#156 - Jessi Barnes MSN - 💁‍♀️ Insights into neonatal nursing from a clinical educator and NICU mom

Experience the raw, emotional rollercoaster with our special guest, Jessi Barnes, a clinical nurse educator who carries an unparalleled passion for neonatal care. Jessi brings a unique perspective to the table - not only is she an expert in her field with a background in high risk perinatal care, neonatal intensive care, and nursing informatics, but she's also a mother who has faced the challenges of the NICU firsthand. 

This episode offers a rare narrative blend of professional expertise and personal experience, as Jessi unfolds her journey of delivering her daughter prematurely at 27 weeks. Her intense commitment to trauma-informed family integrated care is a testament to her personal experiences and her dedication to improving neonatal care. Engage with us as we navigate through Jessi's captivating story. This episode promises to be illuminating, emotional, and inspiring.

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

Enjoy!

Transcript

Ben Courchia MD (00:01.806)
Jesse Barnes, thank you so much for being on the show this morning with us. So Jesse, you are a clinical nurse educator. Your nursing practice really involves high-risk prenatal care, NICU. You've even done some nursing informatics. You have a passion for trauma-informed care. I'm just curious what in your professional education led you...

Jessi Barnes (00:06.259)
Thank you for having me.

Ben Courchia MD (00:31.558)
both to nursing and specifically the perinatal field.

Jessi Barnes (00:37.507)
When I was in college and trying to figure out what I wanted to do, I wanted a challenge. I'm one of those people that kind of tend to gravitate towards being in the ICU, right? Your type A personality, I want to be challenged, I want to help people. And a lot of times nursing or medicine in general is one of those things where that is a big intersection, those things cross. So and then during my...

Ben Courchia MD (00:49.494)
Mm-hmm.

Jessi Barnes (00:57.855)
nursing rotations, I had a time to be in the NICU and I just had this moment walking in. It was just a shadow shift for eight hours, but as soon as I was there, I was like, oh, this is where I'm supposed to be. This is what I'm supposed to do. I remember, and I was just holding a stable baby who was getting ready to go home and nothing of the crazy ICU side that I grew to know and love, but I just remember holding him and helping feeding him and being like...

Ben Courchia MD (01:08.028)
Mm-hmm.

Jessi Barnes (01:22.975)
this is the patient population that I need to work with. It was just this intense moment of alignment, kind of. But political climate for nurse residencies and spots and graduation and everything, I couldn't get into the NICU initially, so I ended up in a high-risk perinatal setting, which ended up setting my career off really well because I knew how those babies grew up. I helped care for those parents who were inpatient with preeclampsia or preterm labor, trying to stay pregnant as long as humanly possible and sometimes successful and sometimes not.

Daphna Yasova Barbeau, MD (01:25.659)
Mm-hmm. Mmm.

Ben Courchia MD (01:53.122)
Mm-hmm.

Jessi Barnes (01:53.127)
So it gave me a unique perspective coming into the NICU to be able to know what it's like being a parent on the other side, not knowing what the outcome of your patient is gonna be. And hoping that you got to get your baby to the NICU and then hoping that it was a decreased stay and all those things. So it ended up being a really good benefit to me to spend my first few years learning the adult side of things before I transitioned over to babies where I knew I belonged. I did it for about two years.

Ben Courchia MD (02:19.374)
How long did you do that for? Oh, that's quite significant. And how's your take on, I think there's, in the NICU there's always this immediate reaction to like, man, this is cool. Like you do things and it's immediate, immediate effect, right? You give surfactant and boom, babies get better. It's very, very neat. But on the other hand, then as you spend a bit more time,

You also have the immediacy of decompensation and you're like, man, when they get sick, they get sick quick. And that's still, I mean, we've been in practice for some time as well. It's terrifying. And I'm wondering as a, how did you, um, did that come into, did that come into your mind when you were doing the same man? That's there's, there's a high reward when they're doing well, but man, the risk when they're not doing well is, is quite scary.

Jessi Barnes (03:09.731)
Right. One of the things that I'll use in education is you can't trust a baby, right? Even when you know that this is how you're going to do it, it could either go really, really well or it could go really, really poorly. You need to be prepared for both outcomes. And when it goes well, it is like this high, that you're just like, wow, we did this. We helped this family. Look at what we did. We got you through this moment that I didn't know you were going to make it through. But when it doesn't go well, it's just as impactful. And

Daphna Yasova Barbeau, MD (03:14.555)
Hehehe

Ben Courchia MD (03:22.186)
Mm-hmm.

Ben Courchia MD (03:29.835)
Mm-hmm.

Daphna Yasova Barbeau, MD (03:37.254)
Mm-hmm.

Jessi Barnes (03:38.227)
Part of what drew me to the trauma-informed paradigm was being able to kind of recognize the fact that I needed to feel that moment too, that I needed to feel it so that I could help facilitate other people feeling it and facilitate the patient and the family experiencing it. And it's so easy to become jaded in healthcare, especially when you work in the critical care setting, you're just like, well, that's what happens. It didn't work. We win some, we lose some, right? And in a way, that's a projection that protects us from feeling that vulnerability. But...

Ben Courchia MD (03:53.614)
Mm-hmm.

Jessi Barnes (04:07.699)
Being able to tap into the humanity and the vulnerability of what we do, I think strengthens our practice and not weakens it.

Daphna Yasova Barbeau, MD (04:15.959)
that and obviously we're going to spend a lot of time on the value of this, someone like you being part of those transitions, right? Those really vulnerable transitions for the family. But I think even for our community who, let's say you don't care about transitions or the impact of the family, I think...

The medicine of following a baby from fetus to neonate is actually quite interesting. And I think that you have this unique perspective or people who are doing high risk or have done high risk care, or those of us like myself who really like doing the prenatal counseling. I think we're learning so much more about these phenotypes of babies.

we can no longer say like, I went into neonatology because the babies, when you take an HPI, they don't have any history, but that's not true, right? They have this whole birth history where they were a developing human that we, once you're one or two days in, we kind of ignore, and I wonder what your thoughts are about that from a medical side.

Jessi Barnes (05:09.662)
No.

Jessi Barnes (05:23.899)
Yeah, yeah, yeah. I think that was something that I struggled with, honestly, when I transitioned from the perinatal setting to the NICU settings. I kept asking and report, okay, but what happened to mom? What was the last BPP? What is it? Do we have an ultrasound? Because I wanted to read these things to try to connect the patient that I was seeing and I had hands-on in the bed with the patient who I might have taken care of two weeks before, because it was in the same hospital. I just transitioned units. And so sometimes I would come through and I'd be like, oh, I know this, mom. I know this story. This is, oh, I wonder how that turned out.

Daphna Yasova Barbeau, MD (05:35.175)
Hmm

Daphna Yasova Barbeau, MD (05:46.391)
Mm-hmm.

Daphna Yasova Barbeau, MD (05:52.458)
Mm-hmm.

Jessi Barnes (05:53.707)
Because a lot of fetal medicine is, well, this is our best guess. This is what we've got based on the diagnostics we have available, but we really have to wait until we see baby to know what exactly we're dealing with. And being able to connect those two, um, was something that I think I annoyed my preceptors with honestly, cause I was like, well, she's small because of this and she's like this because of this. And she's having this, you know, particular reaction because the medication the mom had to be on because of this really weird complication of pregnancy that she had, and they'd be like, oh, I didn't, I don't need to know all that. I was like, but you do though. Right.

Daphna Yasova Barbeau, MD (05:57.54)
Mm-hmm.

Daphna Yasova Barbeau, MD (06:11.682)
Mm-hmm.

Jessi Barnes (06:22.859)
because it's a part of this baby's story. And ultimately it's a part of the family story as well. And so being dismissive of that is really doing your patient and their family a disservice and yourself. Because you could be learning, it's so cool. Everything that happens in pregnancy is so cool.

Daphna Yasova Barbeau, MD (06:23.159)
Absolutely.

Daphna Yasova Barbeau, MD (06:32.835)
Mm-hmm.

Daphna Yasova Barbeau, MD (06:37.291)
Yeah, and I wonder if it would help us anticipate some of the problems we see in the ICU if we spend more time on the history taking.

