A Nurse First

Built from the ground up

• Sigma Nursing • Season 4 • Episode 1

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Anthony Silva dropped out of high school to help his mother pay bills and worked various jobs, including being a medical assistant, before finding a mentor in Dr. Richard de Asla, a foot and ankle surgeon. He offered Anthony a full-time job—and changed his life. Driven by his mentor's encouragement, Anthony became the first registered orthopedic technician in his healthcare system and is now training and inspiring others to do the same.

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Adversity has always been in my deck of cards. Unfortunately, or fortunately, however you want to look at it, I went to a very academic high school in Boston. Life circumstances required that I had to drop out to start helping my mother pay bills. And so I dropped out of high school in junior year. I waited tables. I worked at a call center. I drove Uber. I've done it all. I sort of got sick of getting laid off, not having everyday work. So I actually went to medical assistant school when I was 18. And figured out I was pretty good at it. The surgeon that I work for right now today is the same surgeon that I worked for back then. Welcome to A Nurse First. This is Anthony Silva telling his own A Nurse First story. Dr. Richard de Asla, who is a foot and ankle fellowship trained orthopedic surgeon. Dr. de Asla has been not just an employer. I mean, he's been a mentor to me. He's from New York, went to medical school in Buffalo, did his residency out in Ohio, then came back and did his fellowship at Hospital for Special Surgery in New York. Ultimately became the director of foot and ankle surgery at Mass General Hospital in Boston. And that's how him and I met at a satellite clinic that he was working at. I was struggling then. They only had me part time. It was about an hour and 45 minute ride from where I lived in Boston. So I had to drive a lot. I mean, I was paying my gas money, essentially, because my everyday car was a 77 Cadillac Coupe De Ville. So I was like emptying my bank account just to get gas. And so when he sort of figured some of this stuff out about me, and he had this full time job open up at Boston, you know, the Boston campus from Mass General. So we call it the big house, the main campus. He offered me a job with him to work full time with him. And that was only about a 15 minute train ride from where I lived. So it was life altering for me. I only had 90 days experience. They wanted five years on the job poster. So he gave me a shot when even the human resources department said you shouldn't do it. I'll always thank him like, hey, you gave me this opportunity. You got me out. You know, I should have never made it out of the neighborhood I grew up in. Ultimately, he would move his practice in Naples, Florida, offered me a job to follow him. And I did. He's always told me that I shouldn't stop as a medical assistant. I should continue to pursue higher education to get to where I'm at today. He pressed me to go to nursing school. He's pressing me now that I should get my nurse practitioner license, which I'm in pursuit of right now. And that is with the understanding that I will continue to do what I do, but at a higher level. So I'm going to be able to coordinate patient care on my own. I'd be able to carry my own practice, still scrub surgery with him and just open a new net for the practice that we'll be able to see more patients because we'll be working in tandem together to deliver one to be the kid, the foot and ankle population of the area that we service. Owing so much of his career success to Dr. Diasla, Anthony found an opportunity to give back what he could to him when laws changed around insurance billing and casting. Anthony diligently researched and acquired a specialized certification, dedicating several years to advocating and assisting others within his system to follow suit. So I'm the first registered orthopedic technician who works at Naples Community Hospital in Naples, Florida. Post 2010, they made some changes that medical assistant or staff member in the office could put a cast on, but you couldn't bill for it unless you carried this certification. So it's something that I had caught on to, you know, because I've been casting and splinting my entire career and in the foot and ankle orthopedic practice. I mean, we cast probably roughly 80 to 90 percent of our patients. And so you can imagine that 15 to 25 minutes casting a patient if the physician is being forced to do that because you can't bill for it. Now you're losing those appointment slots because the physician is doing something that I otherwise could be doing that would open up time to book other patients in those slots. And so I talked to hospital and they're sending me to the course and they sent me to it. I was the only one that NCH had. So there were no other, I mean, our orthopedic department is, it's not huge, but it's big enough that there should be more than just me. Because if I took a vacation, now the casting was falling back on the physician or on the provider that was seeing the patient. And even though I support Dr. de Asla's practice directly, we have other surgeons in the practice. And when they found out that I had this credential, I would get pulled into their clinics to to cast their patients because it's the same thing that was saving them time as well. And I have been pressing the hospital for quite some time now to get more staff to get this credential. I worked with the philanthropy department to get funding. The process to get the funding was was was hard fought. I've had a fair amount of managers through the years that I've been here and trying to convince my direct manager that it was needed every time was what was the first hoop. You know, trying to say, hey, you know, if I'm not here, you know, and I have to take time off now, now the surgeons are