Margaret Daneyko currently serves as our Director of Nursing and Clinical Services at RMA of New York. With her 25 years of experience in women’s health, she is an expert voice when it comes to fertility-related operations and care. In this episode, we look behind the scenes at a fertility clinic, discussing empathic burnout and other challenges fertility nurses face; improving patient care; and the awkward waiting room setting. Almost every little girl dreams about becoming a mother one day and never questions whether that would be possible, yet fertility clinics help countless women who face the reality of infertility. This process can be overwhelming, but patients must remain open to all possible avenues that may lead to the desired result.
Margaret Daneyko currently serves as our Director of Nursing and Clinical Services at RMA of New York. With her 25 years of experience in women’s health, she is an expert voice when it comes to fertility-related operations and care. In this episode, we look behind the scenes at a fertility clinic, discussing empathic burnout and other challenges fertility nurses face; improving patient care; and the awkward waiting room setting. Almost every little girl dreams about becoming a mother one day and never questions whether that would be possible, yet fertility clinics help countless women who face the reality of infertility. This process can be overwhelming, but patients must remain open to all possible avenues that may lead to the desired result.
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everyone, We're green and era and welcome to fertility. Ford were part of the wellness team at Army of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our fertility for a podcast brings together advice for medical professionals, mental health specialists, wellness experts and patients because knowledge is power and you're your own best advocate. Margaret Dan ago currently serves as our director of nursing in clinical service, is at Army of New York. She has spent 25 years in the field of women's health. In this episode, we look behind the scenes at a fertility clinic. We talk about empathic burnout and other challenges. Fertility nurse's face and we talk about how to improve patient care and the awkward waiting room. Okay, so thanks for tuning and again this week, And we're so happy to have Margaret Danica here who full disclosure is my pot scared are made from a little bit nervous.
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No need, no need
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dinner. Margaret is our director of nursing and clinical service is, and I think you know she's gonna show a lot of awesome, useful information today. That kind of what goes on behind the scenes Azan. Infertility nurse.
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So let's get started.
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Okay, so this is great. Thank you for inviting. May this my first podcast. Fun. So, yeah, just a little bit about May I have been in the fertility world for almost 20 years. Oh, my gosh. And I've always been women's health nurse. I started on labor and delivery. So, childbirth, you know anything to do with women's health? I've been extremely interested in passionate about. And about 19 years ago, I made the switch over to fertility. Started out from bottom, kind of worked my way up to where I am now. And I have to tell you, it's one of the most rewarding things that I get to do in my life. You know, working with all of you is an amazing experience, because what we're looking to do here is to provide you with that experience of bringing home a baby. So
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what do you mean patient
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meaning? The patient. I know. I'm talking about all of you, The patients out there You are hopefully listening in. So So
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you find it really rewarding and
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I d'oh ay dio. And you know one of the things that I always have spoken to my patients about is that you know, as little girls on this even goes for our men out there is little girls. You know, when you're growing up, you know, one of the things that you think about is growing up in having babies, right? Never did we ever think that you would be in this position and have to really work hard at it. And when someone tells you that you can't do it the way you always thought you could, it becomes very stressful, and that's why we're here. I mean, that's why Rina's here. And that's why Dad is here. Because we want to make this an experience for you that you will be able to handle appropriately and make sure you have all the tools that you need. You know, one of the things that I like to hammer home with my staff is that you know, be that patient, be that person and understand everything that you can about her and know what she's going through and help her along. That journey didn't love
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that. I think of the nurse we Iive you nurses. It's like the heart of everything they show the love and the care and compassion. Um, I think is so important.
