NICU Nurse, Kathleen Wardell

[00:00] Michelle: I'm so glad Kathleen said yes to being on the podcast because you get to experience what I've known for quite a while, what a compassionate, experienced NICU nurse she is. She has worked all four levels of neonatal care, from Level I to Level IV, and she's excelled at every one of them. I love how she described a day in the life of a NICU nurse. It gave us a real peek into critical care, and neonatal nursing. I'm excited to see what her future holds as she embarks on obtaining her Masters in Public Health with her focus on the environment. We also had a lot of laughs in my hot closet with our doll audience. Here is Kathleen Wardell. You're listening to the Conversing Nurse podcast. I'm Michelle, your host. And this is where together, we explore the nursing profession, one conversation at a time. Well, good morning, Kathleen. Welcome to my closet.
[01:02] Kathleen: Thank you for having me. It's very cozy. Got all the dolls.
[01:09] Michelle: Oh, I know. It's kind of spooky, right? Normally I do remote recordings, but since Kathleen and I are friends and she lives right across town, I was like, why don't you come over and we can record in my closet? Just so you know, it's going to be 104 today and the closet is feeling a little bit steamy.
[01:35] Kathleen: Yeah, we're starting to get a little cooked in here. But I think it's early enough.
[01:41] Michelle: Well, Kathleen, I'm so happy to have Kathleen on today because, first of all, like I said, she's a friend and she is a colleague. I'm now retired, which you guys know, and I miss the NICU terribly and I miss my friends terribly, so I'm just trying to figure all that out. But when I thought of my NICU nurse specialist, I thought of Kathleen, because she has so much experience with all different types of babies. And so we're just going to jump right in and I'm just going to let Kathleen kind of tell you, why do you want to be a NICU nurse? Tell me about that.
[02:31] Kathleen: Yeah, so I think it started initially, I was really open-minded when I was in nursing school and in my externship towards the latter half of my nursing education with where I wanted to be. But it wasn't until I worked in a small town hospital, working in postpartum L&D, and I was getting close contact with families, teaching about babies and baby care, that I just loved it. I think I actually it was knowledge I didn't have, I didn't know. And I was curious and I explored it and loved it. And the families just were so thankful and it was just a very genuine connection with the little ones. And then we had a NICU team come, actually, this is in Selma, actually.
[03:17] Michelle: Selma, okay.
[03:19] Kathleen: In?
[03:20] Michelle: That is super small.
[03:21] Kathleen: That was how I got started in the maternal child realm. And we had a tiny baby coming and we prepared. CRMC was the big hospital for transport. They came before the kid was even born, but I, again, was just googly-eyed over, like, who are they? What are they doing? And I wanted to know more, and I was always interested in the ICU aspect, but then the world's collided of NICU babies, and I kind of had a moment where I was like, I think I could see myself doing that long-term. And that was something I was always juggling, was like, I see myself doing this because nursing is a labor-intensive job, and I was scared about how long I could do bedside. Yeah, it was, like, a hard evaluation, but I was like, that's real. Yeah. So I was like, these are all interests. And it was kind of that beacon of light. Like, this is interesting. I want to explore more. And so that's when I kind of triggered, I should look into NICU. But I was scared because I knew it was, like, a very specialized area, and I didn't know that I could get in.
[04:32] Michelle: Yeah, absolutely. When you were talking about, like, being all googly-eyed with the transport team coming, and I remember feeling the same thing at Kaweah when we were just starting to get these really tiny and really sick babies, and when they come in with all their gear and their transport isolette and their flight suits, and they look, because my sister is a flight nurse.
[05:03] Kathleen: Oh, wow.
[05:04] Michelle: And you're just like, oh, my gosh, this is so cool. I can totally identify with that, and I think probably a lot of our listeners can, so thank you for that.
[05:14] Kathleen: Yeah.
[05:15] Michelle: So you went into NICU nursing, like, right out of nursing school. What was your experience like in nursing school? Like, your Peds/NICU rotation that made you go, I might like this.
[05:32] Kathleen: Honestly, my Peds rotation in nursing school, I was scared to death. That's genuine. I went to Valley Children's in the NICU, and I'll never forget I was watching a nurse, watching as usual, and the nurse had the OG tube taped to the isolette that was closed, and she went to pop the top, but it was still taped. She caught it, like, she nearly grabbed the tube, but just, like, it just scared me. I saw that moment, but now on the other side of it, I'm like, okay, yeah. Like, she was able to grab it real quick, and that didn't yank, but that freaked me out, and I was like, oh, I don't know. This is not I think I would be better suited just to start adults. But I did notice how the nurses seemed to really enjoy their job there, and I did like, you know, I like the setup of the NICU. I was still open-minded. I was pretty intimidated and didn't think I would end up there. The nature of how hard a specialty is to get in, it wasn't until my good friend in nursing school got an externship at CRMC's NICU and she loved it. That was it for her. And actually, she's in the process of becoming an NNP in Oregon, but very cool. She and my other good friend who's still at CRMC were pivotal in getting me, I feel like an interview at CRMC, they knew I was really interested and they were needing nurses, and they said, hey, we've got a good friend from nursing school who's interested. And I think that they relayed that. And I think that was huge to help me get in because I know it's not easy. And there's amazing nurses who are all looking for these opportunities. I think that they helped me.
[07:17] Michelle: Sometimes it just takes a bit of, like, good luck and someone knowing your character. They know you don't have any experience, but they know your character and they can vouch that this person is solid, she's intelligent, she's motivated, she can learn. And those things really help a lot.
