Alison:
They get this tunnel vision on what they’re doing. And it’s not that they don’t understand the ABC’s, like that wasn’t driven home in their education. A lot of times when you stop them and say, Hey, they’re desatting. Is the bath as important as their saturation and brain function and those types of things? And then they go, Oh, and that light goes on and then they stop.
Nacole:
The transition from the classroom to the bedside is hard. No matter how well you do in nursing school, there’s still a lot to learn on the job, even for me, and I’ve been in critical care for over nine years now. Luckily, we have nurses like Alison, who act as preceptors. They help us to continue our education without ever compromising patient care. But just two weeks into their preceptor program, Alison and her team got floated to COVID units, and they faced a whole new level of challenges. My name is Nacole Riccaboni. I’m a critical care nurse working in Florida and your host for SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT is sponsored by the Robert Wood Johnson Foundation. Follow us on Instagram at shiftnursing, and for more awesome stories and real talk about nursing, head over to our website at shiftnursing.com. One final note: This episode was recorded in mid-July, and things with COVID might have changed between now and then. Let’s dig in….
Nacole:
So Alison, I understand that you moved to the COVID unit for a little bit in the spring. Did you feel like that was a choice or how did that come about?
Alison:
Yeah, so it was actually around like mid to end of March that they kind of approached us as a whole, the unit, and just kind of let us know that we would be stopping elective surgeries. And that’s exactly what my floor does, is orthopedic and neuro surgical care post-op, completely elective. And so that is when they kind of approached us, said that we would be stopping those procedures and would be floated, which is a word we use where we go as needed to whatever floor. And majority of the time, that means that COVID units were, you know, what they were requiring us to work on.
Nacole:
Okay. So there was no other option besides that.
Alison:
Not really. Obviously we also have a med surg floor, but they also have full-time nurses working on those units as well as the rehab floor. So as needed, we would go to those floors as well, but because of the high need on the COVID units, we were going there quite frequently.
Nacole:
Now did you have some nurses that worked on the surgical floor that did not want to go to the COVID and wouldn’t go?
Alison:
A hundred percent. We definitely had nurses who were apprehensive, not wanting to, I had lots of germaphobes that work on our floor, and they were not excited about going. I also had some PRN nurses, and they weren’t getting their hours. It was just full-time nurses that were really getting the majority of the hours. And so they were not really wanting to work on the COVID floors and kind of excited that they didn’t really have the opportunity.
Nacole:
They’re like, I don’t want it anyway. So forget it.
Alison:
Exactly. They’re like, perfect. We’ll stay at home and be safe. I’m like, ah…
Nacole:
Oh Lord. Now, what type of training did you guys receive once you floated there, if any?
Alison:
Well, minimal training. I would say, obviously, we had these things in the morning called huddles, and it was kind of like 15 minutes before the shift change at like 7:00 AM, where they’d have both night and day shift there so that we could kind of educate everyone as a whole. And that’s when the chiefs would kind of be there, letting us know numbers and new protocols that were rolled out. We also had a booklet that would update with actual, like hard copies of instructions, like how to swab, you know, do the appropriate swabs. And, you know, proning was something that they went over, which is when you’re laying on your stomach. And so like those types of education pieces.
Nacole:
Did you feel like you were prepared with those resources available to you?
Alison:
There was still anxiety surrounding, because I just feel like every day there were new protocols being rolled out. So of course, there was still anxiety, and with it changing and there being so much unknown, I still didn’t feel fully prepped, but I don’t think that even still, we know everything about this virus at this time.
Nacole:
For sure. Even, even now when I go to work, I, I feel like I have all the information that’s available, but there’s still a huge gap in what we should know. And the information changes, like you said, from day to day. So what might’ve worked two weeks ago doesn’t work now. And I could see nurses being frustrated with that process of, the rules are changing so fast. How do I know that I am truly, actually safe? And what’s going on if the rules change next week?
Alison:
Exactly.
Nacole:
They said that you were a preceptor. How did that go?
Alison:
Oh my goodness. Yes, I was preceptor.
Nacole:
That was a big, deep breath.
