How the ER Has Changed: Two Veteran Nurses Reflect on Emergency Medicine Then vs. Now

Emergency medicine isn't what it used to be.

In this episode, Brittney and Felicia take a trip down memory lane, sharing how they each found their way into emergency nursing and reflecting on how the ER has evolved over the years.

From paper charting and handwritten orders to electronic medical records, increasing patient volumes, boarding, workplace violence, and the growing complexity of emergency care, they discuss what's changed—and what hasn't.

While technology and medicine have advanced, one thing remains the same: the heart of emergency nursing is caring for people during some of the hardest moments of their lives.

Whether you're a seasoned nurse, new graduate, nursing student, or simply curious about what happens behind the scenes in the emergency department, this conversation offers an honest look at how the profession has evolved.

In this episode, we discuss:

•  How Brittney and Felicia got started in emergency nursing 
•  What the ER looked like years ago compared to today 
•  The evolution of charting and healthcare technology 
•  Increasing patient acuity and staffing challenges 
•  Burnout, resilience, and why nurses stay 
•  The future of emergency medicine 

If you've been in healthcare for a while, we'd love to know:
 What's the biggest change you've seen in your career?

Transcript

SPEAKER_03 0:02

This is Hold My Stethoscope.

SPEAKER_00 0:06

I like your setup. Hey! Thank you. We are back, guys. Welcome. I was just saying, I really am enjoying Felicia's like new little like studio area there. It just feels so like comfy and cozy. It's crazy.

SPEAKER_01 0:21

It is, and very I would love for you to see the whole thing because this is just one side of it.

SPEAKER_00 0:27

Yeah, well, I'm not maybe maybe next week we'll I'll come over and we could record together. I don't know.

SPEAKER_01 0:32

That would be absolutely amazing. Yeah. We both could can sit at the table and just record and relax and record R and R.

SPEAKER_00 0:43

Yeah, we need to for sure.

SPEAKER_02 0:45

Cause it's hi everybody. Hey.

SPEAKER_00 0:49

Yes. Welcome. I know. I was like, we hadn't recorded in a while, and now it's like, oh, we're kind of trying to get back on that routine again. And it's it's nice.

SPEAKER_02 1:01

So it is nice.

SPEAKER_00 1:02

Um, you'll be seeing that new episode soon, obviously. And then this is the follow-up to it, because we said last week for the last episode that we were going to talk about kind of what's changed in the ER. So when I first started in the ER, it's been oh my gosh, okay, probably 15-ish years at this point since I've been in the ER. It is definitely a completely different world than it looks like today. Like it's it's so different. It's changed a lot. And I mean, healthcare and medicine is constantly changing, but it just it's a very different world than when I entered 15-ish years ago. What about for you?

SPEAKER_01 1:47

It is majorly different. You know, I of course mine has been a lot longer, but you know, the patients have changed. Healthcare has definitely changed. The nurses have changed. But is it all for the worse or is it just different? That's really the question.

SPEAKER_00 2:11

Yeah. So today we're gonna kind of talk about what we've kind of seen over the years, what's gotten harder, what's maybe gotten better, and just what keeps us coming back. And we've talked about that in previous episodes about how the ER just kind of has a hold on people. But yeah, let's kind of talk about it. So we are talking specifically about the ER um and our experiences because that's what we know. So where you start, like go back to your journey for a second, because I know you were like paramedic and LPN and all of that stuff. So, like, how did you get into the ER in the first place?

SPEAKER_01 2:55

That is such a great question. So initially, I worked at one of the sisters' hospitals of the company that we work for as a unit secretary while I was getting my LPN. That was what was crazy. I I got my LPN and I did that within a year. Because I don't know if you guys know, I did not have a desire to be a nurse. My whole desire was to be an FBI agent. That was my plan, that was not God's plan. Okay, so that is why God is in control because I thought I was gonna be that FBI agent, but God had other plans for me. And there's always a reason why, and I thank God for it today. So I decided when I moved to Florida that getting into that medical field just seemed the way to go. There were people that were actually moving down the Florida. I'm not from Florida, but they were moving, lots of people were moving here, elderly people were here, and it just seemed like there was a need in medicine, which is what led me into it in the first place. I decided to go that LPN route, even though my plan was to do the RN. But at that time, everybody would say, do this route first, because this is gonna be a lot faster. And you know what? They were right. And I'm glad I did it because it gave me such an amazing foundation. I knew as an LPN that I did not have the desire to be an inpatient nurse. I don't know what it was. I my hat goes off to everybody that does inpatient nursing. God bless you. I needed something that had me like driven, but I didn't know what that was as an LPN. I didn't know. And back when I was in school, they let you take little field trips. You might go visit in the OR, you might go visit in the ER. You know, this is when they would let you go in the ER and everywhere. And I'll never forget, like Nick, you, whatever. I'll never forget going into the ER and then going back to post-conference to my clinical instructor and saying, Oh, I'm gonna be an ER nurse. And I remember she her looking at me and was like, oh, really? I'm like, that's that is me all day. I don't want to get to know anybody, I want to keep it moving. So that is actually what led me into the ER. And I was in the ER as an LPN first and went on and got my R and. But I knew before even getting a license, I'm gonna be in the ER. That is more of my drive. I want to see the blood, I wanna see what's going on. I like all of this fast-paced movement, get them fixed, move them out, next patient, not coming back, seeing the same patient again, saying, Hey, you know, I saw you yesterday. Not that. Like there are people that like to come back, but it's different. It's it's not the same as caring for someone on a constant basis. And I just knew that the emergency room was the drive for me. It wasn't any like earlier passion, some may say. It was simply just getting that opportunity in school and saying, I think I found where I belong. That's that's what it came down to.

