Nursing Specialty Spotlight: A Look at Endoscopy Nursing

Endoscopy procedures include much more than colorectal cancer screenings, and nurses are key members of teams that provide advanced endoscopies. In the latest episode of Nurse Essentials, Teresita Foliacci, MSN-Ed, RN, CGRN, Endoscopy Nurse Manager at Cleveland Clinic Weston Hospital, talks about the responsibilities, skills and training of endoscopy nurses.

Transcript

Carol Pehotsky (00:04): 

Nurses sometimes want to come to procedural areas such as endoscopy, thinking it's, it's a Monday through Friday role, there's no holidays or no weekends. And while that may be true, endoscopy nursing is also fast-paced, high-tech, high touch, and an area where you really need to have fantastic critical thinking skills to really be able to provide that patient-centered timely care to patients. I'm joined today by Teresita Foliacci, nurse manager of Cleveland Clinic, endoscopy at Weston Hospital to learn more about this special specialty and nursing's role. 

(00:41): 

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career to navigating tough on the job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing. 

(01:01): 

Welcome back everyone. As the podcast has gone on, we we're well into our second year here and covering different topics, we've heard from you, our audience members, which we love. Please keep reaching out and telling us what you'd like to learn, which experts we can bring on the podcast so we can really make this something that's meaningful for you. 

(01:19): 

What we've heard from you as an audience is that you do like when we go into specialties and sort of learning about different specialties and what brought people to these specialties. Within my scope, although it's titled perioperative, in our world, that really means often a lot of procedural areas, right? So it's intraop, it's OR, it's PACU, but also working with procedural areas, cath labs, endoscopies, et cetera. So it's my great pleasure to welcome on the show today, Teresita Foliacci. Terry is the nurse manager at Cleveland Clinic, Weston's gastroenterology department, and the endoscopy area. Terry, thank you so much for joining us today. 

Teresita Foliacci (01:52): 

Thank you for having me. It's very exciting to be here. 

Carol Pehotsky (01:55): 

Yes. So, pardon the pun, but we're gonna start off with a bad dad joke. Talk to us about the scope, haha, of endoscopy and endoscopy nursing please (laughs). 

Teresita Foliacci (02:04): 

Yeah, so endoscopy nursing is a caring for the patients and it's a very compassionate, but at the same time you also have to be very like technically oriented I always say, you know, and very involved with the patient, but also like to do things that make a difference. Like, you know, you're making a difference when you're screening patients for colorectal cancer. You know, you're making a difference when you're connecting with patients and explaining to them about what's about to happen or you are able to ease them or they just get a new diagnosis of something and you're there to like maybe hold their hand. Or somebody just got diagnosed with an inflammatory bowel disease and we know that this is something chronic and, and it's just step or the first time somebody finds out they have cancer. So I think it's a lot of different things. But I also love about endoscopy, nursing, the ability to work in that environment of like procedural environment. We're actually working- 

Carol Pehotsky (02:59): 

Hmm. Mm-hmm. 

Teresita Foliacci (02:59): 

... side by side with the doctor and taking care of the patient and you doing like a lot of different things, I found always that very satisfying. 

Carol Pehotsky (03:05): 

Tell us a little bit about your nursing career and, and how is it that you ended up in endoscopy nursing? Clearly you're very passionate about it. 

Teresita Foliacci (03:11): 

(laughs) I know, I'm very passionate about endoscopy nursing. So many years ago... I've been an endoscopy nurse over 30 years. 

Carol Pehotsky (03:17): 

Oh, wow. 

Teresita Foliacci (03:18): 

But basically I was working in intensive care unit. I have a dear friend of mine that actually encouraged me to come to endoscopy. We're opening a new endoscopy place and she's like, "Oh my God, I would love for you to come to work with me. This is gonna be amazing. We're gonna do..." It was great. And we, a new position was created, everything, I went to work with her. And back then we did everything. So the nurses in GI back then, we sedated our patients, we helped the doctors, we learned how to process scopes. We did a little bit of everything, recover the patients, talk to them, learn about new procedures, was a little bit too much at the time. And thank God anesthesia came and helped us and now things are a little bit better, but it was a lot. 