Jessi Barnes (06:41.084)
Yes.

Jessi Barnes (06:45.779)
I agree, I agree. Cause that's that baby's story. That's where they've grown up. That's how they've lived their life, right? The reason why we have our patient is because of how they were developed in utero. And then you start adding, I know this is a little bit of a tangent, but then you start adding, you know, the social determinants of health and access to care and all of that on top of it, it changes the narrative for the dyad that we're looking at in front of us. That person that might've been.

Daphna Yasova Barbeau, MD (06:50.5)
Hehehe

Jessi Barnes (07:13.323)
non-compliant with visiting, you know, it's easy to say, well, she just didn't care about this pregnancy, but where did we actually facilitate that? Why did we end up in this ICU, you know, setting? Was it because somebody just didn't want to take care of their body while they were pregnant or because they had other issues being able to do so in a safe manner? Right, right.

Daphna Yasova Barbeau, MD (07:19.879)
Mm-hmm.

Ben Courchia MD (07:20.13)
Mm-hm.

Ben Courchia MD (07:31.196)
Uh huh.

Daphna Yasova Barbeau, MD (07:31.211)
Yeah, so many barriers. Yeah. You know, I feel like perinatal care has changed so much. There was a time where the person who took care of the mom took care of the baby. And, you know, so they had that information. And now we've swung in the complete opposite direction where we're so specialized. Oh, obstetrics, maternal fetal medicine, let's say the pre-planning surgical teams, and then the neonatal team. And that doesn't even include the pediatrics team.

right after the NICU. So as someone who's been a part of the continuum of care, what do you think the answer is? What is important about our communication both before and after the NICU stay, where we can bring the pendulum back a little bit?

Jessi Barnes (08:21.851)
Right. I think it's really focusing on collaboration and that interdisciplinary work, right? We tend to think of interdisciplinary work as like, well, in the NICU, we have respiratory therapists, we have dietitians, we have neonatologists, we have nurses, we do well with interdisciplinary team.

But we have to remember the spectrum in which that baby came to exist. So things like care conferences for especially babies that you know are likely to be at risk. We know sometimes kids come out and they surprise us and we didn't have a reason to be concerned about them before this. But sometimes we do have an idea of that maybe this is going to be a challenging situation to manage medically and socially. So why don't we work on.

collaborating and consulting more than just coming down and saying, well, your baby's 28 weeks, so she's likely to have X percentage of survival. More than just that, let's talk about including all disciplines that could be, and having a communication channel in which that can happen along with the family, and let them have that integration of care so that they can be a part as well, which I know is kind of pie in the sky and would be very difficult to actually implement because just thinking about it myself, I was like, how would we do that?

But I think that's what pushes change in healthcare is having those wild pie in the sky ideas and then just figuring out how can I get to that point and maybe I settle for point A and then eventually I'm gonna get all the way to Z to where I wanna be. But stopping at, I'm just a neonatologist, I just need to deal with the baby, can't be the answer, right? Because someone else has been dealing with this baby the entire time and they might have knowledge that could impact the way you're gonna provide care for that family.

Ben Courchia MD (09:55.846)
Yeah, thank you for that. And I think you're saying a lot of things that as neonatologists, we've known and we've heard, and these are lessons that are ingrained into us, whether through education or through experience. But I wanted to maybe circle back to, I guess, your clinical title of clinical nurse educator. And I think I have the humility of saying this as a physician. I'm not exactly sure.

what is the role of a clinical nurse educator? I understand each and every one word of clinical nurse educator. And yet if I had to describe what a clinical nurse educator does, I don't think I would be able to do a good job. So for people who are in my position, what is your role technically in the NICU and what are your objectives when it comes to education?

Jessi Barnes (10:30.26)
I'm sorry.

Jessi Barnes (10:43.399)
Right. So you know, healthcare loves to use titles and then you're like, okay, but what does that mean though? And my title is no different. So the clinical nurse educator helps primarily with facilitating staff development and professional development for the nursing team. And it's different in every organization. Sometimes there's collaboration with a respiratory therapist special because you know, we're not just the nurses aren't the only people there. But some of it is skill-based. Some of it is instilling critical thinking skills. Some of it is quality improvement work.

Ben Courchia MD (11:06.222)
Mm-hmm.

Jessi Barnes (11:13.395)
right, to kind of facilitate. I work closely with our clinical nurse specialist who focuses on kind of being the liaison between the medical team and the nursing team and the system. Because a lot of the problems that we get brought up and the challenges that we have is a system-based challenge. It's not necessarily that the individuals involved don't want to do it, but the system isn't built to do that. So together, I work really closely with our clinical nurse specialist, and this is often how it is in NICUs.

to try to see how can we push through systems change, support the people in doing it, so that then ultimately we can affect positive patient outcomes. Because the nurses want, the medical team, everybody wants to provide good care, and maybe there's something new out there that they just didn't know about, and we can try to incorporate that in there. So it's validating current skills and growing new ones.

Ben Courchia MD (11:58.788)
And how is that achieved? Do you do that by being at the bedside and teaching technique? Is that by just bringing staff in a classroom and going over a PowerPoint presentation? And that may just be also subjective. That may be your opinion, but in your opinion, what is the model that is being followed to achieve that goal?

Jessi Barnes (12:22.183)
Yeah, it's a little bit of everything, right? Sometimes it is being at the bedside and helping and assisting and kind of walking through certain procedures. Sometimes it's sitting in a classroom giving more of a didactic review and then having like case study style discussions where we critically talk about maybe a recent patient that's had this particular problem.

A lot of my work is done with new graduate nurses because, you know, the nursing force is changing. We're bringing in a lot of new graduates straight out of nursing school nurses into the critical care setting and nursing school just does not prepare them for critical care period, but especially in the neonatal timeframe. So some of my page, some of the new grads are coming in and they've never even held a baby and here they are about to take care of very critically medical fragile babies. So I spend a lot of time trying to educate them and give them a

Ben Courchia MD (13:06.318)
Hmm.

Daphna Yasova Barbeau, MD (13:06.88)
Thanks for watching.

Jessi Barnes (13:09.631)
good foundation in which to build their clinical practice. For a long time, the model in nursing used to be, you know, see one, do one, teach one, and that still sometimes applies where you just learned from previous generations and they have a wealth of knowledge to learn from, but sometimes there's different ways or different techniques that we could be using. So it's collaborating with those kind of senior people to share experiences as well as my personal experience and then the evidence to kind of get practice to where we would like for it to be.

Ben Courchia MD (13:38.238)
Interesting. I think for us as physicians, if you had to say like, all right, if I have 20 minutes and I can teach a doctor something about the NICU, I would probably go with like respiratory distress, right? Like the thing you see most commonly in your experience, what is the area that you feel like is the thing you have to teach the most often or something or something? Not necessarily. I'm not saying, by the way, I'm not saying this in a way that like, oh, people are deficient in that area, but I'm saying what is, because I think the highest yield absolutely for nurses.

Daphna Yasova Barbeau, MD (13:46.703)
Mm-hmm.

Daphna Yasova Barbeau, MD (14:03.235)
the highest yield.

Jessi Barnes (14:07.911)
Um, so for sure, I think developmental care is the easiest one to go through because that touches every single system. I know I saw your excitement, right? I.

Ben Courchia MD (14:07.914)
that you're stitching.

Daphna Yasova Barbeau, MD (14:12.475)
Hmm.

Ben Courchia MD (14:17.494)
Daphne is like jumping up and down right now.

Jessi Barnes (14:19.671)
developmental neuroprotective, you know, we have like 15 names for it, right? But I try to hone in, I start off their very first session is on neuroprotective care and family integration because I need them to know that even if you don't know what you're doing, you can do it with empathy, right? Your first few weeks, you might be with a stable baby and you're scared, you don't even know where the bathroom is, right? And then someone says, feed this baby. You can learn how to do so from an empathetic.

place and a protective place because we're all here to grow their brains and save their brains because we are starting out this person on their journey in life, right? And we want to set them up for the most amount of success that they're capable of. And so neuroprotective care is one that I really truly integrate into everything. Close second would also be respiratory management and what to anticipate and how to help you with that because you know, respiratory is like 90% of the NICU, right? Like these babies, that's their biggest struggle. So I want to make sure they have good understanding of what's going on and then how to...

help the baby be successful with the changes that we're having. If you guys write these wonderful treatment protocols and vent protocols and we've got this baby there, but then he's over there hanging off the side of the bed from his ET tube, he's not really gonna manage that well, right? So it's making sure they understand things from stress management, pain management, positioning, and how just that impacts every aspect of the NICU care. They're gonna grow better, they're gonna breathe better, they're gonna do everything better, right? So I kind of really, even if I'm not teaching about that,

I find a way to plug it in because it really does impact everything.

