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Expert to Novice Again: Starting Over as an Attending, Student & a "Soft" Nurse · Banter At The Bedside

• 0:06
  SPEAKER_02: Hi everyone and welcome back to Banter at the Bedside.
• 0:10
  SPEAKER_02: We are here this week to talk about new beginnings.
• 0:14
  SPEAKER_02: There are so many times in healthcare that we start new journeys, we make the jump late in our career, or we're forced into a transition that we've been training for the whole time, like becoming an attending.
• 0:27
  SPEAKER_02: Sometimes we even decide to go back to school and change course fully.
• 0:32
  SPEAKER_02: So we're here today with three co-hosts that are all experiencing their new beginnings in different ways.
• 0:39
  SPEAKER_02: As always, I'm Abby.
• 0:40
  SPEAKER_02: I'm one of your main co-hosts.
• 0:42
  SPEAKER_02: I've been a nurse practitioner for eight years, and I'm the one that's going to be representing what it feels like to be left behind for our friends.
• 0:50
  SPEAKER_02: As always, we're joined with Kaylee, our other main co-host, a nurse of 18 years, most of that in the ICU.
• 0:59
  SPEAKER_02: Hey everybody, welcome back.
• 1:00
  SPEAKER_02: Kaylee has transitioned into her soft nurse era, as they are saying online, and gone from the ICU to the oncology clinic.
• 1:12
  SPEAKER_02: So we'll hear more about that in a minute.
• 1:14
  SPEAKER_02: We're joined again, it's been a minute, with Allison.
• 1:18
  SPEAKER_02: She was a nurse of five years in the ICU, and she's made the transition from being a bedside nurse to going back to school and becoming a perfusionist.
• 1:28
  SPEAKER_02: So not just a new beginning in terms of going back to school, but a whole different field of practice.
• 1:34
  SPEAKER_02: Welcome back, Allison.
• 1:36
  SPEAKER_02: Hey, thanks for having me back.
• 1:37
  SPEAKER_02: Good to be here.
• 1:38
  SPEAKER_02: And finally, we're joined with one of our favorite doctors and one of your favorite doctors, Dr.
• 1:45
  SPEAKER_02: Armando.
• 1:46
  SPEAKER_02: And he has been in training for 14 years, and that is finally done.
• 1:51
  SPEAKER_02: And he's here to talk to us about what it feels like to be an attending finally after all of that hard work.
• 1:58
  SPEAKER_02: A new beginning that's inevitable and probably comes with a lot of good and maybe a little bad.
• 2:05
  SPEAKER_02: We'll see.
• 2:06
  SPEAKER_02: Welcome back, Armando.
• 2:08
  SPEAKER_00: Hey, hi, everyone.
• 2:09
  SPEAKER_00: Glad to be here.
• 2:10
  SPEAKER_02: So before we dive in, just a few of our disclaimers.
• 2:13
  SPEAKER_02: As always, this is not medical advice.
• 2:16
  SPEAKER_02: We these are our thoughts and opinions of our own.
• 2:19
  SPEAKER_02: Make sure you seek the care of your own medical professional.
• 2:22
  SPEAKER_02: And we don't represent any entity at all.
• 2:25
  SPEAKER_02: Again, these are our thoughts and our own opinions.
• 2:28
  SPEAKER_02: And we are all recording from the comfort of our own homes because that is how we have honest conversations in the safety of our home.
• 2:37
  SPEAKER_02: So welcome back, everyone.
• 2:41
  SPEAKER_02: I'm so glad to see y'all.
• 2:42
  SPEAKER_02: I know.
• 2:43
  SPEAKER_02: I haven't seen you in forever.
• 2:44
  SPEAKER_02: I know.
• 2:45
  SPEAKER_01: I think it's flying around.
• 2:47
  SPEAKER_02: Yeah.
• 2:48
  SPEAKER_02: And you made all of you.
• 2:50
  SPEAKER_02: You did.
• 2:51
  SPEAKER_02: You even you went so far as to move states away from us.
• 2:54
  SPEAKER_02: It wasn't on purpose.
• 2:56
  SPEAKER_03: I mean, yes and no.
• 2:58
  SPEAKER_03: It was a forced purpose.
• 2:59
  SPEAKER_03: It was a forced purpose going back to school.
• 3:01
  SPEAKER_03: How many how many proficient schools are there?
• 3:05
  SPEAKER_03: Not many.
• 3:06
  SPEAKER_03: There's like a lot of new ones that keep opening.
• 3:08
  SPEAKER_03: I think it's somewhere around the range of 20, maybe right now.
• 3:11
  SPEAKER_03: 15 to 20 something.
• 3:13
  SPEAKER_02: Not that many.
• 3:14
  SPEAKER_02: Not that many.
• 3:16
  SPEAKER_02: So it was I I say this, but then I was like her letter of recommendation to the school.
• 3:22
  SPEAKER_02: So sometimes it's like, Yeah.
• 3:25
  SPEAKER_02: You could have said bad things about me and you did.
• 3:27
  SPEAKER_02: I could have said bad things and lied about you.
• 3:31
  SPEAKER_02: Yeah.
• 3:31
  SPEAKER_02: No.
• 3:32
  SPEAKER_02: I wanna hear first from Armando because becoming a new attendee is inevitable, right?
• 3:39
  SPEAKER_02: Like that's the whole goal.
• 3:40
  SPEAKER_02: You can't stay in training forever.
• 3:42
  SPEAKER_02: So, what has that been like the last couple of months?
• 3:45
  SPEAKER_02: Being on your own, not being in the learner mode, but still, I'm sure learning every day.
• 3:52
  SPEAKER_00: I mean, it's been pretty exciting.
• 3:54
  SPEAKER_00: I I will say also kind of scary at times, but overall pretty good.
• 3:59
  SPEAKER_00: Definitely, you know, coming out of so many years of training, you feel pretty confident, I think so, as a doctor, to sort of take care of patients.
• 4:07
  SPEAKER_00: But you know, one thing is sort of being a doctor, being a leader, and then another thing is kind of being a boss or sort of having to run that sort of position of also having to run the practice and kind of run the daily flow of patients.
• 4:23
  SPEAKER_00: So that has been a bit a big, big adjustment for me, which I don't think there is a specifically kind of time in our training careers that we sort of focus on that uh aspect.
• 4:33
  SPEAKER_00: But overall it's been pretty good.
• 4:34
  SPEAKER_00: I have a good mentor with me who's kind of has shown me, you know, the everyday uh nuances of running a practice and kind of being being on top of your front desk or or being on top of your nurses, uh, especially now that I'm doing some sort of outpatient practice as well, which I'm enjoying.
• 4:52
  SPEAKER_00: Uh and and yeah, it's it's scary but exciting.
• 4:56
  SPEAKER_00: But I think I'm I'm I'm taking it pretty okay.
• 5:00
  SPEAKER_02: I have no doubt you're taking it.
• 5:02
  SPEAKER_02: I sure you are.
• 5:03
  SPEAKER_02: I bet those nurses are so happy to have you there.
• 5:05
  SPEAKER_02: And the patients.
• 5:06
  SPEAKER_00: Well, they they definitely are pretty happy of having a a an ICU sort of doctor because keeps things moving and keeps the day going kind of smoothly.
• 5:16
  SPEAKER_02: So you and Kaylee can probably answer this right now.
• 5:19
  SPEAKER_02: Allison's our student, but you guys are Dr.
• 5:23
  SPEAKER_02: Armando and Kaylee, you both went from ICU very fast, very high acuity ICU to outpatient life.
• 5:32
  SPEAKER_02: How's that transition?
• 5:34
  SPEAKER_02: You go first.
• 5:36
  SPEAKER_02: Me?
• 5:36
  SPEAKER_01: Yeah, I go first.
• 5:38
  SPEAKER_01: It has been a breath of fresh air, honestly.
• 5:42
  SPEAKER_01: Nobody's more shocked than me that I'm saying that.
• 5:46
  SPEAKER_01: I I can't even describe it.
• 5:49
  SPEAKER_01: It's so nice, it's much lower stress, and I've really, really enjoyed it so far.
• 5:55
  SPEAKER_01: So, how do you think?
• 5:58
  SPEAKER_01: Me?
• 5:58
  SPEAKER_01: Yeah.
• 5:59
  SPEAKER_01: Just over a month.
• 6:00
  SPEAKER_01: Okay.
• 6:00
  SPEAKER_01: I wasn't sure yet.
• 6:01
  SPEAKER_01: So I mean it's it's fresh, but I mean, I would give it a 10 out of 10 so far.
• 6:07
  SPEAKER_01: Love.
• 6:09
  SPEAKER_00: I couldn't disagree with that.
• 6:10
  SPEAKER_00: Is it has been pretty, pretty great.
• 6:13
  SPEAKER_00: I mean, the the working hours, especially the low stress environment, definitely I I have come to like that.
• 6:18
  SPEAKER_00: Also, I do want to say I do kind of miss all this sort of teen workout, like like very teen work, and and everyone kind of knowing their roles from from top to bottom and sort of not having to kind of you know teach new nurses about new things that they might be encountering every day or not.
