A Nurse’s Journey from Air Force Medic to Acute Care Nurse Practitioner

Podcast Transcript

Carol Pehotsky (00:05):

One of the beauties of nursing is that you can take it in so many different directions, and I'm always fascinated by the paths people take. I'm joined today by Andrew Warburton to talk about how going with his gut has let to a career that has spanned everything from military service to flight nursing to critical care.

(00:27):

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

(00:47):

Welcome back, everyone. You know, now that we're about a year into this journey, you may have noticed that some of our guests, we really focus on a specific topic we want to talk about, and some of our episodes are really more about getting to know a nurse's fabulous journey and we hope that as listeners you're enjoying both types of those. I enjoy hosting both of those. It's always amazing (laughs) to me just the different journeys that people can take that ultimately lead into this profession. Some people, you know, are born knowing, "I'm going to be a nurse," and it's always their vision.

(01:17):

And some of us, myself included, it took a little bit of wandering to get there, and I think nursing benefits because we have people who have come to this career in different ways. So, it's my great pleasure to introduce to you on today's episode Andrew Warburton. Andrew is a nurse practitioner with the Cleveland Clinic sepsis emergency response team. We'll get into later in the episode what that is, but I'd just like to kick it off by welcoming you, Andrew, and hoping you can tell us a little bit about your nursing journey to start us off.

Andrew Warburton (01:46):

Oh, sure. Thanks, Carol, for having me. I appreciate the invitation.

Carol Pehotsky (01:49):

Absolutely.

Andrew Warburton (01:49):

Yeah, my nursing journey has been one that's covered about 20 years or so.

Carol Pehotsky (01:50):

All right.

Andrew Warburton (01:53):

I actually got into it via the military which I joined-

Carol Pehotsky (01:56):

Oh.

Andrew Warburton (01:56):

... right out of high school. I was a military and Air Force medic right out the gate at age 18.

Carol Pehotsky (02:00):

(laughs) That's a lot-

Andrew Warburton (02:02):

Yeah.

Carol Pehotsky (02:02):

... of responsibility.

Andrew Warburton (02:03):

It is, yeah. Uh, it was a good starting point, personally and professionally. Med kind of guided me down this path that I've taken over the last 20 years or so.

Carol Pehotsky (02:03):

Okay.

Andrew Warburton (02:11):

I became a medic and I had some very good mentors early on who-

Carol Pehotsky (02:11):

All right.

Andrew Warburton (02:15):

... who got me interested in the, the health care professions, specifically in nursing. And that's it. I was fortunate enough to get into a nursing program and start my career here at Cleveland Clinic and I haven't-

Carol Pehotsky (02:27):

[inaudible 00:02:27]

Andrew Warburton (02:27):

... looked back since.

Carol Pehotsky (02:28):

Wow. So, tell us a little bit about that transition from being a medic to being a student, and then being a- a nurse in a civilian life, if you will.

Andrew Warburton (02:38):

Sure, yeah. The transition was somewhat challenging in certain ways and there were some benefits to it-

Carol Pehotsky (02:42):

Okay.

Andrew Warburton (02:42):

... having some medical knowledge already-

Carol Pehotsky (02:44):

Sure.

Andrew Warburton (02:44):

... from the medic training and so forth. But it also came with knowing that the responsibilities were different from, you know, what you do in uniform to what you do-

Carol Pehotsky (02:45):

Sure.

Andrew Warburton (02:54):

... in a civilian workforce.

Carol Pehotsky (02:55):

Yeah.

Andrew Warburton (02:55):

So there were some things that were helpful in my nursing, uh, education-

Carol Pehotsky (02:55):

Mm-hmm.

Andrew Warburton (02:59):

... and there were sometimes that I had to step back and just learn what was being taught-

Carol Pehotsky (03:03):

(laughs) Sure.

Andrew Warburton (03:04):

... to me from, you know, nursing education, from nursing professionals who've been doing it for a long time. So-

Carol Pehotsky (03:08):

Sure.

Andrew Warburton (03:09):

... there was that, but there were a lot of aspects that were helpful-

Carol Pehotsky (03:09):

Okay.

Andrew Warburton (03:12):

... um, in that.

Carol Pehotsky (03:13):

Oftentimes nursing professionals will say, like, "Go out there and be in the field," but it's that balance of, obviously, uh, the field of a lot of us doing... Student nurses and nurse techs is obviously, like, different than being a medic in the armed forces, but still that piece that says, "What does it look like," versus what's going on in a nurse's mind and the deeper level versus, "Well, I can give medications, too."

Andrew Warburton (03:36):

Mm-hmm. Yeah, it certainly... There was a lot of things militarily speaking that when it comes to, like, the pros entering nursing school and-

Carol Pehotsky (03:36):

Mm-hmm.

Andrew Warburton (03:42):

... then entering the nursing profession that I think helped, just having a foundation, you know, a basic understanding of some medical terminologies and-

Carol Pehotsky (03:50):

Sure.

Andrew Warburton (03:50):

... medications themselves that prepared me. And obviously some of the technical things that medics learn putting in IVs-

Carol Pehotsky (03:50):

Sure.

Andrew Warburton (03:57):

... doing some of the technical skills that nurses are asked to do. I had that edge coming into nursing school-

Carol Pehotsky (03:57):

Certainly.

Andrew Warburton (04:02):

... going into clinicals, being able to get a job while in nursing school.

Carol Pehotsky (04:02):

Yeah.

Andrew Warburton (04:06):

That was one that was actually in, like, a very busy emergency department here in Cleveland-

Carol Pehotsky (04:10):

Nice.

Andrew Warburton (04:10):

... so, and something that I cherished and was a very good couple of years spent before I entered the work force as an RN.