Daphna Yasova Barbeau, MD (15:44.923)
Well, you're speaking my language for sure.

Ben Courchia MD (15:45.002)
Yeah, because yeah, and I think that's interesting because you're, it's really, um, it's really putting nursing care in the, in the realm of really being a catalyst and everybody knows that from my chemistry background, I am a big fan of enzymes and catalysts. The, the idea that you can be very minimally, um, invasive and yet make everything go better is something that is, is to me.

Daphna Yasova Barbeau, MD (16:04.419)
Hehehe

Ben Courchia MD (16:14.402)
the epitome of what the work nurses do, because you feel like they're not there and yet everything is successful because of them. So I really, really like that. I really, really like that.

Jessi Barnes (16:26.716)
Right. I just go ahead.

Daphna Yasova Barbeau, MD (16:29.156)
Yeah. No, I was gonna say when I think about nursing care, the gamut of all of the potential things that nurses can do and all the specialties, I mean, the NICU really straddles the whole thing, right? From the really, really acute management to the minutia, to the teaching, to then the like routine development of quote unquote healthy normal baby.

You know, so it's a lot, right? The spectrum is a lot, but I love your idea and it really reinforces this all cares, brain care, right? That no matter what part of the NIC you were managing, we're growing this little human who's not just had one acute event, but is still really in the stages of development where every interaction, every touch time we have with them impacts.

their chemistry, their chemistry and their anatomy of their brain, right?

Jessi Barnes (17:26.407)
When I was a little baby, NICU nurse, I had somebody teach me, I was told, oh, you don't have to worry about pre-verbal memories don't matter. They don't remember this. And I was like, and at the time that was what she actually thought. Right. Um, and I remember thinking, Ooh, that does, that just doesn't sound right. You know? Um, like it just, I don't have a, I don't have a logical argument for you, but in my soul, I was like, that's not it. You know? Um.

Daphna Yasova Barbeau, MD (17:33.315)
Hmm.

Ben Courchia MD (17:35.968)
Oof.

Daphna Yasova Barbeau, MD (17:46.592)
That doesn't make sense.

Daphna Yasova Barbeau, MD (17:52.203)
That doesn't sit right with me.

Ben Courchia MD (17:53.471)
It didn't pass the whiff test.

Jessi Barnes (17:55.203)
Right. And then, you know, I kind of got interested in developmental care and, you know, kind of found people like Mary Coughlin and like listening to all of those, you know, great works on trauma informed care in the NICU. And I was like, ah, this one makes more sense. Right. We know now that they might not verbally remember and can't verbally recount it, but their body remembers.

their toxic, the overwhelming toxic stress, growing up in that environment, developing your body in that environment has the potential for lifelong outcomes. So if adjusting my nursing care.

Daphna Yasova Barbeau, MD (18:25.232)
Mm-hmm.

Jessi Barnes (18:28.507)
in a small way to be more kind or be more empathetic could potentially impact this patient's life in a positive way, why wouldn't I do that? Because yes, I want to save their body, but I also want to save their brain. I want them to be able to experience the sunshine and experience the highs and lows of life and all the richness that we experience as human beings. And if they can't do that because of how their stress system is constantly upregulated, right? They don't have the ability to decrease their cortisol production and all those other like technical things.

Daphna Yasova Barbeau, MD (18:36.357)
Hehehe

Jessi Barnes (18:57.727)
then we're kind of robbing them a little bit of a quality of life. And I, it's no skin off my back to go in and talk to the baby and say, Hey little guy, I'm here to change your diaper. Oh, I know it's proud, but we're going to be here together and your mom's here and everything's going to be all right. And providing containment and just like minor little things that we can do that isn't as fun as medication. It's not as fun. It's hard to capture and research sometimes cause it's kind of soft, right? But it has these long-term impacts for this family in a positive way.

Daphna Yasova Barbeau, MD (19:00.932)
Hmm.

Daphna Yasova Barbeau, MD (19:07.326)
Mm-hmm.

Daphna Yasova Barbeau, MD (19:19.407)
Hmm.

Daphna Yasova Barbeau, MD (19:27.051)
Well, I, you know, I'm totally on board with this. And I think that, you know, some of the biggest offenders, we have all types of listeners, some of the biggest offenders are the physicians, right? We don't care when the touch time is. I mean, most of us, I care when the touch time is, but we go in, we turn on the lights, we talk loud, we poke the kid, we just keep asking for labs willy nilly. So, you know, I have.

Jessi Barnes (19:31.339)
I'm going to go to bed.

Jessi Barnes (19:49.323)
Thanks for watching!

Daphna Yasova Barbeau, MD (19:55.191)
I have kind of two questions, particularly around your role as the clinical nurse educator. So one, how do we get doctors to care? And two, say I'm a physician who cares in a unit, but this facet of neonatal care falls mainly on the nursing staff. So how do we partner with our nursing colleagues to make these policy and culture changes when

they may say like, that's not even the doctor's responsibility. That's what we do, not what you do.

Jessi Barnes (20:31.847)
Right? It's the million dollar question. How do I get the doctor to care? You said it, right? I was trying to dance around it. But yeah, because, you know, if you think about the difference sometimes between the medical model and the nursing model, nursing models are almost always trained to see the person first and then the outlying community impacts and all the other things. I think my understanding from the medical model is a lot of times it's very like problem focused. You have this problem, I'm gonna draw these labs, and then we're gonna do this thing, and then you should be act like this. And if you don't, I'm gonna go to this phase of the algorithm.

Right? And that's great because we need both sides. But the sweet spot to me in that Venn diagram is where it overlaps. So that we can actually work and collaborate together. Because yes, I understand you need to do this. You have rounds, you have clinic, you have all these other things. You need to see this baby right now. Right? But little things like, hey, so I'm getting ready to get in this baby's bed. Are you able to get in with me? Is mom coming? Like, can you come do four handed care with me?

Daphna Yasova Barbeau, MD (21:26.331)
Mmm.

Jessi Barnes (21:26.967)
I know you need to do an assessment, but can you do some containment while I get in here?" Just asking the question rather than either assuming that the answer is no or not even thinking that the answer. When I was at the bed, go ahead.

Daphna Yasova Barbeau, MD (21:30.789)
Mm-hmm.

Daphna Yasova Barbeau, MD (21:38.951)
I love, sorry, I wanted to before you, I love your specifically about your kind of bundling of care because I think about the way we examine babies sometimes. And the truth is that when we go in and it's not a care time and we do a really cursory exam, we would get theoretically way more information if we encountered the baby during a full touch time, right? The lights are on, the baby's totally naked, we get to see the baby awake.

Jessi Barnes (22:03.045)
Right.

Daphna Yasova Barbeau, MD (22:08.483)
which is not something that is frequently documented on exams.

Jessi Barnes (22:13.211)
Yeah, and when I was at the bedside and I had a patient, especially a patient who I knew was a little bit challenging, right, like they needed, they really needed to be managed. I truly hate the term touch me not, but in that kind of vein, I would call the provider and be like, hey, I'm getting ready to get in this bed space with the RT, do you have a second? Can you come see this kid now? And now sometimes they'd be annoyed, right? Cause y'all got things to do, there are other babies, but I just let them be annoyed because that's okay. You can be mad, I'm just extending the invitation, right? But most of the time,

Daphna Yasova Barbeau, MD (22:18.795)
Hmm.

Daphna Yasova Barbeau, MD (22:40.779)
Mm-hmm.