Alison:
Yes. A huge sigh. Well, I signed up to precept, obviously, prior to us really, fully knowing about COVID-19. I’d signed up months before things were really… Before March, I kind of was saying, Yeah, sure. I’ll precept. And then was, you know, initiated in my preceptorship with these two nurses, two separate nurses. One that was a new grad, fully new to the entire experience of nursing at bedside. And then one who had had experience, and so needs a little less hands on, but focusing on unit specifics, provider preferences and just the facility protocols that we were focusing on with her. But still, you know, needing hands-on somewhat during their education. So I signed up to teach them, had a couple of weeks on our post-op floor. And then we were told as a unit that we would be transitioning to where we were needed. And that was when we all kind of were very, very anxious just about the entire process, just because it would be a new situation for me, and then also teaching and relaying things to them in a way that they can understand.
Nacole:
Now, did you feel that it was hard training a person with experience and then the new grad, how did you kind of bounce that around?
Alison:
Yeah, it was a very interesting situation, because I got to see on either ends of the spectrum, with a nurse who had very little experience at bedside and then one who had, you know, a variety of different areas that she had practiced in. And so just kind of navigating the ways that they learn best was definitely challenging. Like, the one who had experience had understanding of how she learned best, you know, she was an auditory learner. So us saying things aloud, obviously hands-on, doing it herself. But also helping the new grad figure out the best way that she learns at bedside was something that we had to navigate around.
Nacole:
And you’re doing that while working. I couldn’t imagine trying to do that while they’re working. It’s one thing when you’re doing it in the classroom. It’s another thing when you’re doing it on the job.
Alison:
Exactly. It’s a whole other can of worms because you’re balancing what these patients are needing at bedside, what the nurse is needing to drive those skills to home, and so that she can practice in the future on her own.
Nacole:
And how did you feel from day to day, dealing with the COVID patients while you were kind of precepting?
Alison:
Well, I still had, you know, apprehension about being on the unit, just because of, you know, usually my focus points are healthy surgical patients that have just undergone an elective surgery. So these patients are still, you know, highly acute situations. But with this being more of like a respiratory, cardiac situation, it was just very interesting for me to transition and focus on those pieces of education for the nurses rather than, you know, early ambulation, anticoagulant therapy, you know, just kind of rerouting my education points to fit that unit.
Nacole:
What did you show the nurses when you were their preceptors? Was this like task-oriented or kind of education background regarding the disease process or kind of both?
Alison:
Both. Definitely both, just all-encompassing so that they have an understanding of why doing what they’re doing. I think that is one of the most imperative things when you’re teaching, is explaining the why behind what you’re doing, so that you can educate the patients in a way that they understand. And that way they’re going to be more compliant with what you’re teaching them.
Nacole:
Cause so many nurses tell me, like, I didn’t know, what you were asking me to do was so important. If you would have told me the why, I would have understood and done it. Not that it’s, I’m not going to do it versus I’m going to do it, but, I understand where you’re coming from. I know how important it is if you share that information with me from the beginning.
Alison:
Exactly. And I think prioritization for nurses, especially new grad nurses, is something that you need to drive home. You know, you have so many things on your plate to do, having the understanding of how to prioritize your care is going to make you a better, successful nurse and practice as safe as you possibly can.
Nacole:
That’s so true. We had a COVID patient, and the new nurse was giving her a bath, and we’re like, She’s desaturating quickly, stop the bath. And she’s like, no, no, no, but I have to finish. And we’re like, listen, just stop what you’re doing. Sometimes people get really fixated on tasks, and they don’t see the full picture. And it’s like, it’s hard to articulate but airway breathing circulation is a very essential thing, even now don’t ever lose that in the whole task orientation process.
Alison:
A hundred percent. I feel like they get this tunnel vision on what they’re doing. And it’s not that they don’t understand the ABC’s, like that wasn’t driven home in their education. A lot of times when you stop them and say, Hey, they’re desatting. Is the bath as important as their saturation and brain function and those types of things? And then they go, Oh, and that light goes on and then they stop. So it’s helping them understand what is priority at that time, and also how to do it on their own and critically think through that process. Lots of hurdles to overcome, obviously with the seasoned nurse, there were things that she had ingrained in her, like protocols that she had hung in her head. And I’m like, we do it a little bit differently on our, you know, here or there. But really, I mean, just the challenges of having a new grad too, with not having as much knowledge base at bedside. She had lots of textbook, and it had also been a few years since she had graduated. She had kind of pursued another form, another career, she was waitressing. So just kind of reorienting her to nursing in general. And then obviously bedside, because textbook nursing and bedside nursing is different.