spk_2: 4:03
It is. It's It's one of the main things that when you're in nursing school that they do want you to bring home. Is that you know you are the patient advocate. You're the one who's here. Thio, hold your hand and take you through this process. And the nurses here I find him are phenomenal that way. Many of them keep pictures that you send of your babies, that they've helped you through this journey. And I love looking at all these pictures. And I always love hearing the, you know, the success stories, but also the stories that weren't so successful because now we want to make sure that we're gonna focus, you know, maybe do something different. Or maybe and, you know, bring in service is that we have to offer here, you know, see what we can do to make you be part of that. That story,
spk_1: 4:58
that's great. But I feel there must be some challenging Thio. You know, I'm sure you take home a lot of the stories and the experiences with you at the end of the day. How did you deal with it? You
spk_2: 5:11
know, it's very It's very hard Thio when you asked me that question because I have over the years dealt with many, many women, all ages, you know, at all different stages of the process. I mean, just one story that I always loved to tell is that, you know, I I spent a lot of my time in third party. So a lot. I worked with a lot of the patients who need a donor egg or a gestational carrier or donor sperm through the process. And, you know, that is a whole another level to the whole fertility journey. That dumb that your role on
spk_0: 5:49
inside of seven kids, they're our listeners. And get that. So we call our at our member called third Party. You know, the team that works of donor, so donor egg donor sperm. So it was 1/3 party that's over talking. Yeah,
spk_2: 6:00
Thanks. Serena s o. I had this one woman who she was 46 she had finally with donor egg. She had a beautiful baby girl. Just she was so excited. And this is a woman is a career woman. Worked hard every day and she called me and said, I want come and bring the baby to show you and that that's the best part is when is when you come and you show us the baby and it's just like you know, it still brings tears to my eyes, you know? So she came into the waiting room and the waiting room was crowded and I went out and I'm looking for her and I didn't see her until finally she stood up and she waved at me and she was not in her career close. She was like in sweat pants, that's what. And she comes over to me and she says, I she says, I just want to thank you so much, she said, for bringing you know, this little bundle here shoes. But I have to tell you, why didn't anybody tell me how hard it was on? I looked and I said, Yeah, it's hard, she goes. But I wouldn't change anything for the world. And, you know, just seeing that expression in her face and, you know, seeing her with her child. It just really meant so much to me because we had worked so hard to get her there. So there's so many different avenues to take in this process. And I think it's important that everybody be open to the different to their own journey. Exactly. You know, there's nothing set in stone, and you know there's There's definitely many ways to get to that end result. So you want to keep open minded?
spk_0: 7:38
Sure, friend, I think you know, we've talked about that. You know, it's a number other guests before about, you know, everyone kind of grows up, and I think, Margaret, as you touched about, you know, women feel they grow up, they want to have kids, and that's their picture. And sometimes it's about reframing that if you see you know it's not gonna get there with, you know, the picture you saw, you know, with a partner in the biological child, whatever it is, you know, some people get there by themselves with the boner, and it's about refraining and being open on shifting your you're thinking. And you know this process can be really hard, but they're always There's so many options, and you could take you in ways that you never really thought
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absolutely take us through a typical day. What? You d'oh!
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I know that it gets a bit three in the morning early started
spk_2: 8:27
33. 33. Start early. Yeah, I live far away, so I want to be here at seven o'clock when the doors open so that I could be here to address any one of the patients that come through. That may have questions, too. And then to also be here for the staff to make sure that if they have questions, they need help with anything. You know, I like to do rounds through the office, Say good morning to everybody. So, you know, if you're in our waiting room, you may see me walking around saying good morning. And if there's anything anybody ever needs on pretty much always here on at seven in the morning and then once monitoring is over, you know I am, you know, working on different projects, things that are gonna help make your experience a little bit better Here I will work with the recovery room and the O R. Nurses to make sure that your experience in the O. R is nothing short of exceptional. We really like to pride ourselves on excellent patient care. So that's my main goal throughout the course of the day. Is what can I do to help make your experience better? You know, I do. I do a lot of work with the physicians. I do work with all our complimentary service says with Rina, with Darryl with Dr Witkin. You know, I, uh, speak with all the teams, All the make sure if they have any questions about anything, So I kind of do a little bit of everything, so But I enjoy it. It's It's definitely a lot of fun.