Jessi Barnes (22:42.515)
they would take me up on it. They'd be like, oh yeah, actually I'm getting off this one, I'm finishing up this chart, I can be there in five minutes. Okay, what's the difference between eight o'clock and eight o'five, right? And so being able to have that collaboration to where those phone calls or that conversation can happen and then be received well most of the time, sure, there were times where I would call and they'd be like, I'm coding somebody downstairs.

Daphna Yasova Barbeau, MD (22:43.427)
Mm-hmm.

Daphna Yasova Barbeau, MD (22:48.699)
Mm-hmm. And we can plan for it. Yeah.

Daphna Yasova Barbeau, MD (23:05.802)
Mm-hmm.

Jessi Barnes (23:06.059)
Cool, obviously you cannot do that, right? But just when you can really collaborate with it so that you guys are getting good knowledge. I know now what the medical plan is, so I can help support it with the parents coming in and passing it on a nursing report. There's just, to me, the list of reasons to not do it doesn't really exist, right? Like, it might be uncomfortable, there might be some culture change that's needed in order to do it, but that's a drop in the bucket compared to the positive outcomes that you could have from it.

Ben Courchia MD (23:38.479)
I wanted, sorry, definitely we're gonna say something.

Daphna Yasova Barbeau, MD (23:40.299)
No, and the second part of that question was, if you're a physician who's in charge of making policies and protocols, or you want to establish this type of change around family-centered care or trauma-informed care or neurodevelopmental care, that again, the minute-to-minute tasks really fall to the nursing team. How do you, what is, how do we get the buy-in, I guess, for all of our teammates?

Jessi Barnes (23:45.386)
Yes.

Jessi Barnes (24:08.363)
I think it's a lot of modeling. I think being able to show that something works goes a long way, more than your words can ever do, right? I worked with a provider who would do just that. She's like, I'm ready to talk. I know mom said she's coming in yesterday. She said she's coming in around two. I'd like to see the baby before then so that we can talk with mom when she's there. Can we, what works for everybody? And it made, and other providers would say like, okay, that wasn't that bad, right? Or she'd be training somebody and being like, oh.

Daphna Yasova Barbeau, MD (24:35.215)
Hehehehe

Jessi Barnes (24:36.447)
So you just ask them. And I'm sure there's been experiences where nurses have been like, rawr, no, you can't do that, because we're very protective of our patient's bedside and our space. But being the person who's willing to just show, it really is easy. Yes, there needs to be policy, there needs to be education, there needs to be research to support the evidence and all those things. But I think a lot goes in just living the life and setting expectations and showing that it's.

Daphna Yasova Barbeau, MD (24:44.667)
Sure.

Jessi Barnes (25:02.139)
it's not nearly as difficult as we think it is. And you're gonna spend more time and have more work for yourself doing it the other way when you could just cut to the chase and collaborate a little bit.

Ben Courchia MD (25:13.292)
I love that.

I wanted to ask you a little bit about the continuity of skills. As we are reviewing, we're reviewing a lot of evidence on the podcast and there seems to be a clear dogma that outcomes will probably be better. And I say probably because it's not a universal law, but it probably will be better if you do something that may not be the most evidence-based practice, but you do it consistently well rather than.

rapidly shifting practices frequently and not doing this very well, you may actually lose on your outcome metrics. And I feel like nurses are, this applies to doctors as well, but we're talking to you, so I want to focus on nursing, but nurses are very proud of their craft. And I feel like sometimes when a new evidence-based practice comes in, there's almost this nostalgia of like, man, but

Jessi Barnes (25:45.159)
Mm-hmm.

Ben Courchia MD (26:10.438)
we used to do these things so well, and now we're going to change everything. And, and you, despite how good the staff can be, you never know that we're going to be able to then rise up to this new challenge and do things just as well. Everybody has the capacity, but when you're involving a system wide change in how you manage certain things, there's too many moving parts for you to be guaranteed that things are going to go well. And so I'm wondering, what are your, what is your advice and what has been your experience?

when new practices are sort of being accepted in the literature, in the community, and you do have to go to the bedside and say, all right, we're going to change how we do this and how scary that can be and how do you deal with your team at that juncture?

Jessi Barnes (26:57.371)
Yeah, you guys are really saying the quiet part out loud. I love this because change is hard, right? And people often are very resistant to it. Not because they want to have bad outcomes, not because they hope that things can stay the same forever, but they're good at what they do. They identify with the task and being good at it. An example in the NICU is QBase feeding, right? We know overwhelmingly that it does, there's no reason to not do it, right? It helps the baby in pretty much every single way. Plus it just makes sense.

But when we rolled that initiative out at my previous institution, we were met with, well, I've been feeding babies like this for 30 years. You're telling me I've been hurting babies for 30 years? No, those aren't the words I used. No, you did what you were taught. You did what was current then, and now we know better. So we do better, like the words of Maya Angelou. I say that three times a week. You have to just get comfortable with being able to...

Daphna Yasova Barbeau, MD (27:36.667)
Mm-hmm. Ha ha ha.

Jessi Barnes (27:52.391)
Be flexible in the sense that when something new is compelling, like you said, you don't want to flip-flop with every single article. You want to critically consume your research to make your decisions. But when something is compelling to change practice, lean into the why. Learn why you're doing this because then you can learn the how. And you'll understand how the previous way that you did it actually influences the way it is. It's rare that we just completely are like white and black, completely different.

Daphna Yasova Barbeau, MD (27:58.841)
Fuh-Fuh.

Jessi Barnes (28:17.211)
you know, we no longer do this. It's often a spectrum, right? We start off here and then we just kind of end up on the other side. And it's hard to get that buy-in with your stakeholders with change. There's some people that I've worked with where they're just like, what are you changing now? Every time I see you, you're changing something. And I was like, that's not true. I was like, that's not true. I'm not trying to change everything. I mean.

Ben Courchia MD (28:37.815)
I've heard that as well. What are you changing now?

Jessi Barnes (28:45.095)
everything might need to be changed in a little bit, but I'm not doing it all at once. I'm really trying to put some intentionality behind it. But I think consistency is comfortable. And when you're good at something, you like being told, oh, so-and-so can feed that baby. Oh, so-and-so can get your IV in. So-and-so can do this because she's been doing it for X number of years. And it's taking that expertise and the years of experience and translating it into the change process and having those people help.

Ben Courchia MD (28:46.583)
Huh?

Daphna Yasova Barbeau, MD (29:03.874)
Mm-hmm.

Jessi Barnes (29:14.195)
be your agents of change, identifying who those formal and informal leaders are so that you can be like, okay, do you get it? You understand? Oh, okay, light bulb. All right. Now you're going to help me get the buy-in from everyone else. But yeah, it's a struggle, I think, across the age spectrum in healthcare. We just, we don't like change, right? It's, but we have to kind of just lean into it. To me, that's the exciting and the comfort part of it. Knowing I could be better, why wouldn't I want to be better? Right?

Daphna Yasova Barbeau, MD (29:31.695)
Hehehehehe

Ben Courchia MD (29:40.398)
And I think something you mentioned to me that resonates a lot is trying to put things in the perspective of the larger continuum in which things, I think, sometimes we think, oh, they're changing. But then when you present it as like, this has been constantly changing, we're in a constant state of movement, then you're like, oh, so it's just we're just continuing to move forward in a certain direction. I think that's extremely valuable. I think it's extremely valuable.

Daphna Yasova Barbeau, MD (29:56.099)
Yeah.

Jessi Barnes (29:57.48)
Right.

Jessi Barnes (30:09.403)
Yeah, it's like that whole constant readiness thing. It's often talked about in joint commission surveys and things like that. But if you stay in the status of something's gonna come out, I'm gonna learn something today, something's gonna be different, then when it happens, you're just like, ah, there it is, okay. And you keep it moving rather than being like, oh, what now, kind of discussion.

Daphna Yasova Barbeau, MD (30:24.281)
Not surprised.

Ben Courchia MD (30:28.554)
Yeah. Yeah, we were talking about that, Daphne, right? I think it was at the Envision Heartbeat to Home lecture that we gave recently, where we were talking about how we consume information and we're talking about the new ways to consume information. And we're saying, hey, the way we consume information has been constantly changing. Like, it's not like it's changing now. It's been changing. It has changed already. And this is just a new iteration on these multiple changes. And I think from that perspective, especially when you're putting it in the context of the NICU, it's very interesting.