• 6:38
  SPEAKER_00: So I do miss that.
• 6:39
  SPEAKER_00: I feel ICU nurses for the most part, you know, they know so much and kind of keep you also uh on the go and kind of taking care of patients.
• 6:47
  SPEAKER_00: And I feel you feel way more confident when you're in the ICU unit with ICU nurses.
• 6:52
  SPEAKER_00: For me, being outpatient, you know, had have run into some situations that you know not all your the nurses there are are are trained the same way or have encountered those things in their lifetime.
• 7:04
  SPEAKER_00: So having to sort of say, like, hold on, you don't know how to do this?
• 7:09
  SPEAKER_00: Okay, let me step back and kind of put my teacher ahead and kind of think like how I'll be used to do this or how Kaylee used to do this.
• 7:17
  SPEAKER_00: I'll be like, all right, calm down here.
• 7:20
  SPEAKER_00: You know, I think that for me has been a really, really, really wake-up call.
• 7:24
  SPEAKER_00: Like, oh man, I I gotta also do some some teaching bedside for my nurses now.
• 7:29
  SPEAKER_00: I've been spoiled in other ways.
• 7:30
  SPEAKER_00: Yeah.
• 7:31
  SPEAKER_00: For many years.
• 7:32
  SPEAKER_00: Yeah.
• 7:32
  SPEAKER_02: It is very standardized, like education and the ICU or orientation, whereas it's not always the same, probably outpatient or the the background isn't always consistent.
• 7:45
  SPEAKER_02: So I could see that.
• 7:47
  SPEAKER_02: But do you guys miss the adrenaline?
• 7:49
  SPEAKER_03: I mean, yeah, going back to school is like I don't know, it's just two different worlds.
• 7:55
  SPEAKER_03: Because I mean, it's like I'm not working, but I am because I'm a full-time student.
• 7:59
  SPEAKER_03: So it's also going from where I was a preceptor and teaching people a lot of things.
• 8:04
  SPEAKER_03: It's like I know a baseline of stuff that we're being taught, but real reality, I don't know anything.
• 8:10
  SPEAKER_03: So it's like back to underrated amount of information.
• 8:15
  SPEAKER_03: And it's like, can I just go take care of a patient really quick?
• 8:18
  SPEAKER_03: Uh-huh.
• 8:20
  SPEAKER_02: Actually, if if you want to know, that's actually I can pull up a diagram if you give me a moment to show you what you're experiencing.
• 8:32
  SPEAKER_02: Like I have research on what you're experiencing.
• 8:36
  SPEAKER_02: And you all might be experiencing it.
• 8:38
  SPEAKER_00: Great.
• 8:39
  SPEAKER_00: Tell me, because I don't have a name for it.
• 8:40
  SPEAKER_00: So so so how is it to sort of change that mindset?
• 8:44
  SPEAKER_00: Because I've been in training for so long and now it's like thinking about training, learning, and kind of having the everyday mindset of going to work and but your sort of training.
• 8:53
  SPEAKER_00: How how is it for you to sort of be like, I'm independent, I'm working, I'm kind of just getting it done and taking care of people and now kind of switching back your whole sort of train of thought on how to comport, you know, how to input new information in your brain.
• 9:09
  SPEAKER_00: How, how, how is that transition?
• 9:11
  SPEAKER_03: It's a lot different because like, you know, I'm used to just, you know, go to your 12-hour shift and I know what I'm gonna do.
• 9:17
  SPEAKER_03: And then if I have questions, you know, I can go ask somebody.
• 9:20
  SPEAKER_03: But now it's like I've structured class time and then I have to be on top of myself outside of class to like make sure I'm studying to know the information.
• 9:30
  SPEAKER_03: And then like sometimes they'll be saying someone's like, oh, I know that from the ICU.
• 9:34
  SPEAKER_03: And then we go like 10 steps further, and it's like, I did not know that.
• 9:37
  SPEAKER_03: So it's it's like I didn't know how much I didn't know.
• 9:40
  SPEAKER_03: Seriously, it's like a little wake-up call.
• 9:42
  SPEAKER_03: It's like I felt like pretty confident and smart, not saying I'm not, but then it's like, here's this other wealth of knowledge you may not have ever known.
• 9:50
  SPEAKER_03: You may have, but learn this and then all this other new stuff.
• 9:53
  SPEAKER_03: It's a lot of new stuff.
• 9:55
  SPEAKER_01: I bet.
• 9:55
  SPEAKER_03: But it's fun too.
• 9:56
  SPEAKER_01: Well, you also have age on your side where you haven't been out of school that long.
• 10:01
  SPEAKER_01: So, yes, you've been a nurse for five years, which is still a long time.
• 10:05
  SPEAKER_01: But I think you probably have a bit of an advantage going back to school versus somebody who's been out for a decade plus.
• 10:11
  SPEAKER_03: Like a middle age of like my group of classmates.
• 10:14
  SPEAKER_03: So it's like we have some that just came straight out of undergrads, some that have worked for a few years, some that have worked for 10.
• 10:20
  SPEAKER_03: So it's like we have a wide range of everything.
• 10:23
  SPEAKER_02: I can't find my PowerPoint, but this is it.
• 10:26
  SPEAKER_02: So this is what you're experiencing is the novice thing.
• 10:31
  SPEAKER_02: Okay, so it's the novice thing.
• 10:34
  SPEAKER_02: Yeah.
• 10:35
  SPEAKER_02: Um novice to expert continuum.
• 10:38
  SPEAKER_02: So you move up to like an expert somewhere.
• 10:41
  SPEAKER_02: So all of you were the experts where you just were, right?
• 10:45
  SPEAKER_02: Like you three were go-to's for us within our team.
• 10:49
  SPEAKER_02: Um, and then, but this is a continuum, and so you can go from an expert to novice at any point.
• 10:58
  SPEAKER_02: And so you've all gone from expert, and I'm not saying Dr.
• 11:02
  SPEAKER_02: Armando is still not an expert.
• 11:04
  SPEAKER_02: He is, he's spent 14 years of training, but he's a novice, as he touched on, in running a clinic and running the business of medicine.
• 11:15
  SPEAKER_02: So this is that experience, and so it's always a back and forth here, and so it's actually been studied, that's what it is.
• 11:22
  SPEAKER_02: Yeah, I've seen this before.
• 11:24
  SPEAKER_02: Mm-hmm.
• 11:25
  SPEAKER_02: It's very talkative.
• 11:27
  SPEAKER_01: It's very talked about, it's very widely studied.
• 11:30
  SPEAKER_01: Yeah, I mean, it makes sense.
• 11:32
  SPEAKER_01: It it's very weird to go back to the other end.
• 11:36
  SPEAKER_01: It's also like for me, I will say it's not exciting, but it is kind of nice because I'm like, I haven't really learned something new in a long time.
• 11:46
  SPEAKER_01: So it is nice to to learn something new that's completely different for me, anyways.
• 11:51
  SPEAKER_01: Yeah.
• 11:52
  SPEAKER_00: I mean, I've I feel that continuum is gonna be my entire life.
• 11:56
  SPEAKER_02: I I don't know if at some point you feel like that, but it's yeah, it it is it is always a continuum.
• 12:03
  SPEAKER_02: I have to tell my NP students all the time.
• 12:06
  SPEAKER_02: I'm like, they're like, but I'm I I was the person and now I feel so dumb.
• 12:10
  SPEAKER_02: And I'm like, you're not dumb, like you're just a novice again.
• 12:13
  SPEAKER_02: And that's really hard to go from being the person to oh wait, I'm not the person right now.
• 12:21
  SPEAKER_02: But I have faith that you guys will be the person again.
• 12:25
  SPEAKER_02: It just takes.
• 12:26
  SPEAKER_00: I do want to say in this continuum of being a novice, like I'm definitely a novice being a boss and running a practice and all that you know, that sort of thing.
• 12:35
  SPEAKER_00: But it's it's a very unique feeling because you are a novice in those terms for everyone around me, at least all my staff, they know I'm kind of new, right?
• 12:45
  SPEAKER_00: But at the same time, you bring, you know, you bring some expertise from a different environment, right?
• 12:50
  SPEAKER_00: And right, and they get excited too, right?
• 12:53
  SPEAKER_00: Like, like they they go like, look at this guy, I'm teaching him how to tell me that I need to keep my schedule, my you know, my everyday schedule, and fill patience, fill the roster with patience every day or whatnot, but then he's teaching me how to you know prepare an ED2 or something and kind of set up and organize a crash car better.
• 13:12
  SPEAKER_00: So I don't know what are you experiencing that, Kaylee, where you have like other maybe junior nurses that never work in the ICU and they're learning like how to get an IV quicker or something like that.
• 13:23
  SPEAKER_01: We don't be doing IVs.
• 13:25
  SPEAKER_01: When I say Kaylee's in her Okay, they can do an let me just say this.
• 13:30
  SPEAKER_01: We can put an IV in.
• 13:31
  SPEAKER_01: Most of the time they're gonna just gonna go to infusion and do it.
• 13:34
  SPEAKER_01: But they had to do one one time and they were like, Do you care if I go do it?