SPEAKER_02 6:22

How about you? So I knew I was okay really early age.

SPEAKER_00 6:31

I don't know what it was, but I just really loved it. And I always thought I was gonna do like doctor PA and all that stuff. And then in high school, I got an opportunity to do what they call this youth apprenticeship program. So for my senior and junior year of high school, I got to go and spend like a year in four different areas of the hospital. So I got to go to, I was in radiology for half a year, pharmacy for half a year. I was on the OB unit doing nursing for half a year, and then like rehab for half a year. And I just realized that nursing could open up a lot more doors than maybe some of the other fields I was looking at. So I went to uh nursing school right out of high school, graduated with my RN, and I started on a med surge floor, kind of like you know, was the traditional route back in the depth. Right. Absolutely. And did that for about two, maybe three years. I think it was like three years, and I actually really thought I wanted to go to ICU. Like that's I loved critical care and I thought I was meant for ICU. And so I applied to the ICU and I applied, I think I applied to both the ER and ICU kind of around the same time. And I did not get the ICU job, but I got the ER job, and I was like, okay, once again, this God knows. God knew because I am a very classic ER nurse, and I would have not, I don't know, maybe in a different life I would have done good in the the ICU setting, but like you have to have, I feel like most ER or ICU nurses have that certain personality, and I realize I do not. So um, I think the ER was the best choice for me. But so I started my ER career in the hospital, like I literally did my apprenticeship with, and it was like the first hospital I worked at, and all of that stuff. So I started there. We were a I don't know, 20 to 30 bed ER, maybe 40 beds. I honestly, as it's been so long, I'm like, I can't really remember. But we were like a you know community ER. We saw everything there. Um, we had a level two trauma center, kind of about five miles down the road. So I'm from a smaller area in upstate. That's where I was born, raised, did all my stuff. There are about three hospitals within about a 10 mile radius of each other, but that's like essentially all the hospitals that are like within a good 50 mile radius. So it serves a large community. Those three hospitals do, or at least they did back.

SPEAKER_01 9:28

But they were that close?

SPEAKER_00 9:30

They were super close, yeah. So like the level one level, you know, trauma center in our area, and it was a level two, and it was literally like 10 minutes away, and then the other hospital was like 10 minutes the other way. So like we're all very close, but then that's like it for a bigger radius. So um, but I learned a lot there. I can't remember how long my like orientation was there, but it was, you know, there was definitely rough periods because you don't yeah, especially coming, and I love it. Like I'm always one still to this day that's like, I love that I got a med surge experience. I love that I had that background because it really did give me the foundational stuff needed. But at the same time, it's a completely different way of thinking. And that took me a while to kind of unlearn that surge way of thinking and transition into an ER way of thinking, and you know, being able to kind of learn a new set of people and learn new processes. So it definitely was a transition. And like I know the organization we have now, and a lot of organizations these days have like an internship program or some kind of more of a better formal transition into a specialty, didn't have that, just kind of was like go and figure it out. Um, and right, I mean, I did, but it definitely took me. That's why I'm like from experience, it was a good year before I could really like yes, on like, you know, truly like get things. And it was um, I had a great preceptor, Erica. If you're ever listening to this, I still remember she was preceptors at an ER and she was so patient and so kind. And she was it was great. She really gave me like the guidance that I needed to kind of thrive. And you know, she she was kind of like also did like relief charge. And so it was kind of funny because I I've talked about this pediatric code that, you know, my first pediatric code that I did. Yes, she was like the charge nurse that like evening, night, whatever it was. And she I was working in a different kind of area, but she kind of like knew me and at that point knew that I had had experience and all that stuff. So she specifically grabbed me to come into the code to help run it. And I was just like, like, it was just uh, you know, it was definitely a great learning environment. It just was so different, but I fell in love with the ER because it was just like that is what I want to do. And but it's just a different, I don't. It's it's hard because when I went into nursing itself, we were, and I know you were like this too, we were on paper charting. Like when I graduated nursing school, we were still in paper charting. So we transitioned within my first two years to electronic charting. But it was still new and it was still a process that people were gathering. And I feel like that is one thing that's definitely changed, is kind of the documentation has become a lot harder, stricter, whatever you want to say. It's just a lot different than doing. I mean, once again, I worked med surge. So we did one like soap note that things changed for our patients during their 12-hour or eight-hour. We did eight-hour shifts back then. Eight-hour shifts, that's another change. Eight-hour shifts for these patients. So, like, it's just different. Your charting requirements are so different than they used to be. I think that's one of the things there. Yeah, what was your experience like with you know what?

