Latest / Here to Serve - A United Regional Podcast / ICU nurses Ainsley Johnson, Jack Murdock, Renee Howard, and SICU nurse Ryan Inge
Transcript
- United Regional: Welcome to Here to Serve, a United Regional podcast. I'm your host, Ryan Graves. My favorite part of being the director of patient experience at United Regional is the incredible people that I meet and work with on a daily basis. And I want you to meet them too. Join us to meet the people behind the badge and to highlight those who are here to serve. Well, welcome to the Here to Serve podcast. I'm really excited about this episode. We've got four Our incredible ICU nurses joining us today. And so I'm gonna go around the room and just ask you guys, Eve, to introduce yourself, tell me your name, what you do and and how long you've been doing it. We'll start right here. Well, I'm Ainsley Johnson. I've been a nurse for ten years and I've been in ICU for seven. Seven. Mm-hmm. Seven here. Ten total and then seven at ICU. Yep. I started out in PCU at Hendricks and then moved over here, did seven center for a year, and then came to ICU. Right before COVID hit. yeah. We'll have to talk about that perfect time. How about you, sir? My name is Jack Murdoch. I've been in the medical ICU for a little over two years and I've been a nurse for a little over two years as well. So I started as a new grad in ICU. I wanna talk about that a little bit too, because that used to be something that wasn't allowed. And now that that's a thing. And so I wanna that's the really point that I wanna come back and talk about. But glad glad you're here. I hear Really good things about you regularly, by the way. You two Ainsley. We'll see. I'm Renee Howard. I've been a ICU nurse for thirty years. And I started in the CCU at the general as a certified tech and then just stayed there. So I started training early. Back in the day you could do a little bit more as a tech if you were already like in school, but yeah, thirty years. Thirty years in the ICU. Uhhuh. How and how many years in healthcare then? Same. Same. So thirty years. You've been in ICU the whole time. Yeah. Well, you know. I floated everywhere. Sure. You've done it all. I've done I've been to L and D and of course ER and all the all the floors. Yeah. Over the time. Yeah. Incredible. One of the things I want to talk to you about is what's the how much has changed in thirty years. I can't even I I I know how much changes every year. Yeah. So I think thirty years. Mm-hmm. That's awesome. How about you, sir? I'm Ryan Inge. I work in the surgical ICU. These are all medical people here. So I'm the loan representative. holding it down. Yeah, holding it down. I've been at United Regional for a little over a year. I started at Shannon in San Angelo. I was there for two years, all in the ICU. So I also started as a new grad in ICU. So Shannon was medical surgical all in one. So I've worked both sides, but yeah. So what What did you do before nursing? So I actually worked in the in the bar and restaurant industry. Okay. So yeah, it's kinda my second career. Nice. Yeah. I I love I love it when we get any staff, but especially nurses or providers that worked in the service industry before. I think it's such a good foundation. Yeah, that's that's what I did all through much when he said. Yeah, 'cause it's people. It's all it's it's people, you know, and then people are universal. It's a hundred percent. It's all people. So that You know, the when you work in the hospital, what's the root word of hospitality? You know, it's hospital. So knowing how to to serve people, before you go into healthcare, I find is like a superpower that makes everything else you do that much easier if you can know how to interact with people. So it's interesting. shout out to Mandy Seward. Mandy, if any of you guys know Mandy, she's so good with people. And one other thing I was asking her about one day, she's Well, I attended bar for X amount of years. She goes, I think all She's I think all nurses should have to do that first. And she's like, it's sets you up. So it's interesting. Not not recommended that for school, by the way, is but that was interesting. so I'd like to hear just out of my own curiosity, I'm a nurse. I graduated nursing school in 06. And one of the things that fascinates me about nursing school is there's not nursing school, but nursing is there's so many places you can end up and do. It's like One of the things I think that's cool about nursing is you can the sky's the limit of so many paths. So I'd like to talk about the path to ICU. I always kind of feel like different personalities tend to be drawn to different areas of nursing. What do you what drew you guys to ICU? We'll start. You're the newest, right? Let's start with you. What what drew you then? I think I did my clinicals in the medical ICU and Heather Sloan, who's now our educator, trained me. And just working with her and like the advanced pathophysiology and the pharmacology drew me to it and just always learning. Like there's always new stuff coming out in healthcare and you have to be on top of this since you're dealing with these critically ill patients. So that's kinda what drew me to the ICU, just the advanced thinking and thought process behind each patient. I love it. Well definitely in my opinion, ICU is