• 13:38
  SPEAKER_01: I'm like, go ahead.
• 13:39
  SPEAKER_01: They're like, I had it done by while I'm like, please do it.
• 13:42
  SPEAKER_01: But no, like for us, we're not doing like I don't take a vital sign, like the techs do that.
• 13:48
  SPEAKER_01: They sway them, like we have to do QCs on the glucometer and have a defibrillator check.
• 13:54
  SPEAKER_01: I can get I can do that all day long.
• 13:56
  SPEAKER_01: Um Kaylee we do a couple procedures in the clinic sometimes and I assist, but I might take a picture of something to put in the chart or here, roll on your side.
• 14:08
  SPEAKER_01: Like I can't do that.
• 14:09
  SPEAKER_01: You're living the dream daily.
• 14:12
  SPEAKER_00: You're living the dream better than me, I guess.
• 14:15
  SPEAKER_01: I am, and I have really enjoyed being in the novice role again because there is just something after the last few years of my career on CICU some joy of not being the person that everybody asks every question to.
• 14:31
  SPEAKER_01: Now I can punt it to somebody else or be like, you know what, I'm new, I'm gonna have to confer with my preceptor.
• 14:38
  SPEAKER_01: And I can I can scoot it right along.
• 14:40
  SPEAKER_01: You don't have that weight on your shoulders anymore.
• 14:42
  SPEAKER_01: No, I mean, that has been nice personally.
• 14:46
  SPEAKER_01: It's been a long time, I can imagine.
• 14:49
  SPEAKER_00: What are you doing to fill the gap in your life?
• 14:52
  SPEAKER_00: Like now having, I mean, I guess you're not working 12 hours shifts anymore.
• 15:00
  SPEAKER_02: Okay.
• 15:02
  SPEAKER_01: So since you Armando's like, wait, he's like, of note, when I was on the floor, I was part-time, and now I pick up extra shifts, but I only work two shifts a week.
• 15:15
  SPEAKER_01: So now I'm in a full-time position.
• 15:16
  SPEAKER_01: So I am going into the clinic five days a week for now, just because we're not fully staffed.
• 15:22
  SPEAKER_01: Hold up.
• 15:25
  SPEAKER_01: Yeah, it's a clinic.
• 15:26
  SPEAKER_01: I'm saying I'm so I'm in the office in the clinic every day, but I'm not seeing patients every day.
• 15:31
  SPEAKER_00: Okay, I see.
• 15:32
  SPEAKER_01: Different physicians see different see their patients in the clinic different days.
• 15:36
  SPEAKER_01: That's how they fit them all.
• 15:37
  SPEAKER_01: So on Thursdays and some Fridays, we see patients.
• 15:40
  SPEAKER_01: The other days are just helping or doing our administrative stuff.
• 15:44
  SPEAKER_01: But I'm actually working more hours than I was before.
• 15:47
  SPEAKER_01: But it feels like I'm working less.
• 15:49
  SPEAKER_01: Like my body doesn't hurt, my back's not broken.
• 15:55
  SPEAKER_01: And I'm not a nights, so I'm getting a steady sleep schedule.
• 15:58
  SPEAKER_01: And so it's less time at home, Armando, but it feels like more almost.
• 16:03
  SPEAKER_01: It's like I come home every day, I have a schedule, I can see my kids, we can go do something in the evening, I can get a workout in.
• 16:09
  SPEAKER_01: I'm sleeping.
• 16:10
  SPEAKER_01: Do you get my holidays off?
• 16:12
  SPEAKER_01: Yes.
• 16:12
  SPEAKER_00: Yeah, it's not enough.
• 16:13
  SPEAKER_00: I got labor day off.
• 16:14
  SPEAKER_00: No costs.
• 16:15
  SPEAKER_00: I figured not.
• 16:16
  SPEAKER_01: I got labor day.
• 16:17
  SPEAKER_01: No weekends, holidays.
• 16:19
  SPEAKER_02: You both just had lay all of you had labor day off without using PTO.
• 16:23
  SPEAKER_02: What was I did have to use PTO, but it's eight hours, like whatever.
• 16:27
  SPEAKER_01: You know what I mean?
• 16:28
  SPEAKER_00: Do you do you know, talking about PTO?
• 16:30
  SPEAKER_00: It was so funny when I was signing my contract.
• 16:32
  SPEAKER_00: You know, they they say you need you have this X amount of PTO days.
• 16:35
  SPEAKER_00: In my mind, I'm still thinking a resident.
• 16:38
  SPEAKER_00: I'm kind of counting weekends as PTOs.
• 16:40
  SPEAKER_00: And my wife is like, dude, dude, you have like four weeks of vacation.
• 16:44
  SPEAKER_00: I'm like, what it makes it doesn't count.
• 16:46
  SPEAKER_00: Count Monday, you know, Sunday and Saturday, it doesn't count.
• 16:49
  SPEAKER_00: It's like, welcome to the real world out of training where you don't have to work every Saturday or every Sunday.
• 16:55
  SPEAKER_00: That was me.
• 16:56
  SPEAKER_00: That was so nice.
• 16:58
  SPEAKER_00: It is nice, it is nice, very nice.
• 17:00
  SPEAKER_02: What does it feel like for you guys to have a more set schedule?
• 17:04
  SPEAKER_02: Because the hospital isn't very set at all.
• 17:07
  SPEAKER_02: And there's rotating and nights and weekends.
• 17:10
  SPEAKER_02: And how does it feel to be kind of know what every week's going to look like for the foreseeable future?
• 17:16
  SPEAKER_02: Kind of nice.
• 17:17
  SPEAKER_03: It's awesome.
• 17:18
  SPEAKER_03: Like if I want to make plans, I know what day or time I can.
• 17:22
  SPEAKER_03: Not that I have time because I should be studying, but it's like I can even schedule in my own time where I'm not studying my me time.
• 17:28
  SPEAKER_03: And I'm like, hey, I can do something every Saturday at this time if I want to.
• 17:31
  SPEAKER_03: And nobody's gonna call me and say, hey, we're short staffed, come work.
• 17:35
  SPEAKER_03: Cause it's just you're at classes and you study.
• 17:38
  SPEAKER_01: Yeah, I mean, I have flexibility within my hours because if it's not a clinic day and I'm just helping, like I've already been able to enjoy this thing where I was like, I have to go to a doctor's appointment.
• 17:50
  SPEAKER_01: They're like, just come in after.
• 17:52
  SPEAKER_01: Or I gotta leave and go to this appointment because it's the only time they can get me.
• 17:55
  SPEAKER_01: Okay, we'll see you when you get back.
• 17:57
  SPEAKER_01: Easy peasy.
• 17:58
  SPEAKER_01: So yeah, like there's there is like a built-in like schedule, but there's also enough flexibility where it's like, if I need to change something, I can, but it's not gonna be this unknown thing.
• 18:07
  SPEAKER_01: And if there is, like somebody has to go out, everybody, the nurses all gather around and we just talk about who's gonna cover for them and it's done.
• 18:15
  SPEAKER_01: Wow.
• 18:16
  SPEAKER_01: That's it.
• 18:16
  SPEAKER_01: It's amazing.
• 18:17
  SPEAKER_00: I that's I I'm in the same page for me.
• 18:20
  SPEAKER_00: Was for example, I like to go to shares on Sundays and you know, being in training, I there was some Sundays I couldn't go.
• 18:26
  SPEAKER_00: I volunteered on Sundays too, so some like a outpatient clinic, a PCP clinic here, and uh, there were some Sundays I couldn't go.
• 18:33
  SPEAKER_00: So definitely, at least for my end, having some sort of control of you know, at least Sundays, Saturdays for the most part, I'm off.
• 18:40
  SPEAKER_00: So it has opened a whole gamma of my life.
• 18:43
  SPEAKER_00: Like, you know, I'm going to I'm having an international festival coming up in October where I'm gonna cook and bring some local cuisine from my hometown and things, you know, that I I didn't knew I like to do those things, but not since I have a very predictable schedule, I found myself enjoying way more little things than definitely being in training for that long.
• 19:08
  SPEAKER_01: Yeah.
• 19:09
  SPEAKER_01: I really love the predictability of my are you I mean, obviously it's Monday through Friday, but are you working overall less than you were in the hospital?
• 19:19
  SPEAKER_00: Hundred percent.
• 19:20
  SPEAKER_00: Yeah.
• 19:21
  SPEAKER_01: So it's not hard for you to adjust to being a Monday through Friday.
• 19:24
  SPEAKER_00: No, and I can I can I can sort of speed up my days because I'm I do have some procedures during my days, so like some procedures go quicker, some procedures take longer.
• 19:33
  SPEAKER_00: So you you find out that the more skill you get, you know, that's my novice part of it when I was kind of very slow doing new things and kind of having that ICU mentality where everyone is so sick and like this this person was just laughing with me just before coming in for this procedure, you know.
• 19:50
  SPEAKER_00: So I'm like trying to change with like cannot lighting or doing something more minimal, invasive, as as would it be at the in the ICU, and to also consider the nursing in the ICU, right?
