Differences, Not Deficits: Embracing Neurodiversity

Podcast Transcript

Carol Pehotsky (00:05):

We all want to be seen as individuals in this world, and we all want that individualized care when the need arises. This holds just as true for patients who are neurodivergent. But as nurses, we might not always feel equipped to provide that individualized care. We're joined today by Travis Haycook and Lori Matich to learn more about how to provide individualized care to patients who are neurodivergent.

(00:29):

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.

(00:50):

Welcome back, everyone. You know, throughout the almost two years of Nurse Essentials, as we've pondered what topics to bring that might be of interest and of value to our audience, you'll remember we've had episodes where we've talked about the unique needs of patients or sometimes the unique needs of nurses. And really thinking about there's so many ways t- to meet the patient where they are. And we ha- of course always wanna treat our patient as an individual, but sometimes even within that space we don't always as nurses know to even start approaching patients, how to best meet them where they are, how to assess where they are and really meet what they need from us in a way that isn't painting with too broad of a brush, right? And so one of the themes that has come up, we've heard it actually from our listeners who have attended conferences is really wanting to learn more about the nursing care of patients who are neurodivergent, or how to support those of us who are nurses who also identify as being neurodivergent.

(01:45):

And so that's our topic for today, and I'm so thrilled to be joined by two content experts in this space. We have with us today Travis Haycook. Travis is assistant director of Cleveland Clinic Children's Autism Development Solutions. And we also have Lori Matich with us. She's a senior director of nursing at Cleveland Clinic Tradition Hospital in lovely Florida. Good afternoon to you both. Welcome.

Lori Matich (02:04):

Thank you for having us.

Travis Haycook (02:06):

Thank you so much.

Carol Pehotsky (02:07):

So I hope for each of you you will be kind enough to share with us a little bit ab- about your background and what gets your passionate about working with patients who are neurodiverse.

Travis Haycook (02:16):

For me, I've worked with patients with autism for nearly 30 years.

Carol Pehotsky (02:16):

Hmm.

Travis Haycook (02:22):

I started r- at undergrad, and for me, it was an accidental happiness, I guess-

Carol Pehotsky (02:29):

(Laughs)

Travis Haycook (02:29):

Is the best word for it. I started to work with this population, uh, with an adult with autism, and after doing it for one week, I... at that point, it's this is what I was meant to do. I find it so... I've always found it so amazing, and I just... and I loved working with the group. And to me, it's such a, an amazing diagnosis, and it's something that I just... I love working with the population, seeing the changes and learning more about the way that they think. And that's for me what guides me every day.

Carol Pehotsky (02:59):

Yeah, no kidding. And, Lori, for you?

Lori Matich (03:01):

Well, I've been a nurse for over 30 years. Majority of my career was spent working in, clinically in neonatal ICU and in pediatrics. And so obviously I have a love for babies and children. That's where I got my first experience with children with neurodiversities. I would say that most recently it was in position here as senior nursing director at Tradition Hospital, and I've overseen all of nursing, including the emergency room. And what really sparked my passion about this subject and obviously our, our project was that I was hearing from the caregivers in the ED about patients who would come in and, and they felt helpless, and they didn't know how to care for patients who were neurodivergent, whether they were a young child all the way up to adults. And they expressed the need for tools, resources, education, and tapped into caregivers who are touched with neurodivergence in their families. They're the real subject matter experts. And that's what led to us here at Cleveland Clinic Martin Health putting our group together to work on this very important project for our patients.

Carol Pehotsky (04:20):

Excellent. And we'll, and we'll get into the nitty-gritty of that in a moment. To start us off, Travis, would you mind sharing with our audience how to you define neurodiversity?

Travis Haycook (04:28):

Well, neurodiversity, the term itself was originally said by an Australian sociologist, Judy Singer, and it had to do with coming up with a different way of describing somebody without using the terms of, say normal versus-

Carol Pehotsky (04:43):

Mm.

Travis Haycook (04:43):

Abnormal.

Carol Pehotsky (04:43):

Sure.

