Medical-Surgical Nursing: A Specialty, Not a Stepping Stone

Podcast Transcript

Carol (00:04):

Medical-surgical nursing gets some bad press. Many folks see it as a starting point or a steppingstone, but it truly is its own specialty. Our guests today, Julie and Catherine, will share with us what brought them to medical-surgical nursing and what keeps them coming back for more.

(00:23):

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.

(00:44):

Welcome back, everyone. Our topic today is medical-surgical nursing. What is it? Why is it a specialty, right? The medical-surgical specialty truly is a specialty, and sometimes it gets an unfair rap. And I've been a nurse for 20 years now, which is hard to believe, especially considering that some of my favorite, most memorable patient interactions came from 20 years ago when I began my career on a medical-surgical unit. Back in my day, as us old ladies say, you know, the vernacular was that you really had to go to a med-surg unit for a couple of years, and then you could do other specialties. And we'll talk about later some of that still exists (laughs) today. For me, that wasn't necessarily where I started. I did fall in love with a different specialty, and my road traveled there.

(01:26):

But, you know, I still think fondly about one patient who kept hitting the call light all night and, you know, we'd kind of just go in there and chat, and I finally said, like, "I- I'm here for you, but, you know, what's going on?" He said, "Well, y- honey, you just look like you're r- running around too much, I was just trying to give you a break." (laughs)

Julie (01:27):

(laughs)

Catherine (01:27):

(laughs)

Carol (01:42):

And all of the other really special moments that I carry with me that have made me a better nurse and frankly a better human being for those experiences.

(01:50):

So, I'm delighted today to be joined by two guests who are also in love with the specialty of medical-surgical nursing and can't wait to share their experiences with all of you.

(01:58):

Julie Seelie is a medical-surgical nurse from Fairview Hospital, part of the Cleveland Clinic system. Welcome.

Julie (02:02):

Thank you.

Carol (02:03):

And Catherine Skowronsky is the clinical nurse specialist for medical-surgical nursing at Fairview Hospital. Ladies, thank you so much for joining us today.

Catherine (02:09):

Pleasure to be here. Thanks for having us-

Julie (02:10):

Yeah, thank you for having us.

Carol (02:11):

All right. So, Julie, I'll pick on you first. Can you give us a little bit of information about your career, and what drew you to medical-surgical nursing, and what keeps you coming' back for more?

Julie (02:21):

So, I went to nursing school at Ohio University.

Carol (02:24):

Nice!

Julie (02:24):

In Athens, Ohio.

Carol (02:26):

Mm-hmm.

Julie (02:26):

And actually, my freshman-year roommate and I, we did nursing school all-

Carol (02:27):

Oh, nice-

Julie (02:27):

Through together-

Carol (02:31):

Yeah-

Julie (02:32):

Graduated, and both ended up working on the same-

Carol (02:35):

Oh, how [inaudible 00:02:35]

Julie (02:35):

Med-surg unit, yeah-

Carol (02:36):

That's wonderful! (laughs)

Julie (02:37):

So that's been really great, to kind of grow with her-

Carol (02:40):

Mm-hmm-

Julie (02:40):

She works in a different area of the hospital now, but it's been nice to kind of like work through different problems at work together-

Carol (02:46):

Yeah-

Julie (02:46):

Push each other into growth and-

Carol (02:46):

Mm-hmm-

Julie (02:49):

Challenge each other. So, I started in med-surg on Parkview Terrace after doing the nurse associate extern program.

Carol (02:55):

Okay.

Julie (02:56):

I did that on my unit, stayed on as a PCNA, and kind of worked intermittently when I was home from OU.

Carol (03:02):

Mm-hmm-

Julie (03:02):

And then when it came time to apply, I was like, well, I already know where everything is on the unit-

Carol (03:07):

(laughs)

Julie (03:07):

And I already know everyone's names, and that's half the battle-

Carol (03:09):

It's my work home-

Julie (03:09):

Yeah, so I'm like, I might as well start there.

Carol (03:10):

Yeah!

Julie (03:12):

And so, I've been there ever since. And, you know, we still have some of the same faces-

Carol (03:17):

Mm-hmm-

Julie (03:17):

From when I first started, people who were mentors to me, people who taught me things, whether they were aware of it or not... and a lot of new-

Carol (03:24):

Mm-hmm-

Julie (03:25):

Faces too. So that's been really nice to kind of help onboard some new people-

Carol (03:29):

Mm-hmm-

Julie (03:29):

And show them the ropes as well.

Carol (03:30):

Wonderful.

(03:31):

And Catherine, you're a clinical nurse specialist. Career has taken you on all sorts of adventures, but-

Catherine (03:31):

Yeah-

Carol (03:37):

Here you are as a medical-surgical CNS. What is that like-

Catherine (03:39):

Right-

Carol (03:39):

What kind of supports do you give the nurses?

Catherine (03:41):

Oh, it's... what is it like? It's-

Carol (03:41):

(laughs)

Catherine (03:43):

It's great. Actually, similar to Julie and similar to your experience, when I was a new grad out of, uh, school with my ADRN, I thought I would-

Carol (03:43):

Mm-hmm-

Catherine (03:51):

Do this for a couple of years and then move on to the ICU-

Carol (03:51):

Oh yeah-

Catherine (03:55):

I couldn't wait-

Carol (03:55):

Yeah. (laughs)

Catherine (03:56):

But once I got to the med-surg unit, I started on G-81-

Carol (03:56):

Mm-hmm-

Catherine (04:00):

At main campus-

Carol (04:01):

Mm-hmm-

Catherine (04:01):

And just... uh, didn't realize that I was falling in love with it.

Carol (04:05):

(laughs)

Catherine (04:05):

It was-

Carol (04:06):

It snuck up on you?

