From RN to MD: A Leader Shares Their Journey

Podcast Transcript

[00:00:00] Carol Pehotsky: Most of us who are post licensure nurses. Remember either the first time or an early time in our nursing career, we had to page that physician in the middle of the night. Nursing school had prepared us for a lot, but maybe not for a way to overcome the discomfort and uncertainty.

[00:00:19] I'm joined today by Dr. Rita Pappas, who has really made those phone calls and received them both as first a nurse, and now a double boarded pediatric physician. She will share with us her journey along the way and what she's learned about the importance of interprofessional communication.

[00:00:36] 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.

[00:00:57] Welcome back everyone. I'm asking you to get in your time machine with me and go back to probably ‘94, so perhaps before some of you were born. Uh, but there was a TV show on for really entirety of my college career called ER, part of must watch tv. And as, as a busy college student that we gathered around the TV because we didn't have streaming services back then and we would watch shows.

[00:01:21] And I was, I was not in nursing school at the time. That was back when I was studying psychology, and it became the show that you talked about the next day. And it, for, at least for me and my friends, it was meaningful to have those conversations. And as the show went on, there became this plot line where one of the nurses in the emergency room, Abby, transitioned to going to med school.

[00:01:43] And at the time we're like, that would never happen. And now in fairness, I was not a nurse at the time either. But you know, you, you watch these shows and you're wondering how much of it's real. Well, ladies and gentlemen, it's my honor to introduce you all to my friend who started as a nurse and is now a physician in real life.

[00:02:00] And so please join me in welcoming Dr. Rita Pappas to the show. Dr. Pappas is the interim chief for the women's and children's service lines here at Cleveland Clinic, and she is double boarded as a pediatric hospitalist and general pediatrician. Welcome, Rita. Thank you so much for joining me today.

[00:02:15] Dr. Rita Pappas: Oh, thank you. Thank you for having me. I also watched ER.

[00:02:19] Carol Pehotsky: There you go. There you go. It's still available on DVD somewhere, so

[00:02:23] Dr. Rita Pappas: I think it was like Thursday nights.

[00:02:25] Carol Pehotsky: Yeah. Yes. So, with other guests, I'll usually start with, you know, tell me your story and how you got here, but there's a lot to dig into, so, we'll probably spend our time there if it's all right.

[00:02:36] [Yeah.] Talk to us, if you will, to start, you know, that journey from there, I'm curious about healthcare too, I'm going to be a nurse, so can we start there? Tell, share a little bit about what that journey was like, please.

[00:02:46] Dr. Rita Pappas: Oh, sure. So, in eighth grade, I remember we had to put what you wanted to be when you grew up. And I picked nurse or teacher, so it started really early with my grandmother.

[00:02:56] She had a lot of medical needs and I'm a first generation American. My parents were Lebanese immigrants. [Wow.] And so, there was a lot of delegation of authority at a young age, and so I was responsible to help my grandmother. [Oh, okay.] She would stay with us, and so I really enjoyed taking care of her and I enjoy taking care of people.

[00:03:17] And then I had a shadow experience in high school where I shadowed a nurse for a month. [What?] Uh, yes. [Wow.] They called it Project Real. [Okay.] And I had to keep a journal, and I was afforded a lot of opportunities in that shadow experience. I went to the operating room. I was in the ICU. I was on the floor.

[00:03:37] Carol Pehotsky: In high school.

[00:03:37] Dr. Rita Pappas: In high school.

[00:03:38] Carol Pehotsky: That's amazing.

[00:03:38] Dr. Rita Pappas: For an, for an entire month. There was like a term paper you had to write as a result of that experience, but it really reinforced that that was the right career for myself. So, I applied for college and a Bachelor of Science in nursing [Okay] is what I graduated with.

[00:03:54] Between my junior and senior year of college. [Mm-hmm.] They used to call them undergraduate nursing assistants. [Okay.] And I wanted to work on the pediatric floor. If you showed a high caliber of nursing expertise and you were able to prove to the team you were offered a job. So, it worked out really well. So, I had a job even before I graduated.