SPEAKER_01 13:16

It's so interesting because I admire that, Brittany, because there was no internship. I didn't really even have a preceptor. I remember going into so I worked at an in another organization prior to the one that we you know, organization I currently work in. I was working in the emergency room there. That's when I was the LPN. And I got very little training, but I did get some training. But because that hospital was a level one and there were residents, it it made it difficult, whether I've been in LPN or RN to really get the training that I need. However, when I started to adapt, you adapt and you learn a lot by the mistakes that you make. I remember a paramedic teaching me IV skills. It it wasn't your traditional preceptorship orientation shifts like we provide now or even some years ago. I didn't have that.

SPEAKER_00 14:27

And then because I wanted to Were you just like they're like just start and then like you just figure it out as you go?

SPEAKER_01 14:35

You start and they give you people, different people. But to me, when you're brand new, that's not always good because you're trying to find your way, but you don't really know what way you're trying to find because they're putting you with different people, but when you're so fresh and so green, you need somebody to be consistent. So I'm with a paramedic at one point doing this. I'm with an RN. Now I'm an LPN. Never was there an LPN to train me. So it was an RN that gave me some training, and then it's like, okay, you're on, you're on. That I did for eight months before I transferred. That was the good thing about not being or not having an obligation to an organization where you owe time. I then went to the current organization that we've worked for for many years now. And that is where I really learned my nursing skill.

SPEAKER_00 15:38

However, did you go there as an LPN or did you go there after you?

SPEAKER_01 15:43

I went there as an LPN. Okay. I went there as an LPN, but then quickly, not long after the decision was being made that they were trying to get, you know, do away with the LPN, make them the discharge nurse. And I'm just like, I'm not being nobody's discharge nurse. I don't want to be the discharge nurse. And I went back to school. This is when I started working nights. So I started working nights while I went back to school. I had already had plenty of prereqs because I already had two bachelors. So I was able to pretty much jump into an LPN, transistoral RN program. So you eliminate a couple semesters already. And that's when I went on and got my RN. But I, my experience was we didn't still really do, they did give me someone to precept with when I moved on to our organization. But it was more like they would put you in the ER and the staff would decide if you'd work out or not, pretty much. Like it was bizarre. It was, you know, looking back on it, because I then became that person as well. Like we would be, people would come in and we'd be like, oh no, she ain't gonna make it. Or oh yes. But do you know what we were basing it off of? Not their actual nursing skills. It was their personality that we were like, yes or no. But I remember being still pretty green. Gotta remember, I'm coming from one place and really teach me anything into another one where things are completely different. One place, nurses weren't even doing Ivy push with the medications. Everything was going into like a 50cc bag of saline. I'm telling you everything. So then by the time I come over here to this organization, everything is being pushed. We're mixing our own mass. We're playing pharmacists, we're doing the all, we're doing it all. Do you hear? Do you hear me? I remember a nurse making a binder of all the drips. And at that time in this organization, every cardiac drip was mixed, believe it or not, with D5, with dextrose, not normal saline. And I remember this binder, and it would have all the all the drips in it because we had to mix them ourselves. Like we had to mix, we played pharmacists now that I think about it. We really did. We were calculating, calculating them drips, everything, like doing it all. You know, we didn't have those pumps that were smart. You had to know, you know, or you could really hurt them. Did you do like, right? Did you have to just like calculate drip rates and all that stuff? We did, yes. So I don't even know. Do they even do that anymore in school? I don't know. I think so. I don't even know. And then you spoke about charting on paper. Let me tell you guys, that makes my heart happy. I love the paper charting because you could tell a story. And the person who would be taking over for you, so night shift will come in when you if you day shift, day shift, night shift, they could read the story and know what happened. Like, what happened with this patient? Did they come from home? Did EMS bring them in? You know, and what was the situation that occurred? And to me, that eliminated to me a lot of the issues that occur in electronic medical records that occur with us actually typing and putting in all the things. Um there's a lot of mistyping, you know, at least with writing, you know, people could put the line and put your little initials if you made an error and put, you know what I mean, all the all the things that I know we gotta move with times, but my goodness, they if they think back on it, either they weren't looking into this stuff as much, or it just appeared to be less issues than there are now. And maybe because everybody could see the story. And as that ER nurse, never do we want you to sit there and give us a book because we're never going to remember a bit of, not a bit of it, okay? What's left and what needs to be done? Like that's what we need to do. And that's why I knew I was never gonna be an ICU nurse. I didn't I didn't want to wash your hair or do your or do your I wanted to focus. I want, what are you here for? What are you here for today? And and that, I mean, I I quickly grasped that behavior because at the time, nobody was giving any survey scores, you know, as to how they were being treated. I mean, we we were the nurses grabbing our breakfast, honey, before we saw you and sitting in an area with our leg, with our feet popped up on the desk, eating our eggs, looking at somebody as they call a nurse. But when it came down to it, you were gonna get some phenomenal care. It was when nurses could really be nurses. I mean, we would put you on your head and put that IV in your EJ honey, like there was no right in the hallway. Like it was magical. I am blessed to have been able to learn what I learned at the time and what I learned it because that is one of the changes that I do see in today's nursing, that they are spoon-fed. We were not spoon-fed at all. It was shit or get off the pot, people. It really was. You can go sit and tell how your feelings was hurt, but we be like suck it up, buttercup. Like there was none of that cuddling or any of the things that we see now. And I do find that that is not good in healthcare. I don't know why we're doing all. The things if you want patience to survive, we got to stop patting everybody and being all like we can't say this or this, and everybody's feelings hurt. You know what? My feelings would be hurt, but I'd go home and I'd suck it up and I'd come back the next day and I would show you I got this. And that is really where nursing has changed. But that's really the baseline, you know, for me. It was amazing. It was fun. It's kind of um it's it it is.