• 20:02
  SPEAKER_00: Like my n you know, in the ICU, you know how you go and you know do an ultrasound or something, and you know, the nurses they look at you, patient just kind of bad, he was nice, all you know, covered and all this stuff, and then you leave it all uncovered full of jungle and all those things.
• 20:16
  SPEAKER_00: So, like, my nurses are not that picky neither.
• 20:20
  SPEAKER_00: So, also on that flip of the side, you know, I'm being so like cleaning, helping, moving the patient, and the nurse, like, yojo, slow down.
• 20:27
  SPEAKER_00: You know, I I've uh yeah, because we don't come here and say, hey, I'm here by the hour.
• 20:32
  SPEAKER_00: I don't want to quick, I don't want to finish to quick the day.
• 20:35
  SPEAKER_03: Those nerd grabbings say like clean your mess up.
• 20:37
  SPEAKER_03: Yeah, yeah.
• 20:38
  SPEAKER_02: Those nerds are probably like whacking your hand, like stop it.
• 20:41
  SPEAKER_00: This is every day, yeah.
• 20:43
  SPEAKER_00: Every day, you know what they call me?
• 20:45
  SPEAKER_00: They call me the golden retriever.
• 20:47
  SPEAKER_00: You know, sometimes I'm like so so like these, they're like they're saying, like, oh, the golden retriever is it's he wanna play today, I guess.
• 20:54
  SPEAKER_00: So they have to like shut the door or like don't call me too ahead of time and things like that.
• 20:58
  SPEAKER_02: Because I just you do get those vibes though.
• 21:01
  SPEAKER_02: You are a golden retriever.
• 21:02
  SPEAKER_02: I can't believe we didn't call you a golden retriever, to be honest.
• 21:06
  SPEAKER_02: Honestly, that's totally what he is.
• 21:08
  SPEAKER_02: It's so accurate.
• 21:09
  SPEAKER_02: He is, he is so Abby and I are black cats, but until you get to until you get to know me, and then I'm like, Yeah, hey, then I'm like, I'm gonna cuddle you constantly.
• 21:21
  SPEAKER_03: You're you're a little golden.
• 21:23
  SPEAKER_02: Mm-hmm.
• 21:24
  SPEAKER_03: You're like 70-30.
• 21:26
  SPEAKER_02: When uh I'm like a rescue golden, like a little bit of trauma.
• 21:31
  SPEAKER_03: You gotta have your trust set in first and then you can blossom.
• 21:35
  SPEAKER_01: Yeah, and I'm very mistrustful of good things or people being super nice to me like that doesn't make sense.
• 21:42
  SPEAKER_02: See, I think though Armando, what you're talking about, is like one of my biggest fears of like leaving the ICU of like, what would I do?
• 21:51
  SPEAKER_02: Like, I feel like I would like I don't do boredom well.
• 21:56
  SPEAKER_02: Like, we're on this podcast because I couldn't Not having something to do after my doctorate.
• 22:04
  SPEAKER_02: Like I literally came up with this idea for our podcast and I love it.
• 22:09
  SPEAKER_01: But but the truth is many people, including our therapist, saying, you should not fill all your time with work at problems.
• 22:17
  SPEAKER_03: It was like the week after you got done with your doctorate.
• 22:19
  SPEAKER_03: You were like, I am bored, what can I do now?
• 22:22
  SPEAKER_02: Yeah.
• 22:23
  SPEAKER_02: Like I that is a big fear of mine about leaving the ICU.
• 22:26
  SPEAKER_02: Is like I I worry I would be bored.
• 22:30
  SPEAKER_02: Because I'd find something to do.
• 22:31
  SPEAKER_02: Have you met yourself?
• 22:32
  SPEAKER_01: I feel that though.
• 22:33
  SPEAKER_01: I feel that.
• 22:34
  SPEAKER_01: That's what I I was worried for years about that.
• 22:37
  SPEAKER_01: Like, would I be bored?
• 22:39
  SPEAKER_01: You know, could I just and you know, I just got to the point where I was like, I would love to I would actually love to be bored at some point at work because it's just gotten so crazy over the past few years.
• 22:50
  SPEAKER_01: And you know, it's nice to have some boredom to offer.
• 22:55
  SPEAKER_00: When you say got crazy in the past few years, how many years are we talking about?
• 23:00
  SPEAKER_01: I mean the last two or three years, I feel like I don't I'm haven't sat down when I was working.
• 23:04
  SPEAKER_01: I mean, at least on Dacia.
• 23:08
  SPEAKER_01: And you know, like I used to be able to like take a good break or like you could at least leave your pod to talk to somebody.
• 23:13
  SPEAKER_01: And I'd I just felt like over the past few years it was like more and more work, sicker patients, less help.
• 23:19
  SPEAKER_01: And there was just you know, it was like very heavy, heavy work all around for me.
• 23:25
  SPEAKER_01: And that could be part of just, you know, I'm getting older too, and it maybe it's not as easy.
• 23:29
  SPEAKER_01: But I know that a lot of the nurses that have been there for a long time have said the same thing about like the patient loads.
• 23:35
  SPEAKER_00: Do you think your priorities in life have changed to the point that now you're facing the fact that you're spending longer hours and then you're saying, like, damn, I wish I had more time to do this, or you know, being able to take my son for a food game football game or something in that line?
• 23:52
  SPEAKER_01: I mean, I have plenty of time off, but my sleep schedule would be kind of crappy.
• 23:56
  SPEAKER_01: And then, you know, with like my kids and stuff, it wasn't I I would go long stretches without seeing them.
• 24:02
  SPEAKER_01: So I think I just got to the point where I was like, I want to prioritize a job where I'm not gonna be physically unwell and like injure myself.
• 24:09
  SPEAKER_01: I don't want to be constantly stressed, I don't want to dread going in, and I would like to have a more consistent schedule with my kids.
• 24:16
  SPEAKER_01: So maybe a little change in priorities.
• 24:18
  SPEAKER_01: And I needed something full-time, but I was like, I cannot do full-time on the floor, like I just can't.
• 24:23
  SPEAKER_01: So yeah.
• 24:25
  SPEAKER_00: I wanted to dedicate more time to my wife, 100%.
• 24:28
  SPEAKER_00: I admit it.
• 24:29
  SPEAKER_00: You know, I was at some point I remember telling my wife, man, I just want to be able to go consec like a couple weekends back to back and be able to do something with you, you know, without having to concentrate on fellowship or you know, prepping for Monday or getting back to review a 24 patient lease just before you you go to work next day.
• 24:51
  SPEAKER_00: So for me, it has it was all about priorities in life.
• 24:54
  SPEAKER_00: I can agree with that.
• 24:56
  SPEAKER_01: Do you guys feel like just lighter in general from being a little bit more away from the super traumatic stuff that we would have to deal with all the time?
• 25:04
  SPEAKER_01: I mean, Alison, you've been gone the the longest.
• 25:07
  SPEAKER_01: Do you feel like your mental health has been better at all because of that?
• 25:11
  SPEAKER_01: Because I I do.
• 25:12
  SPEAKER_03: Yeah, I mean, honestly, I think it'd be like a mix of that and I mean, not even just the patient load and just like the work environment of itself.
• 25:21
  SPEAKER_03: Like, am I gonna be floated?
• 25:22
  SPEAKER_03: Am I gonna have to be orienting?
• 25:24
  SPEAKER_03: Am I in charge?
• 25:25
  SPEAKER_03: So it's like I think it's a mix of all those things, not having to deal with like traumatic patient things and just the environment is just it's different.
• 25:34
  SPEAKER_03: So it's it's relaxing to not have to deal with that.
• 25:36
  SPEAKER_03: Like, even whenever I was still doing my travel at my job, like I would just go and do my job, not be involved in any of like the hospital drama because I'm not staffed there.
• 25:45
  SPEAKER_03: So that was like a different like stress relieving where I was still involved with the possible like patient scenarios, but then it's like I could still go away from it, so definitely less stress overall.
• 25:58
  SPEAKER_01: See, Abby.
• 26:00
  SPEAKER_00: I mean I'm telling you I think it would be really in an administrative role.
• 26:08
  SPEAKER_00: I miss the camaraderie of the ICU though.
• 26:12
  SPEAKER_00: It kind of felt like going to battle every day and sort of, I mean, I guess good way, that way.
• 26:19
  SPEAKER_00: Yeah, you always have somebody there to help you.
• 26:23
  SPEAKER_00: Correct.
• 26:23
  SPEAKER_00: And like, you know, at the end of the day, while working right now, kind of everyone goes to their own lives, you know, take care of their children or do something else.
• 26:32
  SPEAKER_00: Or so I don't know.
• 26:33
  SPEAKER_00: I do I do kind of miss that.
• 26:35
  SPEAKER_00: So I'm trying to change that when I'm working right now.
• 26:38
  SPEAKER_00: Trying to make some karaoke nights or something like that.
• 26:40
  SPEAKER_00: So we can create a lot of people.
• 26:41
  SPEAKER_03: I'll come to a karaoke night.
• 26:43
  SPEAKER_03: He's like, I'm trying to bring people together.
• 26:45
  SPEAKER_03: I feel like part of that too is like just like the traumatic events in the ICU, it kind of like bonds us in a way because it's like we're the only people that see this stuff.