[00:04:16] And came and worked on an adolescent med-surg unit. Loved it. [Wow.] Loved it.

[00:04:21] Carol Pehotsky: Where was that at?

[00:04:22] Dr. Rita Pappas: M 30.

[00:04:23] Carol Pehotsky: Oh, so here at Cleveland Clinic?

[00:04:24] Dr. Rita Pappas: Yes. [Okay.] Yep. Really loved it. Worked there for several years. Really enjoyed taking care of the teenage population.

[00:04:31] Carol Pehotsky: That takes a special person.

[00:04:34] Dr. Rita Pappas: They were fun, and I really liked the fact that, you know, I could explain why we were doing a certain procedure or you know, what the importance of taking their meds or whatever the case may be.

[00:04:44] But I ended up working then as a nurse clinician, it was like a, [mm-hmm] a role that used to be I would go to the operating room for two days a week. Two days a week in clinic and one day research, and supported Jack Andrish, who was a pediatric orthopedic surgeon. [Mm-hmm. Okay.] I really loved that. That's what actually inspired me to go to medical school.

[00:05:05] [Okay.] Because Jack was part of the interprofessional team, he treated me as a team member, and he was showing me like how to measure angles for scoliosis for children. [Mm-hmm.] And he continued to like encourage me to read more and do more. And it was through his inspiration and mentorship that he actually talked me out of leaving him right out of his job and he said,

[00:05:33] Carol Pehotsky: you can't go.

[00:05:33] Dr. Rita Pappas: Yeah. He's like, Rita, you should go to med school. At that time, the nurse practitioners didn't have a lot of autonomy like they do now.

[00:05:41] Carol Pehotsky: So, it wasn't really a path that you could really see yourself going.

[00:05:44] Dr. Rita Pappas: Right. [Okay.] And so, I left Dr. Andrish's practice to work in the adult cardiothoracic ICUs.

[00:05:51] Carol Pehotsky: Ooh, that's a big change.

[00:05:52] Dr. Rita Pappas: That's a big change. I felt like the ICU experience was something that I hadn't done before. [Mm-hmm.] And it gave me the flexibility to work certain shifts and then take the post-baccalaureate classes I needed to take [Ah, okay] to take the entrance exam, the MCAT. And that was really a great experience.

[00:06:11] From there when I was in the units, a lot of the nurses went to become CRNAs. And so

[00:06:17] Carol Pehotsky: Still to this day, to some degree. But that's what we want. We want ICU trained nurses to head in that direction. Yeah.

[00:06:23] Dr. Rita Pappas: Right, right. And so, I did consider for a short time hanging out with us in Peri-. [Yes.] But you know, I thought, you know, I enjoy talking to people.

[00:06:33] [Yeah]. And I do enjoy procedures, but I felt like I was more on the medical side, like in terms of [mm-hmm] not being in the operating room. And so applied to med school and went to med school and then was the worst medical student, because I loved everything. [Oh] loved everything. Everyone was like, what do you want to do?

[00:06:52] And I was like, oh, I'll do this rotation. Oh, I could definitely see myself doing that.

[00:06:56] Carol Pehotsky: You weren't that in nursing school?

[00:06:57] Dr. Rita Pappas: Yeah. Oh no. I was at a [interesting] I was like, I, nursing school, I was pretty focused [okay] for children's. But then for med school, I do remember deciding to pick pediatrics. [Okay.] And then I ended up doing a pediatric residency.

[00:07:12] But when I was graduating, there wasn't a hospital medicine fellowship [Oh] so you were a general pediatrician, and you could practice in the hospital setting. And I realized that that was probably from my nursing background, I was more comfortable in the hospital setting. [Okay. Mm-hmm.] And so then ended up in peds hospital medicine.