Catherine (04:06):

It- It really did. It was- It was hard and-

Carol (04:07):

Mm-hmm-

Catherine (04:09):

It did, it snuck up on me-

Carol (04:10):

Mm-hmm-

Catherine (04:11):

The next thing I knew, this was where I was going to spend my career in- in this specialty, not necessarily location, but-

Carol (04:11):

Sure, yeah-

Catherine (04:18):

In that specialty. And through the years, moved through the position of nurse educator-

Carol (04:22):

Mm-hmm-

Catherine (04:23):

Clinical nurse specialist, and eventually, uh, just in the last few years, found my way to Fairview. I love being that support for nurses, because when I first started, we didn't really have-

Carol (04:36):

Right, yeah-

Catherine (04:36):

Someone in this position, right-

Carol (04:37):

Mm-hmm-

Catherine (04:39):

Yeah, we were- we were some of the first... myself, some of my colleagues, were some of the first class of CNSs. And I really enjoy getting the phone calls and the voceras.

Carol (04:49):

Mm-hmm-

Catherine (04:49):

"I have this patient who..."

Carol (04:49):

(laughs)

Catherine (04:51):

(laughs) The-

Carol (04:53):

"I'll be right there." (laughs)

Catherine (04:54):

The- Right. This provider wrote this order.

Carol (04:56):

Mm.

Catherine (04:56):

Okay, do we have a policy?

Carol (04:59):

Mm-hmm-

Catherine (04:59):

You know, the things that you need right here, right now-

Carol (04:59):

Sure-

Catherine (05:01):

You can't wait for, you know, a class, you need it right here, right now. So that's what I like to do.

Carol (05:06):

And we're so fortunate to have clinical nurse specialists-

Catherine (05:06):

Thank you-

Carol (05:09):

Who support medical-surgical nursing. It is a specialty like plenty of others that also get that level of support.

Catherine (05:14):

Yes, absolutely. Fortunately, I am not the only one in this system-

Carol (05:14):

(laughs)

Catherine (05:18):

There are many more of me. And we all have one another's phone numbers. (laughs)

Carol (05:22):

Wonderful- Right? Speed dial!

Catherine (05:22):

(laughs)

Carol (05:24):

So going back to the statement I made in- in the intro, y- there's still that perception, whether it's from nurses, nursing schools, et cetera, this whole, "Well, you do your two years of time there and then you go somewhere else." And, uh, for me, although I was that person, I didn't go into that adventure with this ticking clock in mind, it sort of just evolved that way.

(05:45):

What are your thoughts a- about that? And- And, you know, a- are- are you seeing people sort of do their time and move on? What do each of you do to sort of help people understand the specialty and learn to love it? I'm going to ask you first, Julie.

Julie (05:58):

Well, I think that that definitely starts in the nursing schools. I've heard people who say that that was their experience, and I've definitely heard that from people in my nursing school, people in my personal life-

Carol (06:09):

Mm-hmm-

Julie (06:09):

They're like, "You have to pay your dues in med-surg."

Carol (06:12):

(laughs) Yeah-

Julie (06:12):

Yeah-

Carol (06:12):

Yeah-

Julie (06:13):

And I think for some people that might be true; you get there-

Carol (06:13):

Mm-hmm-

Julie (06:17):

You get immersed in your job, you do your two years, whatever, and you want to move on to somewhere else. I don't think there's any shame in that. It's kind of about, the beginning of your career at least, is figuring out what you're passionate-

Carol (06:28):

Mm-

Julie (06:29):

What problems you're passionate about solving.

Carol (06:31):

Ooh, I like that. Don't-

Julie (06:32):

Yeah-

Carol (06:32):

Write that down, folks.

Julie (06:32):

(laughs)

Carol (06:33):

"What problems are you passionate about solving?"

Catherine (06:34):

(laughs)

Carol (06:34):

Okay, go on. (laughs)

Julie (06:36):

But beyond that, I think that saying that you have to pay your dues in med-surg is... it gives people the... a negative perception-

Carol (06:36):

Mm-hmm-

Julie (06:43):

Before they even have a chance-

Carol (06:44):

Right-

Julie (06:44):

To make their own opinion.

Carol (06:46):

Yeah.

Julie (06:46):

And I think that it also discredits the work of nurses in other services, other care settings-

Carol (06:51):

Mm-

Julie (06:52):

Because it makes it seem like med-surg is so hard, these other ones are... oh, these are easy, easy jobs-

Carol (06:59):

Mm-

Julie (06:59):

They're the best places to be.

Carol (07:00):

It's a different hard.

Julie (07:02):

Yeah-

Carol (07:02):

Yeah-

Julie (07:03):

And all areas of nursing are hard; that's one truth that we all know. But it's-

Carol (07:03):

Right-

Julie (07:07):

What are the problems that make it hard?

Carol (07:07):

Mm-

Julie (07:09):

And what are you passionate about? I'm going to continually work through this problem or find a solution to it every day when I go there.

Carol (07:15):

Sure-

Julie (07:16):

It's me with my adult patients on a med-surg unit-

Carol (07:18):

Mm-hmm-

Julie (07:18):

Where maybe your passion is little babies in a NICU.

Carol (07:21):

Yeah. Yeah.

Julie (07:22):

Whatever it is-

Carol (07:23):

Mm-hmm-

Julie (07:23):

You just need to figure that out. But I think med-surg is a great place to kind of get a sample platter of-

Carol (07:23):

(laughs)

Julie (07:31):

All the different things-

Carol (07:31):

That's right-

Catherine (07:32):

(laughs)

Julie (07:32):

That you could go to. Well, maybe not age groups, but-

Carol (07:32):

(laughs) Right-

Julie (07:35):

You know, at least disease processes.

Carol (07:37):

Well, and when you think about patients and families get to know nurses very well in medical-surgical nursing, and they can pick up if somebody is sort of checking a box, doing their time, versus I really want to be here and be invested in that.

(07:51):

Catherine, from your viewpoint, if you have people who are in these units who maybe don't have that spark, how can we support nurses to really embrace the specialty?

Catherine (08:01):

Well, in my role-

Carol (08:03):

Mm-hmm-

Catherine (08:03):

Of what I really try to do is to role-model.

Carol (08:06):

Mm.