Carol Pehotsky (04:16):

Sure. And, yeah, the rest of us as nursing students often struggle getting (laughs) IV experience-

Andrew Warburton (04:16):

Mm-hmm.

Carol Pehotsky (04:22):

... so you have that taken care of. (laughs) Excellent. So, you finished nursing school. Then where does your career take you?

Andrew Warburton (04:27):

Yeah, I finished nursing school. At the time I was working at Metro-

Carol Pehotsky (04:30):

Mm.

Andrew Warburton (04:30):

... in their ER, and I think everybody, at least in the area here, knows that Metro's trauma center is very busy.

Carol Pehotsky (04:36):

Mm-hmm.

Andrew Warburton (04:37):

And so I had a lot of good mentors there as RNs.

Carol Pehotsky (04:39):

Mm.

Andrew Warburton (04:40):

And some of them were more helpful than others. Prior to that experience, one of my lifelong mentors in the military was a flight nurse.

Carol Pehotsky (04:40):

Yeah.

Andrew Warburton (04:48):

And he's the one that kind of got me going on the whole flight nursing thing-

Carol Pehotsky (04:52):

Okay.

Andrew Warburton (04:52):

... um, which was well down the road-

Carol Pehotsky (04:53):

Okay.

Andrew Warburton (04:53):

... from the time I experienced like a ride-along with him-

Carol Pehotsky (04:54):

Oh, okay.

Andrew Warburton (04:57):

... um, in his program too, when I entered like the transport job here at the clinic. But, yeah, the Metro experience, being able to start IVs and do venipuncture.

Carol Pehotsky (04:57):

Gosh, yeah.

Andrew Warburton (05:06):

I mean, I did the thousands over-

Carol Pehotsky (05:06):

Sure, (laughs) yeah.

Andrew Warburton (05:08):

... a course of two years. But at the same time, you know, emergency room nursing and critical care nursing, critical care medicine, ICU, and obvious... It- they're two very different worlds, and it was recommended to me by several nurses at the time that I'd be best suited in an ICU-

Carol Pehotsky (05:08):

Oh, okay.

Andrew Warburton (05:26):

... and get that experience rather than working in the ER. 'Cause, it's ER, it's stabilization, it's getting patients, it's nothing-

Carol Pehotsky (05:31):

And then it's someone else's problem. (laughs)

Andrew Warburton (05:32):

Yeah. That's... Right, you're exactly right. Uh, and then it's someone else's problem, whether it's the operating rooms or-

Carol Pehotsky (05:32):

Right.

Andrew Warburton (05:37):

... the ICUs or what have you. Whereas, you know, in the intensive care unit, you're taking care of patients over a continuum.

Carol Pehotsky (05:42):

Mm-hmm.

Andrew Warburton (05:43):

Sometimes it's for a short stay, a couple of days, you know.

Carol Pehotsky (05:45):

Right.

Andrew Warburton (05:45):

Other times it's months.

Carol Pehotsky (05:46):

Yes.

Andrew Warburton (05:47):

And so, the practice is a lot different. And so, from there, when I graduated nursing school, I left Metro.

Carol Pehotsky (05:47):

Okay.

Andrew Warburton (05:54):

Um, I came here. I don't remember exactly what it was that-

Carol Pehotsky (05:54):

(laughs)

Andrew Warburton (05:57):

... told me, like-

Carol Pehotsky (05:57):

That's all right. This is not a recruitment podcast.

Andrew Warburton (05:59):

... yeah, right. (laughs) I don't know why I left Metro to come to the clinic, but I did. I sent an applications here. It was kind of a general open-

Carol Pehotsky (06:06):

Mm.

Andrew Warburton (06:06):

... application at the time.

Carol Pehotsky (06:06):

Yeah.

Andrew Warburton (06:07):

I got a callback, you know, right after graduation from nursing school for the surgical ICU here.

Carol Pehotsky (06:12):

Oh, fantastic.

Andrew Warburton (06:13):

I interviewed-

Carol Pehotsky (06:13):

Yeah.

Andrew Warburton (06:14):

... and that ended up being my first nursing job.

Carol Pehotsky (06:16):

Yeah, you know, no disrespect to the emergency room nurses. I'm a PACU nurse so I can relate to the, "What is the problem we're solving right now? And (laughs) what can go on later, what is somebody else's to take charge of." And certainly when you think about ICUs you think about floors, of course. That's where it's at. So you spent some time in the ER, you- you've learned the ICU experience and the- that really that, like you said, days' or months' responsibility for those patients. Then where did the road take you?

Andrew Warburton (06:41):

I spent nearly four years in the surgical ICU-

Carol Pehotsky (06:41):

Oh, great.

Andrew Warburton (06:44):

... and from there, it was time to move on. It was time to get some more experience under my belt.

Carol Pehotsky (06:49):

Mm.

Andrew Warburton (06:49):

My goal was still to do transport nursing.

Carol Pehotsky (06:52):

Sure.

Andrew Warburton (06:52):

I knew I needed to do other things in critical care. So, that took me into an agency resources job, CCAR here at the clinic, and in that-

Carol Pehotsky (07:02):

Excellent, yeah.

Andrew Warburton (07:02):

... role I was able to work the Neuro Intensive Care Unit.

Carol Pehotsky (07:05):

Mm.

Andrew Warburton (07:06):

I worked in several CVICUs-

Carol Pehotsky (07:06):

Nice.

Andrew Warburton (07:09):

... and then I did that for about, I don't know, three-and-a-half years-

Carol Pehotsky (07:09):

Mm-hmm.

Andrew Warburton (07:12):

... or so.

Carol Pehotsky (07:13):

Okay.