[00:07:32] Carol Pehotsky: You said in about a sentence and a half went to med school.

[00:07:35] That's a lot. What is that like to go from, you know, full-time employment in a different area of health care? [Yeah.] How you make that all work?

[00:07:44] Dr. Rita Pappas: Yeah. It was difficult. I know now I didn't realize that my parents were very supportive. [Okay.] You know, I wasn't married. I was 31 when I went to med school, but I realize now talking to other distant relatives, they were like, what are you thinking?

[00:08:00] Like you said, I was able to afford a small house on my own as a nurse. [Okay.] So, like I had to actually figure out what to do with my house and I ended up selling it. And then I had to go from being able to afford vacations.

[00:08:14] Carol Pehotsky: Right and a little bit of fun.

[00:08:15] Dr. Rita Pappas: Yeah, a little bit of fun to actually living with two other roommates. In a, like a small bungalow on a small little savings. [Mm-hmm.] Lots of ramen noodles. And I think the hardest part though was the first two years of med school because it mostly you were in the library or in the classroom, and I missed that on patient interaction.

[00:08:40] And it wasn't until like the third year when I started clinicals that I was back in the swing of things and I was like, yes this is why I am here. But the first two years were really challenging. And I did ask myself, am I doing the right thing?

[00:08:54] And it was like resilience, right? I started this and I wanted to finish it, and I just tried to take one day at a time, and I had a lot of support from good family and friends. Who continued to support still to this day.

[00:09:09] Carol Pehotsky: How long had you been a nurse before you?

[00:09:11] Dr. Rita Pappas: Uh, 10 years.

[00:09:12] Carol Pehotsky: Oh, wow. Yeah. So, this is not an insignificant period of time. [No.] You were really at that expert stage. [Yes.] It's hard for any of us, whether we're switching specialties or something a little more dramatic in terms of switching roles.

[00:09:23] It's hard to go from, I'm the person who knows all the answers, and people come to me and I'm the preceptor. It's so hard to go from that to I don't know many or any of the answers. [Yeah.]

[00:09:35] How did you work through that? Any recommendations to anyone who's going through that?

[00:09:39] Dr. Rita Pappas: Yeah, so what was really interesting was when I first started med school, there were some synergies, right? Anatomy.

[00:09:47] Carol Pehotsky: Well, yeah.

[00:09:47] Dr. Rita Pappas: I, and I was like, oh yeah, I've got this right. [Yeah.] I know the muscles. I'm going to be fine. It's going to be okay. There was a little bit of synergies that way and that gave me confidence in that first semester. because we were really kind of doing the basics before we plunge right in.

[00:10:05] The skill sets that I had before, like in nursing, really good visual memory. Could read things. It was again, all of a sudden, the amount of information that was thrown was drinking through a fire hydrant, right? [Mm-hmm.]

[00:10:19] Couldn't really keep up with the volume of information and just kind of relying on what I thought was important and what they were studying, like from my real-life experience. Right.

[00:10:29] Carol Pehotsky: Right. That's hard.

[00:10:31] Dr. Rita Pappas: Yeah, so it was hard. Believing in yourself. There was a little bit of imposter syndrome going on.

[00:10:38] Carol Pehotsky: I'm sure.

[00:10:39] Dr. Rita Pappas: Right. You know, now a student, everyone else is about 10 years younger than I am. But I think the fact that I had to give up so much to do this is what continued to kind of propel me to move forward.

[00:10:53] Carol Pehotsky: Ah, okay.

[00:10:53] Dr. Rita Pappas: And I had seen really wonderful physician and nurse team work too through my career. And I just kept trying to focus on getting through it those first two years before the clinical team started. Yeah.

[00:11:06] Carol Pehotsky: That's a long race to run.

[00:11:08] Dr. Rita Pappas: Yeah. And one of the things though, reflecting on it, was coming back during breaks and making money.

[00:11:16] Carol Pehotsky: Oh, so working as a nurse?