Nacole:
I was a server too. You take some of those skills and kind of put them in the nursing, but it is different. But yeah, serving is, I did that too.
Alison:
Oh my goodness. Serving is an amazing, amazing job for before you’re nursing or during nursing, because you learn so many customer service skills.
Nacole:
Multitasking. Yeah.
Alison:
Oh my goodness yes.
Nacole:
I loved it.
Alison:
Yes. I used to waitress.
Nacole:
You too? I learned so many things from being a server.
Alison:
Oh, a hundred percent. And then dealing with hungry people and sick people, I mean, it’s very different, but at the same time, so similar.
Nacole:
So similar. Now, when you were in the COVID unit, how was your relationship with the hospital administrators? Did you have any issues regarding PPE or the education process?
Alison:
So, at least with the education process, there were things, like I said, changing daily and lots of uncertainty and chaos at the beginning. But I would say, they were in the morning, like doing that huddle every morning with us, our chief nursing officer kind of pumping us up in the morning, letting us know how much we were appreciated, Positivity. They were like making us, when we were gowning, we’d all check each other and make sure that we were gowning appropriately, all of us nurses.
Nacole:
Teamwork, I love it!
Alison:
Yeah! And they went around and would take photos of us with like signs from patients and administrators that wrote, like, Oh, we appreciate you. And just like little positive statements. So that was kind of something that they did to pump us up, give us some positive feedback.
Nacole:
Before you go into the battlefield.
Alison:
And reinforcement. Exactly.
Nacole:
Because you need that!
Alison:
You do. You definitely do. And that kind of inspires that camaraderie. And that’s why I love working for a community hospital is because you know everyone, and there’s definitely teamwork involved and necessary to get this job done. You’ve got to have a good team, and communication is key in order to have that good patient outcome.
Nacole:
Right now in Florida, we’re kind of in the middle of the second wave, and I kind of saw that Nashville numbers were going up too. How is it, you know, in your hospital currently with the whole COVID cases?
Alison:
Yes. So we are currently experiencing what we believe to be the beginning of the second wave. My chiefs have told us to kind of get prepared for the second wave. We are back open, I should say, on our elective surgery floor, and, you know, swabbing patients for COVID pre-op and obviously before they leave to another facility. So that is something that we’re doing, but there’s been whispers that we are going to either decrease our numbers and capacity for the elective surgeries or stop them altogether. There’s been absolutely no confirmation on that. No release, no dates or real statements, but that’s just kind of been whispers. So our nurses are kind of expecting to hear something here in the next week or so, updates on that.
Nacole:
And like you said, there aren’t, there aren’t any official kind of coming out, but you know, little whispers, little hums people are talking.
Alison:
Exactly. And I think as other facilities release statements, that’s when we start to see our hospital do the same. It’s like once one does something, they all kind of try to follow suit.
Nacole:
Yeah. Nobody wants to be the first person though. They want to be like the second or third.
Alison:
Exactly. A hundred percent. Putting their hands up, I don’t want to be the first one.
Nacole:
No, I’ll be the second or third, but not the first. Now I know a lot of nurses are feeling burnt out with the COVID. Have you, has that happened where you’ve worked at?
Alison:
Yes, I would definitely say nurse burnout is just something that is to be expected in very high-anxiety work environments. For sure. I mean knowing how to cope appropriately, getting good sleep, exercise, balanced diet is essential to decrease that burnout and workforce issues. So we’re definitely experiencing it and trying our best as a facility to kind of positively enforce our other units that are taking care of COVID right now.
Nacole:
Now, do you feel that preceptors play a role in kind of helping to prevent the burnout?
Alison:
A hundred percent, I would say that preceptors have a vital role in helping nurses understand what works best for them to decrease their stresses in this new environment that they’re in. Being that mentor, helping them understand, you know, it’s okay to take a break, to step away. It’s great to have that mentor to like talk with, even after work, to decrease our anxiety and stress, chat over kind of what happened that day, the things that went well, the things that went bad, things that we were angry, upset about, sad. Just having people to talk with that have gone through similar situations or have been there during that situation can really help. And just making sure that it’s the right job for them, that they’re transitioning well, helping them find out their strengths and weaknesses, that can also help kind of with decreasing that burnout.
