Critical Care Educator, Sarah Vance

[00:00] Michelle: Are you a critical care nurse or aspiring to become one? If so, you won't want to miss my guest this week, Sarah Vance. With over 15 years of critical care experience, Sarah is dedicated to educating and mentoring nurses both new and new to critical care. Sarah has a knack for simplifying complex concepts and bringing a lighthearted approach to the often intense ICU environment. She shares valuable, free, open-access medical education content on social media, covering topics such as intra-aortic balloon pump placement, sedation and pain management for ventilated patients, and safe blood transfusion administration, all crucial for critical care nurses. Her Instagram handle is @iseeyou_nurse, which is a keen play on words, but clearly communicates that, as a nurse, you are seen. And that is one of Sarah's superpowers. She sees the nurse holistically, recognizing the emotional and interpersonal aspects in addition to the technical skills and protocols. She understands that nursing involves the heart, emotions, relationships, communication, and ongoing self-reflection. In the five-minute snippet, what undo button?  Well, good morning, Sarah. Welcome to the podcast.

[01:50] Sarah: Thank you so much, Michelle, for having me. Good morning as well.

[01:54] Michelle: Yes, I've been excited to talk to you. You came across my Instagram feed as the ISEEYOU nurse and I watched you for a while because I love nurses who educate other nurses. I think that's amazing. It's something that we don't really need to do, but I think some of us actually feel like we need to do it, and I kind of got that sense from you. So you educate critical care nurses, and you have lots of ways that you do that through social media. So you have an amazing Instagram. Your YouTube is just packed full of really specific educational content. Then you have your TikTok, and you have an Etsy store. And I was amazed by your content in your Etsy store because again, those packages, those bundles are super specific and extremely affordable. So we'll talk about all that. But first, I just want to know, why did you start these educational platforms?

[03:22] Sarah: So a little bit about my background. So I started out as a new grad in the ICU back in 2009. So this is, I pretty much, I always say I was born and raised as a critical care nurse. And I understand, even though it was many, many years ago, I still understand how difficult it is to start as a new grad in a specialized area, specifically critical care. I had really great mentorship. I had really great training during my time period, and I have had really great teachers along my entire journey through where I am now. And now I can finally say the imposter syndrome is gone. Where I can say officially I feel like I am an experienced ICU nurse after 15 years, but I've earned that title. I have been mentoring and educating informally for many years as a charge nurse, and as a preceptor. And then about four years ago, this is where things really, really shifted for me. So at that time, you know, three, four years ago, we all know what was happening across the globe and I was a traveler in a critical care area. I was traveling for Covid and I realized, where are all the experienced nurses? They all left. They all left. And we had new nurses coming in still and they needed education. There was not that education that you get from experienced nurses and there really wasn't dedicated education that you get from for critical care specialization as well. So because I saw this major gap within the unit that I was working in at the time as a traveler, I felt really called to step into the role of a formal educator. So I switched from informal education where I was still doing education. But it wasn't that formal title to a now formal title of being an educator. Becoming a formal educator and really focusing on that was such a refreshing component to my career and reinvigorating my nurse's soul post-Covid, during COVID. It really allowed me to take everything that I've done in my career and put it into one package to now just focus on educating new nurses into critical care, experience nurses into critical care, and be that mentor that I know is so needed within our community for nurses. I absolutely love it. It's something that I'm incredibly passionate about and I fully believe in the power of mentorship and the empowerment that comes from having more education and how that impacts our patients at the end of the day because that's the reality of education, is we are still impacting our patients that are being taken care of at the bedside. It's just in a more all-encompassing perspective. Whereas I'm not impacting the single patient that I'm taking care of on my assignment now I'm impacting the nurses who are then going to care for those patients so we can capture larger populations through education. So it all comes back to how are we improving patient outcomes and impacting our patient's care.

[06:52] Michelle: Yeah, that's fantastic. And your passion absolutely comes through when you're teaching. I think that was one of the saddest parts about COVID In addition to just the moral distress that so many healthcare providers were experiencing and all the deaths and just the uncertainty of the time, but also the great resignation of all of those years of experience that. What's the other word? The seasoned, always makes me sound like I'm talking about a steak or something. But the seasoned nurses, like, they come with so many years of experience, and a lot of them are mentors. And then, you know, they left. And you're absolutely right. I remember walking on to our labor and delivery unit and it was about 75% travel nurses. I didn't recognize hardly anybody. Yeah, absolutely. They need education. And I like also that you educate new grads, but you also educate experienced nurses that are coming to the ICU from different specialties. What would you say are the differences between those two groups of people, new grad nurses?