[07:40] Kathleen: Yeah, it did, a lot. So I'm always grateful for that. And they ended up considering me.
[07:48] Michelle: So you started at CRMC?
[07:51] Kathleen: Yeah, that was my first nursing job.
[07:53] Michelle: Wow. And how was that? How long of an orientation did you get?
[07:58] Kathleen: They were really thorough, I would say. I mean, that was a six-month orientation with the preceptor, so pretty solid. Yeah. I would say, like, they're a great foundation. They really want to make sure that everything is safe. They're really thorough.
[08:14] Michelle: I always appreciated their team when they came to get babies. Just so professional and so highly skilled. And the nurses were so warm, and they were so complimentary of us, starting out as, like, a smaller, like you. That was starting to get at this point, we started getting Neo's and so we started keeping our tinier babies and sicker babies, and they knew that we were just growing and learning as a NICU, and they gave us so many just, positive vibes that we felt like, we can do this. I'm getting chills right now because remembering that, it was so important to lift each other up.
[09:01] Kathleen: Yes.
[09:01] Michelle: Right.
[09:02] Kathleen: Yeah.
[09:03] Michelle: So the patients at CRMC, tell me they're a Level III, right?
[09:07] Kathleen: Yes.
[09:08] Michelle: Okay. And tell me and our listeners, like, what kind of patients, what kind of babies did you see in the NICU?
[09:16] Kathleen: Yeah, so they're such a range. I would say kind of similar to where we're at right now. It's kind of a long way, but it would start as when you're first training, you would get babies on room air who are feeding and growing. So they're tiny babies, but they now can breathe on their own, but they're still trying to learn how to eat. And so they have a feeding tube in their nose, more than likely, and bottles, taking bottles as much as they can but needing rest breaks. And they're probably on some spell watches where they can potentially have issues with learning how to breathe.
[09:54] Michelle: Talk about the spells real briefly. I know what they are, but just kind of explain to our listeners what a spell is and how terrifying it can be if you're new or especially if you're a parent.
[10:07] Kathleen: Oh, yeah, I mean, I don't think I ever lose the quick little, it's like when your heart drops, like you're on a roller coaster.
[10:18] Michelle: That's a good analogy.
[10:21] Kathleen: Or like you forget something that you like, oh my God, it's like that feeling. And I don't think it's ever gone away. But I'm better controlled with it, I guess, because I'm like, we'll get through this. But a spell is when a baby forgets to take a breath and they have apnea or they just forget to take a breath. And usually what happens initially is it kind of depends. But usually, they are like their heart rate will drop and then their oxygen saturation will then as a result of the heart rate slowing down, it will drop. And if they don't take a breath, it could go on for however long and you need to intervene. So you would stimulate the baby or sometimes you have to take further interventions if it's really severe, depending on how sick the kiddo is or just their history. And so we simulate them. We kind of rub their foot or rub their back and the baby then quickly okay. And then catches up, take a breath, and a lot of times you can see their color change. It's really frightening, especially when you're going to take this baby home. Eventually, you see that and you're like, oh my God, my babies, are they ever going to be breathed? Like, what happens if this happens at home? Totally get it. And I try to tell parents, this is part of learning how to ride a bike. You kind of have to fall and get back up. And we're going to make sure that by the time they're ready to go home, they're riding that bike and they're confident. And we're going to give you all the education so that you know what to do while we're here and that they understand.
[11:58] Michelle: We talked a little bit about spells and how you keep it together in front of the parents and what you do after. Those are all great things for bringing down the parent's anxiety levels. And ours too, because it freaks us out at times too. But CRMC was a Level III like we talked about earlier. So tell me, what kind of patients did you see? What was their acuity? Certain diagnoses.
[12:29] Kathleen: We had a range of kids. The feeder-grower, to a lot of bubble CPAP, and they're big on bubble CPAP and high flow. We have a lot of vented kids that are premature. Or maybe they had meconium aspiration we had UAC and UVCs. That was pretty common, especially for our tiny little babies. We did have cooling kids. That was something that I started to notice. Not all the time, but every so often we would get a baby that had a hard delivery and there's criteria to meet cooling treatment and we would go to those deliveries and initiate cooling. And I did feel like CRMC kind of kept us a little bit like when we were newbies, we could go and check it out. But they really took their time to make sure you were strong in certain areas. Like you were strong in the more simple, moderate, intermediate care. And then they would start getting you more introduced to the higher acuity.
[13:36] Michelle: Sure.
[13:36] Kathleen: So I didn't get to learn a whole lot about cooling, but I remember seeing a few here and there and they would be on, I believe, Morphine drips at the time for comfort. And they had a cooling bed. So that was really interesting. And then when I was about to leave, we actually were introduced to a pediatric surgery team. They were expanding their care, so they were going through some growing pains to serve the community and they started doing kiddos who had gastroschisis or any kind of bowel repair. They were just starting to do it. And so I got to take care of post-op G tubes and I got to take care of I think I did did I take care of a trach? I remember seeing one and I think maybe I maybe got oriented with someone who was more experienced with a trach baby. So that was neat because I was starting to get exposed to things. I would later be exposed to my next job.
[14:37] Michelle: Right.
[14:37] Kathleen: And I remember caring for a ? baby and I thought that was neat and interesting and I was always really open-minded. And I think what was cool about CRMC was, they were really getting to do more. So they were getting surgery. That was the new thing.