Nacole:
Now, did you feel that your support role was different as a charge nurse versus a preceptor, or were you kind of doing the exact same thing?
Alison:
It’s different. Charge nurses, we really help focus on like the flow of that unit. Like I said, we help with like admissions and discharges. Yes, we are still a mentor and resource for the entire unit. But as a preceptor, I feel like the majority of my time is focused on that one person. So similar, but still, the role kind of shifts to direct your attention and time and responsibility to that one nurse, and obviously their patient load.
Nacole:
Oh for sure. Because their patients are your patients, I’m assuming? You have to check their work and make sure everything’s going okay?
Alison:
We have like the same patient load. So if they’ve got five patients, I’ve got the same five patients and I’m helping oversee that care, either going into rooms with them, or if we’re trying to decrease the PPE usage and I don’t think that it’s medically necessary for me to be in there, you know, for instance, I’ve got to go to the bathroom, maybe necessarily I don’t have to go in there with them when they’re taking that patient to the bathroom. If we’ve already seen them get up, they’re not reporting increased shortness of breath, their vital signs are stable, and I don’t think that there’s going to be a change in status during that round, then of course, having them go in alone to decrease the PPE usage was something that we did.
Nacole:
Look at you being a good steward.
Alison:
Right? So, but obviously, not doing that every single time, understanding when is appropriate and when is not. Because that is something that is key to help make sure that the student or preceptor understands that, you know, you have a resource here at all times, even if I’m not in the room with you.
Nacole:
Now, is there anything else that you want to share at all?
Alison:
I suppose, at least with my background, I think it’s always important and paints a huge perspective on why people became a nurse. I think that shares a lot about who they are. So I guess, like how I got into nursing. I, from a really early age, saw nursing from a whole other perspective with being a family member of someone who was receiving care. So we did end of life care and like home health nursing at my house, my mother and father were amazing people and had their mother and fathers at home. So I got to see nursing on that side of things and had such a great, like just saw so many great things that nurses were doing, and that they were making the largest impact with my grandfather and grandmother’s care, and helping us transition was just one of the greatest things to see. So that’s why I chose nursing. I had, obviously, lots of experience with seeing doctors and physical therapists and all interdisciplinary team members, but it was nursing that I felt like had the largest impact on my family’s outcomes. So that’s at least why I chose nursing.
Nacole:
It’s so funny how you, how you mention that, because you know, I was involved in a drunk driving accident when I was in elementary school, and the nurses there were so nice to me, and I feel like that experience made me want to be in critical care. But you never know what’s going to touch you, but when it does, you just know that it’s meant to be, and that’s what you want to do for the rest of your life.
Alison:
Exactly.Those events in your life really, definitely impact your passions and next steps in your life. So I think, for sure, that it has an influence, and it’s just inspiring to hear people’s story on the why behind why they’re doing what they’re doing.
Nacole:
Now, what is your vision for the future of nursing?
Alison:
The vision for the future of nursing? I hope that communication is definitely still driven home, that it’s an imperative aspect of our care, communicating with everyone on the team. Sometimes I think we forget that even though we’re taking care of the patient, there’s four or five other people who are involved. And I think that also decreases what you’ve got to do as well. It kind of prioritizes what you’re doing versus, you know, making sure that you call dietary and say, you know, can you come up here and explain to the patient why they’re on this carb-restricted diet, kind of go over things. Cause it takes a little bit of a load off of you without passing the buck. Cause you never want to pass the buck, but it also, they’re going to focus on points that maybe you wouldn’t have.
Nacole:
For sure, for sure. Alison, thank you so much for this wonderful interview and for taking the time to kind of share your story with us.
Alison:
Well Nacole, thank you so much for the opportunity to actually share my story. It’s been an absolute pleasure speaking with you.
Nacole:
Yeah, same here. I had such a great time.
Alison:
Thank you. Have a great one.
Nacole:
You too. Take care.
Nacole:
Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT Talk is sponsored by the Robert Wood Johnson Foundation. To learn more about our guest and hear more nurses talk about the important issues we’re all facing right now, visit our website shiftnursing.com. And please subscribe, rate and review SHIFT Talk wherever you get your audio content from. Until next time, stay safe and keep being awesome!