• 26:53
  SPEAKER_03: So it's like we get so close with our coworkers then.
• 26:56
  SPEAKER_03: So then when you go into like an outpatient setting, everybody just you know goes, does their work, sees their patient, and then they go home.
• 27:03
  SPEAKER_03: So it's not to me, I wouldn't see it as being close as close knit.
• 27:07
  SPEAKER_01: Yeah.
• 27:07
  SPEAKER_01: Now I will say the setup for us, we all sit together.
• 27:11
  SPEAKER_01: Now, if everybody's back at work, like if nobody's out, like if you are just doing office stuff, you can go in a like a little room in the back.
• 27:18
  SPEAKER_01: But like we all sit together, and so you're with them all day, like at a central nurses station, which is really nice.
• 27:25
  SPEAKER_01: So I I kind of felt the same way, like it's just gonna be like passing, but you're together a lot and you're talking about, you know, personal stuff or whatever, if you have a little downtime.
• 27:35
  SPEAKER_01: So I felt like it's a good team and it's not very disjointed, and everybody is kind of integrated.
• 27:41
  SPEAKER_01: They do a lot of like dinners after work that people go to and stuff like that for like reps and things.
• 27:46
  SPEAKER_01: And a lot of them seem like they're friends outside of work.
• 27:48
  SPEAKER_01: So that was one of the things that really made me want to work there when I shadows.
• 27:52
  SPEAKER_01: Everybody seemed like they were friends and like they hung out outside of work.
• 27:57
  SPEAKER_01: So it was very similar to like a CICU that way.
• 28:00
  SPEAKER_02: That's good.
• 28:01
  SPEAKER_02: I think I do hear a lot of people when they're thinking about taking that leap and starting something new, and then they end up not, well, I really love my coworkers.
• 28:10
  SPEAKER_02: Like I don't really like what I do much anymore, but I really love my coworkers, I really love my team.
• 28:15
  SPEAKER_02: And so I feel like that can be a hard leap if you don't know what kind of team you're jumping into.
• 28:21
  SPEAKER_02: Very true.
• 28:23
  SPEAKER_02: Yeah.
• 28:24
  SPEAKER_01: You know, I I kind of said like I've been looking for a while, but I was trying to be picky because I wanted to find something that scheduler wise would work, like not set myself up for something else where I don't like the scheduler.
• 28:36
  SPEAKER_01: Whatever.
• 28:37
  SPEAKER_01: But I was like, you know, I feel like if I like my job, that's a bonus.
• 28:41
  SPEAKER_01: If I can find a job that works for me, like that's my priority.
• 28:44
  SPEAKER_01: And like luckily it's in both.
• 28:47
  SPEAKER_01: So good for you.
• 28:48
  SPEAKER_01: I don't know.
• 28:49
  SPEAKER_01: Good for you.
• 28:49
  SPEAKER_01: Parents don't often get the luxury of I think really loving their jobs, but if you find one that works and you like, I feel like that's a a bonus.
• 28:57
  SPEAKER_01: Like it's just great.
• 28:58
  SPEAKER_01: Yeah, absolutely.
• 28:59
  SPEAKER_02: Has there been a moment, Armando, where you've been like, Wow, I'm the attending?
• 29:05
  SPEAKER_02: Like, was there like a first kind of moment where you were like, oh wow, like I'm the I'm I'm an attending?
• 29:11
  SPEAKER_02: Or was it just kind of like finally I'm here?
• 29:14
  SPEAKER_00: Yes, there was a time I do I did had an emergency during a case, a very bad emergency, and you realize that you have to kind of run the code, but at the same time teach people that are not used to running a code and kind of bring them down to the level of listen up, get this, get that.
• 29:34
  SPEAKER_00: I think my reflection at the end of the day, you know, after passing on, signing out to the EMS and so on, you know, I came back and debriefed with the team and then went back to my office.
• 29:45
  SPEAKER_00: And I had this sort of like five-minute moment where I found myself unable to write a note.
• 29:50
  SPEAKER_00: Just I couldn't, I was like, damn, I'm I'm a real attending.
• 29:55
  SPEAKER_00: Like you're the adult that they look for in charge.
• 29:59
  SPEAKER_00: Yeah, I I'm in charge.
• 30:00
  SPEAKER_00: And then I I was trying to say, did I do something wrong thinking, would will my prior presentors, you know, my prior program directors, will de will they be proud of how I handled this situation?
• 30:12
  SPEAKER_00: And you start kind of you start judging yourself to some extent.
• 30:16
  SPEAKER_00: And and and you know, I I I never yeah, I after that I had like a whole week where I went on a on a on a rabbit hole of trying to improve the little things that could go better and whatnot.
• 30:29
  SPEAKER_00: And and I and that's the moment that I kept realizing, wow, I am the attending, and there's a lot of stuff that these people don't know that that I'm here to sort of fill that gap.
• 30:39
  SPEAKER_00: And yeah, that was like almost like three weeks of every day saying, Oh my god, I am an attending.
• 30:45
  SPEAKER_00: I'm the adult, I guess.
• 30:46
  SPEAKER_00: Yes, I am the real adult here.
• 30:48
  SPEAKER_00: And then I realized I'm not I'm actually not the youngest one either.
• 30:51
  SPEAKER_00: So I was like, it makes sense, it makes sense.
• 30:53
  SPEAKER_00: Yeah.
• 30:53
  SPEAKER_01: So that would happen on CICU.
• 30:56
  SPEAKER_01: It was like the end of their fellowship, and they're great, and they're like running the show and they're so confident, and then they come back, and it's been a few weeks, and they're the attending, and they're like frozen.
• 31:04
  SPEAKER_01: It's like just do what you've been doing, you're good.
• 31:06
  SPEAKER_01: But it's something about that like extra responsibility.
• 31:10
  SPEAKER_02: I I do remember when I was training as an NP, like I had a shift as a bedside nurse, and I like kept messaging the fellow about just give me five milligrams of IV Metoparols, every night fib.
• 31:23
  SPEAKER_02: This is a neuropatient, no heart failure.
• 31:26
  SPEAKER_02: Like, this is all I need.
• 31:27
  SPEAKER_02: Just do this, just do this.
• 31:28
  SPEAKER_02: And I was getting frustrated.
• 31:30
  SPEAKER_02: And then, like, two days later, I had a shift as an NP student, and it was a fib.
• 31:36
  SPEAKER_02: And I took like 20 minutes to figure out what to order.
• 31:40
  SPEAKER_02: And I was like, I'm like, what do I order?
• 31:42
  SPEAKER_02: And then I'm like, okay, I view Matoborol.
• 31:44
  SPEAKER_02: I'm like, wait, what's the dosing?
• 31:46
  SPEAKER_02: Oh my god, how much do I dose?
• 31:48
  SPEAKER_02: And I was telling one of I was telling my work wife at the time, she's like, You were literally, she called me out, and that's what I look for in a work wife.
• 31:55
  SPEAKER_02: She's like, You are literally complaining about it, fellow.
• 31:57
  SPEAKER_02: I think you should apologize to him because now you know that it's not that easy.
• 32:03
  SPEAKER_02: And I was like, You're right.
• 32:05
  SPEAKER_02: That was so hard.
• 32:06
  SPEAKER_02: Yeah, it's too much.
• 32:09
  SPEAKER_03: If you ordered it wrong, or like you ordered too much, then it's like the person they look at is you, so it's like you want to make sure you do it right for the patient.
• 32:17
  SPEAKER_02: But that there is, I think, sometimes that mentality switch is we're starting new roles, new jobs, new whatever that it is like I know stuff, but then I'm new, I don't know.
• 32:28
  SPEAKER_02: Do I know?
• 32:29
  SPEAKER_02: I don't know.
• 32:30
  SPEAKER_00: So uh it's just how your mind is thinking, how your brain is you're organized to think in this way, now responsibility changes, stakes are different.
• 32:41
  SPEAKER_00: Yeah, I just now you're the one of those moments.
• 32:46
  SPEAKER_02: Yeah.
• 32:47
  SPEAKER_02: Now you're the one, you don't have an attendee that's going to come behind you and you know, tell you yeah, you're nay on something.
• 32:54
  SPEAKER_02: Yeah, or Manda went this way, I went this way.
• 32:56
  SPEAKER_01: I was like, oh yeah, I can send it up the shape, and now you're at the top.
• 33:01
  SPEAKER_03: I mean, being in like a school setting, I do that like on tests.
• 33:05
  SPEAKER_03: Like I'll answer a question and then I'll psych myself out of it.
• 33:08
  SPEAKER_03: And then I have to be my own work why I get why's in my head because I'm taking a test.
• 33:11
  SPEAKER_03: And it's like, no, don't talk yourself out of what your gut knew was right because you went on a tangent or something in your brain of well, what if this happened and what if this happened?
• 33:20
  SPEAKER_03: Like, if you know it, you know it.
• 33:22
  SPEAKER_03: Mm-hmm.
• 33:23
  SPEAKER_02: That's right.
• 33:25
  SPEAKER_02: So how does it how does it feel?