[14:54] Michelle: I remember that when they were expanding their services. So you talk a little bit about the levels of acuity, that the kids were there and how they prepared you for your next adventure when you moved on to UCSF, which is a Level IV. And so you already have this great foundation of what does a growing premium look like, what does a kid recovering from surgery look like? And then, like you said, what does a cooling kid look like? And now you're there at UCSF and you're probably seeing a lot of those really sick babies and they do ECMO, right?
[15:45] Kathleen: Yeah.
[15:45] Michelle: So tell me a little bit about that experience.
[15:49] Kathleen: Again, that's a whole specialty. You have to kind of I don't even know the word prove yourself, but you have to establish rapport with not only the staff but the leadership and show your competency. So I would say one thing I really noticed that you see is they get you in there and they had spoken really highly of CRMC,  I think they're a feeder so they know the team, they know the doctors. So that was kind of neat. I felt a little bit of camaraderie there.
[16:21] Michelle: Yeah.
[16:22] Kathleen: And they really valued CRMC as a team, so they were again, they knew that patient population. But, yeah, the care definitely was limited at CRMC and that's when they would go to UCSF. And yeah, we had ECMO. Those are those kids who needed to be on a heart and pulmonary bypass. Really sick kids just need that extra level of care. And I remember one specific case of a baby that was going to need ECMO was anticipating related to congenital diaphragmatic hernia. And this patient was out of the valley. And the amount of collaboration amongst Valley Children in UC because they were getting a lot of consultations because they were preparing. So this was well prepared, new. This was a congenital defect. UC is very competent in CDH care and then they have an echo team. So I got to kind of be around as this preparation, I got to ask questions and eventually did care for this baby when it was a lot more stable but really cool to see the full circle of an amazing group of people. Like, it gives me chills just between Valley Children's and UCSF. And they were fully prepared for that delivery and they had a really good outcome of it. And those are complicated, but it was a long process. But, yeah, they did ECMO and all those things because of the severity.
[18:11] Michelle: What do you think? As you were talking. I was thinking if your experience would have been different if you had not come from CRMC which like you said was a feeder to UCSF and you had come from a lower-level NICU and just didn't have that kind of experience. How do you think you would have been received and how do you think you might have felt? Oh. My God. I really have to, like, level up my skills because I don't know any of this.
[18:47] Kathleen: Did you have any yeah, I had a good friend. So the way that you see was they were like they moved from a tiny and they came from humble beginnings. Their NICU was pretty small at the Parnassus campus.
[19:04] Michelle: Okay.
[19:05] Kathleen: And then they came to this beautiful, big, huge kind of like what we did at Kaweah. So it's kind of fun for me. I've seen these evolutions. They came to this beautiful, brand new children's hospital, and oh, my gosh, and then the culture changes as a result. And so, anyway, a couple of us were recruited. They needed nurses. They were like, we move. We got a bigger unit. We need nurses now. And they were like, we'll take level two NICU of two years of ?, we'll take a Level III one year experience, which is what I was so they were needing nurses. And so my friend who was from a smaller unit. We all were kind of scrambling a bit. It was a big learning curve. No one like, made us feel like, you know, I just think you have to own what you know. And I think that's what a learning experience in general is. Nursing is being firm in your position, stating what you know and being confident in it, and don't allow bullying because that is unfortunately a problem in nursing. But there were bullies there, and I'm not going to lie, I think there's always a little bit in every unit, unfortunately, but there were there because there's highly experienced nurses dealing with very stressful situations and as a result, that energy gets displaced on these new nurses.
[20:22] Michelle: Yeah, it's funny that you brought up bullying. That's one of the things we're going to talk about in detail on this podcast coming up. But I just recently interviewed Dr. Dianthe Hoffman. She's a nurse educator over in Santa Barbara. She's got such a great gig at Westmont College. And we talked about bullying, and one of the things she said was that it has to come from the administration, it has to come from the culture, from the management, that this is not acceptable, we're not going to tolerate this at all. It's going to be zero tolerance. And if that means we're going to let you go because you've been bullying people, then that's what it means. And unfortunately, we haven't reached that level yet. We're desperate in nursing. We've reached a critical level in terms of our workforce and all of that. I kind of had the opposite experience when I was a pediatric nurse, and this was back in the late 80s and early 90s. And we had a couple come to Visalia,  and it was a physician and his wife was a nurse practitioner. And she ended up coming to pediatrics because she had some peds experience and she actually had worked at Johns Hopkins. When I think back, I thought, oh my gosh, we didn't do her this service. She was so brilliant and we were so small and just we only knew our small-town pediatric nursing. All of our kids went to Fresno, the tertiary unit, and all that, and we just didn't receive her well, one of the things that she would always say was, well, at Johns Hopkins, we did it this way. Like, she would say, why do you guys do it that way? Because at Johns Hopkins, she came from this huge teaching hospital with all this experience, and instead of embracing that and going, teach us, we need to learn. We didn't do that. And we lost out on all of our good experience. And that makes me sad reflecting on that. I think we just need to do better at that.
[22:49] Kathleen: Yes, definitely.
[22:52] Michelle: So then how many years were you at UCSF?
[22:55] Kathleen: Yeah, it wasn't super long, it was two years, but it was a good little foundation.
[23:04] Michelle: And is this the point where you and your husband took some time off?
[23:09] Kathleen: Yeah, to travel.
[23:11] Michelle: This is such an awesome story, you guys. So how did you do that?