SPEAKER_00 22:34

It's just it's like hard to kind of pinpoint when healthcare changed. Was it with the, you know, kind of addition of the electronic medical records? Was it when, you know, you know, Medicare and Medicaid really started basing reimbursements on patient surveys? You know, people say the death of like the vital signs were when pain became one of those, you know, vital signs. So it's hard to pinpoint what nursing is no doubt that it has, because I think there's definitely improvements, but there's definitely areas like you kind of said that nurses treated patients medically and gave the very great care, but they got to be nurses, like the nurses, like where you gave bed baths, right? Like back on the floor, you you know, you gave bed baths and you made sure patients were emulated, and you made sure patients, you know, right.

SPEAKER_01 23:37

You changed their beds everywhere.

SPEAKER_00 23:38

Remember having to miter the sheets, yeah.

SPEAKER_01 23:41

And then they will use a bucket. I I was so appalled. Yeah. A couple years ago to find out nobody uses the bucket and they just use these wipes. I was like, what? What is that? Like, yeah.

SPEAKER_00 23:55

It's it's it's just strange. And like it just, yeah, like a lot of things have definitely like shifted and changed. And obviously, our you know, the world has shifted and changed, so it's not surprising, but it's just it is crazy when you've been in this role for a while, and it how you've noticed that that shift happened, and it's like where? Like, where along the lines did it happen? Because it just kind of slowly it just slid, it just slid in there.

SPEAKER_01 24:33

Like, when did we go to having to wear one color uniform?

SPEAKER_02 24:38

Yeah.

SPEAKER_01 24:40

Like, I remember wearing what we could wear a t-shirt and scrubs, honey. Nobody cared as long as we was taking care of those patients. But when did it come to a point where all nursing in an organization need to wear one color? And why? Because did that change? Was that something in an in a survey that was put out there that patients say we need this? Because they don't know still who's a nurse and who's not. And patients are gonna ask, it doesn't matter if it's environmental services, a lab tech, ancillary staff, anybody when they need help to please help me. So I'm not sure where all of that even like changed. I can't pinpoint the time and the why. But if I had to think about all the changes that that have made have been made in my career, I would definitely say healthcare became more business and it's what they felt they needed to do to continue receiving and and in whatever way. I'm not necessarily saying they had to be receiving prior. I don't know if what what it was, but it is something and it could be regulatory, it could be the Medicaid, Medicare. Maybe they put their foot down because they've been that they've been there, but maybe they put their foot down and say, you want to get paid? This is what we expect out of you. This is what we want to see to continue to get. I don't know that business aspect of it. I wish I understood so that maybe I could try and process all the drastic changes because people make changes, but they never tell why. It's just this is what it is. And it's like you want a job, this is what you're going to do.

SPEAKER_00 26:34

Well, and the other thing is I literally I have a bad memory in general. I have a weird memory, I'll just say that way. Because sometimes I remember things really randomly.

SPEAKER_01 26:43

You just have a lot in your mind.

SPEAKER_00 26:45

I don't recall there being uh, you know, obviously like age cabs and e d caps and like age experience, right? Like that's a new a new thing. But like also, you're kind of talking about that, and I was like, did we have these other kind of patient safety goals? So, like, you know how there's the national safety goals, and like, you know, it it kind of focuses on, you know, like safe medication administration and and all of these wonderful things that we should absolutely be focusing on. But what were we doing before? Yeah. When you need to start goals start, because then like the goals, the national patient safety goals that are out there in Joint Commission does, they are tied to like Medicare and Medicaid reimbursement when it comes to like health care acquired infections and you know, caught us and clapsis and all of these things. So, like, there is gotta be some kind of correlation. I just don't know within the timeline what it is, but there obviously is a correlation between all of this stuff, and I honestly can't remember like kind of talking or really focusing on it in probably until the last 10 years or so.

