there. That’s simple, real simple. And a show of respect and a show of appreciation, which would be very small. Yeah. And, and I’ll give that feedback, like, I’m happy to give that feedback. I expected it because I’ve seen it at other conferences, but maybe these conference leaders hadn’t been to other conferences outside of nursing.

[00:17:41] And I think that’s an important distinction. So if there are presenters that are listening that want to learn about conferences, go to a conference outside of nursing. Level up your standards so that we can all level up standards for each other inside of nursing, because I’m doing that. And now when I’m asked to present, I ask what’s your anti-racism plan for your company, and what’s the required education that everyone has to take. Who’s teaching inclusivity and gender expansive language in your company. Who’s in charge of marketing and who am I gonna be talking to about my intellectual property.

[00:18:17] Right? I have to be aware of that. A business owner and an online face, an online business, I have to be aware of like, how are you using my intellectual property? Who’s gonna see the video. Where is it going? How long do you have access? I want someone to read the contracts with me so that I know because you have to have your own back.

[00:18:35] So I think it’s interesting to see it from all perspectives and very, very helpful, and also helps me in my business and moving forward with other presenters business leaders, it was all very, very helpful. I got to see posters of folks that I wish I could meet in person. I was like, where are these people?

[00:18:54] I want them to be like, I wanna talk to you. Yeah. So there’s some email follow up that’s gonna happen. It was cool. It was cool to share space and to share energy with other people that was really cool and different. We haven’t seen it. We were all masked.

[00:19:09] We didn’t get COVID. There was very little COVID spread within the whole conference, which I was very impressed with. Okay. And we didn’t like eat together which is probably why. Yeah. I would’ve done love to have done more of that. 

[00:19:26] Give me, COVID let me eat with these people. 

[00:19:28] Oh, I don’t want COVID. I do want like, yeah. I like the round table places that I could be in where I could speak to others one on one. So it was cool to be a presenter and nurses would come up and talk to me. Yeah. Even in the Starbucks line, they would come up and be like, thanks for your presentation. I was there. I was like, Hey, who are you?

[00:19:47] They’re like, oh, I’m a nurse educator. I live in Iowa. And I really liked your presentation. This is what I’m trying to do. And just like see each other and just be like, oh, that’s badass. Like, that’s so great. A nurse came up to me and said, after my presentation on stir ups are restraints, which was really fun.

[00:20:04] It doesn’t sound fun cuz it’s restraints but it was, it was fun. They came up and they said, I want to be an advocate for my patients. I teach them all of these things that you’re saying. I teach them all the information I have, what I have is for them. And you know, she was echoing all of the things that we had just talked about.

[00:20:26] Teaching them, listening to them, hearing their story, being open to where they’re at learning about their goals and advocating for what they want and really trying to center them in a system that just doesn’t do that. And it’s not modeled. You don’t see that. And I was like, that’s great. And she said, well, my frustration is that they still go along with whatever they’re told to do. And so I don’t tell them what to do. I ask what they wanna do. I give them options. I support their answers and I, you know, am with them for like, let’s, I don’t know, let’s try this new thing. Let’s try the, what do you think? And I give them opportunity and I was like, yes, that’s amazing do it.

[00:21:07] And she said, well, when a provider comes in, they get told and they say, this is my recommendation. We need to do this. Whether it’s manipulative or not, or like super direct, they just come in and they’re like, this is what we’re doing.

[00:21:22] And she said, the patients do it. And I’m like, no, no, you don’t have to do it. I’m here, like all this work and all this time and all this education and all this like patient centering that the nurse has done, she was like, it gets washed away. They just do what they’re told and she was upset about it. And she said, what do we do?

[00:21:46] And this was in my role play. Like we had a patient in my role play who finally just turned over and put her legs in stir ups. And I was like, yeah, I know that that happens. It happens all the time. And I tried to just open her perspective to, you know, one of the hardest parts about being a nurse is that we don’t get to see the outcome of our work.

[00:22:06] We don’t get to see what they go do at home. We don’t get to see that they educate their whole family on what we taught them. We don’t get to see what difference we made in their lives. We don’t get to see what happens later. We don’t get to see the end. And I said, what if you’re the first person to ever give them so many choices. They really felt in charge the whole time you were taking care of them, which could be 12 hours. Yeah. And she was like, yeah, that sucks. That’s what I wanna do. That’s who I wanna be. And I was like, yeah, but not the first one. We want this to be normal. We want this, we teaching our children to expect this right.

[00:22:40] To level up their expectations and what respect looks like. And she’s like, of course. And I said, Would you expect your child to then implement everything? You just taught them in one day, in one of the most difficult tests they’ve ever encountered. And she was like, oh, well, no. I mean, that’s really hard.

[00:23:05] And I said, it could be the first time that that patient feels it from you learns it from you. Gets modeled it because you get so many interactions with your patients, you get to be like, what do you think? I’m listening to you. Let’s do what you think. how’s your body feel? Let’s respond to that. You get so many opportunities for that.