Travis Haycook (04:45):

When we think of neurotypical versus somebody who might be diagnosed with some type of disorder, it just... it didn't seem to fit well. So for me, thinking of the term as neurodivergent, it just speaks that all brains are different, and everybody has different ways of thinking. No, no two of us process information the same way, and no two of us react to certain situations in the same manner. So having a term like that, that's what it means to me. It means that everybody approaches it very uniquely. And to think of it like biodiversity. There's a lot of differences, a lot of different types of things in the environment. Neurodiversity is no different than that. It just states that everybody's brain is different. We're all individual. And recognizing that, I think, is really important.

Carol Pehotsky (05:33):

And so when we think about sort of... Uh, I like your comparison of, you know, disorder, right. That, that often creates a deficit-based fe- thinking. And it... And r- researching for this episode, I read a lot about it's really about different, not deficit and really how we meet people where they're at in terms of how their brain works. Can you, can you give us a little more information about how we do that?

Travis Haycook (05:54):

Y- Yeah, I mean, that's... You're spot on with that. It's n- not recognizing something as somebody with a disorder, meaning they, uh, they have a disordered way of thinking. It's just a different way. So what we try to do is when we're working, at least with our autism population, is we, we recognize that, that everybody has a unique way of looking at it. Everybody has a unique approach to things. Everybody has a unique response to certain behavioral situation. So when we're working with patients, we're keeping that at the forefront. We're recognizing that this might very well be the case, that they're not hearing it the way that we're explaining it, or they're not interpreting it the way that we're explaining it. So rather than in a previous model we might be... we keep saying the same thing over and again, explaining it the same way, we recognize that, okay, this is something that we need to ask them different questions. Maybe we need to give them the opportunity to ask us a little bit different questions to get an idea of how they're hearing what we're saying. And I think the key to it is making sure that our caregivers understand that and they recognize that when they're working with a patient, getting information is critical and also not getting stuck in that rut of thinking this is how I've always done it, so-

Carol Pehotsky (05:54):

Mm-hmm.

Travis Haycook (07:08):

So this is how I'm always gonna deal with every patient.

Carol Pehotsky (07:11):

So if each of you will consider for us, since you're with our audience, you know, when you read the literature, it, it really shows that people who have autism, people who have ADHD or, or any type of neurodivergence often access healthcare less than others because there are barriers that come with trying to come into our doors. You know, Travis, I think you're spot on with, with maybe we're not using the right techniques or being welcoming enough or meeting people where they're at. So can you expand a little bit more for our audience in terms of what are some of the things that we basically take for granted in the healthcare setting, the way it looks, the way it sounds, the way it smells, that we need to be thinking of for our patients who are neurodivergent?

Lori Matich (07:48):

Well, I can speak to that-

Carol Pehotsky (07:48):

Mm-hmm.

Lori Matich (07:50):

Because that's actually what led to our project here. So, you know, if you can imagine an emergency department in the middle of season when, you know, we have patients in every room and they're in the hallway and it's busy and it's loud and there's a lot of activity going on, that can be stressful to anybody, you know, let alone someone who has a- any type of a, a neurodivergence, a sensory disorder, you know, whatever that might be. And so that led us to discussing and thinking about what are the tools that we can provide for our caregivers to help with that? Is it noise reduction? Is it lighting? Is it distraction items? What are those things that we can have readily available to the caregivers in the EDs particularly to help with some of that sensory overload and stress and frustration that our patients feel when they come into the emergency department?

Carol Pehotsky (08:51):

Sure. Any other things we should be looking out for, Travis, in terms of working in different spaces and things we should be assessing and be prepared to accommodate?

Travis Haycook (08:59):

Right off the bat, understanding there may be sensitivity. There might be [inaudible 00:09:03] to sounds. When we're in an environment in a hospital, even in an, in an ED, emergency department, there are a lot of sounds that are going on that we're tuning out. We need to be aware that somebody who might be neurodivergent may be hearing that. That may be overwhelming to them. Understanding that right off the get-go, from the first moment they walk in and then to the next level of what's the process going to be? We tend to know when we walk in and if there's a, a group of people. There might be a line and we're gonna stand in a line. I know... We know the process we need to check in. Maybe having somebody be aware that maybe there needs to be a little extra assistance or a different way of explaining it, of explaining the whole procedure of what's gonna happen, instead of, "Look, we're gonna take you back." It's like, "Okay, we're going to go through these doors, and then we're gonna go down through the hallway to the right. There's gonna be an x-ray machine that's gonna be a, a darker room. There's gonna be a table. We're gonna go in there. It's like a giant camera," and giving a lot more information as specifically what it's going to be like.