[08:19] Sarah: When it comes to them, they are used to being in the position of consuming education all the time. They just got out of school. They're used to that kind of effort. But with that, they also don't have the baseline confidence that they need to develop. There is a higher level of imposter syndrome because that exists across the board. Regardless, their process of learning to be a critical care nurse is not even a gradual mountain climb. It is straight up because they have to learn the basic skills of being a nurse. In addition to all the specialized skills that require, that are required of critical care nurses. Now, experienced nurses, come in with some baseline skills. Usually, they have a little bit of confidence that they have developed with those skills. They know how to interact with patients and physicians, and there's just some tweaking that needs to be involved when it comes to things like time management and prioritization. And then they have that gradual climb of, okay, now I'm going to need to learn these specialized skills associated with being a critical care nurse. So there are big differences. I would say that some similar struggles would be still imposter syndrome, still confidence, and still just in general, that critical care nursing is difficult. And there's a lot of stuff that you still have to learn. Now, some differences between the two would be that sometimes with experienced nurses, when they come in that are new to the ICU, I've noticed that it can be a little bit harder for them, and that seems a little bit odd if you think about it. You would think, well, the new grad, that would be more difficult for them, and it is hard for them. But the difficulty is different because, experienced nurses, have been doing this. They have their own flow, they have their own way of doing things, and they have their own method of prioritization. But when you come into the critical care space, you almost have to unlearn those things and relearn how to do it as a critical care nurse. And sometimes that can be really challenging because if you're used to taking care of multiple, less acute patients, then your prioritization is going to be different, your time management is going to be different, and you're probably going to be focused more on, like, tasks and things like that, where the task in the doing of a critical care nurse is, yes, very, very important. But there is that other component of very much critical thinking, the entire picture that you're doing and all the care that you're providing. So sometimes it's a little bit easier to take a new grad that has nothing and mold them into that. They're still going to have struggles because it is hard versus having an experienced nurse where you kind of have to deconstruct things a little bit and then help build them back up into helping them be very successful in a new environment.

[11:16] Michelle: Yeah, that was one of my questions, if you had to, with the experienced nurse, if they had to kind of relearn or unlearn some maybe not-so-great habits that they had picked up working in a different setting. And what you just said is absolutely 100% true for the neonatal intensive care unit that we found. First of all, I was so happy that our institution and I know other institutions are following suit in that new grads. They're not saying you have to do two years of med/surg. If they are really passionate about something, they want to go into emergency nursing or critical care nursing, or NICU right out of the gate. You know, institutions are saying, yes, we want you, we want to train you from the very beginning. We want to mold you in this certain way. And it was very effective. And I found exactly what you said. Some of the nurses that came to the NICU from other maybe adult floors, they were just like, they had to start over again, basically, and it was very difficult for them, whereas our new grads just seemed to just pick it up really quickly because, like you said, they're starting from, you know, ground zero. There's no having to learn anything again. So that's, we found that exactly to be true. Yeah.

[12:53] Sarah: And it can be difficult for experienced nurses. You know, I will say that even though I've worked in critical care my entire career, there was one time when I went to work in the cardiac cath lab. And even as a very experienced ICU nurse, I had challenges being new again. And it was a real good experience for me to have because it allowed me to have that knowledge to then empathize, you know, have some empathy towards nurses that come into critical care with experience or other specialties with experience, to be able to say, you know what? I know that this is uncomfortable. You're used to doing things very quickly. You're used to understanding things very, like, it's just a flow, like, it's a natural process because you have been so used to working in this, this area, and now you're thrown into very uncomfortable feelings because you're just new and it will get better, but it's just the reality of just being new. So there can be some, you know, not only from a skill perspective but feelings involved as well. When it comes to being an experienced nurse, going into any newest specialty, being new is hard. Regardless of where you are, whether you're experienced or if you're just new, new, it's hard and difficult. And when you have the level of, I'm used to doing this and knowing how to do this very effectively and very well to now, oh, my goodness, now I don't know what I'm doing. That is a little bit of a shot to the ego. And regardless of what anyone wants to say, we all have egos. It is a normal thing, and it can be a rude awakening sometimes that you have to just work through and you can work through it. And having a really good mentor and really good educators on your team to help you work through that process has always been beneficial, I think.

[14:38] Michelle: Yeah, I kind of parallel it to driving. You know, when you're a new driver, you are aware of every single thing and when you should put your blinker on and, you know, when, how close to the stop sign you should stop and nothing is automatic. And after you've been a driver for a while, these things, you know, you can drive and have the radio on and still know, you know, hit all your marks, right? And I feel like that is the same for a new grad coming. Yeah, they're very thoughtful about everything because everything is brand new. They don't know it. But then when these experienced nurses come to a critical care setting, you know, as you said, whether they have many years of experience, they're just learning all over again. And it becomes very tedious and they can take a hit to their ego, and that can be hard. And we've had some nurses actually leave the NICU because they're just like, I thought I would pick it up a lot faster. I'm, like, super frustrated. I'm not getting this. And they're like, I feel like I should because I've been a nurse for this many years, and it can be a real challenge. So we've definitely lost some great nurses, too, to that effect. Well, let's talk about academia, because you do work with a lot of new grads, and so you probably see a lot of, obviously, they're coming right out of school. How can academia better prepare nurses for when they're actually working in their specialty area?