[00:23:23] So it’s a lot of learning and a little bit of time over the lifespan. But then when someone in power, I was like, they’re wearing a coat. They’re the doctor. We’ve all been told to do what the doctor says. The family’s saying, do what your doctor says. The doctor’s saying, do what your doctor says. there’s only so much that we can do in the middle of that.

[00:23:42] I said your, their choice is not your responsibility, but what if they make that choice, they decide to go with what the doctor does. Cuz that’s what everyone’s saying. That’s what everyone’s saying. But inside it’s the first time that it feels really wrong and she’s like, oh, I hope so. But I don’t hope so.

[00:23:59] Right. And that is when things change in their life. And that beyond is when they say. I’m not gonna let someone talk to me like that, or I’m gonna listen to my gut because my gut told me that that was a weird decision. And then I did it and then it responded that was a bad decision. What if you listened earlier to yourself and they move forward, teaching their kids how to listen to their gut and how to listen to what their body is saying and how to ask questions and push back to authority or perceived authority in those situations. And she’s like, okay, that’s totally good enough for me. 

[00:24:37] It’s a lot, it’s a lot to think about overhauling, such a dysfunctional system, 

[00:24:43] right? It’s a socialization too. Yeah, it’s not a healthcare system issue. It’s socialization that everyone has told them that the doctor’s always right. And the doctor kind of takes that position of power and feels a responsibility to give answers and to give these are my professional opinions and, you know, you have these two choices that they can see.

[00:25:06] That are kind of subjective. They’re based on a lot of education and experience, but they’re also kind of subjective. You’re gonna get different answers with different physicians, right. And not every physician is like that. And not every provider is like that, but it is so common that that is the, that is the barrier that I get after presentations.

[00:25:21] Like this is like, they still choose what they’re told to do. I’m like, of course they do. They’ve done that for 25 years. Like we did that until we stop doing that. We still do that when we break or when we’re vulnerable or when we 

[00:25:39] in a new situation and you don’t know how to advocate for yourself.

[00:25:41] We’re thinking about our baby. We’re told these things kind of are manipulative or coercive. So it was a cool conversation. And one that I really valued having in person that was really cool. It was really cool. So I will be doing more conferences. I really like it. And the nurse conference loop is, needs work. Just like nurses.

[00:26:10] Nurse culture needs work just like healthcare system needs work. So yeah, I like that. I appreciate that you tied those together in a way that’s super understandable and makes me feel less like I really got taken. I really feel like I came out with a lot, but we did put a lot into it. Money, time, resources, all that.

[00:26:28] And it just goes to show how trauma informed foundational care trauma informed lifestyle education really is a powerful, like compass for how to be treated and how to treat others and how to just think about who are we prioritizing? Who are we centering and listening to? What could possibly be viewed by our actions? Instead of like our intent’s good.

[00:26:57] We, you know, everyone should be so thankful to be here. It just, it it’s, it’s everywhere. It’s mirrored in everything. And I see it everywhere. Even, even at that big fat conference that yeah. Yeah. We went to as a, and that new perspective was super cool. So I’d love to hear if others are thinking about taking their topic and going out to conferences and starting to apply, or even local conferences. There’s a bunch and you know, getting your feet wet in that new territory. I would love to talk about that on this podcast. So find our little form on pulse check dot podcast on Instagram, fill it out. And we’ll have you to talk about it. Have some coffee with you on our show. Thanks for this cool little Q and a hehe.

[00:27:47] Yeah, this was awesome. And look playing devil’s advocate. I think there’s a space of transition where. You know, it happens in every industry. You’ve gotta teach the world and the industry and the leaders of that industry. What is now expected of them as our world grows and continues and as kind of roles change.

[00:28:08] So nurses are leaving bedside. They aren’t gonna be able to speak at conferences for free because this is now their income. And I think there is this gray area where people like you, and I maybe do have to take a conference or two or a handful for free or low fee or for maybe like trades of goods and services type things until we can teach the industry what is the new norm and what now is expected of them to ensure that everybody has you know, Quality of life due to fair compensation, and that people are really being compensated for their expertise, because as much as the leaders of this national conference, probably think that they could all get online on stage and teach I think it’s very apparent that they need nurses from around the country and around the world to truly put this event on. And hopefully in the years to come, the people who are speaking will be compensated for their time and expertise. 

[00:29:06] Yeah, for sure. Equitable compensation. Right? That’s the word I was trying to think of that whole time equitable. That really feels good. Hehe and you’re right. Thanks. 

[00:29:15] yeah, this was fun. Oh my goodness. As always, you guys, if you have a story that you’d like to share with us, if you are a woman or gender expansive person in medicine, we would love to hear your story. Come on here and tell us about what it’s like working within the halls of an American hospital until next time. We’ll see you later. Bye. Bye..