Catherine (08:06):

I am a professional, I've been a nurse for 24 years, and I've been in med-surg all 24 of those years-

Carol (08:13):

(laughs)

Catherine (08:13):

That is my-

Carol (08:14):

Yeah, yeah-

Catherine (08:14):

That is my career, you know-

Carol (08:14):

Yeah-

Catherine (08:15):

It- It- It is not-

Carol (08:16):

Mm-hmm-

Catherine (08:16):

Because I couldn't do anything else, it is not by default-

Carol (08:19):

Right-

Catherine (08:19):

It is by choice, and, and my love for the specialty-

Carol (08:19):

Mm-hmm.

Catherine (08:22):

And I want that to sink in-

Carol (08:25):

Mm-hmm-

Catherine (08:25):

To the nurse who's saying, "I'm not happy, maybe I should leave."

Carol (08:30):

Mm-

Catherine (08:30):

And have that nurse then say, "But at the core, I really do love what I do, I love med-surg. Maybe there's something else I need to change or tweak."

Carol (08:41):

Mm, sure-

Catherine (08:41):

Maybe a different way of looking at it. Or the nurse who says, "She's here because she loves it, not because she's stuck."

Carol (08:49):

Mm.

Catherine (08:49):

"I'm not stuck either, I need to- my passion is leading me elsewhere."

Carol (08:53):

Right, right-

Catherine (08:54):

You know?

Carol (08:54):

Yeah-

Catherine (08:54):

And it comes down to, I- I think Julie said it just-

Carol (08:57):

Mm-hmm-

Catherine (08:58):

So, so well, "What kind of problems do you-"

Carol (08:58):

Yeah-

Catherine (09:00):

"Want to solve?" And I- I hope that helps people a- ask that of themselves.

Carol (09:05):

Yeah, it's just different grass, it's not greener. You know, from a-

Catherine (09:07):

Exactly (laughs)

Carol (09:08):

Uh, from a-

Catherine (09:08):

Yeah-

Carol (09:10):

[inaudible 00:09:10]

Catherine (09:10):

Yeah-

Carol (09:10):

For what it's worth from, from my specialty of perioperative nursing, I can't tell you how many times we would have experienced nurses, they were experienced in something else, they're... they think they're ready to come to the OR, and some of them, yes, it's their life's work and some of them go... "On second thought..."

Catherine (09:10):

Right. (laughs)

Carol (09:26):

I didn't reflect enough to think about, you know... couldn't be two more opposite specialties, right? You know-

Catherine (09:31):

Yeah-

Carol (09:31):

Missing the interaction with the patient, missing the family. So... So, for all of you out there that are thinking the grass is greener, you know, take that moment to really think about-

Catherine (09:39):

Mm-hmm-

Carol (09:39):

What problems you're passionate about solving, and what is driving that feeling.

Catherine (09:43):

Right, exactly. "Where am I right now?"

Carol (09:45):

Mm-hmm-

Catherine (09:45):

"What makes me feel restless?"

Carol (09:47):

Yes-

Catherine (09:48):

And-

Carol (09:48):

Yeah-

Catherine (09:49):

Is- Is it really about the problems I'm solving-

Carol (09:51):

Mm-hmm-

Catherine (09:52):

Is it the patient population? Is it this particular area where I'm working right now-

Carol (09:52):

Right-

Catherine (09:57):

Do I need to shake it up, or is it within me?

Carol (09:59):

Right. (laughs) 

Catherine (10:00):

Is- Is it... Have I-

Carol (10:01):

It's much easier to change jobs-

Catherine (10:03):

Mm-hmm. (laughs)

Carol (10:03):

Than to do internal work sometimes-

Julie (10:03):

(laughs)

Catherine (10:05):

Sometimes yes, yes. But am I stuck in that old-

Carol (10:10):

Mm-hmm-

Catherine (10:10):

Thinking that this is less than.

Carol (10:14):

Right.

Catherine (10:14):

I work on a floor.

Carol (10:17):

I know, right-

Catherine (10:17):

My patients transfer, right-

Carol (10:18):

Right-

Catherine (10:18):

They- They come down to a lower level of care, you know-

Carol (10:19):

Downgraded, below-

Catherine (10:23):

Downgraded, yes-

Carol (10:24):

The words we use-

Catherine (10:24):

Exactly-

Carol (10:24):

Ugh.

Catherine (10:24):

Y- Exactly-

Carol (10:24):

Yeah-

Catherine (10:27):

And those words really, really matter-

Carol (10:29):

Mm-hmm-

Catherine (10:29):

Because it's not just what we're expressing to others, it's what we're telling ourselves, it's our self-talk.

Carol (10:35):

Right-

Catherine (10:36):

And then we begin to internalize it-

Carol (10:36):

Mm-hmm-

Catherine (10:38):

And we believe our own bad press. When I-

Carol (10:41):

(laughs) Right.

Catherine (10:41):

You know? So-

Carol (10:42):

Yeah!

Catherine (10:42):

Maybe I need to start reminding myself, no, I work on a medical-surgical unit-

Carol (10:43):

Right

Catherine (10:47):

This is my nursing unit-

Carol (10:49):

Unit-

Catherine (10:50):

You know-

Carol (10:52):

Not a floor-

Catherine (10:53):

It is not the floor-

Carol (10:53):

(laughs)

Catherine (10:53):

No, no, this- this is a unit, it is a specialty care area.

Carol (10:56):

Mm-hmm.

Catherine (10:56):

With patients with these particular needs.

Carol (11:00):

Mm-hmm.

Catherine (11:00):

And the appropriately trained medical personnel-

Carol (11:03):

Yes-

Catherine (11:03):

To meet those needs.

Carol (11:05):

Well, and you think about how that hits with patients too. You know, saying-

Catherine (11:09):

Mm-hmm-

Carol (11:09):

Mr. So-and-so, we're moving you to a different medical-surgical unit because you're ready to do that, versus-

Catherine (11:14):

Yes-

Carol (11:15):

You're getting downgraded-

Catherine (11:16):

Yes-

Carol (11:16):

Even the perception that creates in the patient's mind, I imagine.