SPEAKER_01 28:01

Like, when did they start studying and and doing evidence-based? Pneumonia's been out all my life. But at what point did they say some studies needed have been done? And this is what has to be done. And don't get me wrong, I'm not saying these things not being in place have not changed things for the better. I'm certain they have, but what was occurring before? Were people doubt dying?

SPEAKER_00 28:34

Or yeah, it's kind of it it would be interesting to kind of really dive deeper into this because I think it's an interesting conversation. It is like w I mean, obviously, as things grow and evolve, like you are looking at hopefully, data and trying to make changes for the better. So, like, how were outcomes measured? What were outcomes measured? How were outcomes? And you you know, you think these policies, procedures, all these things were put in place because maybe we weren't doing the best at it. And you know, can cycle apsies and all of these things that we focus on be prevented? Well, yes, to an extent, right? Right. Obviously, we want to be doing the right things and keeping our patients safe that should always be the forefront of us. But the emphasis that it's being put on and the price, I think it's it's almost in a way taking, and this is my personal opinion. There is some of it that's taking away from the care of the patient. It is, it has, yeah. So it would be interesting to do a deeper dive. I don't have the bandwidth to do that deeper dive, but it would be interesting to do it to see why these things were put into place and what the data or evidence back then showed that made these changes go into place.

SPEAKER_01 30:04

But were they, or was there any data or evidence?

SPEAKER_00 30:08

Yeah, that's true. Or yeah. Yeah, were they even keeping statistics, right?

SPEAKER_01 30:13

When it was put out there, we need data and evidence. Right. If you want to be paid, yeah, to make sure that these patients are being properly cared for in this way. Like, but at what point? Yeah, that'd be you're right. That would be so interesting to dive deep into and and find out.

SPEAKER_00 30:36

Like, well, because the last thing I was thinking was just um we look at I and this has obviously changed over time because you look at the average life expectancy, right? And it has definitely grown over the decades and you know, centuries from you know, people were only living till their 20s and 30s, and now people are living till their 90s and 100s. So we obviously have longer lifespans, right? Because we had advances in medicine, etc. But as the population continues to age, there's also that longer period of time we're having to take care of people with these high morbidities and mortalities. So, like that puts a pressure on a healthcare system, you know, on the whole healthcare system. You know, we have patients that are so much sicker that we now have medical advancements to treat them. Like, you're a perfect case. I'm, and you know this too. 20 years ago, if somebody got diagnosed with pancreatic cancer, they don't have the technology. They didn't have that technology back then that they do today. Like that really was a death sentence back then.

SPEAKER_01 31:43

I mean, it was a death sentence as long as I can remember. So, like it's I mean it's serious. It was straight up a death sentence. Like, I am still baffled about it because yes, technology has come a long way, and there's so much more research and things like that that are out there. There's still a pretty significant amount of people that have, you know, passed on with it. But I would love to dig into that to know what was the change that came about where now a person could live with this, like myself. Like I want to know, you know? It's so interesting. The downfall of all of this to me, Brittany, though, is that are we so caught up on making sure all those metrics, all these things are in place that that the nurses healthcare people in general aren't really learning or I don't know, or being given.

SPEAKER_02 32:47

Yeah, had to know to do. I don't know.

SPEAKER_00 32:55

Like I also think there's a part of it that's you know, with the change in society, right? It's almost like nursing was, you know, they said an R before, right? It was an R, and you had kind of care, right? And I I don't know, I'm not saying this like now that there's that lost element of like that human connection. That used to be more of an emphasis. I do feel like it used to be more of an emphasis on that human connection, and it used to be more of an art, and now it's becoming more of a science as I feel like nursing has shifted a little bit more into that science background. We've shifted more into that research and evidence and numbers, data. Yes, you're absolutely right. I think a part of that has come at the expense of that human touch and interaction. And once again, personal opinion, but I do feel like that I love data and research, you know, like I really do love having numbers and statistics, but with that, I do feel like has come a shift that we're kind of focused more on that sometimes, and especially at a senior leadership level or a bigger hospital system level, then the unmeasurable human touch and interactions that it has kind of been lost. And I mean, I know overall as a society, you know, we're a lot less human connected and a lot more social media and computer connected and all of these things. So that's I think just a shift with society, but I think that plays a part in it too. Like kind of your like your talking. It's just and then I think that trickles into kind of what you're talking about with people learning, you know, because as society, you know, we've gone ahead, there's been more of an emphasis on virtual, like, right? We do a lot more virtual learning and more of a focus on kind of like teaching yourself type of situations, right? Like you know, you might, you know, read that or do that, and you don't maybe have that lecture piece of it, or you know, even clinicals are a little are different than I remember back in the day. And that's me being a clinical instructor, and it just it's less hands-on, yeah. It's just kind of like I don't I don't know because it's like a mind shift, and I really try to like say this to my students like you're gonna be out there like taking care of these people, so you need to use this time to the best of your ability, and it's like some people take that and some people don't, and it's like hard to get them to slide sometimes like buy into it, but yeah.