[23:16] Kathleen: Yeah. Well, I think it was when I first met my husband, I was like, all right, we're from the Central Valley, but I want to explore. I have that travel bug in me, I think maybe for my father, but I just wanted to explore and live in other places, and I was just probably a lot for my husband. He's like, okay when I first met him. So I always had this bug to explore outside of the Central Valley, wherever that could be, and just in general, travel, I guess I feel like I always looked up to people who have traveled. I feel like they have such a different perspective, and I just find it interesting. I find that they have interesting views on takes on life, and I've always admired that, and so I was like, I'd like to do that. So when we first figured out jobs, we got to get jobs, we got to work. We did our time and I said, hey, I'm still wanting to travel. Would you want to join? I know I want to do it, and I want to like to pause. I'll work hard to have my loans, save up. I'll pause on the kid front for a minute just because I know this bug needs to be to get it out. Yeah. And my husband is a pretty easygoing guy. Unfortunately, he was easygoing enough to put his career plans a little bit on hold, which is really uncommon in the American culture of we're all about getting ahead, and we were lucky that we could both work, pay off our student debt pretty quickly. We made good money in the Bay Area and just saved up, put it aside, and then we were like, oh, crap. Are we still doing this? Kind of anxious, like, what's our next step?
[25:02] Michelle: Right?
[25:03] Kathleen: And then just was like, let's take this risk. So, yeah, we quit our jaws in the early fall of 2017.
[25:12] Michelle: Prepandemic.
[25:14] Kathleen: Thank you. That was a good move, right? Real good move. Because the world has changed, and we just did it. We were gone for about six months, and he has a lot of family abroad in India and Australia and just different countries, and I have just some acquaintances, and so we just openmindedly. Just went for it. People wonder how we did it. Just saved a ton of money by adventure. Yeah, but it can be done. We kind of looked at others who have done something similar.
[25:50] Michelle: Right? Well, you're, like, simultaneously a planner because you have to plan all that out, and then also you're kind of like, I'm going to fly by the seat of my pants type of gal.
[26:02] Kathleen: Yeah, I was nervous.
[26:03] Michelle: I merged those, too.
[26:05] Kathleen: I try to do the balance of both, but it was fun, it was a good time, it was a very eye-opening trip.
[26:11] Michelle: And then you came home and that's where I met you, at Kaweah Health. So tell me what it was like from going from a Level IV to a community-level NICU.
[26:28] Kathleen: It was a big change. Very humbling, though, you know, one of the best advice I've got from my grandfather and I really look up to him is just like, always keep your doors open. And never just because you have an opinion about something, you go into something, doesn't mean that this might not open. This might not open a door to another opportunity. That maybe is what you're calling is just basically being open. It's great. It was a big adjustment.
[27:00] Michelle: Were you bored more?
[27:04] Kathleen: Just I was used to having all the backup.
[27:07] Michelle: Got it. Yeah.
[27:10] Kathleen: I feel like it's always hard for me to be bored because you have less resources at Kaweah, so then you have to be more reliant on yourself.
[27:17] Michelle: That's true. Yeah.
[27:18] Kathleen: So there's always like where it was more helpful, there was less there's a give take. I would say that about wherever in life where it was easy there, it was hard here, where it was easy here. It was hard there.
[27:31] Michelle: Had you done Admit at any of those?
[27:34] Kathleen: No.
[27:35] Michelle: So you guys Admit, at our hospital, the Admit nurse is the nurse for the day for a twelve-hour shift that goes to all the high-risk C sections, high-risk deliveries, helps with any admissions on the unit to stabilize the baby. If we don't have a nurse to accept that baby, he or she is usually the person to take that baby as a patient. And inevitably those babies are always like the sickest babies, so you get a lot of experience really fast. But how was that training? Like, did you like it? Did it scare the crap out of you? Talk about that. Yeah.
[28:21] Kathleen: I mean, I always knew about that role. I think you see, in CRMC they maybe called it triage. There are different terms for everything, but Admit, Triage, or delivery nurse, they go to the deliveries and I always was fearful of it because you see the sickest roll through, they're the first hands on the baby and they're having to do all the resuscitation. So naturally, it was the next step as a bedside nurse who has experience and people are scared of it. Some people are like, I'm good, I like my bedside. I like having a little control. Granted, you get a little taste of it if you're the admission nurse taking over for the Admit, but I was like, I need to push myself. And so I was nervous, but I was also like, this is the next step and I think I need to do this. But I was scared.
[29:15] Michelle: I remember my days as an Admit nurse and I just found myself to be simultaneously scared and elated. I loved going to deliveries because each delivery was so different. Yes, like, you might have a mom that's like pushing and everyone can hear her like 20 rooms back, right? And then you go in another room and the lights are low and no one's speaking and she's pushing and you don't hear a sound until the baby comes out and cries and it's just joy. Yeah. Each delivery was so different. And I'm excited to have a labor and delivery nurse on here because to me they're like magic. They are how they can do a vag exam and tell so much about the position of the baby and her effacement and her dilatation. And I'm just like, you guys are like magicians to me. I can't wait to have an L&D nurse on. So just go through with me. For our listeners, like, what's a typical day in the life of a NICU nurse? You come on to your twelve-hour shift and let's say today you're the Admit nurse. So what do you do? Give us a run-through.