Catherine (11:19):

O- Oh yeah, you're going to go down to med-surg, they're going to-

Carol (11:21):

(laughs)

Catherine (11:21):

Send him to the floor, he's doing

Carol (11:22):

Right-

Catherine (11:22):

He's fine now-

Carol (11:23):

Right.

Catherine (11:23):

Right.

Carol (11:24):

So, I want to go back, Julie, to something you said about the smorgasbord of patients (laughs)

Julie (11:24):

(laughs)

Carol (11:28):

That are served in medical-surgical nursing. So, what sort of things are key to a medical-surgical nurse, whether they're new in their career in the specialty or more seasoned to really be able to be ready to handle the smorgasbord and/or to tap in resources when they're not sure.

Julie (11:45):

So, I feel like when you first start out as a nurse, you've passed your NCLEX, you've proven that you can be a safe nurse-

Carol (11:50):

Minimally competent, yep. (laughs)

Julie (11:52):

Yes. But then when you start, it's, like, kind of recognizing the problems that aren't as loud.

Carol (11:57):

Mm-

Julie (11:57):

So, you could have patient one's family member is at the nurse's station, they're agitated, they're raising their voice, they're like, "I need to talk to the nurse now, whatever-

Carol (11:57):

Mm-hmm-

Julie (12:06):

But your patient in room two, who's aphasic with hypoglycemic blood sugar-

Carol (12:12):

Yeah-

Julie (12:12):

That person's not screaming at you, that's not making any noise, but you have this, like, stimulus in front of you that's, like, begging for your a- attention-

Carol (12:12):

Mm-hmm.

Julie (12:19):

And I think growing as a nurse is remaining calm in that situation, saying, "Hey, I hear you, I totally understand what you're saying. I would be frustrated too, I get it."

Carol (12:19):

Mm-hmm-

Julie (12:29):

"I have something very urgent that I need to go address right now, and as soon as I'm done, I'll come talk to you."

(12:33):

But then, like, it's the quiet problems that are-

Carol (12:36):

Mm-hmm-

Julie (12:37):

I think the most dangerous and the most important to recognize. So, I think as a new nurse that's a big challenge, and also feeling comfortable speaking up-

Carol (12:37):

Mm-hmm-

Julie (12:46):

And saying I don't know, that was, like, the hardest thing

Carol (12:46):

Yeah-

Julie (12:46):

For me-

Carol (12:50):

Oh yeah-

Julie (12:50):

And I- This is one of the positives within med-surg, if there's something that you're confused about-

Carol (12:55):

Mm-hmm-

Julie (12:56):

Or y- you're like, "I know enough to do this safely but when I'm educating a patient, I can't really explain it in a way that's understandable for them because I don't know it-

Carol (13:04):

Because I don't understand it-

Julie (13:05):

That in-depth-

Carol (13:05):

Enough to educate them, sure-

Julie (13:06):

Yeah-

Carol (13:07):

Yeah-

Julie (13:07):

And I felt that way with stroke patients and diabetes patients.

Carol (13:11):

Okay-

Julie (13:12):

And I am on the stroke unit.

Carol (13:14):

Oh. (laughs)

Julie (13:14):

So, I was like, "I really need to just-"

Carol (13:14):

Sure (laughs)

Catherine (13:16):

(laughs)

Julie (13:16):

"Pencil dive into, like, learning about this." But within med-surg, there's so many groups that you can join. I joined the diabetes mentor program and our stroke champion group.

Carol (13:24):

Wonderful.

Julie (13:25):

And I think that that is important for multiple things. Learning more, also networking. The two people who lead both of those groups-

Carol (13:25):

Mm-hmm-

Julie (13:34):

Are some of my, like, nursing heroes.

Carol (13:36):

(laughs) Wonderful-

Julie (13:37):

And talking to them brings me back-

Carol (13:37):

Yeah-

Julie (13:38):

When I... I was just telling Cathy on the way in that, like, I was feeling a little bit negative after, like, a couple hard shifts.

Carol (13:44):

Sure-

Julie (13:45):

And talking to the leader of the diabetes mentor program, today, I'm like, that always just brings me back, fills my cup back up, I'm like, all right, I'm happy again, I can go back to work. (laughs)

Carol (13:45):

(laughs)

Julie (13:55):

But yeah, learning more and networking I think is just like a big part of joining into those things, but also feeling comfortable admitting that you don't know something.

Carol (14:03):

Absolutely. I can't tell you how many guests we've had already on this podcast, and we will have in the future, that have said that same thing. So, nursing students, if you're out there, new grads if you're out there, write it down again. (laughs)

Julie (14:04):

(laughs)

Carol (14:16):

We've heard that several times. But it's sometimes often one of our shortcomings as nurses is thinking that-

Julie (14:17):

Right-

Carol (14:21):

Okay, now I- I've passed my NCLEX, I have to have it all figured out versus, whether I'm in med-surg unit or anywhere else, that humility that says, "I don't know and I need help."

Julie (14:30):

And you'd be surprised how many people around you will go, "You know what? I don't know either-"

Carol (14:33):

(laughs) I don't know either-

Julie (14:34):

Yeah, and you're like-

Carol (14:35):

Let's go find out together-

Julie (14:36):

Let's figure it out together-

Carol (14:36):

Yeah! Yeah-

Julie (14:36):

There's strength in numbers.

Carol (14:37):

Absolutely-

Julie (14:38):

Yeah.

Carol (14:38):

There's a lot of things I want to unpack out of all that (laughs) you just said. I want to go back to the comment you made about getting happy again and sort of recharging your batteries. You know, I- I think, when you talk about bad press-

Catherine (14:50):

Mm-hmm

Carol (14:50):

Catherine, you know, we talked about you see it in the media, lots of portrayals of the bad press, right?

Catherine (14:56):

Yeah-

Carol (14:56):

How many patients are being taken care of?

Catherine (14:58):

Right-

Carol (14:58):

And some of the stuff that goes with that, we'll just paraphrase and say-

Catherine (14:58):

Right.