having to put on their own cast. You know, that takes away from the productivity of the practice. And so that getting just getting through that first, you know, foundation, so to speak, was was tough, mainly because I when the management position would turn over, like I would start all over again and tell them, hey, this is why we need to do this. The manager that actually ended up pulling the trigger on it, ironically, is an athletic trainer. And so she sort of really saw what I where I was coming from, mainly because she was clinical. All the other managers before that, they didn't really have a clinical background. She was probably the biggest instrument in that because she started getting me in front of people that could make decisions. And so, you know, I'm on the ambulatory side of the hospital that I support, but I had to get hospital buy in to make this happen. That process was probably the easiest because once you get to the numbers speak for themselves. So once you start to say, hey, you know, I put on 15 casts a day. So, you know, if you multiply that by 25 minutes, that's a couple hours that that's, you know, five to six patients every hour that I'm saving so that the physician can now book other appointments. So I actually got funding to send 10 staff members to take this course. The organization hired me to teach the course. So not only did I get the funding through philanthropy, I actually got to teach it. That just blew my mind because I was wasn't really expecting that. It just made it more fluent because now I was able to talk to the hospital, find a place in the hospital that I could teach it. And everybody that was getting the certification already had exposure to me anyway, because we all work together, you know, in the same department. And now we have 10 registered orthopedic technicians in the in the system. It's not just me anymore, which is kind of special because, you know, I've been here eight years. And I just taught that course last summer. So it was seven years that I function as the only registered orthopedic technician in the whole system. Getting the part of elevating that profession in an area that didn't have it before was kind of special. And it's exploded since then, because now I'm helping the emergency departments. I'm helping the urgent cares. I'm teaching splinting classes for them. Moving beyond that, the philanthropy department is now using me as a resource of what does the orthopedic department need from an equipment standpoint and stuff like that. So I got invited to they do an annual ball and I actually got to raise funding to get new equipment. So it's sort of opened other avenues that I don't think is common for a registered nurse to pursue. Against a lot of odds, you turned your setbacks into so many learning moments that have helped get you here today. I also hear you crediting the people you've met along the way. But you put in the work to cultivate and build these relationships. Why is it important to you to build that trust and rapport with everyone you meet? The power of connection, it's really the root of my existence in health care, to be quite honest. I'm very good at connecting with patients. But even beyond that, I'm very good at connecting with physicians, other nurses in other departments. You know, one of the things that I trademark myself on, you know, I set a benchmark is that I can't have eyes on my patient all hours of the day, every day. You know, especially just being in an ambulatory practice, and it's very episodic. But there are other people who can. And so when I first moved here, like trying to meet people was was very important to me. You know, from home health services to private duty, the surgical reps that, you know, give the equipment. I make it a point to be out in the community and meet people and realizing that I can't deliver patient care without them. I go to their events. I try to network with people, meet them, get business cards, figure out how they can help me with patient care. I try to teach this to my students, you know, and when I when I teach clinical is you can't survive alone in health care. You just can't. And being human first gets lost in patient care. Be yourself. Be professional, but be yourself. You look at the nursing relationship, you're talking about building trust and rapport. If you can't build trust and rapport with your team, then you're not going to build trust and rapport with your patient. So, you know, young nurses that first year transition to practice, you have to do full three sixties. You have to reflect on what your weaknesses are and you have to work on them daily. You can't shy away from something that you know that you're not good at. Like my my patients know that I will always keep an eye on them every time that I see them. I'm not going to lie to them. I'm not going to put them in, you know, in a position where, you know, I'm not giving them my undivided attention, but that comes from life. You're not going to learn that in a textbook. You're not going to read that, you know, somewhere that you should be yourself. You know, it's not going to be a board question. That comes with things that you have learned throughout your matriculation of life. And what I have learned is that if you if you be yourself, patients will patients will appreciate that. And adversity may have made me doubt myself or made me think that I don't belong here. But something that Dr. de Asla told me that's always resonated with me is that if you're the smartest person in the room, you're on the wrong room. Even if I don't think I belong in that, because being around those like those minds are only going to make me more successful. Thank you for listening to a nurse first from Sigma. If you loved this episode, do us a favor and subscribe, rate and leave us a review. It is very much appreciated. For more information about a nurse first and Sigma, visit sigma nursing dot org. Until next time. Thank you.