like kind of, you know, tip of the spear. you know, you're dealing with the sickest of the sick. And shout out to Heather Schlong. Yeah. How awesome is she. Yeah. If you if you're precepted by her, clearly you're gonna go wherever she was at. I mean that's my opinion on the deal. That's awesome. She's great. what about you, Renee? Well, I d I had some really good clinicals too when I was in nursing school and I did like a little bit more of the workflow of the ICU, but As I was about to graduate, someone gave me some advice. Matter of fact, it was Betty Dowdy. She used to be the director of L and D. And she said, if you can learn the heart, you can work anywhere. And that kind of just intrigued me. And so basically I was in the cardiac unit at the general and you know, just the heart is very, very fascinating. And so that's when I went into ICU. But I just love all the just like the evolving is so much faster, and the technology and I love the doctors, the interaction that you have more so than one on one. especially our intensivest. but yeah, pretty much just the anatomy and how the organs all come together. And just it's just amazing. Yeah. There's not just one single thing when an ICU patient is ill. It's so all the organs are involved and it's just great, exciting. Anza, you were PCU first, right? I was Yeah, PCU for a few years and then ICU. Well was talk talk to me about what pushed you to the ICU? Yeah, to the ICU. Well, I'm always wanted to work in ICU. My cousin was in an accident when I was in high school. he had a four wheeling accident and it landed on his head. so he was in ICU in San Antonio for quite a bit, I think three or four months. and just watching those nurses work on him and save him just drew me to ICU. Yeah. while I started in PCU is that's I was a tech in PCU during nursing school. So I worked full time and that's how I got my foot in the door of PCU. And then I came here and the only openings were PCU. And it was very hard to get into ICU here. but a year later I went to ICU and it's where I wanted to be. That's awesome. Mm-hmm. I I tell folks all the time and as it relates to healthcare, United Regional in general, I like, if you'll just get your foot in the door and get started, you know, there'll be opportunities of to do whatever it is that you want to do. You gotta get started. That's excellent. So what I I have a similar question, but I want a little bit different for you is what What pulled you into nursing from a different career? Yeah, so well, COVID happened, of course. All the restaurants and bars were shut down. Okay. My wife and I had our first child in March of twenty twenty. so it was a very hectic time in our lives like everyone else. Sure. and, you know, my younger brother's also a nurse. I've got some cousins that are nurses, my grandmother was a nurse. I was looking A for career stability, sure. You know, being a first time father without a job is a pretty helpless feeling. never wanted to be there again. But then I, you know, the the things you're hearing about nurses during COVID and the things that they're doing and the lives that they're saving or and and things that they're going through, that kind of interested me. And so I started taking some prerequisites as a stay at home dad and got into nursing school and the ICU was appealing to me because like Jack when I was in clinicals, It was great to see the things that were being done there and there's so much going on and so much to learn and and I remember after my first clinical I went and introduced myself to the the unit director and I was like, Hey, you know, I'm Ryan, I'm gonna be applying here. Nice and it w at Shannon it was very competitive, you know, to get in there. And so fortunately I was able to get in. I had some great preceptors that were taking the sickest patients there and It was overwhelming. I remember I was having dinner with my wife after a couple of weeks in and I said, I don't know why I chose the ICU. It was just so much early on. But you know, when I applied here at at United Regional, Amanda, our manager asked me, you know, what what kind of patients do you like taking? And I said, The sickest ones you've got. And and that's kind of how I look at it. It's it's high risk, high reward. And it's it's a it's a fun job, but also like Jack said, you're always learning, it's always evolving. You know, even you know, Renee. working there, there's always things that you see that you may not have ever seen that particular mhm situation, even though you've seen similar ones. And so it's a very rewarding job to work in the ICU. Yeah, I can imagine. Well thank you. Thank you all for for an you know answering. I know the call looks different across each of you, but for going, Hey, I'm gonna I'm gonna step up and do this. I know it's a big it's a big ask, you know, to I know I know and I think back to when I first started nursing, you know, I just remember driving in every day going, Please God, don't let me make a mistake today. You know, like everybody's nightmare. And I wasn't working with the sickest of the sickest. And I was still, you know, terrified of that. so I know it's a lot of responsibility, but also, you know, thank you for for doing that and doing it well and taking it so seriously. you know, my family over the years, you