• 33:27
  SPEAKER_02: How was that leap trend changing really kind of specialties, Allison, and deciding to go back to school full-time?
• 33:35
  SPEAKER_03: I mean, it it's definitely a transition for sure.
• 33:39
  SPEAKER_03: I mean, I had to do some prereqs, so I've been like kind of in class and in school throughout some time, but like they've not been on the level of what it is now.
• 33:47
  SPEAKER_03: So I mean, it was just really an aspect of can I apply myself in this setting?
• 33:52
  SPEAKER_03: And also like going from working full-time to not working at all.
• 33:56
  SPEAKER_03: So it's not even just for me, it wasn't just a mindset of can I do school.
• 34:00
  SPEAKER_03: It's like, can I find out a way to support myself to get through this school so I can see it through to the end?
• 34:05
  SPEAKER_03: Like I'm so used to living on an income that now I have to go back to student loans and all those lovely things.
• 34:12
  SPEAKER_03: So fun.
• 34:13
  SPEAKER_03: Student loans.
• 34:14
  SPEAKER_03: Yeah.
• 34:14
  SPEAKER_03: Yeah, it's like that's don't go out to eat as much anymore, can't have as like extra like you know, I get used to you get used to a certain like lifestyle, and like now it's like back to what I was 10 years ago when I went to undergrad for the first time.
• 34:27
  SPEAKER_03: So it's not necessarily I'm not saying a mind game, but you have to change your way of thinking of everything, not just work and school, if that makes sense.
• 34:37
  SPEAKER_01: And you know it's temporary, and when you're done and you're graduating, you'll be making, I'm assuming, a great salary.
• 34:44
  SPEAKER_01: So you're and you went back to school for something like pretty high stakes.
• 34:48
  SPEAKER_01: Like I mean, perfusionists, those patients are I mean, you you're putting them on pump and bypass.
• 34:55
  SPEAKER_01: Like, if you mess something up, you know, up to you.
• 34:59
  SPEAKER_03: I mean, honestly, every time in class, they're like, if something goes wrong, you're the first person they look at, whether it's you or not you.
• 35:04
  SPEAKER_03: So you gotta know yourself to say, like, no, this wasn't me because of XYZ.
• 35:09
  SPEAKER_03: Because if something goes wrong in a bypass case, who's the person they're gonna ask, but the person running bypass.
• 35:14
  SPEAKER_01: Are you guys just in like classroom settings or like didactic right now?
• 35:17
  SPEAKER_01: Or are you doing like a clinicals or what would you call them?
• 35:20
  SPEAKER_01: Like where you go and practice in person.
• 35:22
  SPEAKER_03: So we're in mostly didactics now, and we're doing like sim labs where we have like all the practice stuff.
• 35:28
  SPEAKER_03: Yeah.
• 35:29
  SPEAKER_03: And like next month, what is it?
• 35:31
  SPEAKER_03: Yeah, next month we'll start shadowing in the OR.
• 35:34
  SPEAKER_03: So we'll be doing just those three things until summer, and then we'll start going into clinical settings.
• 35:39
  SPEAKER_01: Are you excited about getting back into that?
• 35:41
  SPEAKER_01: Are you more nervous?
• 35:43
  SPEAKER_03: I am.
• 35:43
  SPEAKER_03: I mean, a little bit of both because like I'll get to be applying what I'm learning, but also it's just kind of scary going into like a new thing of was I learning the right way?
• 35:53
  SPEAKER_03: Did I absorb the knowledge right?
• 35:55
  SPEAKER_03: Is this preceptor gonna judge me?
• 35:57
  SPEAKER_03: Or am I gonna like detrimentally harm a patient because I'm not the expert anymore?
• 36:03
  SPEAKER_00: Those are the checks and balance of education that you put to yourself, right?
• 36:07
  SPEAKER_00: So yeah, you know, that's that's good.
• 36:10
  SPEAKER_00: That's I mean, that's necessary.
• 36:12
  SPEAKER_01: It's necessary and evil, I guess.
• 36:15
  SPEAKER_01: You have to have some confidence, but I think being humble is great.
• 36:20
  SPEAKER_02: A healthy dose of fear is always good, right?
• 36:24
  SPEAKER_02: Like it doesn't need to be too much.
• 36:26
  SPEAKER_02: But as we've learned on previous episodes, you don't want to fall prey to the Dunning Krueger effect.
• 36:32
  SPEAKER_03: Well, I mean, like, you know, when we were training our newbred nurses, we'd always tell them, like, if you're not if you're overly confident or you think you know it all, like that's when you get to be a scary nurse or a scary provider, is like you don't think you can mess up.
• 36:46
  SPEAKER_03: So it's like you have to know that you know what you're doing, but also like I can still make mistakes because I am human.
• 36:52
  SPEAKER_01: Yeah.
• 36:53
  SPEAKER_03: It's going to happen at some point.
• 36:56
  SPEAKER_01: Yeah.
• 36:56
  SPEAKER_01: I mean, if if I make a mistake, like bad things can happen.
• 36:59
  SPEAKER_01: Like, I don't want somebody to miss their surgery because I didn't do something right.
• 37:03
  SPEAKER_01: And like this is, you know, if it's a cancer patient, like that's a big deal.
• 37:07
  SPEAKER_01: But in the moment, if I make a mistake, it's not nobody's getting hurt, like a patient isn't being harmed, which is really nice.
• 37:14
  SPEAKER_00: That is very nice on my case as well.
• 37:16
  SPEAKER_00: Some sometimes sometimes I find myself like on tough situations, tough cases, and like in the ICU, they're sick, so you're trying to like solve the problem, or you know, bridge them to recover in the next six hours, or bridge them to see what happens in the next hours, and then make another decision.
• 37:33
  SPEAKER_00: Sometimes I still had that mentality, and it's kind of hard to say, hold up, I I fixed what needed to be fixed.
• 37:40
  SPEAKER_00: There's still things to be fixed, but patient is doing well anyways.
• 37:45
  SPEAKER_00: I can bring him back tomorrow or next week or two weeks later and finish the rest of the job.
• 37:51
  SPEAKER_00: So for me, that has been a big adjustment because I do I do two cases throughout the day.
• 37:56
  SPEAKER_00: So like if I stay for too long on a case trying to fix everything, then my whole day becomes very long, and then the nurses don't want to leave early and so on and so on.
• 38:05
  SPEAKER_01: Yeah, you can't keep them there late.
• 38:07
  SPEAKER_02: Then they're slapping your hand for another reason.
• 38:10
  SPEAKER_00: You know what they do?
• 38:11
  SPEAKER_00: They look at the clock.
• 38:13
  SPEAKER_00: They all start looking at the clock like that.
• 38:15
  SPEAKER_00: And I'm like asking for something, and they're all of them looking at the clock.
• 38:19
  SPEAKER_00: The clock is behind me.
• 38:21
  SPEAKER_01: It'll be four o'clock, or like the last it's the last page or something, then somebody'll be like, Can we just do blah blah blah blah blah?
• 38:28
  SPEAKER_01: And it's it's a big thing.
• 38:29
  SPEAKER_01: I'm like, uh uh.
• 38:34
  SPEAKER_01: I don't know.
• 38:35
  SPEAKER_01: I don't know about that.
• 38:36
  SPEAKER_01: Like I can't really say no yet.
• 38:39
  SPEAKER_01: But I'm curious, the people that you graduated with Armando, have you been keeping up with them?
• 38:44
  SPEAKER_01: Have they started their new jobs?
• 38:45
  SPEAKER_01: Is anybody like jealous of you?
• 38:48
  SPEAKER_01: Or are they like, oh, how could you not stay in critical care?
• 38:52
  SPEAKER_01: Like, what's the what's the response on that?
• 38:55
  SPEAKER_00: I think it's it's I think it goes back to priorities.
• 38:58
  SPEAKER_00: Some people, their priorities was to go out and make money.
• 39:01
  SPEAKER_00: And you know, truly, truly, as an ICU attendant, you can go out and make tons of money.
• 39:05
  SPEAKER_00: They don't care about work.
• 39:06
  SPEAKER_00: Some other people just wanted to have some quality time with their family members, wives, family, and so on.
• 39:14
  SPEAKER_00: So I think it depends on the priorities.
• 39:15
  SPEAKER_00: The people who graduated with me, most of them are in the ICU.
• 39:19
  SPEAKER_00: I would say 85% of them are already working in the ICU.
• 39:24
  SPEAKER_00: There's a few of them that are still sort of studying for boards or you know, they're about to start or having parent contracts that haven't been got, you know, haven't been signed and executed for them to start.
• 39:36
  SPEAKER_00: But you know, when I tell them about my life so far, because I went to I started on July 1st, like I finished June, I started right.
• 39:44
  SPEAKER_00: You know, I I I went from being a trainee one day on Monday morning, I was a full attendant.
• 39:51
  SPEAKER_00: So they just don't know because I do very something very specific, very niche, but but they kind of ask me a lot of questions like, are you sure you're getting this?
• 39:59
  SPEAKER_00: And you know, are you sure?
• 40:01
  SPEAKER_00: So I feel like there was a lot of unknowns outside of the ICU.