[16:24] Sarah: So one thing that I've noticed is that it doesn't seem like there is a, how can I put this? There are standards within academia, but there also are no standards within academia. I can have a new grad, and their experience with their clinicals and their education and everything like that could be vastly different than my other nurse. Some of them don't even have a critical care rotation. Some of them don't go into depth as far as ECG analysis. So those are just small examples that I've noticed that you know, those things can be very impactful for a nurse starting out because they're all expected to start out at a certain level, but then you have one that has a little bit more exposure. Maybe they did a rotation in critical care. Maybe they have, you know, ECG analysis was definitely part of their curriculum, more so than the other. And so that's definitely going to impact how they start out as well. So I think that there are some overall differences between schooling that is unfortunate that I wish that there was more standardization. There is standardization in the sense of, okay, these are the things that you have to teach in order to pass the standardized test that you need to get your license from. However, there isn't standardization with the other content that is actually being taught. I think that there is a lot of value in how we train people in education, and I wish that more of it was focused on actual clinical practice versus this is how you pass a test. Like, we need more critical thinking. We also need education that is not even close to passing a test. Like, how do you deal with difficult family members? How do you actually, you know, process death? How do you deal with, you know, work-life balance? How are you going to manage burnout? These are important, impactful conversations that need to be intentional early on in nurses' careers, in order for them to mentally be okay, to help our working environments, and to really support the nurses. So I think there's also some lack of very important conversations and lessons that are happening that are not occurring in academia, and I don't know if they ever will. That would be my hope. But that's also why I created the Critical Care Masterclass because I cover all of that. I create, you know, like, it's related to mentorship and coaching and those lessons that are not being taught, but also the components of. Okay, let's talk about pharmacology and pathophysiology as well.

[19:04] Michelle: Yeah. I feel like there needs to be a more holistic approach to the nurse starting out in school. And those things that you mentioned, the, you know, the self-care, the burnout, the things that nurses see on a daily basis, that is, you know, what's been coined as the cumulative caretaking trauma, right? And nursing schools would really benefit from maybe a shift or just an overhaul in the way that they address these things that affect the nurse, the whole nurse. And nursing is not just about, you know, tasks and medication and time management. It's interpersonal relationships, right? With our patients, our families, each other, and other disciplines. And we can't, we need to just have a more holistic approach instead of such a compartmentalized approach. So I'm totally with you on there. So you are a member of the AACN, which is the American Association of Critical Care Nurses. But how can critical care nurses benefit from professional organizations?

[20:22] Sarah: So I have been a member of AACN for years. I want to say within two years of my career of being an ICU nurse. And this was all on the basis of my preceptor telling me you'd need to become a member of AACN. And some benefits that I've experienced from being a part of the national community of critical care nurses is that number one, you get journals. You get free journals that are the most up-to-date evidence-based practice. I just received one yesterday that, you know, it takes a long time for evidence to trickle down all the way to the bedside, so you get evidence-based practices, things that are changing at your fingertips and more readily available. So for me, that's been incredibly beneficial. In addition to that, there is so much learning and education that comes with being a member. So if you. There's the national level, but there are also more local chapters, so you can become a chapter member of yours. For me, it's AACN because I'm critical care, and you have dinners and you have educational, you know, topics that come every month, and that can be very, very helpful, whether it's vendors or medications or whatever it may be. But you also get a community of different critical care nurses from different hospitals within your area where you can talk to them and say, hey, are you all dealing with this struggle? Or what are you guys doing about this? Or how are you handling this situation? Or, you know, whatever. You get to learn from each other and you have a sense of community for, number one, learning from each other, but also being like, yeah, no, we get it. Like, I'm right there with you. We're dealing with the same struggle, and this is how we've been able to navigate through that. Or sometimes you just need someone to be like, I see you. This is the whole point of, you know, my name is why it's spelled appropriately. You know, that way is sometimes you just need someone to say, I get it, and I see you. And sometimes that's all you need. So I think there's a benefit to that as well. The community associated with it, the education associated with it. You also get, you know, some discounts when it comes to receiving special certifications and discounts when it comes to getting more education that you would need. So there are multiple, multiple benefits as far as community networking and education that I think that are so beneficial being a part of any community or specialization based on where you are, because there's multiple. There's some for Neo, you know, Ob, I'm sure, but I just know critical care is because that's my jam.

[22:57] Michelle: So, yeah, I found all those benefits to be true. For over a decade, I was a member of the National Association of Neonatal Nurses. So, NANN and, you know, access to those listservs, the journals, like you said, just the networking alone, so, so valuable. And discounts to conferences and, you know, you were just a speaker at NTI in June, is that right? So just a few weeks ago. What did you speak about?

[23:30] Sarah: Actually, in May.

[23:32] Michelle: Okay.

[23:32] Sarah: I talked about the role of calcium in our hemorrhagic trauma patients. So the conversation of moving from the triad of death to the diamond of death, which really is just adding a fourth component to the. The old literature of acidosis, hypothermia, and coagulopathy. Now we're adding hypocalcemia because it interacts with all of those to create this bloodied vicious cycle. So that's the topic that I spoke upon this year at NTI. It was a great experience.

[23:59] Michelle: Yeah, that's very cool. What kind of feedback did you get from that?

[24:04] Sarah: So the feedback's been very positive. It was received well. I had probably 200 to 250 people that were actually at the presentation. It's also recorded. So after, I think it'll be like next week, we just had our virtual. So that's the good thing about NCI, is they'll have a live, they have the live conference, but they also have a virtual conference in case people can't go. And then many of the sessions are also going to be recorded where they can have on demand as well. So people can review that. So there are multiple people that are signed up for the on-demand as well. But the feedback has been great. It has. I talked to numerous people about, you know, the role of calcium, what they're doing at their facility, some things that they're going to be able to take back to their facility to advocate for better outcomes for our patients. So, yeah, it's been real. It was received really, really well. It was a great session overall.