Daphna Yasova Barbeau, MD (30:34.434)
Mm-hmm.

Daphna Yasova Barbeau, MD (30:39.215)
Mm-hmm.

Daphna Yasova Barbeau, MD (30:45.288)
Mm-hmm.

Daphna Yasova Barbeau, MD (30:58.895)
I wanted to piggyback off of something that you said specifically about the change makers and your nurse champions and this is something we're dealing with in our own unit. How do we totally hear you about relying on expertise? But how do we not fall into the trap where we rely on the same group of people?

to make all the changes and how can we foster some of the younger newbies to develop an interest in something that the unit needs maybe or something that they already have an interest in.

Jessi Barnes (31:41.127)
Right? That's a challenge I think every unit is facing because a lot of our workforce is turning over, right? Either they're getting older, we're looking at retirement, but then also people are leaving, they're going into advanced practice and people are leaving the professions altogether. So how do we cultivate those new informal leaders, right? And I think part of that is through programs like what I offer for the residency programs, right? Of like really cultivating from the door, this is where we're at, let's give you a foundation, let's get you used to the idea of change.

building your bell curve of change, if you think of Lewin's theory, right? Of how can I get to that 16% to be able to kind of get over? And it can be challenging because sometimes that middle crew gets left out, right? We're focusing so much on the new people and then we expect the experience of the older people that those people that are like eight to 10 years or just kind of like eight to 15 are like, what about me? And so it's also cluing into that group and saying, okay, you've been here long enough.

both, you're straddling both sides. You have the experience of all the experienced people because you were trained by them. You also see what all the change is coming with the newer people. Let's partner. Let's figure out how we can get this together. And if we focus too much on one or the other, like you've identified, you focus too much on that expert level, you're going to miss so many opportunities that you could have in growing that future. And kind of just fostering from beginning and with every interaction, this is how...

Ben Courchia MD (32:51.758)
Mm-hmm.

Jessi Barnes (33:07.923)
we're gonna look at the evidence. This is how we're gonna consume this change. It's not comfortable, but it's gonna happen. So let's partner with it and make it the most palatable as we can, as we're going through it rather than being very, well, I talked to so-and-so who's been here for 35 years and she agrees, so you should just get on board, right? But actually going through and taking that and influencing downward as well, and not just pulling from that top list.

Daphna Yasova Barbeau, MD (33:23.227)
Hehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehe

Daphna Yasova Barbeau, MD (33:31.931)
Mm-hmm. Love that.

Ben Courchia MD (33:34.31)
Jesse, I think we would be remiss if we didn't talk about the second part of our interview. And I think it's quite interesting, especially having spoken to you for the past 30 minutes. There's clearly a sense that emanates from you that you're committed to excellence. And I think that gets very interesting when we're putting this into the context of the fact that you became in August of 2022 yourself a NICU parent.

Daphna Yasova Barbeau, MD (33:52.137)
Okay.

Ben Courchia MD (34:04.47)
And I am wondering if you could briefly for the audience share with us exactly what exactly happened and what that story was before we get into the details of your experience in the NICU directly.

Jessi Barnes (34:21.403)
Yeah, my sweet little baby girl, Aurelia, was born at 27 weeks and five days after a placental abruption that occurred at home. When I woke up, I immediately knew what was happening. I yelled at my husband, we got in the car, I knew all the things, and I just kept telling myself in the car ride over, if she makes it, we still have so much ahead of us, right?

Daphna Yasova Barbeau, MD (34:32.879)
Wow.

Jessi Barnes (34:43.419)
And it was just this moment of, oh, how am I going to do this? How am I going to do this personally as a mother to two other kids at home? How am I going to do this as a mother? How am I going to do it as a professional? I delivered in a facility that I worked at for many, many years. I knew the medical team personally and professionally and the nursing team. And so it was just this moment of how is this going to play out? And having the trauma-informed background, I was like, had this kind of...

Daphna Yasova Barbeau, MD (34:47.594)
Mm-hmm.

Daphna Yasova Barbeau, MD (34:55.227)
Mm-hmm.

Daphna Yasova Barbeau, MD (35:10.444)
Mm-hmm.

Jessi Barnes (35:12.051)
disassociation a little bit where I could kind of sit and think, oh no, you're, you are living your trauma right now. Like you, like I could see it all like out of body kind of experience of knowing it. Um, and even something is as innocuous as when I got to labor and delivery, I called the NICU charge nurse and was like, y'all are about to get a stat 27 week or who's on call. And she goes, who are you? Cause she didn't know me. I'd been gone for two years at that point. And I was like, I used to work there. My name's Jessie. Can you find somebody who knew me? And can you send me the Neo?

Daphna Yasova Barbeau, MD (35:17.987)
Mm-hmm.

Daphna Yasova Barbeau, MD (35:22.34)
Wow.

Daphna Yasova Barbeau, MD (35:31.439)
Hehehehe.

Jessi Barnes (35:41.131)
You know, and they were like, okay, you know, but, and then the labor and delivery nurse kept saying, oh, it's everything's okay. Everything's okay. And I said, no, nothing is okay. I'm having a placental abruption. You haven't found heart tones. I need to be in the OR like five minutes ago. Where is my OB? And they were like, we're going to call in any OB in house. And then my OB walked in because I knew what was happening. And it was just this moment of

Daphna Yasova Barbeau, MD (35:41.307)
Mm-hmm.

Ben Courchia MD (35:41.791)
Yeah.

Daphna Yasova Barbeau, MD (35:44.719)
Hehehe

Daphna Yasova Barbeau, MD (35:53.058)
Mm-hmm.

Daphna Yasova Barbeau, MD (35:57.087)
Mm-hmm. Yeah.

Daphna Yasova Barbeau, MD (36:02.323)
Mm-hmm. Yeah.

Jessi Barnes (36:06.119)
You can't tell me what I'm experiencing. I know what I'm experiencing. I've held the hands of many parents as they've gone through this motion. And to have to do it myself was just eye-opening, traumatic, overwhelming. It was, I had such, and it's also complicated because two things can be true at once, right? I also had a deep amount of gratitude for the medical care that she got and the fact that we were being supported in the ways that we were, even if I had to advocate for that to happen.

Daphna Yasova Barbeau, MD (36:12.534)
Mm-hmm.

Daphna Yasova Barbeau, MD (36:33.083)
Mm-hmm.

Ben Courchia MD (36:33.478)
Mm-hmm. And so I have so many questions. Hold on. Let me just, I have to, I have to put them in order. My first question is, um, tell me if I'm wrong. Um, while a placental abruption, I usually tell parents, my, my analogy of what a preterm birth is, is usually that a preterm birth is like a car accident. It's like, you kind of losing control and things are going to happen. And we're going to just try to make sure that after that happens, everybody's okay. Right? It's literally, uh, something that people can, can unfortunately relate to.

Jessi Barnes (36:36.78)
I'm sorry.

Ben Courchia MD (37:01.686)
But what you're describing is that your background allowed you to keep a sense of control, it seems, that you're like, a little bit like, it reminds me of Rena Audish's book in shock where she knows what the steps she's going through and she's like, I know what's happening, I know what the next step should be and I'm gonna try to just, like a person running a marathon, like, let me just get to the next post and then we'll, is that how you felt it at the time?

Daphna Yasova Barbeau, MD (37:14.615)
needs to be done. Yeah.

Jessi Barnes (37:26.747)
Yes. And much to the chagrin sometimes of the medical team, because they would be like, we're not there yet. And I was like, I know, but that's where we're going. Right. So what's the plan for that? But yes, I remember waking up and just immediately thinking, okay, I don't have a bag. That doesn't matter. We need to get in the car. We need to go. I need to get to the award. I knew what needed to happen. And so that allowed some control. And in the way that only an ICU

Ben Courchia MD (37:34.131)
Yeah.

Daphna Yasova Barbeau, MD (37:35.805)
Yeah.

Ben Courchia MD (37:45.899)
Mm-hmm.

Daphna Yasova Barbeau, MD (37:46.045)
Mm-hmm.