SPEAKER_01 35:55

But I guess one of the questions would be also what made you get into nursing? Like, I I would wanna ask that because I remember there were people that used to be like, Well, I really got into it because of the money, and I'm like, wrong. Like, that is definitely something that it's not gonna make you love it if that is your reason for these are people's lies. And you know, what makes a person do it? I've heard people say, I do it because, you know, my mom did it, or this family member was a nurse as well. Okay, but I didn't have the desire and got into it and absolutely loved it. There are people who say they've always wanted to do it and they get into it and I'm like, Did you really wanna do this in life because you know, you see how they treat their patients, you know, or whatever. But I don't know. I really like do miss those early years. I do. Yeah. Yeah. Because you nursed in those early years. And it's kind of one that's an educated male, I find it difficult to educate yeah nursing staff now.

SPEAKER_00 37:15

I dunno it's there's so many like qu there's way more questions than answers, obviously, with all of this stuff. But you know, one of the things I actually, you know, I've been doing a little bit more kind of self-reflection as well as like a little bit more research because it has really interested in me in the topics of like burnout, compassion, fatigue, and all of that stuff. And, you know, I actually just made a uh post about moral injury, which is I think something newer. It's definitely a newer term that's kind of out there. And I think it's something that with advances in healthcare, there's also that internal struggle. So for instance, right, um, you know, if we got into it right with that, we want to help people, we want to care, but then you get into a system where it's very um based on kind of protecting your license and your stuff. Your license. And I was talking to actually a team member recently, like about moral injury and how you know we we're keeping people alive now that maybe we wouldn't have done 20 years ago. And we're prolonging life at the expense of kind of just keeping them around rather than looking at their quality of life, and that can cause a really big moral injury to people that they're having to do things that go against their true belief and wanting to help people because that's not really helping that person, that's just prolonging suffering in a way, and so that causes a lot of like moral kind of injuries to which takes a toll on people, it does are put in situations where you're having to compromise your true core values, and that makes it really difficult in a healthcare system that has shifted, I feel like, has shifted away from really looking at that kind of whole quality of life, the holistic, right? We the holistic care of people and looking at all aspects and really just looking at how can we move patients along in our system and how can we, you know, get patients back to just kind of their baseline. And it it just there, there's definitely been as well, and that definitely causes more distress on healthcare workers. No, it does burns us out, right? No, it does.

SPEAKER_01 39:48

And actually, you're you brought up a good point because my question to everyone, even out there, and to you, like, or ones who've done it years and go, years ago and and away from the bedside, how many of you are would be that bedside nurse today? I think about that question because I don't think I would. I really don't think that I would I could be that bedside nurse today, which then makes me feel sad.

SPEAKER_00 40:19

Yeah. For the nurse. You can't be the kind of nurse you want to be. There's there's and that's that's the other part of this, right? There are I feel like systems in place almost that prevent people being the type of nurse you want to be.

SPEAKER_01 40:36

Absolutely. Sucks. Like it and it does. And and and then when I think about in that case, that is where nursing has changed. And it's not always on the nurses that are put out there. They have been, they're very limited as opposed to when I was doing it. And like we had to really learn it. Like, you didn't learn it for the moment. Like, we had to know it. And now I feel like they're bombarded with so many constant, this needs to happen, this needs to happen, you need to do this, you need to chart this, you need to make sure you're telling this person this, that it is so overwhelming. I don't think the human brain can handle all of it. And I just think that it's too much.

SPEAKER_00 41:32

I literally was gonna say that exact same thing. You literally said it so perfectly and stole the words out of my mouth. Because I think that's another piece, right? You there is so much advances now, and there's so many things that nurses are needing. Like there's, you know, it's like, what are your top priorities? Well, you have 10 top priorities, like right that you you can't have 10 top priorities upon how it works.

SPEAKER_03 41:59

Right.

SPEAKER_00 42:00

So like you're being set up to fail automatically because the system as a whole, all of healthcare, and especially our, you know, in the United States, there is competing priorities. And so when you have competing priorities, nothing can fill up. So like you're you're being forced to tell everybody all these things, but it's like cognitive overload, and people kind of retain it information because having to like turn it over into something different.

SPEAKER_01 42:34

It's like you can't and how much can you continue to give them in badge buddies or making binders, or you know, because our human brain just, you know, can't handle all the constant changes. And then then everybody wants to know, well, why can't these people remember? Well, we've bombarded them with constant changes. Like, I know, even as an educator, the constant changes that I'm like, I'm gonna have to decipher between what I think needs to be put out right now because it's just so much.