Andrew Warburton (07:14):

And it was like the end of 2010 or so-

Carol Pehotsky (07:16):

Mm.

Andrew Warburton (07:16):

... Critical Care Transport was hiring.

Carol Pehotsky (07:21):

Ah, all right. Here we go. (laughs)

Andrew Warburton (07:22):

And they had... That's when I kind of took a leap of faith and-

Carol Pehotsky (07:22):

Mm-hmm.

Andrew Warburton (07:25):

... you know, I applied. Had some pretty rigorous interviews which is what the department is all about, and-

Carol Pehotsky (07:25):

Mm-hmm.

Andrew Warburton (07:30):

... uh, they really do a great job kind of trying to figure out who are good candidates for the job. When the offer to join their team was extended I was really surprised.

Carol Pehotsky (07:40):

Yeah.

Andrew Warburton (07:40):

You know, I had about seven or eight years of nursing experience.

Carol Pehotsky (07:42):

Mm-hmm.

Andrew Warburton (07:42):

I didn't have everything under the sun, obviously, that I could have had, but I thought it was just the timing was right. And so, when they, you know, extended me the job offer, I was just, I was blown away by it. And from there, it was a lot of humbling experiences early on, things that I didn't know about myself that I have now learned.

Carol Pehotsky (08:00):

Like what?

Andrew Warburton (08:01):

Oh, gosh, again, I could write a book on this, and some of my peers have actually done so in the past. But just realizing that you don't know, you can't come into any job knowing that you know everything.

Carol Pehotsky (08:11):

For sure.

Andrew Warburton (08:12):

You know, I- I came into the job probably a little more arrogant-

Carol Pehotsky (08:17):

Sure. You landed this big job, you kind of like-

Andrew Warburton (08:17):

Yeah.

Carol Pehotsky (08:17):

... huh?

Andrew Warburton (08:17):

Yeah. Yeah.

Carol Pehotsky (08:17):

This... Yeah.

Andrew Warburton (08:17):

There was an air of confidence. Maybe it was over-confidence-

Carol Pehotsky (08:20):

Sure.

Andrew Warburton (08:20):

... that I think rubbed people the wrong way and they told me. (laughing) And some people were point-blank about it. Others, you know, I kind of figured it out over time. It's a challenging job in that regard.

Carol Pehotsky (08:31):

I can't even imagine. Yep.

Andrew Warburton (08:32):

The- the other piece of it is that you're working alongside just one other clinician, two other-

Carol Pehotsky (08:36):

Right.

Andrew Warburton (08:36):

... clinicians, depending on, like, the more of transport you're working.

Carol Pehotsky (08:38):

Right.

Andrew Warburton (08:39):

And you really have to have chemistry with people-

Carol Pehotsky (08:40):

Oh, sure.

Andrew Warburton (08:43):

... to be successful.

Carol Pehotsky (08:44):

Yeah.

Andrew Warburton (08:45):

And oftentimes there isn't-

Carol Pehotsky (08:48):

Mm.

Andrew Warburton (08:48):

... and it can cause problems. They deal with it, obviously, whatever crew is working together, you know-

Carol Pehotsky (08:54):

They got to figure it out in the moment-

Andrew Warburton (08:54):

... um, some days-

Carol Pehotsky (08:55):

Yeah.

Andrew Warburton (08:55):

... see, yeah, some days are better than others-

Carol Pehotsky (08:57):

Mm-hmm.

Andrew Warburton (08:57):

... for whoever's working whatever mode. And when I say mode, I mean, you know, we have mobile ICUs that are ground ambulances that-

Carol Pehotsky (08:57):

Okay.

Andrew Warburton (09:04):

... are configured a certain way. We have our helicopter service, uh, our rotor-

Carol Pehotsky (09:08):

Mm-hmm.

Andrew Warburton (09:08):

... wing service that is configured a certain way, and so on. So you learn what people like, what people expect, every single day, and it's a different chemistry, literally, every shift, you know, especially if you're new-

Carol Pehotsky (09:20):

Gosh, yeah. (laughs)

Andrew Warburton (09:22):

... i- it take, it can take months to years to jive with everybody.

Carol Pehotsky (09:25):

Sure.

Andrew Warburton (09:25):

And sometimes, uh, some people just, they go about their business.

Carol Pehotsky (09:27):

Yes.

Andrew Warburton (09:27):

They do their thing. They come into work and they do the job without getting interpersonal perspectives. But the longer you're there the more that develops and-

Carol Pehotsky (09:36):

Sure. Yeah. It's hard enough to manage critical patients (laughs) in a hospital that is still with resources around you.

Andrew Warburton (09:36):

Right.

Carol Pehotsky (09:43):

I can't even imagine, you're in a moving ambulance, or you're in a helicopter with incredibly limited space.

Andrew Warburton (09:49):

Mm-hmm.

Carol Pehotsky (09:49):

You're in the air, et cetera. What's that like?

Andrew Warburton (09:52):

It's crazy.

Carol Pehotsky (09:53):

Yeah. (laughs)

Andrew Warburton (09:54):

The management of patients-

Carol Pehotsky (09:55):

Mm-hmm.

Andrew Warburton (09:55):

... becomes not secondary, but there's other things you have to consider, and so space is one of those logistics that's a huge-

Carol Pehotsky (10:02):

Mm-hmm. Mm-hmm.

Andrew Warburton (10:02):

... part of the transport job. And being an expert in trying to figure out where things go-

Carol Pehotsky (10:07):

Mm-hmm.

Andrew Warburton (10:07):

... and how to get from point A to point B, and-

Carol Pehotsky (10:08):

Yeah.