Daphna Yasova Barbeau, MD (37:54.927)
Mm-hmm.

Jessi Barnes (37:56.603)
I know what needed to happen, but it also made it that much more stressful when it didn't happen. When I was having to tell people, you should be doing this. Why aren't you doing this? And they'd be like, that's not our protocol. I don't care what your protocol is. This is what it is. Right? Or I would say, no, it is your protocol. I helped write your protocol. I know what this is. And they would be like, oh, okay. And it was just that moment of trying to straddle the line of patient and professional at the same time. And that is, it's an impossible task to be good at without making somebody angry.

Daphna Yasova Barbeau, MD (38:01.369)
Yeah.

Right.

Daphna Yasova Barbeau, MD (38:08.089)
Hehehe

Daphna Yasova Barbeau, MD (38:12.091)
Hehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehe

Mm-hmm.

Ben Courchia MD (38:21.451)
Mm-hmm.

Jessi Barnes (38:26.371)
Like somebody was angry all the time. Sometimes it was me, sometimes it was everybody, but we just had to get over that, right, to incorporate it.

Daphna Yasova Barbeau, MD (38:26.563)
Hmm.

Ben Courchia MD (38:32.478)
Yeah. And before we get into, into that line, I think there's something interesting about, about this whole story, which is you went to the place you practice, right? I think there's an interesting question that everybody probably asks themselves, which is if I had to seek medical care, would I come to my institution? And I think there's several answers to that because, um, for example, if you're working in a hospital that does not have pediatrics, then, then you wouldn't seek care at your institution for your child because they're still.

Daphna Yasova Barbeau, MD (38:41.357)
Mm-hmm.

Daphna Yasova Barbeau, MD (38:46.856)
Where would I go? Yeah.

Ben Courchia MD (39:01.65)
they'll have the service. So eliminating the idea that you wouldn't seek care at your home institution because they do not have the services, which is obviously a no-brainer. You are going to your institution where they have the services that you need. And how do you feel about that? Because on the one hand, I feel like I would trust any of our NICU team, right? But then,

suddenly OB is very adjacent to us, but I don't know all of them as well, and I don't know anymore. And then you have to trust your institution, and that sometimes can be difficult. Sometimes it may be even easier to be a stranger to the institution. So I'm just curious as to...

Daphna Yasova Barbeau, MD (39:35.232)
Mm-hmm.

Daphna Yasova Barbeau, MD (39:48.651)
Or even that, the blurring of your boundaries, right? Of letting these people you work with into your truly, truly private life. You know, it's a whole nother.

Ben Courchia MD (39:56.526)
Yeah. Was that a conscious decision to go to your home institution or was that just, it was not, it was just proximity or something along those lines?

Jessi Barnes (40:06.375)
No, it was a conscious decision. My thoughts were kind of along what Daphne had said about kind of blurring the boundaries of like, yes, it's going to be scary and terrifying and all those things, but also I potentially have a circle of influence here.

right? And I know that I can go to them and I can say, I can talk shop. I can be like, what are her hyperal decisions today? What was her B-Med? What was this? What was that? And like, let's talk about it versus sometimes in healthcare, we tend to get kind of defensive when people ask those questions, you immediately start making the Dr. Google jokes and all the things, right? And so I was like, I want to go to somebody who knows my professional background and can hopefully recognize that and see that and work with me there.

rather than having to surprise, pull it out of the hat, like, oh, by the way, I teach people how to do this. But it was also recognizing that this is gonna be an extra layer of trauma, really, having to let people in a way that we're not used to doing. Sure, I've worked with these people for years and they know all my stories and I share all my ups and downs and the gossip and all the things, but.

But now we're talking about life and death and like the intricacies of my health record, my child's health record, right? Things that should be protected. It was a lot of trauma kind of acknowledging that was gonna happen. But I still felt like it was where I needed to go. It was where I needed to be. I trusted the team. I trusted the care that they've provided. And I knew that it might not be easy and it was gonna be a struggle sometimes, but she still was gonna get top-notch care.

Daphna Yasova Barbeau, MD (41:19.503)
Mm-hmm.

Daphna Yasova Barbeau, MD (41:46.076)
Along the lines of being able to anticipate what was coming next, right, because you'd worked there, you'd quote unquote lived it. But we truly, we know that even as neonatal professionals, we haven't lived it. I think what surprised you the most during your stay in the NICU?

something you maybe hadn't anticipated or you didn't see coming even though you'd worked there for very long.

Jessi Barnes (42:17.791)
the thing... sometimes it was...

just how comfortable people get. And I ask myself often, is this because it's you or people like this with other families? And how comfortable they were just saying things kind of off the cuff. Sometimes from like a toxic positivity standpoint of like, well, at least she's this, at least she's off the ventilators, at least she only needed two doses of surfactant, those kinds of things. Or it was, you know.

Daphna Yasova Barbeau, MD (42:29.423)
Hmm. Mm-hmm.

Daphna Yasova Barbeau, MD (42:37.061)
Hmm.

Daphna Yasova Barbeau, MD (42:43.823)
Mmm.

Jessi Barnes (42:51.975)
Well, you know, you have boys at home, she'll be fine. You just need to stay home. Like, they're gonna remember this, she's not gonna remember this. And I was like, ooh, do you say that to everybody? Cause you probably shouldn't, you know? And even just hearing things that I've been taught to say and that I've taught myself, I said myself to be like, oh, that lands so differently when you're the parent, you know? Seeing something as seemingly innocuous as, trust me, I got this, I do this for a living, you know? Or some version of that sentence where you're like, okay, yeah, but.

Daphna Yasova Barbeau, MD (43:00.592)
Ha ha

Daphna Yasova Barbeau, MD (43:05.423)
success

Daphna Yasova Barbeau, MD (43:11.216)
Hmm.

Daphna Yasova Barbeau, MD (43:16.959)
Mm-hmm.

Jessi Barnes (43:19.975)
you're not doing it the way I would want it to be done, and this is my baby. And how do I know that you're doing it the right way, or are you just doing it the way that you have always done it? Which might be the right way, but I don't know that, right? Because I started kind of sitting in my experience and thinking, what are these other families here? Like, I could do the translation, and I could read between the lines, but what do other people do? And how do they navigate this without that immense privilege of having the background? And it just kind of opened my eyes to, like, how we could just slightly be better, you know?

Daphna Yasova Barbeau, MD (43:23.046)
Mm-hmm.

Daphna Yasova Barbeau, MD (43:27.48)
Mm-hmm.

Daphna Yasova Barbeau, MD (43:39.261)
Mm.

Ben Courchia MD (43:43.682)
That's interesting.

Daphna Yasova Barbeau, MD (43:50.066)
Mm-hmm.

Ben Courchia MD (43:50.87)
I think that's very interesting, right? Because I would trust my home institution, not because of how the nurse gives the feed, but because of the outcome. Because I'm like, I know that when they do their thing, this is the outcome that we can expect. And that means that sometimes you skid a little bit off the road in certain corners, right? And it's like, well, certain things obviously could be done better, but at the end of the day, the outcomes are there.

What's interesting to me is that this is how we measure ourselves. What are our outcomes? How many babies have a complication? How many babies are suffering immortality and so on and so forth? And yet what you're describing is that you went from the mindset of this clinical educator that looks at broad system-based practices to then micro-assessment of every sort of muscle movements of the staff to try to demand...

Daphna Yasova Barbeau, MD (44:26.767)
Mm-hmm.

Ben Courchia MD (44:49.602)
perfection every step of the way. Um, and I think that's just very interesting because it, it seems like. As a clinical educator, you are a level headed person that does a job and then you mix in the parent and then this is where this is what comes out of the oven and I am wondering if you feel that your demands and your, and your demand for, for excellence.

Jessi Barnes (45:17.408)
Thanks for watching!

Ben Courchia MD (45:19.438)
were something that changed you and that after this experience, you then expected people to continue to strive for this level, or you realized that this was also you being a parent and that maybe you should, not back off is not the wrong word, but just step it, dial it down a little bit because it's just a utopia and it's not possible to be like that all the time.

Jessi Barnes (45:34.347)
Thanks for watching!