[24:54] Michelle: That's fantastic. I have fond memories of attending conferences and going to the, you know, the call-out sessions and all of that, and it's just a great way to learn and a great way to connect with other nurses in your specialty. And like you said, you know, troubleshooting about this is what's happening at our institution and this is what we're doing about it. And bringing those ideas home to your group and sharing those with your group. There's just so much growth that can happen and it's fantastic.

[25:29] Sarah: I think that attending conferences is so beneficial. That's a big, huge benefit of being a part of your community, is that you can attend these conferences either live or virtual, but you get more information to then take back to your unit. In addition to that, it's very invigorating. Like, you leave there so charged up, you're like, I can change the world. So you get like this burst of energy that just like revitalizes your soul because we all need that sometimes where you're like, okay, this is a reminder of my why again. And there's all, there's, there were 6000 nurses all that attended the live NTI in Colorado. So there's a huge amount of energy that you, you know, you're surrounded by of individuals that are just there for the same purpose. And it's such a great feeling to be a part of. And I encourage everyone to go to live conferences to learn and to just experience that for themselves.

[26:30] Michelle: Yeah, the energy really is palpable and I think listening to energetic speakers that really know their stuff. I just personally have always been in awe. And I was talking to a guest the other day about attending. So in 2009, I became the developmental specialist for the NICU, and I didn't know anything about that. And so I took a whole year and I really learned and went to conferences and did everything I could, and I was instituting changes to practices that had been held for three decades. And I was talking with this guest about buy-in, and, you know, I mistakenly thought, I don't need to get buy-in. You know, my manager was saying, before you roll this out, you're going to have to get buy-in. And I just thought, you know, why? This is the latest evidence. This is, you know, people should just want to do it because it's the latest and greatest and it's a better way, and it's been proven to improve the care of neonates. And, you know, I learned that it wasn't that easy, right? Rolling out any new change is not easy. But where the difference came was I went to a conference and there was a parent panel, and I sat there for 2 hours in a room where parents of extremely premature infants that had stayed for, you know, months in the NICU and went home with tracheostomies and feeding tubes and on multiple medications and seeing multiple specialists were talking about things that happened in the NICU that either improved the care of their child or did not, things that nurses said that healthcare providers said that were helpful and things that were not. And hearing it from that perspective and then bringing it back to my group and presenting there, like being in the NICU, you don't get to find out what happened to the babies, you know, after they leave. And I imagine that's the same with ICU care, critical care, there's not that follow-up. So then getting that feedback from the parents was just so shocking and so valuable and so humbling that it really was the point where the minds were changed. And I got that buy-in. So, you know, again, I can't say enough about conferences, speakers, you know, it's amazing. I'm a big nerd.

[29:24] Sarah: Yeah. And it is true that you know, with critical care, you don't get to see that follow-through either. And I think that there is some value to the amplification of our patients' voices. And also, when they come back, if they can come back and see you, that's a huge, you know, uplifting moment for the entire team that's involved or if and anyone. I mean, really, because if you think of the emergency department nurses, they, they don't get any follow through with their patients, hardly ever. You know, so, you know, even them more so, at least within critical care, you may hear it from the floor nurse or, you know, they may come back and see you. But the ER nurses, sometimes they don't get any, any follow through, any follow up whatsoever for the care, the very important care that our emergency care nurses provide to critically ill patients in that very acute phase. I mean, they are a huge component of the overall care of our patients.

[30:14] Michelle: So, yeah, absolutely. Super important. Well, on your website, you, say, I have a weird gift of taking complex concepts and making them make total sense. Where did that come from, Sarah?

[30:29] Sarah: I don't know. If I'm being completely honest, I don't know. I don't know where it came from or why I'm able to do it. I just can. I think that maybe it's just the way I just talk in a way that makes sense in my brain. I'm not really sure, but I'm able to just take these topics that are highly complex and really break them down into, okay, what is the stuff that actually nurses need to know? How, how can I make this where it's like, this is the information that you need to know that is going to impact you and your patient care and your patient. What are the highlights? How can I make this simplified into something that really is easily digestible for you? And part of that is also knowing the individual that you're working with. Right. So you, you, education is built off of foundations. And so we have to start with the foundation first. And then once that foundation is built, then we can start adding layers onto it and we can dive even deeper into further understanding even more complex things and talking and, you know, really diving into the nerdy and geeking out and the pathophys and all of that. But in the beginning, we really just have to, you know, simplify it to be like, hey, let's get straight to the point. This is what it is and this is what you need to know. And this is how it's going to impact your patient and this is what you're seeing and what you're going to do about it. Part of that is also that we live in a very fast-paced environment these days. And I think people's attention spans collectively are getting shorter and shorter. So that's also part of being able to break things down very easily and say, okay, this is what it is. This is what we need to do. This is what you need to know. And this is how it's going to impact your patients. So I don't know where it came from.

[32:22] Michelle: Well, it's a gift. I mean, it's a gift. And does it just come naturally to you, your teaching style? Or is it something that you have to take training on to kind of hone your skills to be able to break these concepts down and eliminate the fluff? Because the fluff is where people start falling asleep and disengaging. And I think most nurses just are like, tell me what I need to know. Tell me the meat and potatoes of it. But did you train yourself, or did you have a mentor that trained you in that certain way?