Andrew Warburton (10:09):

... sometimes point A to point B to point C to point D, there's times-

Carol Pehotsky (10:09):

Not in here. (laughs)

Andrew Warburton (10:13):

Yeah. There's times where there's like these variables that just come at you-

Carol Pehotsky (10:14):

Yeah.

Andrew Warburton (10:16):

... and some of it are unexpected.

Carol Pehotsky (10:18):

Mm.

Andrew Warburton (10:19):

There's a lot of factors that play into the transport world that I don't think a lot of people really consider.

Carol Pehotsky (10:19):

Okay.

Andrew Warburton (10:25):

And so, when it comes to weather, just movement of patients, what they have going on with them-

Carol Pehotsky (10:25):

Mm-hmm.

Andrew Warburton (10:32):

... with all the interventions that perhaps they have, and which for our program we do everything from, you know, very quick type of patients-

Carol Pehotsky (10:32):

Okay.

Andrew Warburton (10:39):

... who are... I won't say routine. There's nothing routine about sharing-

Carol Pehotsky (10:42):

Sure. (laughs)

Andrew Warburton (10:42):

... a given transport, but th-

Carol Pehotsky (10:44):

When we're on the stable side of life, then...

Andrew Warburton (10:46):

You... Well, yeah. I mean, anybody can go south-

Carol Pehotsky (10:49):

Sure.

Andrew Warburton (10:49):

... as we know, right?

Carol Pehotsky (10:50):

Yeah.

Andrew Warburton (10:50):

We'll have in and outpatients where we need to get the patient from a, you know, an emergency department where they're having a heart attack and they need to get to, like, the cath lab.

Carol Pehotsky (10:58):

Sure, okay.

Andrew Warburton (10:58):

So, oftentimes it's like, we load and go. We keep the helicopter running, load up the patient, you know, get them on a monitor, get them on whatever drips, if they are on any-

Carol Pehotsky (11:06):

Mm-hmm.

Andrew Warburton (11:06):

... and out the door.

Carol Pehotsky (11:07):

Mm-hmm.

Andrew Warburton (11:07):

Like, in and out. And those tend to be, "routine". Um, they're quick-

Carol Pehotsky (11:12):

(laughs) In the scheme of things-

Andrew Warburton (11:12):

... there's a lot of things-

Carol Pehotsky (11:12):

Sure, yeah.

Andrew Warburton (11:12):

... to consider, like, it's the safety of what you're doing, you know, the safety of the crew, the patient, everything, the general public. You have to consider that. On the flip side of that are the very complicated patients with- which, like, Cleveland Clinic's CCT, like-

Carol Pehotsky (11:26):

Mm.

Andrew Warburton (11:26):

... they really pride themselves on doing a lot of very complicated, very sick patients that-

Carol Pehotsky (11:26):

Mm-hmm.

Andrew Warburton (11:32):

... perhaps people in the hospitals, especially like the sending hospitals, are just kind of stunned by, you know-

Carol Pehotsky (11:32):

Yeah.

Andrew Warburton (11:38):

... because the patients are so sick.

Carol Pehotsky (11:40):

Right.

Andrew Warburton (11:40):

Where, you know, they have a breathing tube in and they're on mechanical ventilation, and they have 10 continuous infusions running-

Carol Pehotsky (11:41):

Yeah.

Andrew Warburton (11:47):

... and they're on ECMO or on a balloo-

Carol Pehotsky (11:48):

And still not stable.

Andrew Warburton (11:49):

... or, and/or on a balloon pump-

Carol Pehotsky (11:51):

Yeah. Yeah.

Andrew Warburton (11:51):

... and all these different, like, mechanisms that we have to keep people alive-

Carol Pehotsky (11:55):

Mm-hmm.

Andrew Warburton (11:56):

... and to get them to one place to the other.

Carol Pehotsky (11:57):

Right.

Andrew Warburton (11:57):

That, and of itself, is what keeps people doing the job. There's a lot of adrenaline to that-

Carol Pehotsky (12:03):

Yes. (laughs) I was just gonna say. You-

Andrew Warburton (12:05):

... but-

Carol Pehotsky (12:06):

... had a lot of adrenaline in you-

Andrew Warburton (12:07):

... I don't-

Carol Pehotsky (12:07):

Yeah.

Andrew Warburton (12:07):

... I don't think people do it for that. I know I certainly didn't. I did it 'cause I like taking care of patients.

Carol Pehotsky (12:14):

Okay.

Andrew Warburton (12:14):

And I like being a nurse, and I loved being a nurse in that environment. Does it get your heart racing and your blood boiling and-

Carol Pehotsky (12:19):

Hope it's not.

Andrew Warburton (12:19):

... stuff like that?

Carol Pehotsky (12:19):

Yeah.

Andrew Warburton (12:19):

Absolutely.

Carol Pehotsky (12:19):

Yeah.

Andrew Warburton (12:21):

Does it make you nervous? Absolutely.

Carol Pehotsky (12:21):

(laughs)

Andrew Warburton (12:23):

I mean, that's the scope of, you know-

Carol Pehotsky (12:23):

Right.

Andrew Warburton (12:25):

... what any transport agency does, and certainly our program here at the clinic doesn't shy away from-

Carol Pehotsky (12:30):

Really challenging patients.

Andrew Warburton (12:31):

... really challenging patients.

Carol Pehotsky (12:32):

Yeah. So, rea... Those of you who aren't in Cleveland, Ohio, or nearby, (laughs) get all... The point you made about weather is very well taken.

Andrew Warburton (12:38):

(laughs)

Carol Pehotsky (12:39):

And, yes, we have lake-effect snow and all of that, but the Clinical Care Transport Team actually came to the aid of a friend of mine's spouse who was in a distant hospital at that point struggling with COVID symptoms. Really needed to come to a Cleveland Clinic facility. And it was really windy that day. And so it was that, you know, the commitment from the team was, "We're gonna get in the air as soon as we can safely."