[30:38] Kathleen: Yeah, I would say that role is so like you never know what you're going to walk into. You have to have a certain personality and be open to. But I think like you said, it's kind of exhilarating and you grow into the role too. At first, you're scared, just like with anything, but then it gets and there's always a little bit of that small anxiety, but you learn to love it. So a typical day, we come in and we talk about what is on the board is what we say. It's what is ever on the labor and delivery floor, the list of patients and what is going on. So we get report about that and find out the high-risk cases. What's on the board? Is it a premature baby? Does it have a congenital defect that we need to be prepared and have transport on standby? Or, you know, that they know we're going to attend the delivery and that they need to be prepared? Or is it a case that's so severe that maybe we can transport this mom stable and have them up there? Is it a really large baby and we just need to be prepared for that? Is there if mom has ruptured her fluids? Is it meconium stained? That's a high-risk case. So anything that's pertinent for high risk, we're going to be aware. And then, in addition, there's a C-section side. These cases are going to be vaginal deliveries. Then we find out if there are scheduled C sections in that case. We need to know how many they are and at what time. Because as our facility runs, NICU attends every C-section delivery. Now, some facilities are different. Sometimes it's just only high-risk. But for us in this case, we attend every C-section and then there's inductions and that's just moms that are being induced. Maybe everything is going great. But it's time. She's 40 weeks and three days. Four days. Or 41 and three and sitting on it. And we need to get this baby out. So they'll come in and we'll start to take measures to get this baby out. And it's all for safety reasons. Nothing more than just we want a safe delivery because what we see and.
[32:55] Michelle: We know statistically and the C-sections can be piled up and scheduled every one and a half hours.
[33:03] Kathleen: Yeah.
[33:04] Michelle: So that can make a twelve-hour shift really go quite fast and be really exhausting. I know sometimes the Admit nurses have a hard time getting water and going to the bathroom and getting a break, especially if the NICU upstairs is really busy and we're kind of spread thin.
[33:25] Kathleen: Yes.
[33:26] Michelle: And I bet you go home at night and you're just like, exhausted.[33:31] Kathleen: Yeah. You can't judge a book by its cover period. Going back to what you said, I've worked at these different places, but nursing in every facility, it's a hard job and you get into these different roles and whatever throws at you. But as an Admit nurse, you never know what your day could look like. You have one scheduled or nothing, and then you have someone roll through the triage with something very serious.
[33:57] Michelle: Yeah, diaphragmatic hernia,  heart condition. We get so many heart kids, undiagnosed.
[34:06] Kathleen: Cardiac defects, it needs medication.
[34:11] Michelle: All of a sudden they're on Prostaglandin and they're being transported and the whole day just goes south.
[34:20] Kathleen: Yeah. You have to roll with what you have and the resources, but like you said yeah. You could have a day of eight scheduled C-sections and you're not getting lunch and your RT is bringing you a bar.
[34:36] Michelle: Right.
[34:36] Kathleen: And you're just doing it because that's what you're working with.
[34:39] Michelle: Yeah. Been there.
[34:42] Kathleen: Yeah.
[34:43] Michelle: It's crazy. So talk to our listeners about a day in the life you come on and you have a 26 week that was born during the night and it's 06:00 A.m. And you're taking report. What would it be like caring for that baby during the day?
[35:04] Kathleen: Yeah. Typically it's going to be a lot of kind of re-evaluating what's our plan of care with our doctor. A premature baby at 26 weeks, hopefully, it depends on what we're sitting with. If we have a UAC or UVC, then I'm feeling pretty good. That means I have access for IV fluids, I have access to draw blood. I'm not having to extra stimulate the baby. A tiny 26 week or you don't want to be poking and prodding. And when we first get admissions, we do a lot of things initially, and it's very stimulating and it's a lot. So I would hope that my baby is set up with some important just set up tools like a UAC, UVC. I'm hoping that this kid depending on how this baby presented, and I'm hoping that maybe it receives some surfactant in its lungs to help with its process of how the lungs need.
[36:07] Michelle: And you hope kind of that the baby is on bubble CPAP and not a ventilator.
[36:13] Kathleen: Yeah, it kind of just depends. We do get in our units, more units like intubated babies. We're used to it, but it's back and forth. I'm okay with the vent. I'd like to know that my tubes are nicely taped.
[36:32] Michelle: That's why you have your RT standing by.
[36:35] Kathleen: Yeah, I'm very particular about certain things, but we've come a long way in that specific area.
[36:40] Michelle: We have a great RT team. We're very lucky in that. And we rely very heavily on our RTS. They're buddies. Yeah, for sure. So kind of with a 26-week where you would take, like a hands-off approach, I know we have that 72 hours bundle where we're just trying to really decrease as much stimulation as possible. Think back to nursing. Like, what do you think in neonatal nursing? What do you think has been your hardest moment either with a family or a baby or just with some situation?
[37:22] Kathleen: I think my hardest moment is coming into a shift and finding out a baby that I cared for the day before, we had a hard day. It was a premature baby, but we discovered a really severe fungal growth on the back. But we were able to catch it and we were making interventions to improve it. So I was feeling hopeful that I was able to improve that care. But also concerned for a tiny baby going through something like that. I came in on shift change, a shift, and the baby had deceased, passed away, and it literally had just happened. So the night team was emotional giving a report, and I walked in not even knowing that was my patient because it just happened. And then I found out it was the one I cared for the day before. It was my first moment where I didn't know how to deal with my emotions. And I was so caught off guard because I did not expect it to go that way, I guess because of my past, my preemies, while it's hard and we have long days, I hadn't experienced that. And so that was a hard day for me. I had a hard time making just me doing things. I had a hard time.