(10:02):

Is it going to be dark? Is it gonna be loud? Are there gonna be other people in there when you come in? Things like that, being able to explain what we're doing. In healthcare we're so used to doing things quick, saying things, "This is what we're doing," and... or, "We need to do this now," but not really explaining it to the point that it's computized, that's it's in a very direct way, "This is exactly what's going to happen." So being aware that that might be something that we may need to do more explanation of. And I think that even gets even beyond working with somebody who might be neurodivergent. I mean, there a lot of times in healthcare where even... regardless of what the procedure is, a lot of times we're not told exactly what's gonna happen, and there's a lot of questions. So we walk around with that big question bubble over our head.

Carol Pehotsky (10:52):

I, I think that's a great point. As you were describing that scenario, I think about, you know, even as somebody who usually is fairly informed about what's happening when I'm the patient, there's (laughs) still some anxiety that what's gonna happen [inaudible 00:11:02]? So really embracing that into our everyday practice is gonna be an accommodation for somebody who's neurodivergent, but really good care for anyone who has a little bit of anxiety or just unknown. And we know that we all walk around with biases, right? It's about servicing those biases, acknowledging them, working through them. That's just part of being a human being. So what are some biases that you each see in terms of how we care for patients with neurodivergence that we need to be thinking about? Do I have that bias? And what do I need to do as a nurse, as a healthcare provider to really make sure that I'm tackling that bias and eroding it away?

Lori Matich (11:35):

Well, I think for me and for nursing, it's a bias that Travis actually helped us understand when he came to do some education down here in Florida for us, and it's that all patients with neurodivergence are the same, a- you know, but there's, you know [inaudible 00:11:56]. That's why they call, you know, autism spectrum disorder, for example, because it is a spectrum, right? I, I think that we had a bias that they're all the same, they're all, you know, have the same stress, frustrations. Even that came out in just the way we were caring for patients who were neurodivergent. We just assumed that they would be impulsive, that they would act out, that they would be difficult, if you will, you know, and that just comes from not knowing and, and not having the education and not having the tools and resources to really provide that inclusive, but also very individualized care, you know, that, that we need to be providing to patients.

Travis Haycook (12:39):

Yeah, to almost piggyback on what Lori was just saying, I think that's absolutely the case. Everybody has a, a previous experience with someone with autism, and that becomes their, their benchmark or their point of reference. And it's... even subconsciously they may see on a form that this, this individual is diagnosed with autism, so they're going to that experience and they're expecting that person to be exactly like the person that they've seen with autism before. And that is not the case. There is a researcher named s- Dr. Stephen Shore, and he said, "If you've met one person with autism, you've met one person with autism." No truer statement has ever been made, because you can try to say, well, everybody with autism does this or everybody with autism does that or everybody with autism likes this or doesn't like that, and that's not the case.

(13:29):

And unfortunately I think that bias comes out when a patient comes into the hospital and they're seen by a clinician, uh, that they're expecting it to be a certain way, and then when it doesn't go that way, instead of thinking, huh, you know, this, this is interesting, this person, they see things a little bit different, they s- almost try to, to push that point, like, okay, well, no, I... this is how it's supposed to be. And I think that unfortunately does come into play. So the more information that's out there, that... the more people have a better understanding of the neurodivergent population, their approach will begin to change and they can let go of some of those previous experiences. [inaudible 00:14:13] we take that into everything that we do, but I think in this case, that's a big issue that can be addressed successfully.

Carol Pehotsky (14:21):

Sure. And, and when you think about, you know, other neurodivergencies like ADHD, the... again, I think, uh, the wisdom reigns true, you know, if you've met one person with ADHD, you've met (laughs) one person with ADHD, how they present. You know, whether it's someone in your family, somebody you work with, somebody who's kiddo lives down the street, we're all people who deserve that individualized care. And it's really about learning from the patient, the patient's parents if they're a minor, or, or whoever their support person is, who is this person and how do I best support them through their healthcare journey? You guys have done a really nice job of talking us through some really good verbal techniques to really help really any of us (laughs) go through our healthcare journey. What are some other things, other techniques, whether that's non-verbal or other approaches that nurses can take and can advocate to be done with the rest of the interprofessional team t- caring for a patient?