Carol (15:02):

What are some things that... I mean, all of us nurses need to recharge our batteries, but in light of the specialty and the smorgasbord of patients and their families, and some of the issues that you're managing with a complex patient population, what can nurses do to really recharge their batteries knowing that some shifts are going to be harder than others?

Catherine (15:21):

I think for everyone it comes back to finding your why.

Carol (15:21):

Mm-hmm.

Catherine (15:26):

W- Why did I go into nursing?

Carol (15:27):

Mm-hmm-

Catherine (15:29):

And maybe some days you're asking that with a different tone.

Carol (15:29):

(laughs)

Julie (15:31):

(laughs)

Catherine (15:32):

"Why? Why did I do..."

Carol (15:32):

(laughs)

Catherine (15:33):

But when you get sincere about, really, what did bring me here-

Carol (15:37):

Mm-hmm-

Catherine (15:37):

Okay, this was it. And can I find an example of that today or recently? When was the last time I felt that?

Carol (15:47):

Sure.

Catherine (15:48):

And I think inevitably, we come to that one interaction-

Carol (15:48):

Mm-hmm-

Catherine (15:52):

That patient, that other nurse, it may be even a family member that just... you felt the warmth. You know, you- you-

Carol (16:00):

Yes-

Catherine (16:00):

You felt that-

Carol (16:00):

They saw you. Yeah-

Catherine (16:01):

Yes, you felt that light up inside-

Carol (16:04):

Mm-hmm. Mm-hmm.

Catherine (16:04):

And that was your why. And as long as that is still there, that is where you belong, and all the rest we can deal with.

Carol (16:13):

Yeah. Julie, you- you mentioned calling and chatting with a mentor to sort of help revive you. Anything else you would recommend to medical-surgical nurses who have a string of bad shifts in a row or really need that pep talk? What are some other things that you've tried?

Julie (16:28):

Well, one thing that I've definitely tried to do is, when I have those moments, and I don't do it perfect a hundred percent of the time-

Carol (16:29):

(laughs)

Julie (16:35):

And probably not really most of the time-

Carol (16:36):

(laughs)

Catherine (16:36):

(laughs)

Julie (16:38):

If I'm being totally honest, but recognizing that I'm feeling a certain way, and I have four patients that are all really busy and I'm running around, whatever, but letting myself get overstimulated, I don't want to bring down those around me. And I feel like sometimes-

Carol (16:38):

Mm-

Julie (16:50):

I do that. I'm very-

Carol (16:51):

Self-awareness, yeah-

Julie (16:51):

Yeah-

Carol (16:51):

Sure.

Catherine (16:51):

Mm-hmm-

Julie (16:53):

I'm even aware when I'm doing it, and I just still continue doing it. (laughs)

Carol (16:53):

Mm-hmm!

Julie (16:56):

It's hard, but-

Carol (16:57):

Yeah-

Julie (16:57):

Being honest with yourself, checking in with yourself, but also checking in with your coworkers, because the people around you, you're with them for 12 hours a day.

Carol (17:05):

Right.

Julie (17:05):

And the- sometimes they spend more time with you than they do with their own family.

Carol (17:08):

Yeah-

Julie (17:09):

And, you know, we don't all get time to sit and chat and say everything that's going on in our lives, but you don't really know what's going on-

Carol (17:15):

Sure-

Julie (17:16):

In the life of the person sitting next to you. And we're surrounded by these patients, trying to care for them; it could very well be some of the worst days of their lives.

Carol (17:16):

Yeah-

Julie (17:23):

But also, the people around us at the nurse's station-

Carol (17:27):

Mm-hmm-

Julie (17:27):

The people who walk among you, it could be some of the hardest days of their lives as well. So-

Carol (17:27):

Sure-

Julie (17:31):

Uh, kind of being cognizant of that and respectful and trying to be empathetic to your coworkers, and then also empathetic with yourself-

Carol (17:39):

Yeah.

Julie (17:40):

Nurses, I feel like, are perfectionists; you just want to do the best thing-

Carol (17:40):

(laughs)

Catherine (17:40):

Yeah-

Carol (17:40):

(laughs)

Julie (17:43):

A hundred percent of the time. And just know that it's mostly not going to go that way.

Carol (17:47):

(laughs)

Julie (17:47):

Uh, but you're going to do your best-

Carol (17:49):

That's right, yeah, that's right-

Julie (17:49):

And you're going to do it-

Carol (17:49):

Yeah-

Julie (17:50):

As long as nothing terrible happens-

Carol (17:52):

That's right-

Catherine (17:52):

Mm-hmm-

Julie (17:52):

You know, things happen, and cutting yourself a break, and definitely sleeping a lot.

Catherine (17:52):

(laughs)

Carol (17:52):

Yeah, that's right-

Julie (17:57):

Whenever you can-

Carol (17:58):

That's right-

Julie (17:58):

If you have time. Yeah-

Carol (18:00):

(laughs) That's right, especially... We- We have a separate e- episode o- on sleep habits, everyone, so go back and check on that-

Catherine (18:00):

(laughs) Right

Carol (18:05):

Episode. Beautifully said. And when you think about... I love how you talked about being overstimulated because I don't think we acknowledge that enough. You think about-

Julie (18:13):

Yeah-

Carol (18:13):

You know, a m- a busy medical-surgical unit, you've got this IV pump and that oxygen sensor and this chair alarm, and all of that, that's-

Julie (18:13):

Mm-hmm-

Carol (18:22):

I think that's a beautiful call-out that I don't think we recognize enough, that, you know, maybe I'm just overstimulated.

Julie (18:26):

I think I definitely recognize it enough, I'm, like, const- Cathy's like, "Hi, how are you?" I'm like, "I'm overstimulated."