(03:57): 

But I really truly enjoyed it. I would like the fact that I was able to do like a lot of different things and have a really good connection with patients. And to me that was really important. So I went to endoscopy and I literally pretty much, I stayed there and I went to an organization and I became the leader of the organization. Then we opened another endoscopy center. So then I went to another organization and also worked there in a leadership role and then also work as staff as well. And like two and a half years ago, I came here to Cleveland Clinic and I worked here at Cleveland Clinic.  

(04:29): 

And I wanted to do something different because it was very interesting the way I came here because we actually found out that they needed a nurse manager here and like literally me and my friend and we're like thinking, "Okay, we need to find somebody that knows GI that needs to go to Cleveland Clinic." We're like literally looking for someone, you know, if it's not me, it's, it's gotta be, you know, they, they reach out to me and stuff. But we felt, because I had been here to events and conferences and stuff and I just felt, and I love the place and I figured whoever's there really needs to know, this is a lot of high-tech stuff, they need to know GI nursing. 

Carol Pehotsky (05:03): 

Well we're very fortunate that you figured out that it was supposed to you that we were supposed to have and- 

Teresita Foliacci (05:07): 

It was really funny. It was great. Mm-hmm. 

Carol Pehotsky (05:09): 

Yes. You've, you've done great things for our patients there. 

Teresita Foliacci (05:09): 

Yeah. 

Carol Pehotsky (05:11): 

So we're so glad you're with us. So for people who are completely unfamiliar with endoscopy, this can be everything from, we're looking at somebody's stomach to somebody's intestines. Can you talk to us a little bit about... You'd mentioned some procedures, some of them are screening, some of them are diagnostic and some of their high-tech. Can you give us a little more information about the different types of procedures? 

Teresita Foliacci (05:30): 

You could do endoscopies, you know, you can go to the doctor, you have belly pain and you may end up having, uh, you know, reflux disease, different things. And you come in and you get, you get endoscopy done. They just wanna take, take a look, something very simple, take a biopsy, make sure you don't have an infection in your stomach, it could be causing ulcers. There's a lot variety of the whole GI tract. And of course we do focus on colorectal cancer screenings. If we can scope patients, we know we can prevent colorectal cancer. So we do, you know, encourage patients to start getting their colonoscopies at the age of 45. These are the guidelines. So that's part of it. And a lot of it, and a lot of that happens in endoscopies, a lot of colorectal cancer screening. But then on the other side of endoscopy, we also have what we call advanced procedures or advanced endoscopy. 

(06:15): 

So we do more complicated things like placing stents and relieving strictures, draining cysts, I mean, everything having to do with the biliary tract and also with the pancreas, here we do a lot of pancreatic work as well. So it could be biliary, pancreas, stomach, so everywhere in the GI tract, including liver as well. So you could see patients because they could be bleeding and we need to treat the bleed to, dilating their esophagus, putting a stent in, relieving a stricture, removing stones, crushing stones, [inaudible 00:06:47], so there's a lot of stuff that goes on, so it's not just GI. And the field continues to grow. 

(06:54): 

And now we're doing, you know, really complicated procedures that originally were going to surgery that we're able to do here. Like patients who have issues with swallowing, the achalasia patients, we can do a procedure called poem and we can bring them here. And we know that that prevents them from getting a myotomy, which is the, you know, the actual surgical procedure. So how we can do that in the Polaris and, you know, we can do a lot of different things endoscopically and more and more endoscopies continue to grow and the specialty continues to grow and the technology continues to grow. 