spk_0: 10:00
And I think it's been I think one of the things that I think are made is so beautifully is how you know each doctor really hasn't team. So if you're with a doctor, you have one consistent nurse coordinator on. I don't know a lot of other clinics that are run like that. And I see you know, as I collaborate with teams and my patients, they really they really they really respond to that. And people get very attached to their nurses. You know, you calling for blood dress, you know, it's a comfort thing. You see a familiar face. You know, our nurses are so great of responding. Everyone here, really, you know, doesn't really work 9 to 5. It's really kind of You get to know someone, you become involved. And, you know, I think we're all very responsive out of the office too. And you know, Margaret, I'm wondering, too. How is that gonna play a role in what you do? Also, you know, managing kind of staff burnout because it does become a lot to be compassionate all the time. And is that a big part of your job to managing staff and, you know, pass it, burn out. Do you see a lot of that, too?
spk_2: 10:54
Yes, of course. A lot of my nurses will come to me and say, you know, they're they're been working with, you know, a lot of patients who are having a difficult time and a lot of the times the nurses will Ben, with the word I'm looking for. They internalize exactly what's happening, and they bring it home so they'll come to me and, you know, we usually sit down, We talk about it. I'll tell you know, maybe you should take a little bit of a bright go for a walk, clear your head, do things like that. Because at the end of the day, you know they do want to be able to get back there and give you, um, the patient, what you need from them and, you know, they will smile with you. They'll laugh with you, they'll cry with you. They go through the whole journey with you and that same holds true for the coordinators. I'm sure the IVF coordinators, they are the ones who are prepping you for this journey. And they're the ones who are holding your hand up until the time you do start to take your medications. And so those are things that I like to work with the team with and making sure that they have the tools that they need so they can give you what you need. So I mean, it could be difficult at times, but, uh, you know, we figure out ways to to get aboard each other. Exactly. That's the big K and what Rina was talking about about the team approach. What I like to say about that is that each position does have their own team. But we also have the global team which is our May. And so you're underneath that umbrella. So if for some reason your nurses on vacation or away there's always somebody there who's going Thio be a backup. Who's going to be able to follow up for you? Same thing with the coordinators or the physicians were also very collaborative. You know, we work with, um, you know, dare from the nutrition aspect and we work with arena. If you know you need some extra support we work with, you know, outside vendors. If there's something piece of equipment that we think is gonna help your journey be better, we'll work with that. I mean, it's just it's an extremely collaborative environment. We have our fellowship program where the fellows who are, you know, very involved with research and that research helps us provide better care for you. So I think overall we have the global team. But then you have the individual teams as well.
spk_1: 13:27
The collaboration and communication is so essential and myself being a patient here years bank, I got to experience that from the other side, and I never felt like I was a number. I felt like I had a name and people knew I waas and yes, working closely with one or a couple specific nurses really helped you. Some of my worries know that someone was on my team to support me.
spk_2: 13:58
That's good to hear. And that's so important. Because if you think about it, you know anything that we d'oh that we're not familiar with that. You know, we need someone who's gonna guide us through that and make sure that we understand everything every step of the way. And, ah, lot of what happens when you're going through this process is that you lose control. You know, many women. Most of us, I think, are very much people that like to be in control of things. You know, we're trying to do six different things in London in our lives. Now we've taken that that piece has been taken away from us, so we have no control. And so I think that's why sometimes it's important that that team just be there a little bit more to help guide you through the process, because we want to make sure that you are feeling some sort of control over your care on. And that's one of the things that I like to also work with the nurses on is, you know, it should be a joint process where the patient and the nurse work together. There's accountability on both sides, you know, And as providers of health care, we want to make sure that the patient that we're accountable, but also too, we want to make sure that our patients are accountable for their care. You know, they definitely have a voice. And we want to We want to hear from you. We want to hear that. You know, you're taking control of part of what's going on because in the end, you know, the outcome is what it's gonna be a
spk_0: 15:34
sure and that's the night. You know, I work with patients on a lot, is coming up with plans, you know, option a option B, option C and I say, Okay, you you come up with your your plan and your options. You know that's in your control. Come up with a column, come up with a viable plan to go through everything down to how you're gonna afford it, how it's gonna fit into your lifestyle. You have a trip coming up. What is the timing, and that really helps people to feel more in control health and take a step back and say, OK, sure. This is my choice, you know, Tell my nursing team Look, you know these dates of visits? I'm going on this trip. It's not negotiable. I'm not going to be here. How could we work around this? What is my timing? I'm going to help people. See, You know, they do have a voice in this process, and it's okay to ask questions. Absolutely. And if
spk_1: 16:16
anything, I feel like the nurses really do encourage anything that you're you don't know. But you have any concerns? Let us know. Because if that's gonna help decrease those stress levels, we want that.