[33:02] Sarah: So I think that part of it is I'm a very, very direct human being. I don't like fluff myself in critical care, specifically. I don't have time for fluff. I have a million things that I need to do, and I need to know exactly what I need to do in order to safely care for my patients and have whatever needs to happen done quickly for them. So I think that's also part of it, is that I am a direct human being. I've always been that way. I don't believe in fluff. I think that it's just, you know, it's a waste of my time when it comes to caring for my critically ill patients. Like, let's just get to the point here so we can just continue to do what we need to do for this person. So I think that's also part of it, is this. It's just part of my personality of being very direct. But I will say that my preceptor, my very first preceptor and my very first critical care educator, they were also that way. They were very direct. Straight to the point. This is what it is. This is what it was not.  No fluff involved. And so I think it's a combination of both. I don't think I was not, you know, I didn't train myself. It's just who I am.

[34:10] Michelle: Who you are? Yeah. Wow. That's amazing that it translates so well. It's like you were born for critical care. Another thing on your website that I found is your free tip sheet, which I thought was amazing and just so many little gems there. But something really resonated with me, and you're talking about fear and your line, "I encourage you to grow towards that fear." I think that's amazing. Being a mentor myself to nurses, new and old, one of the things that if they were having trouble with doing a certain skill like, let's say it's IVs. I said, here's what you need to do. You need to do a lot of IVs. They're scared, so they don't want to do it. But it's like, no, you're going to get over that fear by addressing it head-on and doing the thing that scares the shit out of you and doing it a lot. So when you come on the unit, you tell all the other nurses, if you need an IV started today, call me, here's my number. And you do that until that fear is gone. But, speak to that because there is a lot of fear, and how do we get over that? How do we address that?

[35:29] Sarah: So I think this is a little bit of a loaded question because it's very easy for us to say fear, but I think there's a lot of words that are underneath the label of fear. Part of that is, I don't have confidence. I'm uncertain. This is uncomfortable, you know, so all of that is, comes out as I'm scared. When really, when you get into it, it's like, okay, but what's, what's actually underneath here? Like, what is it? You know, is it that you just don't have the confidence? Well, you don't just develop. Confidence isn't just something that you magically find in a box. You know, you're not born per Maybelline. You're not born with it. You have to develop it. And you develop it through doing the thing slowly and progressing, and that's how you build confidence. Is it that you have imposter syndrome, which is associated with, you know, that confidence and also not, you know, really believing in yourself quite yet? The only way that you're going to continue through imposter syndrome is by growing in your education and your understanding and doing the thing so you can have that validation for yourself coming from yourself of, no, I can really do this. So I think there's, you know, some words underneath the label of fear that we have to look at that are really kind of like surface dwellers underneath it. And when it comes to it, the only way that we can really move through that truly is by just continuing to take those steps towards it. We don't grow by staying stagnant in anything in our lives at all. Anything that we want to excel in has been a result of doing it over and over and deepening ourselves and putting ourselves in that situation time and time again. I kind of like to use an analogy that it's time under pressure that's how you really get good and deepen your knowledge of caring for critically ill patients and being able to stay calm and chaos and recognize things before things happen, to then intervene. So your patient doesn't code. It's time under pressure, and unfortunately, the pressure is uncomfortable at times. However, if you remain in that, that's when you will continue to grow, you will learn, and you will become more comfortable with the discomfort because sometimes the discomfort doesn't go away. You're going to be in situations where you're like, this is uncomfortable. But I know that I can handle this discomfort because I've been here time and time again. And when I am uncomfortable, I know in my mind that I have these baseline skills that I have honed in so well that I can call upon that are the basic foundations of caring for this patient if they would decompensate very quickly. I am good at these things. I may not know this yet, but I am good here right now. And so I can always call upon those skills if I need to. And some of that may be the skill of just saying I don't know and I need help because that is a skill to be able to say that. So really, it's a matter of continuing to do the things. That's how you really do learn and move through that fear and where you just embrace it and you're like, you know what? This is a little intimidating, but I'm going to continue to learn because I've been here before and I know that I can work through this, and I know that once I do work through this I'm going to learn something. I'm going to learn something from it to then be able to be better once I'm in this situation again.

[38:51] Michelle: Yeah. I really love how you are able to read between the lines and see those things that, you know, when the nurse says, this is scary, to be able to say that there are things underlying that and it's confidence issues or experience issues, and just allowing the nurse to just saying sometimes those words is that that's okay. That's normal, that's okay. Because I think so many times we're much harder on ourselves than we need to be or that other people are on us. And to hear somebody, especially an educator, say, it's okay, you're gonna work through it, these are normal feelings that's just so validating. So that's amazing. That's amazing.

[39:42] Sarah: Yeah. I mean, one thing that I say to my nurses when they tell me, you know, if they ever say, I'm scared. I always tell them, well, I would be scared if you weren't. Like, that's what would be concerning to me. It's appropriate to be scared in this situation that you've never, ever been in. I would be scared if you were not because that would tell me that you don't have the skill to be able to say, this is not something I'm used to because you have to have that skill to practice safely and you wouldn't have that skill to say, I need help and I'm going to call upon my resources. So that's what would make me scared as an experienced nurse. So I always say, like, you should be scared, and if you weren't, then I would be concerned. And I also think that fear, sometimes we think that it's always a negative thing as well, but sometimes excitement can be actually looked at as fear. Maybe you're a little, you know, excited or you have a little bit of adrenaline and that might be labeled as fear as well. So there are many layers to the word fear that I've learned to kind of discover and unpack through working with multiple, multiple people and mentoring them, and educating them. But it's always interesting. But, yeah, you have to, you have to kind of run through the fear. Anything that I've done in my career has always been related to me learning to go forward through that. If I stayed shying away from that, then I would be nowhere compared to where I am today. Absolutely not. I definitely wouldn't be talking at NTI, that's for sure. I wouldn't be talking at conferences. I wouldn't have, you know, I wouldn't be here with you. None of that would have existed if I didn't allow myself to have time under pressure to move towards fear and learn that it's okay.