Andrew Warburton (12:39):

Mm.

Carol Pehotsky (13:01):

And so, really, even the conversation, I wasn't part of them, but she would relate to me, as the spouse of... Uh, but how connected she felt and then talking about, "We'll, we'll go by ambulance if we need to. We're going to make sure that we get him here safely," and they did, and he's doing very well today because of the efforts of the Critical Care Transport Team. You know, if a patient's deteriorating in an ICU on a floor, in a PAC unit or OR, there's always somebody else you can call and-

Andrew Warburton (13:01):

Mm-hmm.

Carol Pehotsky (13:26):

... and that's what the joy of nursing is, is right, people are there and ready to hop in and help. You cannot bring more than two people in a helicopter I assume, right? How do you-

Andrew Warburton (13:37):

No, we can-

Carol Pehotsky (13:37):

... can't call for help.

Andrew Warburton (13:38):

Yeah. So, the helicopter is... It's currently, there's enough for four passengers in the-

Carol Pehotsky (13:38):

Oh, okay.

Andrew Warburton (13:42):

... in the medical side of-

Carol Pehotsky (13:42):

All right.

Andrew Warburton (13:43):

... uh, of the helicopter. So, there were times where we had a full helicopter.

Carol Pehotsky (13:47):

So you can assess it and say-

Andrew Warburton (13:48):

Yeah.

Carol Pehotsky (13:48):

... two is not enough, I need more help.

Andrew Warburton (13:50):

Usually it's two. It's the, it's the on-duty crew for the day is two people.

Carol Pehotsky (13:53):

Okay.

Andrew Warburton (13:53):

Back, years ago, there used to be one of our bases, used to have three clinicians on it, but that went away some time ago. We generally, it's- it's two people. There are times when there's like real sick respiratory-type patients who-

Carol Pehotsky (13:54):

Sure.

Andrew Warburton (14:06):

... they have, like, certain inhaled gases that are going, that the program will take a respiratory therapist with them-

Carol Pehotsky (14:12):

Oh, okay.

Andrew Warburton (14:13):

... to s- specifically set up the vent and set up the inhaled gas and have it going through-

Carol Pehotsky (14:18):

[inaudible 00:14:18]

Andrew Warburton (14:18):

... the patient to continue it, or to even start it. Some hospitals won't have that kind of resource.

Carol Pehotsky (14:23):

Sure.

Andrew Warburton (14:24):

And so we'll take somebody along with us to start that in route-

Carol Pehotsky (14:24):

Mm-hmm.

Andrew Warburton (14:27):

... at the referring facility. There is room for others beyond the- the two-

Carol Pehotsky (14:27):

Oh, that's good.

Andrew Warburton (14:32):

... the two-person medical crew.

Carol Pehotsky (14:33):

So it's all about sort of assessing before you leave-

Andrew Warburton (14:34):

Yeah.

Carol Pehotsky (14:34):

... (laughs) how much help you need.

Andrew Warburton (14:34):

Yeah.

Carol Pehotsky (14:34):

Yeah.

Andrew Warburton (14:37):

Yeah, generally speaking, I think, you know, the majority of patients, you know, will... They'll go with the- the on-duty crew.

Carol Pehotsky (14:42):

Mm-hmm.

Andrew Warburton (14:42):

You know, it's a little bit more, the, more specialized patients or the ones that take some more planning-

Carol Pehotsky (14:47):

Yeah.

Andrew Warburton (14:47):

... and consideration when we have to do certain things. Like, so, for example, when the patient's on like ECMO-

Carol Pehotsky (14:53):

Mm-hmm.

Andrew Warburton (14:53):

... the team will take a perfusionist with them.

Carol Pehotsky (14:53):

Yeah. (laughs) Yeah.

Andrew Warburton (14:56):

And so, sometimes, there... You know, there may not be a perfusionist readily available-

Carol Pehotsky (14:59):

Mm.

Andrew Warburton (15:00):

... so sometimes there's a... There can be delays and that, but-

Carol Pehotsky (15:02):

Sure.

Andrew Warburton (15:02):

... generally speaking, they're usually good about providing us that help, and we have that room. So, and then, also, n- not to get away from just the helicopter service, you know, and obviously the-

Carol Pehotsky (15:03):

Mm-hmm.

Andrew Warburton (15:13):

... the logistical considerations and, and stuff like that, when you factor in weather and stuff, especially in the-

Carol Pehotsky (15:17):

Yeah.

Andrew Warburton (15:18):

... dead of winter, you know, oftentimes those transports are going by ground.

Carol Pehotsky (15:23):

Right.

Andrew Warburton (15:23):

And so you have a little bit more room, I mean, in-

Carol Pehotsky (15:23):

Yeah.

Andrew Warburton (15:23):

... the back of our ambulances to fit, you know, crew members and whatnot. That usually doesn't change the configuration of the crew.

Carol Pehotsky (15:29):

Sure, okay.

Andrew Warburton (15:30):

Um, but, you know, there's more room for additional items and stuff that you may need over a long transport, so...

Carol Pehotsky (15:36):

So, you do not work with Critical Care Transport any more, so you transitioned. You became a nurse practitioner. What was that calling like, and how did that journey go for you?

Andrew Warburton (15:45):

That journey was, I think, one that I was really fortunate to kind of be in a situation where I was able to get into a program, you know, and get my master's-

Carol Pehotsky (15:45):

Mm.

Andrew Warburton (15:54):

... and I knew I wanted something else at some point.

Carol Pehotsky (15:54):

Sure.