Lori Matich (15:09):

Well, one of the, the things we've learned through our project that I know we'll discuss in more detail later is involving the parents or caregivers of the patients, talking to them about what does your child or loved one like? What do they not like? Travis told us a great story when he was here, and it kinda hits home because it's about Mickey Mouse (laughs) and Disney World. And he said, "You know, you would think that every child in the world loves Mickey Mouse," and he w- uh, knows a child who's terrified of Mickey Mouse, right? And so just making sure that make it very family-centered, talk to families, take their input. You know, I, I have a, a story that came about, which also led to some of the work that we're doing here, where I, I was talking to a mom with a child with autism who is in our emergency department who really felt like she was not listened to. And that hit home to me, you know, for her child or for anybody that's in the emergency department. And, you know, she was trying to explain, you know, she knew her child wasn't gonna take an oral med. She knew her child was going to react in a certain way to things. And we definitely had an opportunity to listen to her more.

Carol Pehotsky (16:27):

Mm-hmm.

Lori Matich (16:27):

I think that's very, very important.

Carol Pehotsky (16:29):

Travis, any other th- other techniques we should be considering, especially when we think about our non-verbals, right? We're, we're, we're walking in to any patient encounter. Sometimes it's hard to check our (laughs) non-verbals at the door. What are some things we can do to help build trust?

Travis Haycook (16:42):

I think it starts with the approach. You don't wanna approach our individuals too quickly.

Carol Pehotsky (16:48):

Mm-hmm.

Travis Haycook (16:48):

You don't wanna approach them from the side of the back where you s- startle them maybe. Have them see you coming. I do agree with Lori 100%. Talking to the caregivers who might be with the patient is very important to find out any information that might be pertinent to that situation. If you have items that you're gonna offer them maybe as calming items, I would have them visually out there, that they can see it, maybe instead of just bombarding them with a whole s- tub of something. Maybe have a larger picture menu of things, like we have these, and they can point to what they might want to investigate more. Fidget spinners might be something that one of our individuals really loves. Fidget spinners may not be. So I think that is helpful. And also using clear language, using, uh, less language, not using any jargon, being more direct in a, a level that you're using a few words. A lot of times some of the best ways to communicate to somebody if you want them to stand up is to say, "Stand up." Things like that, approaching it at that level is very helpful.

(17:54):

Be aware of things that might be in the room. Be aware of the environment. Is it too warm? Is it too cold? Is there a fan on? Is it blowing right on the patient? Is it, the fan making it colder? Is the fan making a different noise? Being aware of those type of things. But also as a caregiver, paying attention to the patient. Watch what they're doing. What are they looking at? What are they orienting to while you're in there? Is there something that's taking, that's peaked their interest? Things like that. Watch how they're looking at you. What, what... Are you doing things with your hands that's making them look to you that might be frightening them?

Carol Pehotsky (17:55):

Hmm.

Travis Haycook (18:33):

Things like that. Just being, being more aware of our place in space around the patient is helpful.

Carol Pehotsky (18:41):

So as promised, Lori will talk about (laughs) the s- really f- real exciting work that you and your team have done. Tell us a bit more about the sensory carts, how they came to be, where they are at and where you're looking to go next with this.

Lori Matich (18:53):

So when we decided that we wanted to start with providing some tools and resources to our caregivers, we knew that it wasn't gonna end there, that there was going to... It was ongoing work we wanted to do. So we thought, well, let's start small. Let's put our group together. Reached out to a few subject matter experts. I had the opportunity when I was Ohio to meet with Travis out at the School for Autism and got to ask him a ton of questions, and he provided us with so much of his expertise and knowledge as well. So decided to keep the scope of our project small at first. And so we have a cart in each of our four emergency rooms here at Cleveland Clinic Martin Health. We have one in each of our ambulatory pediatric offices. And we have one on our pediatric unit here at Tradition Hospital. Um, by no means was this geared towards just pediatric patients however. It's all patients that would benefit from the cart.