[38:39] Michelle: Exactly. We have to put our emotions aside because we have other patients to take care of or we have C-sections to go to. And you sometimes can't process those feelings until maybe you get home from work and now you're coming into your husband and your son and being a mom and a wife and you have all this heaviness, like, hanging over you, and that's just profound. That's a lot to deal with. What do you think has been your highest moment? A NICU grad that you didn't think was going to make it, something that you did in the moment to save a life. Talk about that.
[39:30] Kathleen: Gosh, that's a special one because I feel like there's been a lot of little ones charged me to put one specific thing that's okay, too. Yeah, the little things that I've experienced yesterday was just a small one that I had a nurse intern with me and this little tiny was like a 34 and change. Wee baby, but like, doing great. The timing was perfect. It was a touch time.  Touch time is like when we do our care time where we assess baby and then do feeding. And mom came at the right time. He was cueing. We were just about to start feeds from NPO, and he was cueing. And I was like, mom, you want to breastfeed? Yes. And he went on and he went on for 30 minutes and it was like my student nurse intern was like, oh my gosh, I was too, because I wasn't expecting. Every baby is different. But I guess I kept saying the stars aligned and we made it happen. And it's like little moments like that that make me love the NICU and love my job. So I always have such a love for it and I love teaching and I love breastfeeding and all the teachers.
[40:42] Michelle: I know I don't need all that high acuity.
[40:44] Kathleen: Sometimes I'm like, that was enough. That made my day.
[40:48] Michelle: And I don't know if my listeners know that in the NICU, I was a certified lactation counselor for about eleven years and just loved it. And Kathleen and I always worked together. Kathleen was always like, I'm game. The baby looks like its ready, mom's ready. Let's do it.
[41:09] Kathleen: Yes.
[41:09] Michelle: And I have to say, a lot of those babies I had in the back of my mind just like kind of I'm embarrassed to say this, but just kind of like, this isn't going to happen. Like, I think we have so many failures that we become kind of jaded to like, if this is going to work. And then the baby just latches on and goes to town and is drinking and swallowing and I'm like as excited as the mom and going, oh, my God, this worked. I need to teach myself to be more hopeful in those situations.
[41:52] Kathleen: Yeah, just trying to be refreshed in that, but yeah, like another just brief moment. We had a really bad cardiac case and this kid was purple or blue. No respiratory issues. Just it was concerning. We knew that this was cardiac and we needed to get an IV stat. No access. Yeah, we're going to put lines. I forget what exactly, but we just needed an IV. And I will be honest, like IVs, it's one of my more insecure areas. I think I relied too much on my early days of the expert nurses that I kind of sat on it. So now I'm like the experienced nurse. I'm like, dude, I should be better at this, but I'm humble about it. I'm like, hey, I'll do my best. And fortunately, that day I was able to get this IV fast, and we were able to start prostaglandin to help with this severe cardiac defect. I remember my doctor was just like, oh, good. And I was like, oh, my God. When I needed to make this happen, I was able to.
[42:56] Michelle: And thank God, you're praying to God.
[42:58] Kathleen: On the basic admission. I'm over here calling my Admit like, or my Charge like, hey, I'm trying to get, like, what's supposed to be a simple IV.
[43:05] Michelle: But those are the things that keep you coming back every day.
[43:12] Kathleen: Those are just little tiny moments of things that are great, cool.
[43:17] Michelle: Talk for a moment about primary nursing. Just kind of explain what that is and maybe just a couple of pros and cons because our listeners might not know what primary nursing is.
[43:29] Kathleen: Yes, primary nursing is something I only found out about when I worked at UCSF. And it's basically kind of a nursing model that's used in hospitals to keep continuity of care between patients, families, and a nurse. And if you're in a very if you're in the hospital for a while and you get used to certain nurses, you kind of want to keep that same nurse. The families will ask, hey, are you back? That's kind of a typical response you get. And so I noticed that UCSF had this really great program where, like, these nurses would on the day of the week, fill out what days are working for these certain babies. And they were, like, part of this care team of nurses that knew the baby really well. And I thought that was brilliant. I hadn't seen that in my first job in Fresno, and I just thought that was cool. And I really looked up to these nurses who had established such great relationships with the families, and it was kind of a big deal. Like, if you had done a primary case, you were looked at well at work. Good for you. Those are hard, but good for you for establishing that rapport and helping basically helps improve outcomes because you know that baby well, so you're not getting a new nurse every shift. But I was still at the baby stage of understanding primary nursing there, and I only did one or two there, and they were hard primaries. And I struggled with it and kind of didn't love it, but I saw the big picture of it in the unit and saw that it was really beneficial. And so I eventually brought it to when I came to our hospital here, I brought primary care nursing because I saw that it was a need. And I had too many families asking for not just me, like they would ask, oh, my God, that night shift nurse. I loved her. I had families actually recommend it, is there a way that we could get the same nurses or if you guys could change something, that's something I would recommend. I mean, I remember one specifically when I first came in, so I was like, well, this is hard to not want to fix because I actually have a tool and resources to implement it. And I felt kind of like a calling to do it. And it wasn't even a personal reason. I was not the primary nurse girl. I was pretty insecure myself. I just wanted to help implement it because I saw it for the betterment. Yeah, and I'm still struggling with primary. Like I said, it's a fine-tuned thing. But I think overall it does have huge benefits.