Andrew Warburton (15:57):

I wasn't sure what that was, and that was one of the challenging parts of, like, pursuing, you know, a master's degree and becoming a nurse-

Carol Pehotsky (16:03):

Yeah. (laughs)

Andrew Warburton (16:03):

... practitioner, is that-

Carol Pehotsky (16:05):

What kind of nurse practitioner? Yeah. (laughs)

Andrew Warburton (16:06):

... and, yeah, and what... And the job that I have now isn't necessarily... It's not all the excitement and stuff like that of transport. It's a job that was new when I started.

Carol Pehotsky (16:15):

Mm.

Andrew Warburton (16:16):

I was one of the first, you know, NPs that, like, was full-time on this sepsis team. And so, the way I saw it as a new nurse practitioner was one that I met with, like, excitement because-

Carol Pehotsky (16:16):

Yeah.

Andrew Warburton (16:28):

... it was a new program.

Carol Pehotsky (16:29):

Mm-hmm.

Andrew Warburton (16:29):

It's one that I've continued to, you know, obviously work in because I think we're doing good for our patients. We're seeing the data come back that has shown that our interventions are helping our patients out, so-

Carol Pehotsky (16:41):

Excellent.

Andrew Warburton (16:42):

... helping our, like, morbidity and mortality numbers, and, and whatnot when it comes to sepsis care.

Carol Pehotsky (16:47):

You know, we're very fortunate here to have the sepsis emergency response team. It's, I think you told me before we started, just, at- at two years-

Andrew Warburton (16:47):

Yep.

Carol Pehotsky (16:54):

... of inception. For our listeners who aren't from Cleveland Clinic, can you tell us a little bit more about that program and the services this team provides to our patients.

Andrew Warburton (17:03):

Yeah. So, the sepsis emergency response team came out of the need that the executives of the clinic-

Carol Pehotsky (17:10):

Mm.

Andrew Warburton (17:10):

... really wanted because of our morbidity and mortality numbers as it pertains to sepsis-

Carol Pehotsky (17:14):

Okay.

Andrew Warburton (17:14):

... management, and so the SERT team was born early in-

Carol Pehotsky (17:15):

Hmm, hmm, hmm.

Andrew Warburton (17:18):

... 2022, and the way we operate, it takes multiple teams to do what we're doing, just like-

Carol Pehotsky (17:23):

Okay.

Andrew Warburton (17:23):

... any other team here at the clinic. There's a lot of input behind the scenes.

Carol Pehotsky (17:28):

Mm-hmm.

Andrew Warburton (17:28):

But clinically it's made up of nurse practitioners and physician assistants-

Carol Pehotsky (17:32):

Okay.

Andrew Warburton (17:32):

... from both the Anesthesia Institute and the Respiratory Institute. So, we-

Carol Pehotsky (17:33):

Mm, okay.

Andrew Warburton (17:37):

... we collaborate on-

Carol Pehotsky (17:37):

Yeah.

Andrew Warburton (17:38):

... and we cover the schedule 24/7.

Carol Pehotsky (17:40):

Nice.

Andrew Warburton (17:41):

And we work, you know, hand-in-hand with one another. The idea is that we have a program that's built into the Electronic Medical Record in the Epic that alerts us of potential sepsis patients.

Carol Pehotsky (17:53):

Mm. So reminding that list and sort of looking at-

Andrew Warburton (17:54):

Yes.

Carol Pehotsky (17:56):

... those alerts? Okay.

Andrew Warburton (17:56):

Yeah. So we maintain a list. We triage patients as-

Carol Pehotsky (18:00):

Mm.

Andrew Warburton (18:00):

... they come to us, and they come to us via our phone.

Carol Pehotsky (18:02):

Mm-hmm.

Andrew Warburton (18:02):

We have multiple phones that we carry, and so we get a page, and it's, you know, we go on Epic, we look at the patient and we go through and determine whether or not they need interventions-

Carol Pehotsky (18:02):

Mm.

Andrew Warburton (18:13):

... or they need to be looked at either by us-

Carol Pehotsky (18:15):

Are they at risk or they're developing-

Andrew Warburton (18:16):

... or by their... Yeah, or their primary team needs to look at them a little more careful. And then we, we try to collaborate with the primary service as a team, similar in fashion to, like, AMET, so, like, the Adult Medical Emergency Team or the Cardiac-

Carol Pehotsky (18:29):

Other rapid response team.

Andrew Warburton (18:30):

Yeah, yeah, the other emergency response teams. And we can go from looking at a patient, determining that none of the vital signs that were alerting us of s- of sepsis were in fact related to sepsis.

Carol Pehotsky (18:30):

Sure.

Andrew Warburton (18:40):

It's basically how we take those patients off of our list.

Carol Pehotsky (18:40):

Yes, they're...

Andrew Warburton (18:43):

And then there's the patients that are clearly something's wrong with them.

Carol Pehotsky (18:45):

Yeah.

Andrew Warburton (18:46):

Where they have a new fever, they have a new white blood cell count, a number of other factors. Their heart rate's, you know, up, their blood pressure's low. Those are things that we take a little bit more seriously and-

Carol Pehotsky (18:46):

Sure. Yeah.

Andrew Warburton (18:57):

... look into that are new compared to trends that we've seen, you know, for patients-

Carol Pehotsky (18:57):

Yeah.

Andrew Warburton (19:01):

... that perhaps have been here for a while, you know, and all of a sudden they have all these things going on.

Carol Pehotsky (19:01):

Mm.

Andrew Warburton (19:05):

And that's when we kind of interject ourselves-

Carol Pehotsky (19:07):

Yeah.

Andrew Warburton (19:07):

... and go to the bedside, talk to the team, talk to the primary nursing and determine, you know, writing orders, doing a... We have a sepsis order set that we have-

Carol Pehotsky (19:07):

Mm. Great.