Jessi Barnes (45:48.967)
Yeah, I think I've always been a person and in my nursing care kind of held myself to a really high standard and I wanted to be able to hold the people that took care of Aurelia to that same standard. And some of the people who I've worked with who took care of her were like, yeah, I mean, they're saying stuff, but you know, that's just how you are. Like I know you, you want to do what you've done before. And I would say things like, you know, she's my most important patient, right? Because she was.

Daphna Yasova Barbeau, MD (46:10.267)
Hmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm

Ben Courchia MD (46:18.83)
Mm-hmm.

Jessi Barnes (46:19.035)
I wanted things to be done correctly for her because she was, it was my baby in that bed. But I also held myself to that same standard for other people's babies as well. I was never one of those nurses who, yes, I individualized and yes, I understood that we're not gonna win every case and all those things, but I also was like, but there's a reason why we do this the way we do it. There's a reason why we should follow.

the rules, quote unquote, right? And we know in neonatology sometimes we're writing the rules as we're living, because it's such a young subspecialty with all the newness that's coming up with it. But that, yes, it's a challenging question to answer because yes, I want to hold people to be excellent because I feel like we should be excellent as to the best of our abilities from the systems level all the way down to the individual level. But identifying it as a utopia that could never be reached is something that I don't know.

that I agree with in the sense of like, we should always strive towards that. We should always look to do that. Cause at the end of the day, this is someone's baby. And I wanna make sure that they have the best outcome possible. And maybe that means pushing ourselves as a specialty and as a team and as an organization, but if it leads to more positive outcomes.

Daphna Yasova Barbeau, MD (47:12.027)
Hmm.

Jessi Barnes (47:29.251)
then why wouldn't we do that? Think of all the treatment protocols we have because someone decided that 1% was still too much. You know, like we wanted to try to eliminate certain problems to the best of our ability.

Daphna Yasova Barbeau, MD (47:35.642)
Mm-hmm.

Daphna Yasova Barbeau, MD (47:41.531)
How do you think that this, you know, that experience has changed your practice? It sounds like caring for the family and the baby as an individual was something that was already part of your professional development, but how did it change?

Jessi Barnes (48:01.403)
I think it became a little more introspective in the sense of...

How can I hold myself accountable in the ways in which it's reasonable to do so, to provide that trauma-informed, empathetic care? Instead of saying, don't worry about the monitor, mom, I got this, I'm paid to watch this, you just look at baby. You say something as simple as, I know you're scared because the monitor's going off and it's kind of overstimulating in the NICU, but know that I'm right here with you and I'm going to help you through feeding her for the first time.

Daphna Yasova Barbeau, MD (48:25.152)
Mm-hmm.

Daphna Yasova Barbeau, MD (48:34.191)
Mm-hmm.

Jessi Barnes (48:38.517)
you know, that first statement is in fact true. The mom doesn't need to worry about the monitor. I am paid to watch for it, right? But just acknowledging her fear and centering her experience and the baby's experience often leads to better outcomes for both in measurable, you know, my metrics and non-measurable metrics, right?

Daphna Yasova Barbeau, MD (48:56.867)
Because it doesn't matter what we say, she's going to be worried about the monitor. Yeah.

Jessi Barnes (48:59.215)
Exactly, exactly. So part of trauma is having an experience that isn't validated by those around you, right? And so having someone say, I see you, I can't automatically, I can't take it away, I can't fix it, but I see you. And I'm gonna stand here with you in this dark time, and I'm gonna sit with you and offer you empathy and recognize that what you're going through is something that few people in your life understand. But I'm gonna try to, to the best of my ability.

Daphna Yasova Barbeau, MD (49:05.304)
Mm-hmm.

Jessi Barnes (49:24.687)
rather than just downplaying it. Just be a mom. That was one of my biggest triggers when we were in the NICU was, you're not a nurse right now, you're her mom. No, I'm always a nurse. I'm a nurse when I go to Publix. I'm a nurse when I go to the bank. I'm a nurse when I go to the hospital. I'm never not a nurse, right? In medicine, we tend to very strongly identify with our roles. So yes, I am her mother, but I'm also this other thing. And asking me to just turn that part of my brain off is not, I can't do it. It's not possible. And...

Daphna Yasova Barbeau, MD (49:28.512)
Mmm.

Daphna Yasova Barbeau, MD (49:32.528)
Mm-hmm.

Mm-hmm.

Jessi Barnes (49:51.995)
That's true of all the backgrounds of all of our family members, and we don't need to know the specifics of where they come from to just recognize their struggle in that moment. And oftentimes parents will get labeled as difficult or challenging when really they're just scared, they have questions, their needs aren't being met. And you just have to figure out, what can I do to show them that I see them? I understand where they're coming from to get them to be able to relax and enjoy their baby.

Right? I had a dad once that he was some kind of engineer. I don't know what kind, but he was obsessed with the phototherapy lights and he needed to know the wavelength of light. And he was labeled as being difficult because he would ask 50,000 questions. So, right. And so I figured out like, I personally didn't know it, but I was like, oh, this is what you wanna know. We're gonna Google it and then we're gonna call a doctor and confirm it and then you're gonna get your answer. And he didn't. And after that, he was like, okay, all right, that makes sense.

Daphna Yasova Barbeau, MD (50:29.919)
Mm-hmm.

Daphna Yasova Barbeau, MD (50:34.001)
Well, we could have just told him, we know the wavelength, right?

Daphna Yasova Barbeau, MD (50:45.252)
Yeah.

Jessi Barnes (50:49.115)
And then it was just smooth sailing for the rest of the shift. And I was like, that one question was all he needed to answer. He needed somebody to see that he was, he just needed that, that it scratched, you know, so that he could go forward. And then everything kind of shifted for them. They were no longer the difficult people because their needs were being met.

Daphna Yasova Barbeau, MD (50:53.643)
Mm-hmm.

Daphna Yasova Barbeau, MD (51:04.667)
Mm.

Daphna Yasova Barbeau, MD (51:07.823)
So to that point, both in, I think, nursing education, physician education, all of these medical professional educations, do you think we need to spend more time on communication skills training?

Jessi Barnes (51:24.423)
Yes. I would love to see somehow across the board, just like infection prevention training, some kind of communication trauma-informed paradigm, like that whole education happening. Because sometimes it's just having the ability to take the perspective of someone else will shift entirely your body language, the words you use, the way you explain something. And if we...

Daphna Yasova Barbeau, MD (51:32.621)
Mm-hmm.

Jessi Barnes (51:53.703)
don't take those opportunities to shift, we're gonna end up perpetuating harm rather than stopping it. And even though that's not our intent, no one clocks into work being like, I hope I hurt somebody's feelings today. Like you really want to, for your information to land, you want to collaborate with your patients. We've known from across the lifespan, if you can get the family and the patient on board, your job is easier, right? Things go better. But how we do that is by seeing them where they are.

Daphna Yasova Barbeau, MD (52:04.076)
Mm-hmm.

Jessi Barnes (52:21.031)
and then helping them learn how to advocate for themselves to get their own experience, to know how to hold everybody accountable and to learn what they need to actively participate in the patient's care versus just being like, well, the doctor said that, so I guess that's it. I don't really need to question him. If you don't understand, be able to ask and be able to answer that question because then everybody learns in that moment, right?

The parent learns, the staff member learns, the provider learns of every interaction you have with somebody has the potential to teach you something. And if you approach the world with curiosity, you're just gonna soak up all the experiences that are offered to you.

Daphna Yasova Barbeau, MD (53:01.127)
I have one more question as we're nearing the end and then I feel like Ben has a few more questions that he wants to say. So you know, we, and we alluded to this earlier that a lot of our benchmarks are this quote unquote outcome based benchmarking. I'm part of a national group, the Family Centered Care Task Force, which anybody can follow along and join as well. We've got webinars almost every month.

Um, but one of the things we're working on is creating benchmarks for that, for family centered care, so that hospitals have to be held to some sort of minimum standard, but in the interim, um, when we can't necessarily prove yet cost savings or, you know, the need to, to be, uh, up to par with all the other hospitals, what are your recommendations for helping units change that culture?

for speaking to the administration about saying like maybe you can't see the benefits yet, but it's there and it's something we need to do. We have to make the change so that we can see the benefit. How do we get there in the interim?