[41:29] Michelle: Yeah, fear can be motivating, right? And speaking publicly, speaking at those big conferences to your peers, can be terrifying. And there'd be a lot of people that would be like, nah, sorry, I'll take a pass. Hard pass right? Well, I want to talk for a moment about mental health, and I'm sure over the years you have figured out what you need to do for yourself in terms of mental health. How do you advise your students on how to take care of their mental health?

[42:06] Sarah: So I love this question. Discussing mental health and caring for the caretaker is what I like to call it, is a huge component of what I like to instill in anyone that I work with. It's actually one of the very second lessons that I did as far as the critical care masterclass was talking about this subject because I think it is so important and it is not talked about enough. And as I said earlier, it has to be intentional. So one thing I think that we need to do, or that I've found helpful is to do something proactive versus reactive. You have to know how to care for yourself before you need to absolutely care for yourself. Because when you're in a crisis situation and your mental health is through the gutter, that's not the time to learn how to navigate it. You need to have those skills in place that you can call upon when that does happen. Additionally, I think that every nurse can have the benefit of going to therapy if they can have that resource. I think it's very beneficial. Usually, facilities will also have free services related to getting someone set up for that service. I think that you have to have a very solid support system. So every time that I, my first interaction when I've met a new grad or a new ICU nurse, I always say, who are your people or who do you have in place? And it doesn't even have to be people. Sometimes it's animals, whatever. Who is your support system for when you need it? Because this job is going to be tough. That's the reality. I would love to sit here and lie and say that it's all butterflies and rainbows, but we work in critical care. We work with really traumatic, difficult things sometimes that you're going to feel from a human, human perspective and how are you going to navigate that? So I think being proactive is the biggest thing. Having intentional steps in place and then being very, very aware, which can be hard, being aware in the sense of when you need to ask for help again, but now for your brain and also when you need to step out and step back and find something else. And that can be very hard for people. Specifically for critical care nurses, I have found to say and accept, I need to leave right now. There's a lot of fear associated with that. There are a lot of feelings that come up associated with that. There's a lot of ego involved with that because there's ego death that can happen associated with leaving that high-intensity area. And you have to be aware of when you need to do this for yourself. Critical care is always going to be here. You can come back. I did. I took a step back. I took a step back for over a year and I came back to it and it was the best thing that I could have done for myself. I've had my bouts of burnout. I've had my bouts of not being the best mentally, especially after Covid. And sometimes you just need to take a break, and if you can do that, that's okay. You have to give yourself permission and the compassion that you give to others, we have to learn to give to ourselves. And sometimes a question that I ask people is, okay, if you. If you were giving advice to somebody that you love, what would it be? What would you tell them in this situation? And it's usually very, very easy for people to say, oh, well, I would tell them this, this, this, and I would, you know, I would do this for them. And this is what I think, that, blah, blah, blah, they can do all that. And then I'm like, okay, well, then why aren't we doing it for you? Why. Why can't you just do it for yourself? And it's a lot harder to then take that and go, whoa, okay, now I need to mirror it onto myself, but it usually will allow them to say, oh, no, you're right. And that's kind of a conversation I have with a lot of people. If they're dealing with, you know, making their first mistake, if they're feeling burnout, if they feel a certain way about navigating a traumatic situation, like, well, what would you say to this person? Okay, now listen to that again and take that onto yourself. So developing this inner caretaker that we all have, we all have one within ourselves. Oftentimes it's just hidden by this inner critic that takes over. That voice becomes very loud. But once you can tap into that inner self-compassion and caretaker and be proactive in engaging in that and taking steps, I think that's the biggest thing that we can help, we can do to help our own mental health and within our community as well.

[46:31] Michelle: Yeah. Really happy that you're addressing that. I think it's just a necessity today in light of all the things that we've gone through to really shine a light on mental health. And the ego death is a real thing. I took a great course from Debriefing the Front Lines called Ego Death of the ICU. And I took it specifically because I retired from the NICU after, you know, so many years. And, man, I was feeling all the things, you know, my life is over. I have no usefulness anymore. I have no purpose, you know, what am I going to do with my life now? All those things we tell ourselves, right?

[47:18] Sarah: There's a lot of identity that happens, right?

[47:21] Michelle: 100%.

[47:22] Sarah: There's ego death and what I like to call it is identity crisis. You're kind of like, well, who am I? Outside of being an ICU nurse? An ICU nurse, just like us. The trope is a trope for a reason, right? Like, we will tell you if we're an ICU nurse, right? We will tell you if we work in NICU. We tell you what ER, we tell you. And that's because it becomes so etched into our identity, and I think that's also a component, too, is how do you separate yourself outside of that? Yes, you are a nurse, but something I've been very curious about recently, and I'm about to make a video about it soon, is what components of nursing actually speak to who you are as a person because that's. That's who you are. Like, I'm a caretaker regardless of if I'm a nurse. I am a compassionate person, regardless. I'm an advocate through and through. Those things exist as Sarah. They don't exist because I'm a nurse. They exist because I am Sarah. And nursing is a way that I can amplify those components of who I am as a person.