know, my my both my grandparents have been through there and I've had friends and family and And I always have, you know, such confidence in our in our ICU teams that that you guys 'cause I know how seriously you take it, how much you train, how much you work and that you live it. And I always I'm always thankful and and brag on you guys. So we've kind of mentioned it a little bit, but I wanna come back around to just some of the advancements. I know we could spend hours talking about how far everything's come. So maybe what's one or two like cool things that you guys have seen change? that, you know, maybe that are kind of some game changers. you would like to talk about? Keep looking at me. Yeah. Thanks. Yeah. I honestly, I'm I was mentioning the intensivist and I really think that, especially here at United Regional, that that just exploded the ICU when we had a doctor that's specific for every patient in the unit. So tell for anybody that's listening that may not know that term intensivist. It's the ICU doctors, but just I mean most of the ones that we have now are are pulmonologists. Okay. and we've had also trauma doctors before, but it was actually Dr. Mercer way back in the day that brought the intensibist to the hospital ICU. So it's basically a doctor that is on call twenty four seven specifically for the units of ICU. And before that you would just have whatever doctor admitted the patient would kinda take care of him in the IC. Like what did that look like? That's even before like you know, the hospitalist and everything for it. So yeah, you had your basically your primary doctor mhm and then if they would consult, you know. Different specialist in Yes, if it was neurological, then you'd get a a a neurologist or current status you have a doctor that specializes in the care of ICU patients. And then they're on call. And so they're very familiar with every aspect of the patient. They're very know all the the labs and the history and you know, sometimes it's their own patient, especially if it's a pulmonologist, they have a lung issue or whatever. They already know the patient from the office or whatever. but it just having that basically one on one is it's a great teaching opportunity for them. So they're teaching us all the time and guiding us and we have their full support. And then it also as time goes on you have a little bit more autonomy because you built a rapport with them and a trust and you know, they know your abilities and it just just makes your your day your shift, just y you know, more organized and a lot easier as to as far as getting a hold of doctors and and guiding the care makes total sense of the day. Yeah. Well, it makes total sense too, instead of a generalist that, you know, you nobody can know everything. You know, and so if you're doing all sorts of different medicine, there's just too much to keep up with, especially in today's healthcare space. I mean it's all moving so quick. So to have somebody that has narrowed their their field or their focus, at least for this shift to this. I mean it's so how long has that been going on? You think probably, I'd say maybe fifteen to twenty years. So probably so big difference pre and post when we when you move absolutely. Yes. Trying to get a hold of maybe the cardiologist or whatever. Maybe they're doing a procedure or something, they're not even available and then like, well what do I do now? You know, so it's like, yeah, you always have somebody has your back. Yeah, that's fa that's so fascinating. I never even thought about a world before intensivists. I you know I've we've had intensivist for a long time. but I I can absolutely see in that see that being a huge paradigm shift. Yes. I c absolutely. And then on the on the other side, you know, Jack and I are on the dark side. We work nights. These ladies work days. you know but we have Chris and David Chris and David, intensivist nurse nurse practitioners at night that are on the units and available. You know, there's there's obviously one of the physicians available, you know, as well on call, but you know, they're in the units doing intubations, putting in lines, things that, you know, we need as well. So it's a great resource to have somebody that just manages ICU patients. So And they were both ICU right nurses before. So they it's great to work w with them side by side. I would trust them to save my life. Absolutely. Yes. Yeah shout out to those guys. Yeah. I love it. Any anything else you guys want to share as far as advancements? I mean, all the toys. Yeah. I mean, there's not a high scarce done like all the toys. Yeah. I mean our ECMO program is growing. We're doing more patients. What's ECMO? I know what it is, but tell for the for anybody that explained ECMO. Basically it's like the highest form of life support that we can do at the patient's bedside and they put like two cannulas usually in the groin at least here and it helps perfuse the rest of the body. say while your heart's not able to. and like I said, it's just I'm former life support that we can do for those patients. So and you know, like Renee was saying, the heart is fascinating to me as well. And I enjoy those kind of patients. And along the same lines as that, we're also working on creating a cardiogenic shock program at our hospital as well. That