spk_2: 16:28
Absolutely, You know, questions. In my book, you can ask a 1,000,000 questions, a 1,000,000 different questions. That just means that you're engaged. Your focus, that you really want to know all about this process, you know? And then, you know you turned the tables. If you keep asking us the same question that I need to go back to my staff and say, Hey, why aren't you communicating this information to the patient than they understand it you know, the first time that you say it? Why were they needing to ask this question over and over again? So it definitely is a joint process.
spk_0: 17:02
Yeah, I think it was great here. The email access eyes. Wonderful. You know, I got a lot of patients who say, Oh, I wanted to ask this, but I was scared. I want to bother anyone, and I say, No, no, it's not about It is It's so helpful, you know, that's what we're here
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is what I want
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to do. Yes. They want to hear from you ask questions, or we won't know. But I think it's so important. And, you know, I think I'm thinking back to my time and treatment, and I always wondered. Okay, where do these nurses go? You know, they come out to get you there in the white coat. What? Where did they disappear too? And I think it might be home over and listeners t here. I'm Aziz. What? The gardener here. You know, they sit there in cubicles. You know, some people have standing best. We're all next to each other, you know, they're taking calls. They're wearing regular clothes, talking about shoes. You know, if they're not on the phone, if they need a little break and they're they're really people, you know, they sit. It's an office setting. And it, you know, they're on the computer looking at charts and results, and that's where they go, you know, And I think it's so funny, at least to me, to think that's where they're sitting in a really kind of office. Seven.
spk_2: 18:04
But I mean, the thing about it is, what's the type of setting that they're in is that they are able to turn to their coworker and say, Oh, you know what? I have this patient and she's not responding toe, you know this medication, What do you think? And, you know, we always bounce things off of each other as well as the physicians. The physicians are very accessible in the sense that they are there, you know, they come in tow where all the nurses air sitting, and they're you know very much about teaching there very much about making sure that their understanding, everything that they're telling the patient and it just creates a very nice environment and then, you know, hopefully you know, now in turn rubs off on what they're talking to you about it and ensure that you understand. You know why we're doing the things that we're doing. But that's that's a good question. Could Sometimes I think about that when I go to other offices, you know, like where they going,
spk_0: 19:02
It's just, you know, kind of an office and, you know, collaborating. The doctors air, they're real people,
spk_2: 19:08
you know? It is it can be really scary. There's no question, you know, you walk in, there's a ton of people in the waiting room and it's overwhelming. Can be absolutely. But we want to make sure that we're making it has not overwhelming as possible, you know.
spk_0: 19:27
And you know, that's what I love to hear. You know, Listen, our feedback to, you know, write Indiana's on instagram the MLS. What would make it a better experience or less overwhelming for you to come sit in the waiting room? You know what would you like to see? What would make that better when the
spk_1: 19:42
cliffside what does worry? Once that was the first thing that worries you and you come on office. And how would things be different?
spk_0: 19:49
Yeah,
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feedback is so important
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that I would love to hear that, really curious to hear your chances on that.
spk_2: 19:54
A lot of the times, you know, we send out surveys and our patients give us feedback. And when I call the patients, one of the first thing I say to them is, You know, I really appreciate your feedback because your feedback enables May to go back to my staff and see how we can do things fast. You make those changes so you know, don't don't hesitate. You know, if you think that maybe we can do something better, we're here for the DNC. Think their experiences Absolutely positive. It's possible. Absolutely no, it's, uh it definitely gives me a lot of pleasure and happiness, too. See, people get discharged to their obi do I n and they're so excited and they cut. They walk around with their pictures, and you know, that's the ultimate goal here, whatever we can do to make that happen and we're going to do that.