Andrew Warburton (19:17):

... built to the Epic where we can just plug that in, determine what needs to be done that hasn't already been done, and go from there.

Carol Pehotsky (19:24):

And in two years already showing some positive effects of your team and how it's changed?

Andrew Warburton (19:28):

Yeah. We just had our monthly staff meeting last week and there was numbers shared. They're shared often to our providers and to others as well, like, in the Nursing Institute and whatnot-

Carol Pehotsky (19:28):

Mm-hmm.

Andrew Warburton (19:38):

... that we collaborate with. So we do have nursing support. We have laboratory support. We have some other folks that... They help us, you know, on the background and ensuring our success. And so far, those are promising.

Carol Pehotsky (19:50):

Yeah.

Andrew Warburton (19:50):

So...

Carol Pehotsky (19:50):

What a fascinating career. So-

Andrew Warburton (19:51):

Yeah, it's interesting.

Carol Pehotsky (19:52):

(laughs)

Andrew Warburton (19:52):

It's certainly a different job than what I had for a long time prior to that as a nurse.

Carol Pehotsky (19:53):

That's right.

Andrew Warburton (19:56):

It's one that I kind of fell into. It was one that, at-

Carol Pehotsky (19:59):

Yeah.

Andrew Warburton (19:59):

... like I said, it was new at the time. The program was new, so I chose to pursue that.

Carol Pehotsky (20:04):

Right.

Andrew Warburton (20:04):

Now I'm able to have some work-life balance-

Carol Pehotsky (20:07):

Mm.

Andrew Warburton (20:07):

... you know, with my family, and-

Carol Pehotsky (20:07):

Mm-hmm.

Andrew Warburton (20:08):

... I work straight nights.

Carol Pehotsky (20:09):

But folks, we are in the middle of the afternoon recording this. Thank you (laughs) for-

Andrew Warburton (20:12):

Yes. (laughs)

Carol Pehotsky (20:13):

... coming in, my goodness.

Andrew Warburton (20:14):

Yeah. I'm on a- a little break here from work, so it's, uh-

Carol Pehotsky (20:15):

Oh. (laughs)

Andrew Warburton (20:17):

... not any trouble to be here. I think there's some application of, like, things that I've learned-

Carol Pehotsky (20:21):

Mm-hmm.

Andrew Warburton (20:21):

... in terms of, like, acute care, obviously, 'cause all of us that are doing the job are acute care clinicians.

Carol Pehotsky (20:26):

Oh, okay.

Andrew Warburton (20:28):

And so, a lot of that is thinking through things in a way that-

Carol Pehotsky (20:28):

Yeah.

Andrew Warburton (20:31):

... like, acute care physicians-

Carol Pehotsky (20:32):

The- those assessment skills are so important. Yeah.

Andrew Warburton (20:33):

... yeah, that you may see as an acute care provider versus-

Carol Pehotsky (20:36):

Mm.

Andrew Warburton (20:36):

... perhaps other people. Though I think my education and my background has prepared me for that, and-

Carol Pehotsky (20:36):

Yeah.

Andrew Warburton (20:40):

... I feel like it's been helpful, so...

Carol Pehotsky (20:42):

That's awesome. So, listeners, it's a great lesson in just... The way you come into nursing doesn't have to be the way you leave nursing. There's no shortage of options and, uh, in a previous episode we had Meredith Foxx on and she talked about, really, you know, saying yes. And so, clearly, you've done that same thing, to say yes to some opportunities-

Andrew Warburton (20:42):

Yeah.

Carol Pehotsky (20:59):

... and look where you are now.

Andrew Warburton (21:01):

Yes.

Carol Pehotsky (21:01):

Awesome.

Andrew Warburton (21:02):

(laughs)

Carol Pehotsky (21:03):

Well, we're running short on time. I could talk more about sepsis and everything else, but (laughs) here we are at the end, and we've reached the speed round where we like to ask our guests some, maybe, slightly different questions to help our audience get to know you a little bit better.

Andrew Warburton (21:15):

Okay.

Carol Pehotsky (21:15):

So I'm hoping you'll get us started with sharing the best advice you've ever received.

Andrew Warburton (21:21):

Going with your gut.

Carol Pehotsky (21:22):

Okay.

Andrew Warburton (21:23):

And not only in terms of, like, career-wise, doing what you wanna do. My older brother, he's a full bird colonel. He was my f- very first real mentor. He's what got me started on my military path, you know, got me into the-

Carol Pehotsky (21:23):

Mm.

Andrew Warburton (21:38):

... the unit that I started with right out of high school, and even to this day, we kind of bounce things back and forth off of each other.

Carol Pehotsky (21:45):

Nice.

Andrew Warburton (21:45):

There was a point in my military career where I felt like it was stagnant-

Carol Pehotsky (21:50):

Mm.

Andrew Warburton (21:51):

... and there was an opportunity at a different base here in Ohio. Most of my career I spent up in Toledo.

Carol Pehotsky (21:57):

Oh, okay.

Andrew Warburton (21:57):

Uh, there was an opportunity back, I don't know, in 2009 or 2008, somewhere in there, where it was an opportunity to get my commission. That was one of my goals-

Carol Pehotsky (22:06):

Mm. Okay.

Andrew Warburton (22:06):

... was to be a c- a commission officer.

Carol Pehotsky (22:08):

Mm-hmm.

Andrew Warburton (22:08):

So, for those that are perhaps not well engaged in the military vernacular (laughing) there is enlisted folks and then there's officers-

Carol Pehotsky (22:17):

Mm.

Andrew Warburton (22:17):

... right?