(19:57):

So from our subject matter experts, we put a list of things together that we thought would be great tools in the cart. So we have picture cards for patients who might be non-verbal. One of my caregivers came to me one day. They were just heartbroken that they had a patient that they were caring for that was non-verbal, had been just dropped off my their caregivers, and the patient had no way to even say, you know, I'm thirsty. I need a drink. I need a sandwich. I'm hungry. I'm in pain. No way to communicate whatsoever. So we, we really honed in on that. We have, like Travis mentioned, fidget toys, fidget spinners. We put little kinda nightlight lamps in, so for patients that might have a sensitivity to light we could turn the lights down in the room and have, you know, the, the nightlights. We have activity boards. We have story books with textures on them. And we have noise-canceling headphones. So we really try to run the gamut. You know, like Travis said, not every patient's gonna like everything in the cart, but we did put kinda little menu cards together where they could point and say, "You know, my child would, you know, really like this," or, you know, "My loved one would, would really benefit from having a nightlight," or whatever.

(21:16):

So it, it really has been great to get feedback on that from patients and families and from caregivers that have really appreciated. Even though it's something that seems so small, it means a lot-

Carol Pehotsky (21:17):

Mm-hmm.

Lori Matich (21:30):

That we are putting effort into this and want to do what we can to provide more inclusive care. That was, you know, part of the title of our project-

Carol Pehotsky (21:30):

(Laughs)

Lori Matich (21:39):

Was Providing Inclusive Care. So yeah.

Carol Pehotsky (21:42):

One... And it's a beautiful marriage of making sure your team got the right education as well as-

Lori Matich (21:47):

Yes.

Carol Pehotsky (21:47):

These resources so they can use them more effectively. And to our audience, there was a lovely article posted on our organization's internet page. And so looking at that, right before I came over, just countless comments from a lot of people saying, "When can you come (laughs) to us?" (Laughs) So, so, Travis, no shortage of work for you to do (laughs) in the foreseeable future. And everybody's eager to get one of these carts, but also really, uh, just... it's just so interesting how people sometimes poor their hearts out in front of like public spaces, you know, stories of, of moms or dads or caregivers who as patients, you know, said, "I really could've used this," or, "My, my child really could've used this," and thankfulness that we're moving into this space where we're really thinking about how to individualize care.

(22:29):

So [inaudible 00:22:30] switch the topic before we wrap up. When... Looking at some of the research, it, it shows that at least 20% of the US population probably falls somewhere within a neurodivergent category. And that's those folks who are actually knowing about it, diagnosed with it, et cetera. And so we've spent most of our time talking about patients, but certainly there are healthcare workers that are also neurodivergent. I, I stumbled across this great article. Uh, if you're listening, I'm gonna get her name wrong, but Asa Hedlund. She wrote an article. It said, "Autistic nurses: do they exist?" And she said, "Well, at least one does, 'cause it's me." (Laughs) And so, so this great article that talked about, you know, there's a lot of bias out there about somebody with autism or someone who's neurodivergent wouldn't necessarily go into healthcare, but when she started looking, there were quite a few folks in this space. And so what should employers be doing to really help acknowledge the gifts that each individual brings, including somebody who happens to be neurodivergent and is a healthcare worker?

Travis Haycook (23:31):

First and foremost, recognize that the skillset that applicant might bring to the position is valuable. And they may have a very valuable perspective or very different perspective, and that offers a change of view. And sometimes I think recognizing that, embracing that rather than saying, well, they look at things differently than I do, they're gonna be hard to work with, I don't know how I could work with somebody like that. Be more accepting of that, recognizing that they bring a very unique viewpoint to things. And especially if we're gonna be working with a population of patients that do define themselves as neurodivergent, what better person to have than somebody who is, that understands that? And I think that is probably the most important piece of it.

Lori Matich (24:22):

Uh, you know, when Travis was here doing education, he talked about how this actually describes all of us. He pointed out, you know, oh, look at all of you that are sitting there, you know, tapping your foot around or who checks their 20 times to make sure it's turned off. I mean, (laughs) those are all just different ways in how we all express a little bit of neurodivergence. And, again, it's that inclusiveness. It's that understanding and acceptance of each other. And I think it starts with this, but it takes us across the whole spectrum of being accepting and inclusive of everyone, you know-

Carol Pehotsky (25:03):

That's right.