[00:11:17] Dr. Rita Pappas: Yeah, as a cardiothoracic ICU nurse. I,

[00:11:20] Carol Pehotsky: That nurse money is always there.

[00:11:22] Dr. Rita Pappas: Like book money and things like that. So that experience kept me going too. [Okay.] Right. Because the nurses in the unit were very supportive and they welcomed me back to come in. But I couldn't continue in my third year because clinicals were 24-7, so I had to like give it up then.

[00:11:39] Carol Pehotsky: But so nice that, that you were able to continue employment and get that re-dosing if you will. [Yes.] So you talked about that connection with some of the coursework, obviously, when getting into your third and fourth year in your residency.

[00:11:52] Any other aspects of nursing that you think gave you an advantage in med school or residency or really helped you sort of see the bigger picture? Anything like that?

[00:12:01] Dr. Rita Pappas: Yeah, I, I mean, I do remember saying to my colleagues, like the other residents that the nurses are at the bedside 24 7. Right. We're there for just a snapshot. [Mm-hmm.] Come in, evaluate the vital signs and all of that. Do a quick physical exam, make an assessment, and plan with the team, and then move on.

[00:12:21] Right. But I knew like when the nurse called, something was wrong.

[00:12:25] Carol Pehotsky: Oh, sure. Right.

[00:12:27] Dr. Rita Pappas: I needed to,

[00:12:27] Carol Pehotsky: you had been on the other side of that phone?

[00:12:29] Dr. Rita Pappas: Yes, and I needed to go to the bedside and evaluate the patients. And I could see like a lot of my resident peers struggling with that. [Hmm.] I do remember saying it like one night like, they don't want to call you.

[00:12:44] Carol Pehotsky: No, they really don't.

[00:12:45] Dr. Rita Pappas: They don't really want to call you. If they're calling you, it's important. You need to go. And I think modeling that showed how to take care of the patients the best way because it's all about the patients.

[00:12:57] And I round on the floors at night and check in with the nurses on each of the patients.

[00:13:04] Carol Pehotsky: You were their favorite I'm sure.

[00:13:06] Dr. Rita Pappas: I know. So, they knew I was coming. Like they knew like

[00:13:09] Carol Pehotsky: So, they could bundle.

[00:13:10] Dr. Rita Pappas: Yes. Yeah. So, they knew I, they like, oh, Rita's on. So, I start, and I would stop and I'd be like, what's going on tonight? Who are you worried about? Everything okay? Do you need anything?

[00:13:21] And they would help, like say they would triage the questions, right? [Yeah.] It was really good. And then my interns saw that, right? And then they modeled it forward. So. It was good.

[00:13:31] Carol Pehotsky: In case there's any physicians listening. Yes. We love when that happens. That's amazing. Over that transition then, from nurse to learning to independent double boarded physician.

[00:13:44] [Mm-hmm.] How has your perspective changed on patient care now that you're a physician?

[00:13:48] Dr. Rita Pappas: Well, I think this is really so important. This goes back to family centered rounds. So, Meredith Fox was working in the Children's Institute with me, and I was a young peds hospitalist, maybe not young.

[00:14:01] Carol Pehotsky: We were all young back then. It's fine.

[00:14:03] Dr. Rita Pappas: Early career hospitalist, I'll just say that. And the team was in a conference room rounding. And then what would happen was we would go over the plan of care, they'd present, and then I would go back out and there would be the scuttle of activity. And the residents would go put the orders in and I just felt like things could be better.

[00:14:26] [Mm-hmm.] And why weren't we all there together talking to the patient at the same time? And I do remember being accused of like, and some point that I was going to ruin residency education. [Oh my.] Yes. Right.

[00:14:39] And there was one parent that wrote a beautiful little antidote that she sent in. And she said for like the first time ever, this was so rewarding. She was an integral part of like shared decision-making [Wow] with all of the team members and that we weren't just off creating something [mm-hmm] on our own and then bringing it back. So that was really rewarding.