I think will be an awesome addition to our patients and escalating their care and the drip different treatment modalities that we have available as well. I was actually in on a meeting yesterday where Kelly and Heather were presenting that to the hospitalists. It was really, really interesting to hear about that cardiogenic shocks. Jack's baby escalation. Actually so it's funny you say that one of the hospitalists actually asked what why why are we doing this? Where did this come from? And Heather said, and I didn't connect it, but she said, one of our nurse interns had this idea. so there's that was that you? You were Yeah, so ba yeah, it's basically once we start as new grads, as new nurses, we have to do a nurse residency project. So we get our patients back from the cath lab and, you know, some things would go well, some not. And I just thought maybe there's a better way to escalate their care quicker or to find these patients before they need to go up to the cath lab or whatever. And so doing research we found that there are protocols and algorithm to find the patients quicker but also g escalate their care quicker as well. and that we just kinda took off with it from there. we went to present in Arizona too as well for like the National Nurse Residency Conference. And then now we've been working alongside Doctor Obiagu and the cardiologist and Doctor Law with the intensivist to get this program up and running. Man, that's awesome. That's that's so good. That's the way it's supposed to work. Somebody sees something, hey, why are we not doing this? Let's look into it. Let's do it. And then I mean, I guarantee you this is gonna save lives. Cause it's an early detection program, right? It's basically what it is. It's we're gonna recognize this much faster than we were recognizing it before and take action faster. and which is gonna save people's lives, no doubt. Yeah, and it really elevates the standard of care that we're able to provide. You know, you detect it earlier than we would without the protocols in place. it allows us to make the right decisions for these patients and ultimately will provide better outcomes than if we didn't have it in place and you're waiting, you know, and recognize these things later. So I'm excited for it. I think it's gonna be good. So so I love it. That's just that's the kind of stuff that makes me super proud. I'm sure it feels good to go, hey, this I mean if I mean you're being humble about it, I would have a T shirt that's a cardiogenic protocol was it was me. If you're wondering it was okay. no, that's awesome. I love it. That's the kind of stuff that gets me fired up and excited to see. and it's the ever learning, always growing, always like, Hey, this why are we not doing this? What do you guys wish? see how we're doing on time. What do you guys wish everybody knew about the ICU? You know, I know there's probably there's stereotypes and tropes and movies and you know, whatever. I can't my my wife gets mad at me because I I can't watch medical stuff if we just can't do it. I'm I'm like, That's not she's like, Shut up, it's a movie. I'm like, it's still you the anyway. The pit's like the most realistic I've ever seen though. It's it's pretty crazy. I can't make myself watch it. So no, I wait, I'm already yeah like here all it just I was hesitant as well. But it's pretty good. Okay. I know it's gonna be good, but I'm not compared to Grey's Anatomy. I know yeah, well, the reason I haven't watched the pit is i everybody says it so real. I'm like, I don't know if I wanna I don't wanna be realistic. I don't wanna cry in my living room watching this, so yeah. yeah, I cry easy. You know, the the ICU, I w somebody told me one time, you know, that the E D is chaos, the ICU is controlled chaos. And that's pretty true. Say that again. the E D is chaos. The ICU is controlled chaos. And and it's pretty true. we get, you know, patients that are a lot of the times just stable enough to make the transport to us. And and that's kind of really when it all, you know, escalates and things like that a lot of the time. You know, shout out to the ED. Their job's crazy. They they do a lot of things. But a misconception from a nurse standpoint, I think, is y'all get two patients and we're up there reading books and things like that. And you know, the ICU is it truly is all nursing is a 24 hour job, but the ICU specifically, I mean, their meds your entire shift. You know, it's not a 2100 med pass and a 9 a.m. med pass. And there's things that are constantly evolving with these patients, and so you're constantly monitoring. rhythm changes, you know, oxygenation, a lot of different things. And so you really have to be on your game when you show up to the unit for work. You don't know what's gonna happen, what you're gonna get, what you're gonna see. And that's part of the intriguing part for me, is is how the how unstable some of these patients can be. but but it's a it's a lot of fun to work there, but it's pretty hectic at times too. sure. I think one of the things is just the amount of concentration it really takes. And sometimes visitors or whatever, they just wanna like chit chat. I'm like remember one of the times that we had I was setting up the C or R T machine which is bedside dialysis and it's a new machine and I'm like