Carol (18:26):

(laughs)

Catherine (18:31):

(laughs)

Julie (18:31):

We- Just the other day, like, we had a rapid-

Carol (18:31):

Yeah-

Julie (18:34):

On our pod, and Cathy had come down-

Carol (18:34):

Mm-hmm-

Julie (18:36):

I have so much respect for Cathy and the work that she does-

Carol (18:36):

(laughs)

Julie (18:39):

Because she's in a role that also affects, like, decisions for-

Carol (18:42):

Absolutely-

Julie (18:42):

Bedside nurses-

Carol (18:42):

Yeah-

Catherine (18:42):

Mm-hmm-

Carol (18:42):

Yes, mm-hmm-

Julie (18:43):

It affects our day-to-day work and our processes. But Cathy's still someone who comes down to the units and is on the floor.

Carol (18:49):

Mm-hmm.

Julie (18:50):

And I walked out of a room, I'm like, "Oh my gosh, she needs to be turned, she's in so much pain, this person needs this." And I'm trying to help the other nurse who's dealing with a rapid, and Cathy's like, "Well, I'll go do something. Which one of those do you want me to do?" I'm like, "Okay, thank you-"

Carol (18:51):

(laughs)

Julie (19:02):

"That's one less thing," then I'm like, "All right, maybe I'm being a little dramatic." Like, (laughs) I'm really checking these tasks off really quickly, with help. But I really respect Cathy for how much she comes down and-

Catherine (19:12):

Well, thank you-

Julie (19:12):

Jumps in there with us and is always educating us causse we don't know it all.

Carol (19:16):

Yeah. Well, lots to figure out in that smorgasbord. (laughs)

Catherine (19:20):

(laughs) Yeah, that's, that's okay, I- I don't know it all-

Carol (19:22):

Yeah-

Catherine (19:22):

Either, by any means, I just know where to find a whole lot of it.

Carol (19:25):

Yeah.

Catherine (19:25):

And just to jump off of what-

Carol (19:28):

Mm-hmm-

Catherine (19:28):

Julie was just talking about, Julie, the story you were telling, you were saying, well, all these tasks, really-

Carol (19:28):

Mm-hmm-

Catherine (19:33):

You know, they were all patient care: this patient needs to be turned, they're in pain. You're assessing their pain, you want to intervene, you want to try to treat their pain. You're mentoring and supporting your coworker, who's-

Carol (19:34):

Mm-hmm-

Catherine (19:45):

In the middle of a rapid response, a patient emergency, and you're also supporting that patient-

Carol (19:45):

Right-

Catherine (19:50):

In that emergency, so you're going to bring your clinical judgment, you're going to bring your brain, you're going to bring your heart to that situation, and give support. So, there's so much-

Carol (19:50):

Beautifully said-

Catherine (20:00):

That's behind the-

Carol (20:01):

Yes-

Catherine (20:02):

The task-

Carol (20:02):

Yeah! No-

Catherine (20:02):

Yeah-

Carol (20:03):

I think that's perfect because, uh, even thinking back to way back (laughs) when I was a new graduate-

Catherine (20:03):

(laughs)

Carol (20:06):

Right, what did we talk about?

Catherine (20:07):

Yeah-

Carol (20:08):

I haven't had enough IV starts or I, I haven't had enough urinary catheter insertions.

Catherine (20:11):

(laughs)

Carol (20:12):

Um, and so it's so easy to get into that mindset versus... it's about critical thinking, it's about prioritization.

Catherine (20:19):

Yes-

Carol (20:19):

So, from each of your vantage points, knowing that a, a lot of us, if not all of us, (laughs) come out of nursing school... yes, we're taught critical thinking and the nursing process, but it doesn't all click yet, right? We're- We're-

Catherine (20:29):

Right-

Carol (20:29):

Too novice in our thinking, and so we go back to those tasks. What can we do to help that nurse evolve sort of in that piece to remember that it wasn't about the tasks, it's about the critical thinking, it's about the prioritization, it... Some of that is definitely not book-learned, so how do we help nurses get to that stage where they can remember that their bringing their full, full selves to those tasks?

Catherine (20:51):

Well, it has to start early.

Carol (20:53):

Mm-hmm-

Catherine (20:53):

It has to start with, you know, with that orientation, with that resident, with the new nurse. Uh, you know, that- that's when it- the, the ground is the most fertile, right?

Carol (21:01):

(laughs) Yeah, yeah-

Julie (21:01):

Mm-hmm-

Catherine (21:01):

It's when we're- we're the most subject to the, the right influences. And saying, you know, you did these things, that's just what people saw. But when you were in that room, and you were-

Carol (21:12):

Mm-hmm, pointing it out, yeah-

Catherine (21:12):

Calling, right-

Carol (21:13):

Yeah-

Catherine (21:13):

You were calling the provider, you were trying to get help, why was it? Because you saw this, you heard that. You... Maybe you smelled something, you felt something, and the-

Carol (21:13):

Mm-hmm-

Catherine (21:22):

It wasn't right. And then those pieces click together in your head. That was the value that you brought to that situation, that's what you brought to that bedside. Calling it out-

Carol (21:32):

So, pulling them into the [inaudible 00:21:32]

Catherine (21:32):

And not talking it for granted. Yes-

Carol (21:32):

Okay-

Catherine (21:34):

Yes, absolutely.

Carol (21:34):

All right-

Catherine (21:34):

Absolutely-

Carol (21:35):

Julie, any, any other thoughts?

Julie (21:37):

I think I would definitely agree with Cathy that it starts at the beginning of-

Carol (21:38):

Mm-hmm-

Julie (21:41):

You’re training. But also, like, just never stop asking the question, "Why?"

Carol (21:45):

Mm.

Julie (21:45):

This is not an original thought of my own, but someone-

Carol (21:45):

(laughs)

Julie (21:48):

One time said that you have to ask why, like, seven times to get to, like, the root cause-

Carol (21:53):

Yeah!

Julie (21:53):

Have you ever heard that before?

Carol (21:53):

The five why's, yes-

Julie (21:55):

Yes, okay-

Catherine (21:55):

Yeah-

Carol (21:55):

(laughs)

Julie (21:55):

Maybe it's just five, I've-

Carol (21:56):

That's all right-

Julie (21:56):

I've been overdoing it. (laughs)

Catherine (21:57):

(laughs)

Carol (21:57):

Hey, sometimes we need more, right?