[00:15:04] And I think that's what opened my eyes, like this is the way I could contribute to patient care. Was like enforcing the fact that we were all part of one team, caring for the patient and not just silos of care [yep] that were occurring.

[00:15:19] Carol Pehotsky: And now it's an expectation in our organization [Yes] that we include nursing and family members in the patient in our rounds and plan of care. Yeah. Look at that.

[00:15:26] Dr. Rita Pappas: And then when we started in the children's hospital, the adult side, they were like, we can't do this. It's going to take too much time. We did an initial survey; we rolled it out on one team first. [Mm-hmm.] And the team got less pages that were [Sure] doing it right. There was good communication. Just thought it was just a better way of practicing.

[00:15:47] Carol Pehotsky: And it stuck. And it's sustained. [Yes.] So certainly.

[00:15:50] Dr. Rita Pappas: Yeah. Yeah. Absolutely.

[00:15:52] Carol Pehotsky: So same line. [Mm-hmm.] Now that you're a physician, has your perspective on nursing changed?

[00:15:57] Dr. Rita Pappas: No, I have the utmost respect for nurses.

[00:15:59] Carol Pehotsky: She really does.

[00:16:00] Dr. Rita Pappas: Even more respect, even more respect now. Like thinking about all of the workplace violence that's happening. [Yeah.] you know, that's saddens me.

[00:16:09] I want to be clear, sometimes I think people assume I wasn't happy in nursing. That's not the case. Like I loved being a nurse and if the laws had been changed differently, I'm sure I might've taken the nursing [sure] like an NP type. Right? [Right.] But I think at the time it wasn't available to me, and I wanted more autonomy.

[00:16:29] [Mm-hmm.] And so being the oldest of five, I think that was, that's what the reason I wanted more autonomy. But just the utmost respect is the way I think of it. And a lot of my daughter's friends and my son's friends that are pursuing nursing, and they ask me because it offers a lot of flexibility, you know in terms of your nursing career, being a physician, I don't have as much, I would say flexibility in my schedule. [Yeah.]

[00:16:59] In terms of like crafting what I need to craft. [Mm-hmm.] You know, and so thinking about that, I've always encouraged the young women I talk to and the young men I talk to. because my cousin's son, Zach, is actually a proud nurse [awesome] now. And he was trying to decide what to do, and we were talking like quite frankly about all of the pluses. And I didn't feel like there's any minuses either. And so, he chose nursing and I'm really happy that he did.

[00:17:28] So I'm very grateful for the experiences I had, and I really believe being a nurse makes me a better physician.

[00:17:34] Carol Pehotsky: And you've, you've been involved in leadership for several years and that's mostly where I've had the honor of interacting with you. Folks we were joking before the mics were hot about little squares on Teams meetings during COVID as you were leading hospital operations.

[00:17:48] So how has all of this, your nursing experience and your physician experience really formed your leadership?

[00:17:53] Dr. Rita Pappas: One of the team members was teasing me, calling it the Pappas model. But I, I do think that if we take care of the patients and then we take care of each other, meaning the whole team [mm-hmm] and then it's fiscally responsible that that's like a, the best model of care that we can provide my nursing and physician roles helped me come to that. [Okay.]

[00:18:19] It was at one of the leadership classes, because they asked like, can you give us a pearl? They said, that's really simple. And I said, but if you think about caring for the patients, caring for each other [Mm-hmm] meaning the whole team and making it fiscally responsible, everything else will come. [Yeah.] The quality, the safety, all of that will come as long as you use those three tenets.

[00:18:39] Carol Pehotsky: Going back to the comment about nobody likes to call in the middle of the night. [Right]. You know, we do have pre-licensure nurses who listen. [Mm-hmm.] I vividly remember the very first shift I had and the very first physician I paged in the middle of the night working night shift. And thankfully they were collaborative, and it was good.