[46:01] Michelle: Have to find you establish a rapport. The family, they really trust you. Their anxiety level goes down in terms of knowing their baby. It's huge. Right. Because every time you come to work, you care for this baby. So you can see changes in their condition, like way quicker than somebody that it's their first shift and they really don't know this baby. So there's so many benefits. But what would you say is like the biggest con for primary nursing?
[46:38] Kathleen: It's when families get so used to the continuity that when you do happen to get the nurse. There's going to be gaps in a week's period where sometimes you don't get your primary nurse because maybe they called out sick or maybe they're on vacation or maybe they need to take a break and you'll have a nurse come in because someone has to get assigned and they're not a primary and the families just set them off. That change just can't and I think.
[47:13] Michelle: We had discussed before too, about boundaries.
[47:17] Kathleen: Yeah. And boundaries are another added point of we establish these relationships and rapport, but sometimes it just can push, they get too comfortable, I guess would be and it could go both ways, but I'd say you build more than just like this relationship. It's almost like family and so things sometimes can get blurred and we have to sit back and like really reevaluate, okay, where could we have improved or where could we have said, you know, I mean, those are some great points. Unfortunately, I'd love to come in and like do like I'm not saying I was adamant and I was a primary, but I had to be Admit that day. They want me to come in and do stuff and I'm like, you know, I'm not telling your nurse can help you with that because I'm not your nurse today. And having to really set the tone there, it's hard. But also they have to respect that and usually they do it. You have to find that boundaries setting.
[48:26] Michelle: I do think you have to have the right nurse matched to the right family and that's difficult to do and especially in a unit that's really busy and short-staffed a lot of times. And it's just hard to coordinate all those puzzle pieces so that they fit exactly right.
[48:50] Kathleen: Yeah. And we have some really big-hearted people in our unit, and I get it. We want to do everything, and we want to make it. And so nursing, I think, gray area. I mean, it's really hard. It's real hard.
[49:05] Michelle: Well, let's talk about your new adventure. So you're going back to school and tell me why you're doing that because I think our listeners are going to find this very interesting.
[49:16] Kathleen: Yeah. So I would tell you that I have always been such an open-minded person, and I love nursing, and I've got a lot of heart and compassion and part of why I went into it and job security was super important. But I do have a passion for just being an environmental steward. And before I started undergrad, I was kind of between environmental science and nursing, and I had to go with job security. But they're both kind of equal passions. So this is me kind of reassessing my career point right now. I do find that nursing is hard right now, bedside in general, and I'm concerned that I could be I don't know if the word is burned out, but I'm concerned that I could be getting I find myself complaining versus making action, and I don't like that. If I want to fix something, I should do something about it. And so this is kind of me venturing in that direction and chasing a personal, just passion. So I'm noticing with me doing bedside, that we are and in general as a community member, we could do better. So with that, public health is the topic. So I am concerned about the environment and public health and our community's health and so wanting to explore this space. And I feel an actual, like, calling right now after traveling, after kind of having a child. I just did not kind of, I had a child. What does that mean? I had a child a year and a half ago, and I want to do better for my child's future. And so I'm really interested in improving population health and making improvements, and Central Valley really needs advocates for that and frankly, bulldogs to get in there. And I'm hoping that I can do something, even something small. I'm just willing to do something. So we'll see.
[51:34] Michelle: If anybody is a bulldog, it's you.
[51:37] Kathleen: I'm going to try.
[51:38] Michelle: That is so cool. Kathleen shared with me a podcast that she listens to, and I think it's.
[51:45] Kathleen: Nurses for healthy environments.
[51:47] Michelle: For healthy environment, thank you. And I'm going to link that in the show notes, and I'll also link it in Kathleen's bio on my website. So you guys check that out. But I've listened to a few episodes and I'm just blown away by these nurses. That what they're doing. They're some NICU nurses on there. Yeah, they're so active. The solar nurse blew my mind. So you guys will be able to check that out, but I think we are ready for the five-minute snippet.
[52:23] Kathleen: Okay, sounds good.
[52:24] Michelle: Okay. So I'm going to get my timer going, and we've had a couple of little issues with the five-minute snippet today, so I'm just going to wing it, and I'm going to ask Kathleen some questions. So let me get my timer up and let me get my app up.
[52:52] Kathleen: Okay.
[52:53] Michelle: We'll see what we can do. So Kathleen has a lot of different interests. She loves to travel. Obviously, you guys heard that. She loves food, all of that stuff. So we'll see if we can go through some of those.
[53:06] Kathleen: Okay.
[53:06] Michelle: Okay. This is going to be a foodie question. What's your most-priced kitchen gadget?
[53:18] Kathleen: Gosh. Maybe right now I'm going to say currently my garlic presser because this is a newfound love.
[53:26] Michelle: Okay. I love it. It makes it very easy to do. Get it all over your hands.
[53:31] Kathleen: Yes.
[53:32] Michelle: When's the last time that you tried a new food for the very first time?
[53:38] Kathleen: Gosh. That's a really good one. And hard. A new food. I feel like that might have happened recently. Something I got at the farmers market.
[53:49] Michelle: Is it moringa? I think. What is that?
[53:52] Kathleen: It's like a leaf that they put. It's like it's a green, the powder that they put in smoothies, but it's awesome.
[53:56] Michelle: How do you feel about organ meats? Like liver and tripe?
[54:04] Kathleen: If you can make it taste good, I'm down for that.
[54:08] Michelle: So who's your favorite celebrity chef?
[54:14] Kathleen: Gosh, I love British bake show, bake off.
[54:18] Michelle: Me too.