• 40:04
  SPEAKER_00: I feel a lot, a lot of the fellows, especially in the clinical care, that's all we know.
• 40:09
  SPEAKER_00: We know ICU, ICU, ICU.
• 40:11
  SPEAKER_00: And and you know, I do want to say shout out to my mentors after I did the fellowship where where they did tell me, at least half of them told me, sort of like, you know, look into outpatient too.
• 40:24
  SPEAKER_00: You gotta have a life as well, and try to create a balance early in your career.
• 40:28
  SPEAKER_00: And I think I took that to my heart and I have found it.
• 40:32
  SPEAKER_00: And I'm I'm building my ICU, I'm getting back to the to going back to the creek or girl world slowly.
• 40:38
  SPEAKER_00: Now that's full-time, but I definitely prioritizing more of an outpatient as my primary rather than the ICU as a full-time.
• 40:46
  SPEAKER_02: And I don't think that's bad, especially knowing you and your wife.
• 40:51
  SPEAKER_02: I think that that's beautiful for you guys.
• 40:53
  SPEAKER_02: And that I know she's gotta be happy getting you back.
• 40:56
  SPEAKER_00: Jeez.
• 40:57
  SPEAKER_01: I mean, it's like she's done it with you, right?
• 40:59
  SPEAKER_01: You know?
• 41:00
  SPEAKER_00: She's been with me since 2012.
• 41:03
  SPEAKER_00: Do the math.
• 41:04
  SPEAKER_01: Well, I just think that a lot of times in critical care, people have egos and they like to be able to say, like, oh yeah, I work in the ICU.
• 41:14
  SPEAKER_01: And like for me, it made me proud to say that because I loved our unit and I thought our unit was great.
• 41:18
  SPEAKER_01: But I don't think that makes me a better nurse than somebody who works on the floor or wherever else.
• 41:22
  SPEAKER_01: It was just like CICU was, you know, that was it.
• 41:25
  SPEAKER_01: Like it was the unit.
• 41:27
  SPEAKER_01: Um, and so that's what I had that like pride when I would say where I worked.
• 41:31
  SPEAKER_01: But I think a lot of people when they think about transitioning elsewhere, it's like, oh now I don't get to say I work in the ICU anymore, or I'm not doing like the hardest job.
• 41:40
  SPEAKER_01: But it ain't bothered me.
• 41:42
  SPEAKER_01: I'm like, yeah, I don't I'm working my what did you call my soft nursing?
• 41:45
  SPEAKER_01: That's what they call it online.
• 41:47
  SPEAKER_01: Soft soft nurse era.
• 41:49
  SPEAKER_01: I'm working my soft nursing job.
• 41:51
  SPEAKER_02: I guess Armando's in in his soft.
• 41:54
  SPEAKER_02: I don't know.
• 41:54
  SPEAKER_01: It sounds like it may not be soft medicine.
• 41:56
  SPEAKER_01: He's already coded somebody, like, dang.
• 41:59
  SPEAKER_01: I think our crash already has some dust on it.
• 42:04
  SPEAKER_00: It's a different, it's a different environment.
• 42:07
  SPEAKER_00: It's a different I will consider my soft era.
• 42:10
  SPEAKER_00: I I I like that term.
• 42:11
  SPEAKER_01: Yeah, I aren't my soft nursing era.
• 42:15
  SPEAKER_01: So, you know, I don't care how much hate I get, or if anybody wants to be like, oh, I can't believe you're doing that.
• 42:19
  SPEAKER_01: I'd be like, it's amazing.
• 42:21
  SPEAKER_03: I mean, you even said like, sorry, go ahead.
• 42:23
  SPEAKER_03: You I was gonna say you even said, like, you know, you're not doing the hardest job anymore.
• 42:27
  SPEAKER_03: But when you think about it, like even like in the medical world, it's like each position or role or scenario has its harder parts.
• 42:35
  SPEAKER_03: Like a lot of ICU nurses are like, I could never be a floor nurse because like they have four to six patients that are getting meds all the time, walking on in the bathroom.
• 42:43
  SPEAKER_03: I mean, your schedule might be the harder part for you, getting used to working five days a week.
• 42:47
  SPEAKER_03: So it's like you're just not doing the same thing.
• 42:50
  SPEAKER_03: It might not be that it it may be that it's like less, I don't know what I'm trying to say.
• 42:54
  SPEAKER_03: Like, not less like brain power, but like the hardest different way.
• 42:58
  SPEAKER_01: It's a different way of focusing, it's a different way of um using it, I guess.
• 43:02
  SPEAKER_01: Yeah, you know, it's a whole different skill set.
• 43:05
  SPEAKER_01: Yeah.
• 43:05
  SPEAKER_00: What about patient patient sort of per patient relationship?
• 43:10
  SPEAKER_00: I definitely the the type of relationships and conversations I get now with patients are a hundred, one hundred and eighty different from the ones that I would have getting the ICU.
• 43:20
  SPEAKER_00: So like I have yeah, I have this patient and you know, managed to like have a con she was doing fine, and we just had a normal conversation.
• 43:28
  SPEAKER_00: So I thought that was pretty neat as a change for me as well, that I'm having a different sort of connections with patients, uh time being, you know, starting from a happy moment, happy conversation, happy starter, finishing with a happy starter as well and a positive, you know, versus in the I series, like sometimes you know that starting conversation can be pretty rough.
• 43:50
  SPEAKER_00: And then you finish with even a rougher conversation.
• 43:53
  SPEAKER_01: So one of your I think meeting patients now, like how we would always say like that's the worst thing of their life because.
• 44:00
  SPEAKER_01: Because they're in the hospital and they're in the ICU.
• 44:02
  SPEAKER_01: And it's now you're meeting patients, and it's not the worst day of their life.
• 44:05
  SPEAKER_01: Now they're still coming in because they need help or they're sick, but it is a much different dynamic.
• 44:10
  SPEAKER_01: And then having them come back and like getting to know them and you know where they live and what their daughter, you know, does and all that kind of stuff.
• 44:18
  SPEAKER_01: It it is nice because you can kind of slow down a little bit and like have a little bit more of a connection to someone.
• 44:24
  SPEAKER_01: When I know some of the nurses are they'll be like, oh yeah, he's blah, blah, blah, blah, blah.
• 44:28
  SPEAKER_01: And they just know it.
• 44:29
  SPEAKER_01: They just know it.
• 44:30
  SPEAKER_02: And you guys might not have experienced a lot of this yet because it is still so new for both of you.
• 44:35
  SPEAKER_02: But what is it like to like see patients over and over again?
• 44:39
  SPEAKER_02: Or have you not had that?
• 44:41
  SPEAKER_02: Yeah.
• 44:42
  SPEAKER_02: I have.
• 44:42
  SPEAKER_02: Yeah.
• 44:43
  SPEAKER_01: We've seen people are remote.
• 44:48
  SPEAKER_01: And I don't know about you, but they'd be using that my chart.
• 44:51
  SPEAKER_01: Yeah.
• 44:51
  SPEAKER_01: Maybe messaging on the my chart.
• 44:53
  SPEAKER_01: So I don't I don't it can be good.
• 44:56
  SPEAKER_03: Is it different than like, you know, obviously in the ICU we had our repeat offenders.
• 45:01
  SPEAKER_03: Like you had your patients that would like go to the floor and bounce back.
• 45:03
  SPEAKER_03: And it's like, we know these patients.
• 45:05
  SPEAKER_03: Is it kind of like that?
• 45:06
  SPEAKER_03: Like you're like, I know this person, but they're supposed to be coming back.
• 45:10
  SPEAKER_03: Because the physician wants them to come back for the most part.
• 45:13
  SPEAKER_03: I mean because they've had a necessary detrimental change in their health status.
• 45:17
  SPEAKER_03: Right.
• 45:18
  SPEAKER_01: Yeah.
• 45:18
  SPEAKER_01: Well, maybe it just depends.
• 45:20
  SPEAKER_01: So, like the way that the clinics are set up, the patient might see two out of the three clin or two out of the four, three out of the four.
• 45:28
  SPEAKER_01: Because they might need surgery to take a mask off and do a biopsy.
• 45:31
  SPEAKER_01: And then they're gonna go to the medical oncologist for their chemotherapy treatment and regimen, and then they might have to go to radiation.
• 45:38
  SPEAKER_01: So it it's like this network, and then they'll follow back up with you.
• 45:41
  SPEAKER_01: Yeah.
• 45:42
  SPEAKER_01: And so it's different.
• 45:43
  SPEAKER_01: It's not a repeat offender, it's almost just like more planned.
• 45:47
  SPEAKER_01: Circling back around, following up.
• 45:49
  SPEAKER_01: It's a very cohesive, like all aspects, like to center around the patient to make sure they're getting the treatment they need.
• 45:55
  SPEAKER_00: Yeah.
• 45:56
  SPEAKER_00: Each encounter is a different expectation from the patient.
• 46:00
  SPEAKER_00: I like sometimes they come for something and something else next time.
• 46:04
  SPEAKER_00: And I think overall, that that is actually a nice thing about our patient.
• 46:08
  SPEAKER_00: I feel in the ICU, you know, everyone wants to make it out of life.