(07:25): 

So I always say for people who come to this specialty, do you like technology, troubleshooting equipment and, and kind of like understanding how things work and that kind of thing? If you enjoy that setting and at the same time have the ability to connect with patients when you're prepping and recovering, well that could be something you like, but you have to really like this. This is a lot of stuff to learn. And it's also new, you know, it's, it's uh, sometime... When I came to endoscopy it was something that you can't really relate it to a lot. It's not like you are a nurse, you know, but then you come to here and you're like, okay, like the equipment's different. You, you're not really sure you being a tech or are you being a nurse. So I always tell people, you need to give yourself a year to feel okay, 'cause it's so different from anything we've done. 

Carol Pehotsky (08:09): 

This is fantastic. So I was a good patient. I did my colonoscopy at 45 like I was supposed to. We know that people aren't necessarily super excited about that procedure, whether we are nurses who know we need that procedure (laughs) or patients who don't have any healthcare background. And similarly, I can imagine those who are having upper GI scopes, quite a bit of anxiety, worry about being uncomfortable, worry about what the preparation is like, especially for colonoscopies. So nurses I imagine can have a lot of influence in that space. So tell us a bit more, if you will, about what nurses do to help really allay that. 

Teresita Foliacci (08:45): 

I think it's about more listening to the patient. You know, what are their concerns. Some patients are like, really, "I don't really wanna know. Like don't tell me." I kind of get exactly what is it that they wanna know. Answer their questions, make sure they're comfortable that they understand. But not to minimize like the feeling of the anxiety and don't say, "Oh it's not, it's not a big deal, this is fine." No, but like hear what they have to say, answer any questions, make sure like they're comfortable. I think if you kinda answer that and not minimize the importance because you made me nothing to you. But they're very worried. They're thinking, you know, "My dad had cancer and now I've been having rectal bleeding. What if I do have cancer?" You know? So kind of putting yourself there and not minimizing it, but giving the information is important. 

(09:26): 

Making sure they get all their questions answered, that you make them comfortable, the environment where they're in and, you know, introduce yourself and just make it like a pleasant environment for them. And because I always tell the nurses here, "They're gonna be with us, kill them with kindness." They're gonna be here with like literally three hours. We're trying to decrease it, but it's so little time. So when you make that connection with them, it's wonderful because they're able to say, "Okay, this person really cared. They took the time." And I think it's important for that not to minimize the anxiety, 'cause maybe you, it's not anxious for you, but it may be for them. 

Carol Pehotsky (10:01): 

That's a great point. No matter why they're coming to your area, even if it is quote, just a screening that can come with a lot of anxiety no matter why they're coming. 

Teresita Foliacci (10:09): 

Absolutely. And then they're not feeling all that great. Maybe they didn't wanna do it to begin with, you know, and now they're actually here. Yeah. Yeah. 

Carol Pehotsky (10:16): 

So you'd mentioned earlier that scopes are being done under anesthesia, but we do know that there are places where nurses are administering the sedation. Can you spend a little time talking to our audience about the training that a nurse would undergo to be able to provide moderate sedation and, and how that differs from anesthesia supported endoscopy cases? 

Teresita Foliacci (10:34): 

Yeah. So moderate sedation is something where the patient is not completely asleep. So the nurse is responsible to get them to that level where they're comfortable and you coach them and you tell 'em, "You know, take a deep breath. You, you may feel this." They're actually, they're not asleep because otherwise you're gonna put them on anesthesia. So it's a very kind of fine line. Therefore, that does requires some skillset, right? So you need to, it's not just being ACLS certified and taking a little course, but it's also the practice. 

(11:02): 

You know, the more you do it, the more comfortable you become, understanding, yeah, you're doing it in the direction of the physician. They're the ones telling you the medications to give. But as a nurse, you need to also be, whoever's administering the medication is also needs to be familiar with it. You need to make sure you have your reversal agents available, your airway, you need to still kind of have the mentality of thinking, "Okay, I need to be able to recognize if I need to give her," which the doctor will tell you to get the reversal agent or work with whatever it is. But it's a lighter sedation. You can't put the patient completely out. 