Lori Matich (25:04):

In, in everyone that we care for and everyone that we work with.

Carol Pehotsky (25:07):

Beautifully said. So we're very fortunate to have, uh, Travis (laughs) and, and other wonderful resources when it comes to supporting our neurodivergent patients as well as, as our caregivers in that care. And we're delighted to have people like Lori who say let's get projects together and make things better. But we have audience members that don't have a Travis, that don't have the ability to access some funding for some of these carts, et cetera. What advice would you give them? They're listening and say, "I, I would love to do something like this in my hospital too."

Lori Matich (25:35):

Well, for us here, we did it as a Catalyst Grant. So we're very lucky at Cleveland Clinic that we have a community that is very philanthropic and provide funds for us to be able to apply for grants where it supports our innovation. And we were selected for some funding for these carts. And I've actually... It's funny you say that because I've had several hospitals reach out and ask me, you know, "How can I get a cart? Will you put me on the list?" And they're really not expensive, honestly, but I would say, you know, there's grants out there. S- To me, seeing how successful the project has been in caring for our patients, it should almost be that everybody has it because it's a standard of care almost. Just like we have other supplies to care for patients, these are supplies that help us care for a select group of patients who, in my opinion, belong with our children, our very vulnerable population that-

Carol Pehotsky (25:36):

Mm-hmm.

Lori Matich (26:37):

That we need to care for.

Carol Pehotsky (26:39):

Sure. And, Travis, somebody wants to educate themselves or help educate their teams. W- Where should they go? What resources are out there?

Travis Haycook (26:46):

I think they could start with us at Cleveland Clinic Children's, reaching out to us at the Center for Autism. We have a very large group of clinicians or professionals that are very open to helping however we can. Use us as a resource within their community, from the autism community. There may be an Autism Society of America chapter or reaching out to Autism Speaks, is a national organization that has information about autism. Within a hospital system, looking for other caregivers that might be working that, that do identify as neurodivergent and approaching them and say, "Hey, can you give us more information about how [inaudible 00:27:25]. Use those resources that are right there with you.

Carol Pehotsky (27:29):

Sure. Wonderful. Well, you, you guys have been so informative. I could be talking about this for hours, but (laughs) it's about time to wrap up. So we're going to just take a quick moment to let our listeners learn a little bit more about you as amazing human beings, in addition to the fabulous subject matter experts you've been for us today. So I don't care who goes first, but would love to hear from each of you. You're very committed, v- very busy professionals. It's finally time for little you time, time to unwind and recharge. What's your go-to?

Lori Matich (27:59):

I can go first.

Carol Pehotsky (27:59):

Okay.

Lori Matich (28:01):

So that's easy. My yellow lab, Charlie-

Carol Pehotsky (28:04):

Aw.

Lori Matich (28:05):

And taking him out on the boat. So I'm here in Florida. Obviously we've got the sunshine in the water-

Carol Pehotsky (28:10):

(Laughs)

Lori Matich (28:10):

Almost year round. And so Charlie the boat lab-

Carol Pehotsky (28:13):

(Laughs)

Lori Matich (28:14):

He has his own Instagram page. You can follow him.

Carol Pehotsky (28:14):

(Laughs)

Lori Matich (28:14):

(Laughs)

Carol Pehotsky (28:17):

Travis, how about you? (Laughs)

Travis Haycook (28:19):

Mine a little bit different than Lori's. I'm in Cleveland-

Carol Pehotsky (28:22):

(Laughs)

Travis Haycook (28:22):

So we don't (laughs) have the, the warm weather and the sun. So mine's a more of an indoor type of thing. I've played electric guitar, 80s heavy metal. So for me-

Carol Pehotsky (28:32):

[inaudible 00:28:32].

Travis Haycook (28:32):

Sitting down playing my guitar, kinda just doing that, that's my go-to.

Carol Pehotsky (28:38):

That's fantastic. Well, thank you so much for sharing your expertise with our audience today.

Lori Matich (28:42):

Thank you for having us.

Travis Haycook (28:44):

Absolutely. Thank you so much.

Carol Pehotsky (28:49):

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.

(29:23):

The information in this podcast is 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.