[48:28] Michelle: Wow.

[48:28] Sarah: So I think that that's like, you know, dismantling your identity and not going into that identity crisis because it's very, very hard if for some reason, number one, you know, everything has a timeline, but what if you have to leave when you're not ready to? I know many nurses that had to go through this process because they got injured and now they have to leave the bedside completely, and that's a tough situation. It wasn't expected, and so they have this. But if you can, you know, have some compassion and. And realize you are, yes, you are a nurse, but you're also. This is who you are, and you have other things and you have worth outside of who you are outside of this. So it's a real thing, man.

[49:15] Michelle: I love that reframing. It's so powerful. I just got it. It was like, that's exactly what I needed. I just got it. And so, succinctly. You have such a gift for looking at things, so thank you for that. I'm going to reflect on that, and I can't wait for your video to come out to think about that more. What can we find in your masterclass, Sarah? Yeah.

[49:39] Sarah: 

[51:03] Michelle: That's fantastic. And they can access that from your website, right?

[51:07] Sarah: Yes. They can sign up, and they also get digital resources that they can print out to be able to take back with them to the bedside. So they have something that's, you know, a resource that is all up to date, evidence-based practice. I mean, I put a lot of research into everything I do.

[51:21] Michelle: So, yeah, that's totally evident. And, you know, it's, it's so needed in terms of how we look at things. So, you know, as nurses, we understand steps, right? And, you know, you could say, well, there's a protocol for starting pressers on somebody, and so you do ABCD, but when you're dealing with, you know, how do I process this patient that died, you know, right in front of me? And there's just, there's, there's not, like, succinct steps for that. And so that's so hard to navigate. But I'm just so glad that those components are weaved into your teaching because those things are just not addressed and they need to be. So you have a really high degree of emotional intelligence in terms of your capabilities and in terms of communicating the things that critical care nurses need to hear. So fantastic. You have shared so many gems today. I have just been in awe, and I love checking out all your social media and just learning from you. So thank you for that.

[52:44] Sarah: Well, thank you, Michelle. I really appreciate those compliments, and I appreciate that you gave me an opportunity to come in and talk with you and learn more about you, and share my love and passion for what I do. I really wholeheartedly love still being a critical care nurse and sharing my knowledge and helping new critical care nurses. I mean, they are the future. Eventually, we're all going to know somebody who's probably going to end up in that same area. And there's so much that we can do to support these new nurses, whether they're experienced or brand new nurses. It's just so needed, and I feel very honored to be able to do it. And I learn just as much as the people that I teach and I get just as much back. So this really has, you know, is my service now. My service initially was to take care of my patients, and it still is. That's the base of what I do. But now my service is to our community in a different way.

[53:43] Michelle: Yeah, it totally comes through you. You know, you can't fake authenticity and passion and love, and those things are definitely there and they come through and they're communicated and needed and valued. So thank you.

[54:00] Sarah: Thank you.

[54:00] Michelle: Well, Sarah, is there someone that you recommend as a guest on this podcast?

[54:06] Sarah: So I would say that when it comes to. We talked about how we amplify patients and their stories. Kali from The Awake and Walking ICU is an amazing individual. I can't speak highly enough about the work that she does. She has her own podcast where she actually interviews patients that have been in critical care to talk about their experience within that. She is a groundbreaking individual, creating impactful change for our patients. And she is somebody I highly, highly respect. I would definitely suggest Kali if you can. I don't know who exactly your population is, your community, but she talks about pediatrics. She talks about all of it. She's an amazing human being.

[54:54] Michelle: Amazing. Awesome. I heard about Kali from another guest, so I did go check her LinkedIn out, and yeah, she's doing some amazing things in the ICU in terms of, you know, having intubated patients up and walking around and, yeah, amazing. I would love to have Kali, so I will definitely reach out to her. Well, where can we find you, Sarah? I mean, you're everywhere, but where else can we find you?

[55:26] Sarah: So, yeah, my main website is icunurse.com. That's where you can find the links to all of my social media. My social media is @ISEEYOU_nurse, and that's pretty much where I'll be. And you can find me, you know, all over. Like you said, I feel like I try to be as accessible as I can to individuals on a variety of levels, depending on what they need.

[55:46] Michelle: Yeah. Thank you. I love your Etsy store. First of all, I'm a huge fan of Etsy. So anytime anybody has an Etsy store, it's like, I'm right there. And I just found it to be so cool and just the content that you have for the price. And I was like, you, how could a nurse, like, not get this? Like, this is so awesome. So you make it easy for everybody. And I love that. We need easy sometimes. Yeah. Well, cool. Well, are you ready for the five minutes of fun?

[56:19] Sarah: Oh, okay. Let me get ready.