[54:19] Kathleen: So, like, I recently dove deep into, like, all of the hosts there. But I have loved hate to call.
[54:26] Michelle: I know.
[54:27] Kathleen: I still appreciate his bread obsession.
[54:31] Michelle: Oh, my gosh. Okay. How do you like your eggs?
[54:36] Kathleen: Over hard. Wild. Overhard, I know.
[54:40] Michelle: All right, we're going to go into globetrotter because you are very much so during your travels, what's the most unique food dish that you've had?
[54:50] Kathleen: I think we had horse cartilage in Italy.
[54:53] Michelle: Oh, my. That sounds, I don't know. It doesn't sound good.
[54:58] Kathleen: No, it was different. We ate it. The texture was challenging.
[55:02] Michelle: That's what I was going to say.
[55:04] Kathleen: The flavor was good. It was just different.
[55:06] Michelle: What's the first thing that you do when you get to your new destination?
[55:11] Kathleen: Probably look up food restaurants somehow.
[55:16] Michelle: I could totally peg you for that. What's the most fascinating museum you've visited?
[55:23] Kathleen: Well, this is more of just my personal interest when I lived in Oakland, the Oakland museum in downtown. It has a whole thing on California history. And I drink the juice. I love California's history of Americans, like civil rights. I love that museum.
[55:41] Michelle: Have to make a trip.
[55:42] Kathleen: You have to go.
[55:43] Michelle: Are you more of a glamper or an old-fashioned camper?
[55:48] Kathleen: Old fashioned camper.
[55:51] Michelle: What's the most important item that you've lost on the trip?
[55:57] Kathleen: Oh, that's a great one. Ow.
[56:03] Michelle: Two minutes.
[56:04] Kathleen: I'm just gonna tell you. When I went skiing once, I forgot my ski pants. So I skied in my pajama pants and I did a whole day in pajama pants.
[56:12] Michelle: Were they flannel?
[56:13] Kathleen: Yeah. It wasn't cute, but it was probably cute. It was funny. It's a story that goes down in history. I was like, I'm not not going to ski. Or snowboard.
[56:22] Michelle: That's right. I love it.
[56:24] Kathleen: I forgot that.
[56:25] Michelle: Which is prettier, a sunrise or a sunset?
[56:30] Kathleen: I just have good memories. Oh, God. Both. I can't, I don't know.
[56:36] Michelle: How you could pick between.
[56:37] Kathleen: I have memories of both.
[56:38] Michelle: Yeah.
[56:39] Kathleen: It's hard for me.
[56:40] Michelle: All right, I'm going to ask you a true crime, a couple of true crimes, because I know that you like those. Is there a murder case that you feel you could solve? I'm telling you, these are the greatest. They're very thought-provoking.
[56:59] Kathleen: I mean, we're still on that. Jon Bennett Ramsay one.
[57:02] Michelle: Oh, thank you.
[57:08] Kathleen: Because she's like, my age.
[57:10] Michelle: Yeah.
[57:10] Kathleen: And I remember watching it.
[57:13] Michelle: This could happen.
[57:14] Kathleen: Maybe a dive into that. I don't know.
[57:16] Michelle: What do you think would have never been caught if they would not have opened their mouth? Who do you think? I'm sorry.
[57:24] Kathleen: Like a case where they talk because.
[57:29] Michelle: They eventually do.
[57:34] Kathleen: God, I can't think of one off the cuff. But what was that one guy, he was so out there and wanted the attention. The guy that went, he said, from Washington state, I'm drawing a blank.
[57:53] Michelle: That's okay. Are lie detectors a good tool for solving cases, or can they be easily manipulated?
[57:59] Kathleen: I think they're easily manipulated, and I just think that they're kind of an old tool at this point. And I don't know, I'm kind of over. I don't think they're helpful.
[58:10] Michelle: Here's one that follows up. What's one murder that is too close to home for you?
[58:15] Kathleen: Lacey Peterson.
[58:17] Michelle: All right.
[58:18] Kathleen: Yeah.
[58:19] Michelle: It's in that area.
[58:20] Kathleen: Oh, yeah. And I got a scholarship.
[58:23] Michelle: Wow. Okay.
[58:25] Kathleen: I feel really close when it happened when I was old enough that I remember being on TV a lot. But then when I was in high school, she went to my high school, and they had a scholarship, and we applied, and I applied, and they wanted someone that had yeah, that's really close down there.
[58:47] Michelle: We're going to end our snippet on a WTF.
[58:51] Kathleen: Yeah. Serious.
[58:53] Michelle: Okay. If you were a member of the Spice Girls, what would your spice handle be?
[58:59] Kathleen: I'm just going to go with my OG posh because that was who I was. I don't know if I was really like her, but I was proud of being that rep, that girl.
[59:09] Michelle: That girl. Oh, my gosh. You've been so much fun, Kathleen, and so much knowledge and experience, and gosh, the babies and the families that you've touched, they're so fortunate to have you. I'm fortunate to have you as a friend.
[59:28] Kathleen: Yeah. I know. And you too, in our little closet.
[59:30] Michelle: Our chat has been a lot of fun. I know.
[59:32] Kathleen: I'm so glad you're doing this. And we need more nurses to get out and have conversations. You have a lot to share.
[59:39] Michelle: I hope that I see you soon on a podcast of your own.
[59:44] Kathleen: That would be cool. Thank you. We'll see where I'm headed.
[59:49] Michelle: Okay. Thank you for having me.