Carol Pehotsky (11:36): 

No. 

Teresita Foliacci (11:36): 

You know, and they're, they're probably not gonna remember either, 'cause we do, you know, we do use that. They do still use [inaudible 00:11:42] and they're not gonna remember. But the patients have to be able to, like if you tell 'em to take a deep breath, take a deep breath, you know, that type of thing. Much more completely different. I've done it, I've done it before 'cause that's the way we did endoscopy many years ago. You just did it and that's what you did. You didn't know any different, you know. 

(12:00): 

So you would sedate patients and assist the doctors and monitor them and, and they were good and we just kind of, you know, we, we figured it out as we went. And, and, but we got the training by actually doing it, taking the courses, making sure you know how to rescue a patient, ACLS certified and that type thing. And making sure you're doing those competencies every year. But also hands-on is super important actually doing it. 

Carol Pehotsky (12:25): 

So I imagine the assessment skills and being able to identify, you know, you talked about it, it's sort of a dance of level. You wanna get them comfortable but they can't be too sedated. So what are some assessment skills that nurses really need to have? 

Teresita Foliacci (12:38): 

You need to like have, you know, make sure like, you know, if the patient tells you okay that you've had sleep apnea, you need to make sure that that's been addressed and that you let the doctor know and make sure that... And the nurse's side, there needs to be an airway assessment no matter who's giving the moderate sedation. 

Carol Pehotsky (12:38): 

Mm-hmm. 

Teresita Foliacci (12:53): 

The airway assessment still needs to be done. The endoscopist is, is under the direction of the endoscopist. But you need to make sure. And also recognize, "Okay, no this is not gonna work. This is not a moderate sedation case. I cannot sit, you know, I don't feel like I, this is gonna be okay." 

(13:09): 

And having that conversation, you know, with a provider and feeling comfortable with that, which is another thing that's super important I think in our specialty, is having that assertiveness of knowledge and comfort level and say, you know, "It's not okay and anesthesia is not gonna, you know, we may need to get them involved or something," and, and work with them not to make them feel in any sort of way but say, "You know, this may not be the ideal situation, you know, for that." Because with moderate sedation, the patient has to be, so you either do it where they're almost awake. 

Carol Pehotsky (13:39): 

Mm-hmm. 

Teresita Foliacci (13:40): 

You know, which is the best way actually (laughs) to do it. Uh, or, you know, just a very fine line. 

Carol Pehotsky (13:44): 

Well and, and even, you know, we talk a lot about speaking up in these podcasts and the ability even in the moment speak up and say, you know, "This patient's getting more sedated than they should be," or- 

Teresita Foliacci (13:44): 

Yeah. 

Carol Pehotsky (13:54): 

... or they're gonna need possibly some reversal. That nurse probably really needs to have that assertiveness, that confidence to, to at least speak up and say, this is what I see. Yeah. 

Teresita Foliacci (14:03): 

I came from an intensive care unit when I came to endo, so I kind of felt like, okay in like the critical care setting type thing. But really I think here you need to have that assertive and questioning attitude and they need to know that you are in charge of the room. You are there to help them support them and everything, but you are the patient advocate and things are gonna get done the way they need to get done. That type, you know, that type thing. And that's really important I think in this specialty 'cause everybody wants to do their part and we're all trying to do our part, but at the end of the day we're still, you know, we're here for the patients, we're patient advocates and we have to protect them. 

(14:36): 

So if we identify something that's not, doesn't sit right, it's like, "Okay, no, let's look into this or you know, let's get another, speak to someone else what have you." You need to also be familiar with cardiac arrhythmias and stuff. You know, when you put a patient on a monitor, recognize arrhythmias quickly and stuff. It isn't something that you should have that like under your belt type thing. 'Cause it's more than just it's, yeah you can do ACLS but if you're not familiar with recognizing arrhythmias and something happened to your patient, yeah. So it is a considered, you know, that's why they, when they have issues with patients that are high risk, they just don't even wanna get involved with. 