SPEAKER_00 43:10

And they can't, it's no way. It is, it's so true. You're like, I need you to learn everything about sepsis, and then I need you to learn everything about cardiac CHF, and then everything about trauma, and everything about this thing and this thing. It's like who can? And then then, okay, here's this process. Nope, nope, nope, nope. We found this workflow, and that's fine because things do change. We understand things change, things don't work, you try it, it doesn't work. But like when there's constant change, that makes it really difficult for somebody to be able to keep up. Truly, it's so hard. Like, yeah, like you're kind of talking about like looking back now at where healthcare is, what I have still chosen to go into nursing and I honestly don't know. Like I really don't know because I don't, you know, I've been away from the bedside now for a little bit. I still, you know, occasionally pick up here and there. And I still really love it. I still really do love interacting with patients and taking care of patients. But like to do that every day, that mental load is just like extreme. And like you're constantly like, I feel like just being set up to fail. Like so you are, it's you are so hard. Like it's so hard.

SPEAKER_02 44:31

And like I don't yeah.

SPEAKER_01 44:33

So and it's it's something that I can't even begin to say how to be fixed. I don't even it's I don't know.

SPEAKER_02 44:43

I don't know either.

SPEAKER_00 44:44

Like it's it's crazy to like look back because like out of site nursing was fun. Like it was you know, you interact, you know, like you had these awesome like teams and right. You had this big really close-knit team, and like you went and like did things together and not saying that. They were your family, your work like you would joke and like have fun at work, and like it wasn't anything bad. Now, like you make a joke at the nurses, everybody's a dude. It's like it's just like nursing used to be a lot funner, like it was it was fun and it was autonomous, it's none of that now.

SPEAKER_01 45:27

It was like it was such a rewarding feeling to be like I'm a nurse, like I'm an emergency room nurse. Like I felt like a hero. Like, seriously, like making a difference. And then as healthcare has changed, it is burning out nursing staff. I see it. Like, I see it. I recently onboarded someone, not even in emergency room nursing, who literally was on orientation and resigned before the shifts could be done. And that's where we are today, because it's so overwhelming and it's just not fun anymore. And it's burning people out and people just don't have it in them to to to do that, to deal with that and and all the constant changes. And why are you worried about? I mean, yeah, it's cold, I got on a jacket, but why are you so worried about whether if it's fleece or not? Or why why do we worry about such small things that I'm just happy that people are making it work and that they're caring for patients, but then we worry about certain things that I just think that they really should not worry with, worry less about those things. And maybe people will not get so stressed out when you're coming down on them about other things. Like I feel like we need to start picking our battles, if that makes sense. You know, and I do know that that depends on the department and the leader that they have, if they, you know, but just to say to the leaders out there who are, I understand being black and white following rules, but sometimes we have to pick those battles too. Like those are things that are pushing nurses away. They're they're not like how I was this loyal person feelings might get hurt, go home, come back the next day, start all over again. They're like deuces, I ain't coming back. Like, and those are the things we need to figure out the why. Why, you know, um, but I don't know if those things will ever change. Will they continue to just get worse? Where will healthcare be years from now? So many areas.

SPEAKER_00 47:56

We got so many questions and so little answers and no answers.

SPEAKER_01 48:00

So if you have some answers, please share them with us because maybe there's a maybe there's things that we just don't know, you know? It's so interesting, Brittany, that you were saying how you know you never really work the best side, but occasionally you definitely do. I was just thinking about that. Like wanting to occasionally just I don't want it as a full-time thing, but jumping back in because I do love taking care of patients and seeing them turn around from being very sick to where we have pretty much nursed them back to where they're on the road of recovery. That is what was rewarding to me as an emergency room nurse. Like nothing to me was any better. I'm sure maybe labor delivery nurses feel that way when they deliver the ladies. But you know, those are the things that I do miss. And then I I just was saying maybe you need to just not as a shift, but like start jumping in throughout maybe even a a day or whatever, and trying to get myself back in there because right about now, it's kind of scary when you've not done it for some years. They say it's like riding a bike. It is, but you know, and I I don't I don't want to not feel that that comfort that well, it's never should you feel that comfortable. You should always be willing to continue to learn because let me tell you something. Us seasoned nurses need to know that things have changed and they're not the way that we have known them to be. And as an educator, I realize that because oftentimes I have to look up in our resources to make sure that I am giving the correct information to our clinical staff just because things have changed. Not always because I didn't know it, some things I may not know. I'm gonna tell you if I don't, but just because things have changed. I I remember being told that they didn't aspirate anymore with I am shots and being shocked. I couldn't believe it. Because me as a nurse, that's what I do. That's how I learned it. They're like, oh, they don't do that anymore, Felicia. I'm like, wow.

SPEAKER_00 50:34

So yeah, you know, well, that's I mean, medicine is constantly changing. It's constantly changing. There's definitely good things about that, right? Like, definitely. We are making advances that are really changing patients' outcomes, really changing. Amazing equipment. Mobility, more, more mortality, and really improving patients' lives and really letting them fully like have recovery with ADL. So, like, there's definitely a great shift in medicine. Obviously, like you know, we talked about before, like Felicia's still here with us because of shifts in medicine. So, like, it is not always a bad thing. It's no how do you kind of have more of a balance, you know? And I don't we're I don't know here talked about it for an hour now, and we're we're still like, we don't know. So, is there anything for your our drop our stethoscope moments that we want to talk about before we kind of wrap up this very intense but really great conversation episode?