spk_1: 20:46
So, Margaret, it's changed. You've been here for quite some time. You've been in our May. You've been a nurse in this realm for quite some time. How have things changed over the years. Now also, what would you like to see? Change down the road? That's a
spk_2: 21:03
good question. Well, what I've seen change. Obviously. When I first started in the fertility field, you know, we were doing day three fresh transmitters. You know, there was no day five blasts that there was no such thing as p g T. There was no such thing as, you know, freezing all your embryos
spk_0: 21:22
this Can you tell her what? What did a three way? So
spk_2: 21:29
Day three embryo is, um, the third day after the trade and fertilized on Day three is when we would put the embryo back and do a transfer. And And when I first started, 99% of them were fresh. I would say 99.9% and fresh. So you had your retrieval and
spk_1: 21:52
then always day three,
spk_2: 21:53
right? Always day three. And and then over time, we moved to day five on. Then over time, we moved Thio being able to test the embryos. And that technology has changed tremendously over the years. It's become very sophisticated, and it continues to become very sophisticated. You know, you were able to take just a few cells from the embryo. Send them off to a lab to be analyzed that we can determine if that embryo isn't normal. Chromosome a embryo. And what day is that? Usually the agents usually day five or six. Sometimes sometimes they won't go to day seven. But it's usually day five or six where they will take a look at the embryos. They will biopsy just a few cells. And I think some of them misconceptions that the patients have is that they take the whole embryo and they send it to this lab. Help on everything. Right? I know what happens. This is Thea, are you know, tremendous embryology staff who are just, you know, very skilled technicians are able to just biopsy a few cells off of the embryo not doing any harm to the embryo. And they send those cells off to the lab and then they freeze the embryo. So it is there, and it stays in our facility. Those cells go to the lab, the lab build and test them, and then send a report back and let us know which ones are you employed, which means that they're chromosomally normal or any employee, which is their chromosomally abnormal. And when they come back, then your physician or your physician team will let you know how many of your embryos air normal versus abnormal. And then they'll set up a plan for you now to do a transfer and you will do a frozen embryo transfer cycle. But that's one of the main questions I get is Well, what do you mean? My Where's my embryo things? And it doesn't leave on facility and safe here in your lab until you're ready to use them.
spk_1: 24:05
So frozen on day seven. Approximately. Well,
spk_2: 24:09
Dave, usually day five or six? Yeah, sometimes day seven, but a five or six? Yeah,
spk_0: 24:15
And so, what are you doing? The stats on that? You know, I got patients. You know, I'm setting out 10 embryos. How many Rick's gonna come back?
spk_2: 24:20
Well, this totally depends on a number of criteria. It has to do with the patient age. It has to do with the quality of the egg, the quality of the sperm. Those are all factors at your physician will speak to you about. And there's always attrition. It doesn't matter how old or how young you are. You know you can be 30 years old and send out 10 embryos for biopsy, and only four or five of them are normal. If you're 40 years old, you may only have three embryos to send out. Maybe one of them is normal, but maybe all three of them are abnormal. And then there's everything in between, and there's no given formula for that. Each person is individual, and there outcome is gonna be individual. And those are all things that your physician will speak to you about based on your results
spk_1: 25:15
and also, for each cycle, beat every such pain.
spk_2: 25:17
Absolutely every cycle. You can have one cycle where you have 12 eggs and one cycle when you're up for rent. So you know where you have to remember where Jenna was with human bodies. It's not an exact science. Would we love it to be an exact science, of course, but it's not so. That's why there's different protocols, different ways of doing things, because if something doesn't work one time than our physicians, you know, they're always researching, always looking at maybe a different way to do something. So that's why it's so important that you keep the communication with your physician.