Carol Pehotsky (22:17):

Yeah.

Andrew Warburton (22:17):

So I joined as a enlisted medic-

Carol Pehotsky (22:17):

Mm-hmm.

Andrew Warburton (22:19):

... and I, you know, got promoted and such, you know, over time. But my goal, like, having had a bachelor's degree in nursing-

Carol Pehotsky (22:19):

Ah, yeah.

Andrew Warburton (22:26):

... my goal was to become an officer-

Carol Pehotsky (22:28):

Mm-hmm.

Andrew Warburton (22:28):

... and get my commission and go up that leadership-

Carol Pehotsky (22:30):

Mm-hmm.

Andrew Warburton (22:31):

... pathway. And so I took a kind of step outside of my box-

Carol Pehotsky (22:36):

Mm-hmm. (laughs)

Andrew Warburton (22:36):

... so to speak, and I applied for a job down in Columbus at a base down there-

Carol Pehotsky (22:36):

Mm.

Andrew Warburton (22:41):

... for a commissioning opportunity. And, like a lot of places are, there's a lot of politics involved and-

Carol Pehotsky (22:46):

Mm.

Andrew Warburton (22:46):

... favoritism and stuff like that, unfortunately, and that's just the way it goes. I was an outside person-

Carol Pehotsky (22:51):

Mm.

Andrew Warburton (22:51):

... applying where there was other candidates-

Carol Pehotsky (22:53):

Sure.

Andrew Warburton (22:54):

... internally that were prepared as well as I was-

Carol Pehotsky (22:57):

Mm.

Andrew Warburton (22:57):

... uh, for that, and I interviewed and I didn't get selected. And I was kinda bummed out 'cause I had-

Carol Pehotsky (22:57):

Mm-hmm.

Andrew Warburton (23:02):

... at that point, I had been practicing as a nurse, had had my bachelor's for, I don't know-

Carol Pehotsky (23:03):

Mm. Mm-hmm.

Andrew Warburton (23:06):

... four or five years at that point.

Carol Pehotsky (23:08):

Yeah.

Andrew Warburton (23:08):

And that's what I wanted to do, and unfortunately I wasn't given the opportunity. The fortunate side of that is that, like, I was patient-

Carol Pehotsky (23:09):

Mm.

Andrew Warburton (23:16):

... and a couple of years later my home unit in Toledo had a couple of nursing officer positions-

Carol Pehotsky (23:16):

Outstanding.

Andrew Warburton (23:21):

... open up. And so, obviously, I applied-

Carol Pehotsky (23:24):

Mm-hmm.

Andrew Warburton (23:24):

... and there's a lot of applicants to that job 'cause there was a... Several positions open, and I was fortunate to be selected, and that's kind of-

Carol Pehotsky (23:24):

Awesome.

Andrew Warburton (23:31):

... what set me off down the rest of my military path where that opened up a lot of doors for me-

Carol Pehotsky (23:35):

Yeah.

Andrew Warburton (23:36):

... in terms of, like, leadership opportunities and things that had, like, in deployment settings and stuff like that, that I was-

Carol Pehotsky (23:36):

Mm-hmm.

Andrew Warburton (23:42):

... really fortunate to be able to provide. So, pursue what you want to pursue.

Carol Pehotsky (23:46):

Mm-hmm.

Andrew Warburton (23:47):

Don't let anybody tell you that you can't do it.

Carol Pehotsky (23:49):

You only get one time around, so... (laughs)

Andrew Warburton (23:50):

Yeah, you only got one time around. I tell people, I've been fortunate enough to be able to share my story a little bit more intimately-

Carol Pehotsky (23:57):

Mm.

Andrew Warburton (23:57):

... as a guest speaker in other venues, with, like, the Civil Air Patrol-

Carol Pehotsky (24:01):

Oh, okay.

Andrew Warburton (24:02):

... on several times.

Carol Pehotsky (24:03):

Mm-hmm.

Andrew Warburton (24:03):

I was invited to speak to them. I wouldn't be here if I hadn't just followed mentors and- and-

Carol Pehotsky (24:03):

Yeah.

Andrew Warburton (24:10):

... and listened-

Carol Pehotsky (24:10):

Mm-hmm.

Andrew Warburton (24:10):

... to the advice of people from an early age.

Carol Pehotsky (24:14):

Mm-hmm.

Andrew Warburton (24:14):

You know, I was lost coming out of my high school days. I had no idea what I was gonna do as a adult.

Carol Pehotsky (24:17):

It's a lot of pressure on a 17 or 18-year-old. (laughs)

Andrew Warburton (24:21):

Yeah. And, you know, my grades at the time weren't great, and my parents, they sat me down and they said, "What are you doing after (laughing) high school?" And I hadn't even thought of it. So after that it was all being in positions where, "What's next? What are you gonna-

Carol Pehotsky (24:21):

Mm-hmm.

Andrew Warburton (24:32):

"... do? How are you gonna do it?" And, "Is it worth it?" And, to this point, it's been worth-

Carol Pehotsky (24:37):

Yeah.

Andrew Warburton (24:37):

... those decisions being made. So-

Carol Pehotsky (24:39):

Clearly.

Andrew Warburton (24:41):

... you know, if you wanna do something, do it.

Carol Pehotsky (24:42):

Go with your gut and do it.

Andrew Warburton (24:43):

Go. Yep.

Carol Pehotsky (24:43):

Well, Andrew, thank you very much for your service-

Andrew Warburton (24:43):

Well-

Carol Pehotsky (24:45):

... and thank you very much for joining me today.

Andrew Warburton (24:47):

Well, thank you for having me, Carol. It was a pleasure talking with you.

Carol Pehotsky (24:53):

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

(25:27):

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