Catherine (21:57):

Yeah, yeah.

Julie (21:59):

But, like, when you're in orientation, and you're sitting there-

Carol (21:59):

Mm-hmm-

Julie (22:01):

With the nurse, and they're like, "We're going to go see this patient," why? Why are we seeing them-

Carol (22:05):

Yeah-

Julie (22:05):

First?

Carol (22:05):

Yeah.

Julie (22:06):

Okay, I'm going to hold this med, but why?

Carol (22:08):

Mm-hmm-

Julie (22:08):

Their blood pressure's r- low. Why?

Carol (22:10):

Right-

Julie (22:10):

You know?

Carol (22:11):

Yeah-

Julie (22:11):

Trying to-

Carol (22:11):

Absolutely-

Julie (22:11):

Figure that out. And making note of it. And also, as our... I don't know, I've been a nurse for about six years-

Carol (22:17):

Okay-

Julie (22:18):

But y- you know, thinking when I have a student with me, you have to remember how you felt when you were...

Catherine (22:23):

Yes. (laughs)

Carol (22:24):

Yes-

Julie (22:24):

Yes, when you first start out-

Carol (22:24):

Yes-

Julie (22:24):

You're so scared-

Carol (22:26):

I'm a new nurse, I'm a student-

Catherine (22:27):

Yeah-

Julie (22:27):

Yeah-

Carol (22:27):

I'm terrified-

Julie (22:27):

You're shy-

Carol (22:28):

Nice-

Julie (22:28):

You're so nervous to s- like, say, like, I don't know something.

Carol (22:31):

Mm-hmm.

Julie (22:31):

That's the time-

Carol (22:32):

Mm-hmm-

Julie (22:33):

To say you don't know. But even beyond that...

Carol (22:35):

Mm-hmm-

Julie (22:36):

You should absolutely feel comfortable speaking up and admitting that you don't know something and seeking clarification. But yeah, to those nurses that have more experience, and you're taking those students on-

Carol (22:46):

Mm-hmm-

Julie (22:47):

Remembering how you felt, and remember to give them a little bit of explanation-

Catherine (22:50):

Mm-hmm-

Julie (22:50):

Because sometimes we forget-

Catherine (22:52):

Mm-hmm-

Carol (22:53):

Yes-

Julie (22:54):

How much we know-

Carol (22:54):

It makes the difference, yeah-

Julie (22:54):

Yeah-

Carol (22:54):

Yeah-

Julie (22:54):

It's like, you don't know how much you know, and when you're talking to them, I'm like, did I just like really simplify that, and I- I missed like 10 steps along the way-

Carol (22:54):

(laughs)

Julie (23:01):

So, you're never going to connect those two thoughts-

Catherine (23:01):

(laughs)

Carol (23:03):

(laughs) You know, this episode is technically about medical-surgical nursing-

Catherine (23:04):

Yes-

Carol (23:06):

But I feel like we've talked about things that are universal to nursing. And you guys have been so wonderful to have on. I want to close this topic out, knowing that we could talk about this for hours-

Catherine (23:17):

Mm-hmm-

Carol (23:17):

But, you know, there are listeners who are nearing the end of their nursing school career, or they're feeling restless.

Catherine (23:24):

Mm-hmm.

Carol (23:24):

Why should they honestly consider medical-surgical nursing as a specialty and not as a stepping stone?

Catherine (23:30):

Well, I think it was actually in one of the Consult QD articles from Cleveland Clinic-

Carol (23:30):

Mm-hmm-

Catherine (23:35):

That referred to medical-surgical nursing as the backbone-

Carol (23:39):

Yeah-

Catherine (23:39):

Of nursing-

Carol (23:39):

Mm-hmm-

Catherine (23:40):

And I just thought that was great because it runs through-

Carol (23:40):

Mm-hmm-

Catherine (23:45):

All of nursing-

Carol (23:45):

Mm-hmm-

Catherine (23:46):

And the skills cross what- whatever other specialties you may find yourself in throughout your career. And it is structural-

Carol (23:54):

I like that-

Catherine (23:54):

It holds it up, but it's not at the bottom, you- you know, it's not the base-

Carol (23:59):

(laughs) It's not the foot-

Catherine (23:59):

It's not the bedrock. It's not the foot-

Carol (23:59):

(laughs)

Catherine (24:01):

That's right, it's not on the floor. But it gives that structure. So, by all means, give medical-surgical nursing that chance-

Carol (24:09):

Mm-hmm-

Catherine (24:09):

And you'll be amazed at what you find. And if I could shamelessly plug-

Carol (24:15):

Do it-

Catherine (24:15):

Our professional organization-

Carol (24:17):

(laughs)

Catherine (24:17):

The academy of medical-surgical nurses-

Julie (24:17):

(laughs)

Carol (24:19):

Yeah!

Catherine (24:19):

The largest representative of, uh, the largest nursing specialty.

Carol (24:24):

Mm-hmm-

Catherine (24:24):

That there is right now. We are a great organization looking to move medical-surgical nursing forward, further advance the reputation of the med-surg nurse as well as the clinical acumen. So-

Carol (24:38):

Great-

Catherine (24:38):

Amsn.org-

Carol (24:39):

(laughs)

Catherine (24:40):

Check it out.

Carol (24:40):

And... You know, when- when you talked earlier, Julie, about networking, what another great resource that, you know-

Catherine (24:45):

Right-

Carol (24:46):

Folks who don't have the blessing of having a- access to clinical nurse specialists like we do, there's other places you can get that level of support.

Catherine (24:52):

Yes.

Carol (24:53):

Julie, now I'll turn to you. Why med-surg nursing?