[56:24]  I'm doing something different, and you're the first one that I'm doing it with. So I'll tell you what. Tell you what this is about. I went to my local bookstore, which is actually a huge chain store, Barnes and Noble. I say my local bookstore, but, you know, they're everywhere. And I found this set of cards, and it was created by the organization called the Moth, which was founded by a novelist who wanted to recreate in New York the feeling of sultry summer evenings in his native Georgia when moths were attracted to the light on the porch where he and his friends would gather to spin spellbinding tales. So basically, the Moth is storytelling. Okay, so we're going to do, like, a little short version of storytelling today. So first question, or I guess it's not a question. First, ask. Tell us about a time as a nurse when you chose fight instead of flight.

[58:06] Sarah: So, man, so many times you're like, plus one. So many times. I think that, you know, like I said, I'm a very big advocate for my patients. My mother raised me to be a very vocal woman, and I am so thankful for her to do that. I never felt silenced in the sense of advocating for my patients. So during COVID you know, a lot of our patients were very, very, very sick, and I was taking care of a patient who was clearly in the late stages of COVID ICU or Covid and had some pretty extensive ards. And as we know, with ARDS, patient's lungs become very, very non-compliant. And there's only so much that you can do to help with ventilator and patient desynchrony. As far as sedation, at some point, you have to take them out of the picture by adding on neuromuscular blocking agents to then be able to truly ventilate and oxygenate these people. So this patient had been quite desynchronous with the vent, despite my attempts of going up on any of the sedative medications that I had. And so I was talking to the provider and I said, hey, you know what, I really think that we need to paralyze this patient at this point. I think that they need neuromuscular blocking agents. Their ventilation is not getting better, the ABGs are not improving, and their oxygenation is poor. I think we're at this point, I have done everything I can. The patient is sedated, but I am not taking this drive out by sedation. They are just trying and huffing and puffing. And the provider said, okay, why don't we just add Precedex? And if anybody knows anything about Precedex, it's not going to do anything for your respiratory drive. It is not going to blunt it. That's the good thing about Precedex, is that it doesn't do anything to your respiratory drive, but it allows for the patient to have a sedative effect. And I said, you know what, I just don't think that this is appropriate for this patient. And they said, no, I really do think it is. I said I don't think it is. So I tried anyway, and sure enough, it did not work. And so I went back to the provider and we went back and forth quite a few times, and eventually, we were able to come to the agreement that the patient needed to be on neuromuscular blocking agents. So we sure, as we definitely paralyzed the patient, and their ventilation and oxygenation did improve and we were able to, within the next day or two, start to come down slowly on their vent setting. But that's just one example. I am not a silent nurse. I am a fearless advocator for my patients. I just did this yesterday with the patient where we were in the middle of an emergency situation and I had to, you know, set some boundaries in place. There are so many stories that I could really tell, but I fear fearless is I'm definitely that when it comes to doing what is right for my patient.

[01:01:12] Michelle: Damn, Sarah, I'm thankful for your mom, too. That's amazing. You're a great storyteller. All right, let's do one more. Let's see. Okay. Tell us about a time you wish you had an undo button.

[01:01:34] Sarah: I don't wish to undo anything that I've been through or experienced in my life, because that is exactly what has made me who I am today. Anything that I could say I wish that I could undo has allowed me to learn a lesson, to then be a better person. Human, nurse, friend, daughter, partner, whatever. It's all led up to who I am today, and I am very proud and content with the person that I am today. So even though I've been through some very difficult moments, very difficult times in my life, and experienced some hardships, they've all led to where I am now. And without them, I don't think that you know, I would be who I am. I think the only thing that I could truly think of that I wish that I could undo is that I lost my soulmate dog probably last September. And that's the only thing that I could honestly think of. If I could undo it and bring her back, I would. However, even with that experience, because it was a traumatic experience, it was sudden, and I had to see her attempts at resuscitation like she was on a breathing tube and all sorts of stuff. It was a terrible situation. That experience and the experience of grief have given me a different perspective and how I see my family members that I now care for when they are going through that same experience. Yes, I always had empathy, but it is different when you experience it yourself. And so even with that, there have been benefits. You know, it's led me to be a better human being because now I can truly say, oh, I get it. Like, I really understand this pain. I really understand why people, you know, as nurses, we get, you know, it's like, well, why are they doing this? Why are they holding on to this person? Well, they literally, their loved one was just walking and talking the day before. So this is a traumatic experience for them. It takes time to process. They are going to have these reactions because I now know and fully understand to my core what it's like. So even with that, I mean, that is the one thing I wish I could bring her back. I mean, her picture is sitting right next to me, you know, like, I loved that dog. She is my soulmate, my best friend. But other than that, I mean, everything has made me who I am. So I can't really say that I would undo anything.

[01:04:12] Michelle: Well, I'll tell you what, every nurse needs a Sarah Vance in their life. And I am just so thankful that I met you and that I had the opportunity to talk to you. And you should check out the Moth on Instagram because I could see you there telling one of your stories. You are a master storyteller, and I thank you for indulging me today in this new part of the five-minute snippet, but, man, I'm blown away.

[01:04:41] Sarah: Thank you. I will check it out. It sounds interesting. I'd love to hear other people's stories, too, so.

[01:04:46] Michelle: Yeah, it is. Wow. Well, this has been great. Sarah, thank you so much for coming on and sharing everything that you love and are passionate about, and is authentic to you. Again, kudos to your mom for raising such an amazing woman and nurse. So have a great rest of your day, whatever you're doing.

[01:05:07] Sarah: Thank you, Michelle. I appreciate it. It's been fun.

[01:05:10] Michelle: Same. All right, take care.