• 46:12
  SPEAKER_00: The ICU, like probably their first priority.
• 46:14
  SPEAKER_00: Am I alive, doctor?
• 46:16
  SPEAKER_00: Yes, you are doing fine.
• 46:17
  SPEAKER_00: Am I gonna get better?
• 46:18
  SPEAKER_00: Yes, you are here.
• 46:20
  SPEAKER_00: You know, I don't get a lot of am I gonna get better?
• 46:22
  SPEAKER_00: Am I gonna be fine?
• 46:23
  SPEAKER_00: Yours more like, I gotta go and see my grandson or pick up my child at at four in the afternoon.
• 46:29
  SPEAKER_00: Let's get it done, doctor.
• 46:30
  SPEAKER_00: What what we need to do, you know.
• 46:32
  SPEAKER_00: So I don't know, it's it's it's it's a different vibe for sure.
• 46:36
  SPEAKER_02: Yeah.
• 46:37
  SPEAKER_03: Allison, while you're in school, do you miss patients?
• 46:40
  SPEAKER_03: Yes and no.
• 46:41
  SPEAKER_03: I feel like, I mean, obviously we've all had bad interactions with patients, so I definitely don't necessarily miss those, but I do miss like being able to take care of a person and like seeing them get better by the things that I'm doing, or not even necessarily the patient, but the family members, because sometimes our patients and the IC weren't able to talk to us.
• 47:01
  SPEAKER_03: So it's like you get those family members that are really appreciative and thank you for everything that you're doing.
• 47:06
  SPEAKER_03: So it's like not in like a self-fulfilling sort of way, but just like being recognized that what I'm doing is affecting somebody in a positive way.
• 47:15
  SPEAKER_03: Whereas right now, I don't get any of that.
• 47:19
  SPEAKER_03: You just get great.
• 47:20
  SPEAKER_03: And it's not you're gonna be able to do that.
• 47:22
  SPEAKER_03: And I may not anymore because I won't ever I won't interact with my patients probably much.
• 47:26
  SPEAKER_03: I won't interact with family members, so it's like maybe I can just work to please the surgeons.
• 47:31
  SPEAKER_03: Yeah, you're kind of keep my patients alive.
• 47:35
  SPEAKER_03: Yeah.
• 47:37
  SPEAKER_03: Don't don't make the OR circulating nurses mad or anything like that.
• 47:43
  SPEAKER_02: All right.
• 47:44
  SPEAKER_02: So for my three new beginning people, what's one piece of advice you would give a new attending that's about us to start, or someone that's considering making that leap?
• 47:55
  SPEAKER_00: I'm gonna say what I did.
• 47:57
  SPEAKER_00: I started making stat pearls every day.
• 47:59
  SPEAKER_00: Every day that I started my first day, I had this little notebook where I will write at the end of the day before I walked out, I will write what I didn't knew that day.
• 48:09
  SPEAKER_00: It was maybe some administrative, something clinical, something whatever it is, and start making a kind of bullet points of why I what things I didn't knew and also what I did to sort of handle those things.
• 48:22
  SPEAKER_00: I think that was a helpful thing for me.
• 48:26
  SPEAKER_00: That's great.
• 48:27
  SPEAKER_00: Of course, obviously.
• 48:30
  SPEAKER_02: It's Dr.
• 48:30
  SPEAKER_02: Armando.
• 48:31
  SPEAKER_02: That's why we love you.
• 48:33
  SPEAKER_00: Hey, I gotta I gotta make sure I don't mess up the next day because my boss he does has high expectations from me.
• 48:40
  SPEAKER_00: So he goes, like, do you forgot what I taught you a week ago?
• 48:44
  SPEAKER_00: I'm like, I know man, I know right here.
• 48:48
  SPEAKER_01: Yeah, that's great.
• 48:51
  SPEAKER_01: I would say don't be afraid to ask questions and just let people know that you're new.
• 48:56
  SPEAKER_01: So, like, you know, don't be afraid to look stupid or ask a question because it's just a completely different way of like charting seeing the patients, the flow is all different.
• 49:05
  SPEAKER_01: And if you haven't figured out a way to be organized, then you should probably do that before you start in the outpatient setting.
• 49:12
  SPEAKER_01: Otherwise, you might have 40 sticky notes at the end of the day and you're trying to figure out what was what.
• 49:16
  SPEAKER_01: That's I think that would be probably the advice I could give now so far.
• 49:20
  SPEAKER_01: Allison.
• 49:21
  SPEAKER_03: I mean, for school, definitely organization, because I mean, you've got to keep track of study time whenever you have quizzes or tests and what classes, but also just not not, I don't want to say prioritizing, but making sure you have a way to relieve the stress of being in this setting.
• 49:39
  SPEAKER_03: Because if you overly stress out, then I feel like you're not gonna absorb or learn the information well.
• 49:44
  SPEAKER_03: So then you're paying money to go to school to stress yourself out to not really learn it.
• 49:48
  SPEAKER_03: So you're just shooting yourself in the foot.
• 49:50
  SPEAKER_03: So like you have to have a relief somewhere in your life.
• 49:53
  SPEAKER_03: So you can't just be a hundred percent school.
• 49:57
  SPEAKER_03: You have to take care of yourself too, just like whenever you're working as a nurse, you have to take care of yourself because you have to fuel your body to be good at what you're doing.
• 50:04
  SPEAKER_03: So keeping that in mind.
• 50:06
  SPEAKER_00: Very good advice.
• 50:07
  SPEAKER_00: What was it called?
• 50:07
  SPEAKER_00: Code lavender is what he was.
• 50:09
  SPEAKER_02: Code lavender.
• 50:10
  SPEAKER_02: Oh, yeah.
• 50:11
  SPEAKER_02: That's well, this has been so fun for me to hear about three of my favorite people's new beginnings, what it's like.
• 50:21
  SPEAKER_02: I mean, they all left me behind.
• 50:22
  SPEAKER_02: I'm still working where we all the ghost loves you, Abby.
• 50:26
  SPEAKER_02: Yeah, I did uh Allison was the first one that left me, and I did refer to her as a ghost for a while.
• 50:32
  SPEAKER_02: She'd walk into the room.
• 50:33
  SPEAKER_02: She did it yesterday.
• 50:37
  SPEAKER_00: I do want to say we do remember you.
• 50:42
  SPEAKER_00: I I do remember all of you.
• 50:43
  SPEAKER_00: You know, kind of thinking, what would Abby done?
• 50:46
  SPEAKER_00: You know.
• 50:47
  SPEAKER_01: I saw Abby this morning walking into work about getting her a heart attack because I said, Hey Abby.
• 50:52
  SPEAKER_01: Okay, you did not go, hey Abby.
• 50:54
  SPEAKER_01: You went, Abby, and I was kind of but yeah.
• 51:01
  SPEAKER_01: We personally left Abby behind.
• 51:03
  SPEAKER_01: That was the point of leaving.
• 51:04
  SPEAKER_01: It was the personal attack.
• 51:06
  SPEAKER_01: It was nobody else or anything else.
• 51:08
  SPEAKER_03: It was just Abby.
• 51:09
  SPEAKER_03: Just Abby.
• 51:10
  SPEAKER_03: We all actually got together and said, hey, this is our plan for how and when we're gonna leave Abby.
• 51:15
  SPEAKER_03: We can't do it all at once.
• 51:16
  SPEAKER_03: We gotta stagger it out so she doesn't combust.
• 51:21
  SPEAKER_00: Like it's slow, slowly getting there.
• 51:25
  SPEAKER_02: Maybe they maybe you all have convinced me it's time for my soft NP era too.
• 51:30
  SPEAKER_02: I don't know.
• 51:31
  SPEAKER_02: We might end up with two podcasts.
• 51:34
  SPEAKER_00: And then two.
• 51:34
  SPEAKER_02: I was gonna say four podcasts.
• 51:37
  SPEAKER_02: We might we might end up with way more.
• 51:41
  SPEAKER_02: Well, thank you guys so much for sharing this.
• 51:44
  SPEAKER_02: I'm so excited for each of you, even though I pick on each of you a little bit.
• 51:49
  SPEAKER_02: I am so happy for each of you and the growth and how happy you all are in your lives.
• 51:56
  SPEAKER_02: But if you're still listening, make sure you hit the like, the follow, leave us a comment, and tell us about your new beginnings.
• 52:01
  SPEAKER_02: Have you experienced the same thing?
• 52:03
  SPEAKER_02: Are you about to come and become an attending?
• 52:07
  SPEAKER_02: Are you now compelled to do your soft nurse era with Kaylee?
• 52:11
  SPEAKER_02: It's gonna be great, apparently.
• 52:13
  SPEAKER_02: But from all of us shift talkers here at Banter at the Bedside, until next time.
• 52:18
  SPEAKER_02: Bye.
• 52:19
  SPEAKER_02: Bye.
• 52:22
  SPEAKER_02: If this felt your kind of conversation, make sure you're following, leave us a review, and we'll see you back here soon.
• 52:28
  SPEAKER_02: Bye.
• 52:30
  SPEAKER_04: Step into the light where the stories come.