Jessi Barnes (54:14.391)
Yeah, I think some of the evidence is starting to be there, right? We're able to associate things like QBase feedings with decreased length of stay. Because unfortunately with a lot of health care, you do have to kind of speak to the financial impacts of it. But it's starting to develop. There are people out there doing that work. I mean, Mary Copland's been doing that work for decades, right? I always joke that she is who I want to be when I grow up. But it's...

Again, modeling it, right? Just incorporating it at every turn. Because now when we get to that point in the education, my staff will be like, oh, here we go. And I was like, yes, here we go. Because this is a part developmental care and neuroprotective care is here. And you can do it with anything from communicating with empathy, trauma-informed, whatever your way you wanted to approach it is. Just have it be something that truly gets integrated into the practice in your unit, because it will eventually be integrated into the culture of your unit.

And some of this work can be done without financial incentives. We don't have to have approval. Sure, there's systems work that needs to happen too. I don't want to act like it's just this thing that we could flip a switch on and it'd be perfect. But...

There's things that we can do on the individual level that will have exponential growth potentials of just people just watching it and realizing how it is. Something as simple as somebody's getting labs on a baby and he's screaming his head off, someone just coming over and being like, oh, hey, let me do some containment while you do that. Whoever that is, whether it's the provider that's doing it, the nurse that's doing it, the unit clerk, whoever has clean hands and the ability to do it safely.

Daphna Yasova Barbeau, MD (55:39.919)
Mm-hmm.

Jessi Barnes (55:50.971)
And I think a little bit goes a long way when you're just kind of chipping away at a big change like that.

Ben Courchia MD (55:59.61)
My last question for you, Jesse, is you're obviously, I think another trait that comes across in this interview is that you're a very curious person. And I've mentioned this quote on the podcast many times from Neil deGrasse Tyson that says that as the area of our knowledge grows, so does the perimeter of our ignorance. And I think in the NICU, it's particularly true. The more you read, the more you're acutely aware of how little we know.

And also how all the evidence that we have in place are very rarely showing a dramatic change. Right? All the things that we do have an infinitesimal small change. Like it's moving us in the right direction, but at a pace that is so slow. And so I am wondering how you are a nurse, you are an educator, you're now a parent, you're...

while it's a continuum and all these stay with you as sort of a baggage, right? You... Don't worry about it. You are coming out on the other end with this wealth of knowledge and experience. What's your take on certainty and uncertainty in the NICU and how we can accept sometimes that we don't know?

Jessi Barnes (57:16.723)
and

Jessi Barnes (57:23.796)
Yeah, can I let her out before I answer that? Because she's going to let us know in a second.

Ben Courchia MD (57:25.442)
Please, please.

Daphna Yasova Barbeau, MD (57:26.256)
Hehehe

Ben Courchia MD (57:28.75)
Please.

Daphna Yasova Barbeau, MD (57:28.915)
Mm-hmm.

Ben Courchia MD (57:35.575)
Let's see.

Jessi Barnes (57:42.027)
Thanks for watching!

Jessi Barnes (57:50.807)
I apologize. The best bet is to have them in here, but I knew they were going to, towards the end, be like, they're senior dogs, so they have a short window. So it's about kind of the uncertainty of the NICU.

Ben Courchia MD (57:51.67)
No worries.

Daphna Yasova Barbeau, MD (57:57.979)
Mm-hmm.

Ben Courchia MD (58:01.246)
No, yeah, I think you start off as a trainee, as a young professional, you're like, oh, I know this, right? This is truth. Then you get some experience and you're like, we really don't know. And then you've had the particular experience of being a parent and you're like, we don't know squat basically. But at the end of the day, you do have a child and things are going okay. And so I am wondering what is your perspective on the things that matter?

because we hold our practices like so dear. And yet after years of experience, you're like, well, you know, does it really matter if we do it this way or that way? Because at the end of the day, when we distill all these practices into what truly matters for patients and families, that doesn't matter. So I'm just curious, you have a unique set of experiences. What is your take on the OCD-ness of the NICU?

after your years of being a nurse, of being an educator, and now of being a parent.

Jessi Barnes (59:02.643)
Yeah, I think the uncertainty is what gives me hope, actually. Because you're able to build that catalog of experience throughout all your time. You know that certain things, there should be an A, a B, a C, a D, and E, right? But then you're going to meet that baby who's like, I want to talk to you about Q. And you're like, how do I get there? I don't know. And you take all your previous experiences.

Daphna Yasova Barbeau, MD (59:23.495)
Hehehe

Jessi Barnes (59:28.767)
to give you the best informed decision from a care management standpoint for that particular patient. And now you're adding a page in your book of experience professionally, right? And so it's staying open to most of the time, it's gonna go like this, but every now and then it's gonna go like this, but look, that led to a good outcome too. So then is it really, does it always have to go like it does 99% of the time? And start being critical of your own practice and...

being able to grow because I think that's where the innovation comes in. Because you have to start thinking, well, normally I would do it this way, but this kid, I don't think he would tolerate that or this particular situation, it wouldn't match. So let's try it this way and then let's see. As long as it's done from a place of empathy and compassion, right? You're not just experimenting on people. But you're really using your library that you've been building to make that the best decision you can for that family. And to me, that's what makes, that's just

Ben Courchia MD (01:00:24.376)
Mm-hmm.

Jessi Barnes (01:00:27.507)
That's what makes this such a cool specialty, right? Because there's a lot of your treatment protocols for the adult side, they're tried and true, right? They've been around forever. But here we are on the ground floor building some of those. And you have the way to be, to really integrate and do that very specific level of care for that exact patient population.

Ben Courchia MD (01:00:30.171)
Mm-hmm.

Daphna Yasova Barbeau, MD (01:00:35.811)
Uh huh.

Ben Courchia MD (01:00:53.554)
I think that's very interesting because you're talking about something that Daphne and I talked to parents a lot about, right? As a provider, you're running a unit. You're running 30 kids, 40 kids, 50 kids, 100 kids. But as a parent, you're running N of one, right? Like I'm running, I don't really care that 30% of the kids have this bad outcome. If I beat your outcomes, I'm good, right? It's very selfish, but for us as a parent, that makes absolute sense. And I think it's interesting that...

Daphna Yasova Barbeau, MD (01:01:07.003)
Mm-hmm.

Daphna Yasova Barbeau, MD (01:01:11.191)
Mm-hmm.

Jessi Barnes (01:01:15.891)
Right.

Ben Courchia MD (01:01:23.038)
Yeah, I think what I'm gathering, I guess, from our conversation is basically the struggle for excellence comes from how do we bridge that gap between what we know to be true on a statistical level and a population level versus doing what's right for that end of one of a family. And I think if you walk in between those goalposts, then you're going to score.

Daphna Yasova Barbeau, MD (01:01:35.011)
Mm-hmm.

Jessi Barnes (01:01:46.407)
Yeah, and what a challenge that is, right? To figure that out. But I think that's what often attracts people to specialties like neonatology, is that challenge, right? So don't get comfortable. Constantly ask yourself, how can I get closer to that goalpost, right? Like, how can I get there? Because when you do, you're gonna be like, oh my God.

Ben Courchia MD (01:01:49.534)
Oh yeah, very narrow.

Ben Courchia MD (01:01:57.454)
Mm-hmm. Yeah.

Ben Courchia MD (01:02:05.294)
Mm-hmm.

Jessi Barnes (01:02:09.479)
this is amazing, you know, and look what we were able to do for this family and what we could potentially do for all these other families.

Ben Courchia MD (01:02:17.262)
We're going to end on this. This is too good. Jesse Barnes, thank you so much for making the time to be with us today. It was a fantastic conversation. It was a pleasure talking to you. Uh, we wish you continued success and, uh, a lot of joy with your family. Thank you so much for being on the podcast information about how to get in contact with you, uh, will be in the episode show notes, you are, um, available on LinkedIn as well, people can just look you up. Um, thank you very much for making the time today. It was a pleasure.

Daphna Yasova Barbeau, MD (01:02:19.551)
Agreed.

Jessi Barnes (01:02:45.139)
Yeah, thank you for having me.