Carol Pehotsky (15:12): 

We have seen an introduction of anesthesia into some of these procedures and certainly this I'm, there's some procedures that have to have anesthesia. 

Teresita Foliacci (15:19): 

Yeah. 

Carol Pehotsky (15:20): 

Can you talk to us a little bit about then how the role of the nurse changes? You know, what does anesthesia look like in these procedures? And then you'd mentioned sometimes you feel like a tech and sometimes you feel like a nurse. So, so what are the full roles that nursing can provide in these rooms? 

Teresita Foliacci (15:31): 

When you're working in the monitoring role, I think at any point in time when you're in the room, you're part of that team. So I still think even though anesthesia is there, you also need to be in that supportive role to them as well. Like, if you're monitoring the patient or you're the tech, what have you, you always have to be, you know, like kind of ready. That's the way I always saw it. Kind of aware. Like, okay, yeah, there's sedating, but you can't be completely disconnected from like what's happening with the patient. You have to be thinking, "Okay, what if I need to call the anesthesiologist? Do I have a number? Am I good? What is the plan here? Shouldn't it..." Because sometimes people take it lightly, but these endoscopies, especially upper endoscopies, are very high risk procedure and patients can go an obstructive airway in a heartbeat. So we need to be able to respond quickly.  

(16:15): 

So even though you are not responsible for that part, your mentality needs to be, "Okay, if something happens, I need to be in that supportive role for that person who's giving anesthesia." So therefore you should be kind of familiar like, you know, opening up and, and the tracheal tube and handing it to, you know, just kind of like in that assistive role. I always found that to be, you know, part of it like kind of like, "Okay, if we need to intubate, you know, kind of help them if they need to?" You know, just being kind of like involved. 

Carol Pehotsky (16:43): 

When we think about the, the rest of the team, right, often that can be a nurse who is in the tech role or is, you know, we call it circulating the OR, I know it, that's not what it is. But talk us through a little bit about, you know, the handling of specimens and the handling of scopes. What do the rest of the roles look like from a nursing perspective? 

Teresita Foliacci (16:58): 

So you could have a nurse doing the tech role, which, and that person could be, you know, setting up the endoscope, checking everything, assisting the doctor and everything else. And then, you know, handling the specimen, putting them in the specimen container, making sure that all that it's done. And then the nurse who's the circulator needs to verify the specimens with the tech role. The person who's, whether it's a nurse or a tech, verify the specimens at the end of the case and everything like that. Or, or just do again, I always tell them just do a close loop communication. Always do it. Like say okay, always verify and say, you know, "Repeat what they're giving you, repeat what they're giving you. I'm closing the bottle. Okay, I'm closing the bottle." 

(17:35): 

It sounds so redundant, but we're in this environment where people wanna do everything super quick and you really need to like stop a moment. And I always tell if you're not sure, just stop and say, "Okay, I'm not sure what just happened here. I'm not sure how the specimen, let's stop. And either you need to probably give me..." You need to be involved in what's going on and whether you're the circulator, the tech, everybody's like a team and needs to be, you know, involved in that. And specimens are just, to be taken very seriously. And I learned that you invaded my thing... I remember one of the doctors, "You invaded somebody's body to take a piece of them. You have to take care of it and make sure that it's done correctly," you know. 

Carol Pehotsky (18:16): 

When you think about very fast-paced, high risk in terms of the things that we're doing, you know, often a fun place for our regulatory friends to come, right (laughs)? They know, right, that whether we're handling specimens, whether we're delivering sedation and how we're handling the scopes before, during, and afterwards, they are all rife with potential for problems. So can you talk to us a little bit about sort of ongoing competency and how you make sure that your teams, of course you're doing the right thing and then feel comfortable were they to be part of a survey to be able to speak to what they do? 