I'm just like you have all these orders and all these fluids to hang and all that and I'm going through it all in my mind, I'm trying to set it up and they're just chit chatting and I'm like I'm trying to concentrate and I'm trying to be friendly. And so, you know, I've got this super serious look on my face. I'm thinking, I mean, there's like a hundred things going on in my brain right now, not only what I have to do for this unstable patient, but everything I've got to do next door to the other one. And then your orders change. Or the alarm's going off right. And maybe they're they're climbing out of the bed or something and I'm like, which way do I go? but yeah, they're it just d not Yeah. I mean, it's really just so much studying and reviewing and just checking s checking and checking and making sure that you know, you're doing what you're supposed to be doing and anticipating. That's why we monitor so closely. We're watching those trends so we can anticipate something before it happens. yes. And 'cause we know it's gonna happen. Right. If we don't. I as a med search nurse, I You know, and MedSearch has its own set of challenges, right? But whenever I'm in the ICU, I'm always kind of just in awe of how many lines you're dealing with. Yeah. You know, I don't I don't like two or three, you know. And then I'm sitting there and and it's somebody stu like of I've been in the room where I where an ICU nurse or somebody is they're talking to me while they're adjusting like Forty seven lines and and I'm just like, How are you keeping all this straight as to what's what? Yeah. It's impressive and I can only imagine the amount of concentration that that it takes. And it's ha such high you mentioned earlier, it's such high stakes. You know, it's so sacred. Like, man, I don't it's that's a lot. It's a lot. What anything to add over here? Misconceptions? I mean, I think sometimes we can come off as cold or like you know, since we're used to seeing people passing six in rough situations, but at the end of the day I think we care about that patient in the bed and your family member. Like we treat them as our own and our own family and we truly do care about them. But sometimes like they said we could be setting up the C R T or something is alarming that we need to fix right then and there and we'll get to your question eventually or be able to talk here shortly but that we ultimately do care about that patient in the bed and It's we treat it as our own, you know. So I love that. I I'll just second that behind the you know, being in healthcare this year's twenty years. it's been a little starting to I try to I try to think that it's not real, but then I look in the mirror and all this gray is showing up and then I go, No, it's definitely twenty years. I've rarely in twenty years met s met healthcare personnel that didn't care. I've met a couple. They don't work here anymore, right? Almost everyone like genuinely cares. but it's hard sometimes to get that across in the in the middle of whatever we're doing 'cause it's there's a lot. So there's it's ch it's a that's a huge challenge in healthcare, I think. so having lived this for some time now, what advice would you give patients and or families when they find themselves, you know, in the ICU? I guess just give us some grace. Grace. Yeah. we don't have all the answers. And to me, like I see you as like a puzzle. We're trying to find all the puzzle pieces to put together. And so just give us grace. We're doing our best. And I treat all my fa all my patients just like do my family. Yeah. so I would say just give us some grace. I I love that. I think and I worked in the advocacy office, and this working with my own family over the years. I one of my favorite phrases, I say it all the time, is they call it practicing medicine for a reason. Right. It's not people I think I wish the T V show House never existed. Because everybody sees that show and goes, Man, if Dr. House was here, he would just figure out what this was and we would be my mom would be okay or whatever it is. And it's like, man, if the in the real world like it is we are trying to figure this out. and everybody wants this person to get better. And we're gonna do everything we can to make it. But at the end of the day, we're not God. Right. At the of the day, we you know, we cannot always control this and it's not always the outcome losing a lot, but it's not because we don't care. Well, I really like that is to come in understanding that every doctor, every nurse, every single person this that's walking in this room or interacting with is a human, right? and we don't have all the answers. Yeah, unfortunately in in the area we work, there's really no quick fixes. Everything takes time, so Patience is important, but sometimes not speaking for these guys, but me personally, it is hard to realize that this is sometimes, a lot of the times, the toughest thing families and patients have ever gone through in their lives. Because we see it every day, that's easy to lose track of. but you know, we're doing everything that we can. Right. We really are. interventions are happening as needed and and tests take time and You know, all the answers don't happen overnight and and I wish they did, but they don't. And so sometimes the families get frustrated. We get