Julie (24:56):

I mean, I kind of touched on this before, but it really is a sampler of-

Carol (24:56):

(laughs)

Julie (24:59):

All these different disease processes-

Carol (25:01):

Mm-hmm-

Julie (25:01):

And types of patients. So, if you want to figure out what you like, what you don't like, what you're super, super passionate about, then med-surg is a great place for that. And for as long as it's been around, it is by no means a perfect system. There are so many problems, but instead of looking at it in a negative way-

Carol (25:18):

Mm-

Julie (25:19):

There's so much room for improvement.

Carol (25:21):

Yeah-

Julie (25:21):

So, people who are innovative, like-

Carol (25:21):

Yeah-

Julie (25:23):

That's a place where you can, you know, think, "I have this [recurring 00:25:26] problem, you know, every shift." You're not the only one who's experiencing that-

Carol (25:23):

Right.

Catherine (25:23):

(laughs)

Julie (25:31):

What's the solution? And so that's where networking comes along as well-

Carol (25:31):

Mm-hmm-

Julie (25:34):

Is like, you know, figuring out, even if it's just improving a process, figuring out who's the stakeholders there-

Carol (25:40):

Mm-hmm-

Julie (25:40):

Who can I reach out to get this accomplished? But also, like, coming up with the product development and stuff like that-

Carol (25:40):

Sure!

Julie (25:45):

I know we've had a- quite a few nurses within Cleveland Clinic do that-

Carol (25:45):

Mm-hmm-

Julie (25:48):

And were very successful. So, med-surg is definitely a place that could use a lot of innovation and energetic people, so it's definitely a good place to start out for new nurses. You get a lot of experience, and you learn a lot very quickly, but you learn a lot about yourself, and I think you grow a lot-

Carol (25:48):

Mm-

Julie (26:05):

As a person as well.

Carol (26:06):

Beautifully said. All right, well, we've come to the speed round part of the episode-

Julie (26:06):

(laughs)

Carol (26:10):

Where we like to let our guests learn a little bit more about you as the amazing human beings you are, in addition to being amazing representatives of your specialty. So, I'll let whichever one of you wants to go first, but same question to you both. What's the best advice you've ever received?

[NEW_PARAGRAPH](laughs) As they're looking at each other [inaudible 00:26:27]

Julie (26:10):

Do you want me to go?

Catherine (26:27):

Go ahead-

Carol (26:28):

All right, go for it, Julie. (laughs)

Julie (26:29):

Well, actually, I have two.

Carol (26:30):

Okay-

Julie (26:30):

One is from Megan Edwards, she's a nurse at Fairview Hospital as well-

Carol (26:35):

Great-

Catherine (26:35):

Mm-hmm-

Julie (26:35):

And, uh, she's such a mentor to me, but I would, uh, be like, "You know, I'm really upset about this." And she's like, "Is it a person problem or a process problem?"

Carol (26:41):

Oh-

Julie (26:42):

Are you reacting like, "I'm offended because I'm, uh, I'm put- making it like it's a jab against me, or-"

Carol (26:42):

Mm-

Julie (26:48):

Is there a process here that's caused two people to both be frustrated, and now I'm making it about me? So-

Carol (26:54):

Oh, that's... that's good.

Julie (26:56):

I know-

Carol (26:56):

That's really good-

Julie (26:56):

That's helped me a lot-

Carol (26:56):

(laughs) Yeah-

Julie (26:58):

And then this was never advice that was given to me, but it's something that my uncle Bob-

Carol (27:04):

Mm-hmm-

Julie (27:04):

Said, and it's online somewhere in a newspaper article about him-

Carol (27:07):

Hmm-

Julie (27:07):

But he mentioned the two concepts of unconditional love and purpose. And he didn't mean anything remotely related to nursing when he said that.

Carol (27:17):

(laughs)

Julie (27:17):

But I have always... I have it tattooed on my hand-

Carol (27:21):

Mm-

Julie (27:21):

And I feel like that is nursing; everything that we do is love for a complete stranger, for humanity-

Carol (27:29):

Mm-

Julie (27:29):

For our coworkers. And we know what our purpose is, and that's to comfort and heal and care. So, whenever I get frustrated, I just kind of think about those two things. I think they're my guiding principles. But maybe it's a little corny, but-

Carol (27:42):

I love it. Ooh, you've- you've got... you've got a hard act to follow there. (laughs)

Catherine (27:46):

I know-

Carol (27:47):

[inaudible 00:27:47]

Catherine (27:47):

I was actually going to go with, I had advice from my best friend who told me one time, "Well, be afraid and do it anyway."

Carol (27:55):

Ooh-

Catherine (27:55):

And it goes along with a favorite quote of mine from Amelia Earhart, who's been a hero of mine since childhood-

Carol (28:03):

Mm-hmm-

Julie (28:03):

Uh-huh-

Catherine (28:03):

That "Courage is that price that life demands for granting peace."

Carol (28:07):

Ooh-

Catherine (28:07):

And... Uh- Uh, right? But it- And it's-

Carol (28:09):

I just got goosebumps.

Catherine (28:10):

Uh, it sounds-

Carol (28:10):

Yeah-

Catherine (28:10):

It sounds so big-

Carol (28:12):

Mm-hmm-

Catherine (28:12):

it sounds so big, but it- it sometimes comes down to those moments-

Carol (28:14):

Mm-hmm-

Catherine (28:15):

Of getting ready to walk into the room where you know somebody's not happy with you, or-

Carol (28:20):

Sure. (laughs)

Catherine (28:21):

Something's wrong and you don't know what yet, and you're trying to figure it out-

Carol (28:25):

Sure-

Catherine (28:25):

How am I going to solve this problem? This person really needs me-

Carol (28:25):

Mm-hmm-

Catherine (28:29):

To solve this, and it's really scary. But someone else needs you, even if they're not happy with you, they need you. And for their sake, you just be afraid and do it anyway.

Carol (28:41):

I love it.

(28:41):

Ladies, thank you so much for joining me today.

Julie (28:43):

Thank you so much for having us-

Catherine (28:44):

Yes, thank you. Appreciate you, Carol.

Carol (28:51):

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.

(29:11):

To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing.

(29:17):

Until next time, take care of yourselves and take care of each other.`

(29:25):

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.