Teresita Foliacci (18:49): 

Absolutely. So here at Cleveland Clinic, we, we do have SPD doing the reprocessing of the endoscopes and everyone who handle scopes has to do point of view treatment, right? So everybody gets done. So that's something that we do as a yearly competency. The initial competency and then yearly competency. You know, we work with Olympus Scope, so I bring the rep in and do, do some initial training, bring them in for more training during the year if we need to. We have it posted in our rooms, the pre-cleaning process. 'Cause they're responsible for the pre-cleaning process, making sure they're doing, you know, seconds there, 10, whatever it is. And we just put it there so everybody's following the same process. And then whenever we introduce a new instrument, a new scope or something that we again have the company come in, do the initial and go through that. 

(19:33): 

Because even though SPD does the reprocessing of endoscope, the point of care use for these scopes, it's very important. You need, they need to be familiar with it. We all need to know exactly, you know, how it's done and, and that type of thing. So that's super important. And the handling of the scope. Here, we have a good process. I think in term, in terms of that, I think we're doing good. We do the pre-cleaning in the room, the, everything is always, uh, covered. When it leaves the room, we have a holder to put the scope that's hardcover, you know, everything's so everything is good. And we have a really good system here and we do have, uh, scope reprocessors that are certified as well. So there's a lot of good things that are happening, you know, here in terms of that. 

(20:15): 

I find it challenging what we're trying to have, everybody doing everything. I feel when you have a dedicated for the reprocessing, it's easier. A lot of times it depends obviously on the volume. It just wouldn't work here, uh, to have everybody doing everything. It's a much better and that way, you know, it's getting done correctly. 

Carol Pehotsky (20:33): 

Well, sure you think about high risk, uh, scope is to process. You don't have to go very deep into the news archives to find stories across the country and across the world where unfortunately scopes weren't processed correctly and patients ended up with infections. 

Teresita Foliacci (20:44): 

Yeah. I mean we still, it's still a high risk area and we know that- 

Carol Pehotsky (20:48): 

Mm-hmm. 

Teresita Foliacci (20:48): 

... the RCP is a high risk area, and we are now, you know, we do know we have disposable, uh, anoscope for ERCPs, but, you know, some, they, we are currently not using them. But I know as technology moves forward, that'll be something definitely to do to be able to use disposable anoscopes, um, so that we can do it. Those are very difficult to move, to clean equipment. And those are high risk type of procedure. They're special cleaning and training that's required for those scopes. And it's important, like whoever is running units and stuff like that, they need to be familiar with the scope handling, cleaning scopes, what, how the scopes are made, you know, what is inside the scope, you know, they'll, you need to know what it is because we, it is a high risk area for sure. Yeah. 

Carol Pehotsky (21:31): 

And become friends with your, uh, local infection prevention resource, (laughs). 

Teresita Foliacci (21:35): 

Absolutely, absolutely. Whenever there's a question, you, you, they have to be like your best friend. 

Carol Pehotsky (21:39): 

Yeah. 

Teresita Foliacci (21:39): 

You just have to... And here they've been great. You know, they'll come, if they have a question about anything or anything happens, they're, they're right there for us. So, yeah. 

Carol Pehotsky (21:48): 

So you've been such a fantastic resource for the nurses at Cleveland Clinic, Weston when it comes to endoscopy care. But what our audience also should know is that you're also serving endoscopy nurses at a national level. I, I understand you're currently the treasurer and soon to be president elect of Society of Gastroenterology Nursing and Associates. Congratulations. 

Teresita Foliacci (22:08): 

Thank you. It has been a wonderful journey with SGNA. I joined many years ago. I started locally, you know, I was the president of the regional chapter. I started with a small group of like, we were all like good friends- 

Carol Pehotsky (22:08): 

(laughs). 

Teresita Foliacci (22:21): 

... and we, we started putting programs together and we would do these regional programs in different hospitals and stuff like that. And we learned a lot. And then we did state, we also do state in Florida, we do a state meeting that we do every year with the doctors, which is a really good program. And we, you know, so I became very involved with it. And then I went, you know, they asked me to serve on the national, and then I did, and I did program, like program chair there as well. And I've helped a lot with putting programs together and stuff at the national level. 