frustrated as well. Sure You know, we're working, there's teams working for this patient to have a good outcome, and and sometimes those outcomes just aren't there. There's nothing that we can do. And and we've exhausted every option we have, and that's unfortunate, but that's Unfortunately the way it is, it but but patience is key. We have to be patient. Families have to be patient. Patience. Yeah. you know, but but there's a lot going on. There's a lot of moving parts and and we're all working as one and we want the best for these patients and the families as well. Yeah. I'd like to build on that too. and this is probably before they even get to the ICU, but I would hope that families would have difficult conversations with their loved ones. if you've been diagnosed with like a some comorbidity of I don't maybe cancer, heart failure, lung failure, those kinds of things, make your wishes known. Do you want if when you do end up in an intensive care or, you know, is is that what you want? I would just like we don't want to put treatment on someone that just really would like to be at the house and be with their family. in this set of just being up there ha you know, not alone, but a lot of times, you know, you c your whole family can't be up there at one time and they're still trying to have their lives and that kind of stuff. So have those conversations with your family members. What do that you want? And that way when the time if the time comes, you're not having to decide that absolutely when they're like critically ill. Well the once you're if you're in the ICU trying to decide that it's that's a that's the worst time to try to figure out. You know, especially if you're not able to decide for yourself. Right. And now your family is trying to guess at what you would have wanted. A lot of family does family doesn't always agree. Yeah. And what I have found my advice in in the ICU for families is give the staff some grace. Give yourself a lot of grace. Give your family a lot of grace. Yeah. 'Cause everybody's emotional. Everybody's upset. What I've seen in the ICU is if there is anything underlying in your family, and almost every family has things un like every family, including my own, we all have stuff, right? It comes out when the loved one's in the bed. And so now we're not only we have all this emotion, but now we're trying to make a decision that we don't even have the information to make a decision. And it's it's it's terrible. So if anybody listening out there, please he Renee's advice here. I'm I'm telling you. That's great. and and have these hard conversations with your family. What would you want? What would you not want? If you need help having that conversation, we call the patient advocate office, call one of our social workers, 764-3685. we will what we've got packets, we can give you information. You can walk through, you can fill it out yourself. You don't need a notary. Just you can fill this stuff out. It's the best gift you can give your family so that they're not stuck. in an already bad situation making it worse and that your wishes would be honored, you know. I and I I think it's a good good place to close is what you know the advice you guys are giving about the ICU is one of the things you said nothing happens quickly, right? If you're sick enough to be in the ICU, chances are this is gonna be a marathon, not a sprint. And so for families to take care of themselves, sleep, Don't try to sit there twenty four seven. I I get the desire to do that. but you're gonna wear yourself out. your loved one needs you. You need to go home and sleep, whatever that looks like for you. give yourself a lot of grace, give the team grace, and we'll be there for you, you know, along the way. And so what what have I not asked you guys about that you wanted to talk about today? There's one thing I wanted to add is that we couldn't be as good as we are without all our ancillary. We have great respiratory therapists. We have wonderful physical therap I know I'm gonna forget somebody now. All the way from nutrition to radiology and our lab and our pharmacy. also our palliative care team. Absolutely. Yeah. They're a big resource in our department. You know even our management and our leadership, I really do believe everyone's doing the best that they can to support us. we're hard to support because we're all very independent. We like to advocate. Yes. Very and there's not very many personality. Certain personality types are drawn to the federal type type A all the way. so that's hard to manage. And but we have great, great teamwork. Not with just ourselves, absolutely. We win or lose together. I mean that's just a at the end of the day, we win or lose together. Right. And it takes every single person. We generally like even we care about each other. I mean, there's not anything I wouldn't do for any of these sitting right here and some that are not here. No, I'm distancing. But no, I really do have a a mama love for my coworkers and truly care about and I know they feel the same way. Load it. No doubt. Well, thank guys. Thanks again for coming on. I'm excited to get to visit with you guys today. Thank you for all you do, for all of our patients, our community, and for each other. and I look forward to continuing to to grow with you guys. Thank you.