spk_0: 25:53
A Sure. And I know you know, for myself. You know, I, you know, did IVF in. I went through back then called P g t Test in her, Pete know when I was PG and e t and that very quickly. But, you know, waiting for the results on that was very difficult, you know, waiting for the call, How many embryos do you have? And I don't know, vacations now and not wait. Time is very tough, you know, just waiting. You know he won't go to the process. You do everything on the injections that were treatable. And then why am I still gonna have anything at the end? And that's what really, really tough time mentally, Because you sort of feel like there's nothing you can be doing. You're really just waiting for a very, very tough time in the process, It iss
spk_2: 26:36
and that's where you usually encourage people thio, you know, go do something that is gonna hopefully take your mind off it. You know, maybe this is a good time to take a vacation. Maybe you wantto you know, go visit that museum or something you want you've been wanting to do like don't put your life on hold to try and do some things to keep your mind off of it Until that time frame comes. And the same holds true for that time frame between the transfer and the pregnancy test. Done. Two weeks can be a long as two weeks of your life. But if you try and focus on doing something that will keep your mind off of it, huh? Then we definitely encourage it instead of just like right. Well,
spk_0: 27:21
I you know, people always say, Well, I think I have to be doing something. I don't know how to kind of live it up to that. I'm doing something for this process. And I say, Listen, you know, I was there in school. You have a free period. You know what you're figuring? That's right. You're still in school. Take the free period. You're still here. You're still in the process. Think of this as you are. Free period. You haven't left school. You haven't left the process. Who doesn't want a free period, you know. Go, Jake. This time you don't do anything. People sometimes you know it's hard for them to do that until I was trying to encourage people. You're still here. You're not not doing something right. But, you know, take this, you know, given break. It's a gift,
spk_2: 27:58
right? Enjoy the time where maybe you don't have to really think about it too much because there's really nothing you can do. It's out of your hands. It's out of our hands, you know? So definitely it's a good analogy. Free period,
spk_1: 28:13
period, spring break, lunch. Talking about things to take your mind off of you. But things did to do that makes him happy. What do you d'oh! On your day off, That brings you joy, My
spk_2: 28:26
dogs! I love my dog. Some have two dogs and my grandson and soon to be second grandchild. They give me happiness, but yeah, I mean, you know, she
spk_0: 28:38
answered my text messages on the way. You're thinking
spk_1: 28:45
so early? D'oh! You know,
spk_2: 28:50
I got it's really hard because the time I get home and then, you know, line one I'm blind. And if I want to try and work out, which, you know, I try d'oh! And then you're clean and then, you know, go spend. Sometimes the husband's not enough hours in the day, but yeah, but I enjoy going home to my dogs, and they are definitely happy all the time. So they keep you uplifted for those Grover don't people.
spk_0: 29:21
Well, you know, I have to say thank you for so many people here, Margaret really is kind of this, like Mama Bear. Here she is the most caring, warm personal takes care of so many people, and I think, you know, are made. But patience is not everyone is so lucky to have Mervyn, I think, you know, really never come oppress Someone really genuinely cares so much about people's well being. And I think it's so wonderful. And, you know, I always love finding other people in the world that really, truly, genuinely care. I think it's hard to find and thank you.
spk_1: 29:52
Hear about the staff, Care about the patients? Yeah, We're very lucky to have you. Well,
spk_2: 29:57
thank you. I'm lucky to be here because it's a great place and we really strive to do really good things for a patient's
spk_1: 30:05
way. Typically, end our podcast with gratitude. So going around, just letting everyone know what you are grateful for today at this very moment. Oh,
spk_2: 30:18
wow. Ee Oh, no, I just think I'm grateful for good health of myself, my family and my friends. You know, I think that's the most important thing that you can you can have in life right now. So
spk_0: 30:36
what? You really uh uh, you know, I think it goes back. Thio sort of what I said about Margaret and being grateful to find other people in the world who you really are just so genuinely kind of doing that. You know, I really try and practice, you know, random acts of love and kindness. And someday then better that than other than I'm cranking it. They won't hold the elevator for you. But I think you know, it's been grateful for really kind, good people and finding that in the world there
spk_1: 31:05
Hi, I am. There's lots that I'm grateful for. But at this very moment, as Margaret mentioned about collaboration here, I am so lucky and fortunate to be here to be able to collaborate, worked by myself before in private practice. But there's something to be said about working in a team, dancing ideas off each other,
spk_0: 31:23
having Rina right next door. I ever have
spk_1: 31:25
any questions? Or do you just get my mind off of what I'm doing? Just having that really good support system here? It's great for the patients, but selfishly, it's great for me as well. Sure thanks for being here. Thank you. Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram at fertility. Underscore forward. And if you're looking for more support, visit us at www dot r m a n y dot com and tune in next week for more fertility forward.