(22:50): 

And now I'm there and, you know, I've just met a lot of amazing, incredible people that have so much talent and people from all over the nation that love this, uh, that love GI nursing and love endoscopy and, and are really, really super, you know, talented people that are very passionate about what they do. So I've been able to learn a lot and I've also been able to develop my leadership skills and just being part of a, of a team of, with people that are like, you learn from them. 

Carol Pehotsky (22:51): 

Yeah. 

Teresita Foliacci (23:21): 

You know, they, you always feel like, oh my God, I'm blessed to know these people because you just learn stuff from them and, and they're just such a positive force and you're like, oh my God, all this amazing work that they're doing. And especially when people from different states. 

Carol Pehotsky (23:34): 

Do you find that practices are, are more the same than different? And what have you brought to Cleveland Clinic that you've learned by interacting with our national colleagues? 

Teresita Foliacci (23:43): 

You know, like we try to have standard of practice throughout and we do, you know, forums and stuff to kind of like see what's going on. It's, what's interesting is a lot of people are doing kind of like the same thing. A lot of people in different states are, they have a lot of, a lot of stuff. They have like the same questions and stuff like that. In terms of what I brought to Cleveland Clinic, it's just about the nursing perspective and how this is, and how you have to just take it always like a step further. 

Carol Pehotsky (24:09): 

Hmm. 

Teresita Foliacci (24:09): 

And you always have to be learning and you always have to be involved. And I try to bring SGNA here a little bit. I'm still working on it, but I was able to always use them as a resource as well. You know, whenever anything was going on here, always use SGNA as a resource and, and always try to use, you know, uh, practice guidelines and that type thing. 

Carol Pehotsky (24:30): 

Yeah. You've you've brought so much to us through that as well, and we certainly wish you well as you, uh, become president-elect and then- 

Teresita Foliacci (24:35): 

Yeah. Yeah. Yeah. 

Carol Pehotsky (24:36): 

... president shortly afterwards. So we're all very proud. It's very exciting. Yeah. 

Teresita Foliacci (24:39): 

Thank you. Thank you. Yeah. 

Carol Pehotsky (24:41): 

So you have shared just an amazing amount of information, hopefully are planting seeds for future endoscopy nurses who are listening. And your phone's gonna start blowing up. But before we say goodbye, I wanted to flip the conversation a little bit, uh, to our speed round where we like to let our audience in to know a little bit more about you beyond your subject matter expertise. So first question for you, if you weren't a nurse, what would your passion career be? 

Teresita Foliacci (25:06): 

I always say I love dermatology. I love skin. I love to, you know, go to the dermatology and they always have like the magic creams and, and it's just an amazing, I don't know, I, I think it's great. Yeah. (laughs). 

Carol Pehotsky (25:16): 

All right. Yeah. (laughs). And what's something about you that surprises people? 

Teresita Foliacci (25:21): 

Well, I was not born here. I was born in Cuba. 

Carol Pehotsky (25:25): 

Oh. 

Teresita Foliacci (25:25): 

Came here, uh, from very humble beginnings. I came to this country when I was like nine years old. My last name is Foliacci. My husband is Italian descent. 

Carol Pehotsky (25:34): 

(laughs). 

Teresita Foliacci (25:34): 

So everybody, they can't really pinpoint me exactly where I'm at. "Where is she from? Is she Italian? Not Italian. Where she's from?" From my, my family is actually descendant from Spain. 

Carol Pehotsky (25:43): 

Oh, wow. Well, Teresita, thank you so much for joining us today. We're so fortunate to have had you on. 

Teresita Foliacci (25:48): 

Thank you so much for having me. It's been a pleasure. 

Carol Pehotsky (25:54): 

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@cc.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other. 

(26:28): 

The information in this podcast is for educational and entertainment purposes only, and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.