[00:18:57] But in terms of whether it's that middle of the night phone call or just communication in general, any pearls you have for nurses and speaking in a way that our physician colleagues can relate to, can understand what the ask is.

[00:19:10] Dr. Rita Pappas: Yeah. I love SBAR, and I even say like to the residents too, and medical students SBAR. Right. What's the situation? What's the background? What's your assessment? And what do you recommend?

[00:19:23] And then there's certain words you want to use. Like if you're really worried, say those words. I am worried. Right? [Yeah.] I am worried. [Mm-hmm.] My concern is. Just articulating as concisely as you can, what you're asking about, and that I think is very much appreciated.

[00:19:41] No one is ever going to fault you and as much as you can, use data. Like I've noticed, the vital signs have changed. You know these are like key words [Yeah] that the physicians will like, definitely respond to.

[00:19:54] And I was also reprimanded in the middle of the night when I called. I do remember one physician apologizing too. Because I said I was worried about some peak T waves that I'd seen on the screen. And I asked about getting a 12 lead EKG, and they ordered the EKG.

[00:20:13] And then he came up afterwards and he's like, I'm really sorry I'm, that was a good catch. You know, like, because he was a little irritated that I was calling. And then he apologized and said he was sorry and thanked me for being observant and for reaching out on behalf of the patient.

[00:20:28] Carol Pehotsky: Well, they call it the practice of healthcare for a reason.

[00:20:30] Dr. Rita Pappas: Yes. Yes.

[00:20:31] Carol Pehotsky: Excellent. Before we call it a day, I'm hoping you'll be cool with me asking a couple fun questions [oh, of course] where audience can get to know you as an amazing human being. [Yeah.]

[00:20:39] So. You have a lot going on, but it's finally time to unwind. What's your go-to? How do you take care of yourself?

[00:20:46] Dr. Rita Pappas: Yeah, thanks. That's a great question. I wish I could practice better self-care, but I have a lovely daughter, 24 and a son, soon to be 21, so I love spending time with them. [Mm-hmm.] They really are the love of my lives. They just give me a lot of joy, so spending time with them is very fun.

[00:21:06] And I love beach time reading a book, walking on the sand as much as I can getting away that's helpful. I still love reading and so I've been in a book club for [Oh, nice.] Yeah, for many, many, many years. From when the kids were in grade school.

[00:21:24] You might be surprised to know it's about like strong feminine women, [shocking] mostly nonfiction like The Other Einstein and you know, all of these great stories like the Rose Code. So great books and that book club has been a lot of support.

[00:21:42] Carol Pehotsky: What's your favorite beach?

[00:21:43] Dr. Rita Pappas: It's Vanderbilt Beach in Naples, Florida. Okay. Because I really would love to go to Greece and some of these other great beaches

[00:21:50] Carol Pehotsky: in the meantime,

[00:21:51] Dr. Rita Pappas: like in Santorini, but yeah, but within the United States [all right.] Yeah, it's Naples.

[00:21:57] Carol Pehotsky: Nice. Yeah, and we've spent as an organization a lot of times here talking about our, the power of purpose and what our whys are. I'm hoping you're willing to share with us what's your why?

[00:22:07] Dr. Rita Pappas: Yeah, I think it stems back to the, my grandmother that I talked about earlier. She's just a loving, caring woman and she had many medical problems, you know, that she needed help and I would attend her doctor's appointments with her too. [Oh.] and she's really the reason that I got into healthcare and why continue today. So, she's my why.

[00:22:29] Carol Pehotsky: Wonderful. Yeah. Thank you so much for joining us today.

[00:22:32] Dr. Rita Pappas: Yes, thank you.

[00:22:37] Carol Pehotsky: 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 Nurse essentials@cc.org. To learn more about nursing at Cleveland Clinic, please check us out@clevelandclinic.org slash nursing.

[00:23:04] Until next time, take care of yourselves and take care of each other.

[00:23:11] 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.