SPEAKER_01 51:39

Just that, you know, my drop that you know, dropping that stethoscope moment is just the excitement of I see new growth coming along, you know. For me, I see some changes. I am very excited about that and the and the opportunities that could come along with it. And just continuing to try to stay in good health to keep you up on things. I do go to the doctor on Thursday, and I am going to try and have a conversation to discuss what those next steps. I think I mentioned that in our last episode, but just want to let you know that's coming soon. And other than that, just trying to stay positive and not fall in my bubble too much. So I'm doing pretty good these past few weeks. Um I'm I'm feeling really good. So that's just a moment that I wanted to be able to share with everybody. How about you, Brittany?

SPEAKER_00 52:44

Um I'm trying to think since our last episode. So it's really funny. We were talking about like shows last week, right? And I still have um because I haven't watched it yet. So we'll have to talk about it soon. The shack, right? It's it's it's I I still got it on my to-do list, but I need you to watch it.

SPEAKER_01 53:03

And when you see me Thursday, there needs to be a discussion.

SPEAKER_00 53:05

I know. I'm gonna have to put it on the agenda for tomorrow. But I, you know, I think there was like a moment maybe last week where I was just like, I can't show my brain off. I can't, you know, like I constantly do it. And my boyfriend was like, you need to stop like worrying about kind of because I'm trying to like kind of grow my social media and things like that. He's like, you just need to just chill. Like, he's like, you never really, because I said this, I'll never really stop and like watch shows with him or do that because I'm just constantly like, I gotta figure out what to post next, or I've gotta like figure out how to market my class, or I've gotta do, you know, like all these other things. And he's like, you just need to like put your phone down, just like it's okay for it to just be away and just literally like completely check out. And I was like, okay. So I'm really gonna try to just like try to plan my like social media stuff a little bit better, so I'm not constantly being kind of consumed with it. Right. Social media is wonderful and it's really opened up a lot of new doors for me and kind of my career growth and different aspects outside of traditional nursing, but I don't want it to consume me. So I'm trying to find more of that balance. So that's kind of where I'm at right now is I love that for you.

SPEAKER_01 54:19

I love it. And thank you, thank you, Tony. I love that. Thank you for telling her because life is too short. So we need her to like just put things in the bucket where they need to be, and then shut things off.

SPEAKER_00 54:31

Yeah, because if not, I will constantly be going and I'm just like, okay, why social media trends are out there now? What do I need to jump on? What do I need to post it? Like, so like I'm thinking at it really in like that business kind of mindset, but it's still the same thing. If it's gonna be another consumption thing, like it's just not worth it. And he's like, it's not worth your mental health. So I'm like, I'm gonna try to have more of a balance for sure.

SPEAKER_01 54:53

So I like it, I love it. Love it.

SPEAKER_00 54:56

Johnny's at this moment is you know, as much as he can be a pain in my butt. My my boyfriend is right, he's he's great, he's a great balance for me.

SPEAKER_01 55:05

Right, he is a great balance, and that's exactly what you needed to hear, my friend.

SPEAKER_00 55:09

Just like you tell me when I need to like yeah, sometimes you just need that like shock of truth to like get us to be like, okay, that was a little that stung a little bit, but thank you because I really needed to hear that. So yes.

SPEAKER_01 55:22

So, guys, it has been another wonderful episode talking with you. Yes, please love us.

SPEAKER_00 55:32

Well, I just wanted to say, just to kind of like kind of wrap up this episode, there's a lot of things that we're kind of we've talked about, like we can't control staffing or patient volumes or acuities or policies, and we can't control a lot of things, but what we can control is how we show up to work every day. Like we've talked about positive attitudes all the time and being kind to yourself, giving yourself that grace. We talked about that last week and giving your coworkers grace, being kind to patients and to co-workers, and just remembering that a lot of things have shifted, but every shift that we go to work is still an opportunity to make people feel seen. Like we talked about kind of losing the art of nursing. Well, we can consciously work to kind of bring that back, and it's tough, but we can do it. Like we can do it, just it's hard. We have a lot of systems in place around us, but those are things we can't control. So we gotta work on what we can control, and that includes myself, everybody, right? Absolutely all we have room for improvement. So once again, thank you for listening to our please drop a comment if this resonated with you, or like what your ear's doing differently that's kind of shifting things, or like how things are working at your place because all ears work a little more. Absolutely.

SPEAKER_01 57:01

Give the input, share, talk to us, talk to us, let us know. Guides, help guide us, guys. Yes, yes, thank you. Love you guys, thank you, and make sure you have a lovely evening.

SPEAKER_00 57:16

Don't forget, like, subscribe, share. We love y'all. Love you guys.