Family Nurse Practitioner, Alisha Sandidge-Renteria

[00:00] Michelle: I've often said on this podcast that many nurses choose this profession for reasons that aren't noble or lofty. Alisha Sandidge-Renteria changed that for me. As a teenager, she witnessed the economic disparity in healthcare after seeing her mother, who was fighting cancer, be forced to choose a cheaper, experimental, and less effective regimen which ultimately ended her life. Since then, Alisha has embodied the words of Gandhi, "Be the change you wish to see in the world." And as a nurse practitioner, she can do just that. Of course, we talked about the particulars of the job, the schooling, the patient population, work settings, diagnosing, and, you know, me, we also discussed professional organizations and board certification. There was some heavy lifting as well. We talked about broken systems and broken people. But through it all, there was one common thread evident in our discussion: connection, with our patients, our communities, each other, and ourselves. In the five-minute snippet, I see a commune in her future. Here is Alisha Sandidge-Renteria.
[01:36] Michelle: Well, hi, Alisha, welcome to the program.
[01:38] Alisha: Thank you, ma'am.
[01:40] Michelle: So great to have you here in my closet. We're going to talk about all things nurse practitioner. So I'm excited and we'll just get started.
[01:50] Alisha: Awesome.
[01:51] Michelle: Yeah. Tell me, how did you get started in nursing?
[01:54] Alisha: Well, my mom was a nurse. She worked at the VA for like, 25 years, probably before she got sick with terminal cancer. And so I'd say that she's a huge, caught me on a day that I'm feeling sentimental. Yeah, she's a huge reason. But I saw a defibrillator when I was in fourth grade. They were doing an EMT paramedic type of situation. Cool. And I said, I want to use that, and I'm going to figure out how.
[02:24] Michelle: Oh, my gosh. That's show and tell right to the max where you can really influence somebody.
[02:32] Alisha: And then I used it too many times, and I was like, I feel like I didn't think this through. I want to use it until you're in that moment and you actually understand what's happening.
[02:41] Michelle: Exactly.
[02:42] Alisha: But that's kind of what sparked my interest in healthcare.
[02:46] Michelle: I love it. I've talked to so many nurses now, and the reasons that people get into nursing are so varied, and I always say they're not always like, these noble reasons. Sometimes it's like, oh, that's a cool tool. I would like to use that. How do I do that? And of course, you have your mom's influence. That's really important, too.
[03:11] Alisha: Well, I think it was the disparity, actually, that I saw in her care because we did not have a lot of money. In fact, we had to plug the pump in to get water into my house in South Dakota. And my mom was a victim of kind of just a dysfunctional domestic violence type of situation. And then when she got cancer, we took her up to the Mayo Clinic and they said, okay, so she can have this chemo or this chemo. This one is cheaper. Basically, all we heard was it's cheaper and less effective. And it's also what's the word when they are testing something? Experimental. We don't even know if it's going to work, but if you had money, then you get this. And so that was tough. Excuse me, my continuous glucose monitor going off here. Yeah. So at that point, I was like, wow, is this what happens to people that don't have money?
[04:09] Michelle: What year is this? Like, what decade?
[04:11] Alisha: Yeah, that was when I was probably in the early two thousands.
[04:16] Michelle: Oh, wow. Okay. really sad.
[04:18] Alisha: Yeah, really sad. And I thought, like, what do people do that don't have money?
[04:21] Michelle: Yeah. They just die.
[04:24] Alisha: And I wasn't cool with that. Not at all.
[04:26] Michelle: So you're kind of a change agent in your practice. You have a varied background. So tell me some of the areas that you've worked in.
[04:35] Alisha: Yeah. So in South Dakota, you get to work young. I was working in healthcare at like, 13, and so I was like a med tech. Started out then as a CNA in a nursing home.
[04:44] Michelle: Oh, my God.
[04:45] Alisha: Yeah. And then went on I went to three years of high school because my mom, I knew she wasn't going to live long enough to see me graduate, so I said, fine, I'll just do it early. And so I graduated early. And I was a CNA at the time, and it's been mentors throughout my life, and your brother is one of the main reasons where I am, why I am in the situation I am in now. But it was another nurse who gave me an opportunity and just gave me, like, light during such a dark time. And so I worked for her. And I remember she paid me $9.75 an hour. And I thought I'd hit the big bucks, right? Yes, I hit the big bucks as a CNA. I went to school and got my four-year bachelor's degree. And at that time I was a waitress and a bartender and then went on to get my registered nursing. And I had to stalk my way into the hospital that I worked for many years.
[05:44] Michelle: Yeah.
[05:44] Alisha: So I started cardiology, mental health, ortho, neuro, med-surg. Did some SART nursing for a while. Family practice, gerontology, research. Because I have, like, flaring ADHD. So it's a gift. It's a gift.
[05:59] Michelle: It is. Well, because look at the experience that you've gained. Yeah, for sure. But it's a little bit squirrel.
[06:06] Alisha: Yes, squirrel all the way.
[06:07] Michelle: That's great though. It's benefiting you now, though, as a nurse practitioner. So how do you think all those experiences in all those different specialties have helped you as a nurse practitioner in your practice right now?
[06:22] Alisha: Oh, my gosh. It's helped me tremendously because patients that I see, I see anything from little babies to our grandmas and grandpas and anywhere in between and we see cardiac, we see med-surg, we see TBI patients, we see patients that are struggling with eating disorders. And because of my experiences sprinkled in in the last 20 years, I feel like I have a little bit of a foundation to stand on to kind of guide the next step, I think.
[06:52] Michelle: A lot of foundation. That's amazing. Yeah. So why were you attracted to being a nurse practitioner? What was the pull for you?
[07:03] Alisha: That's really interesting because I never once said to myself, I'm going to be a nurse practitioner. It was actually that I forecasted my life out and I'm so glad that I did because it allowed me to have options to still be a healer. But know that bedside nursing takes a lot out of you. Right. Especially like an ortho floor, right? Heavy lifting and all the things. But I actually looked at the nurses that had been in the profession for 30 years and I thought, what kind of lives do they have? What's the quality of their life? And unfortunately, the quality of life was not what I wanted to do. That's not how I wanted to live. I wanted to have time for my family. I wanted to give to the community. But I think so often we give and give and give to a system that actually doesn't support healing for the healers. And that I just said, okay, well, what else can I do? Because I know my body is not going to last for 30 years doing bedside. And so I said, okay, well, what are my options? And I think that the most important thing, is that if someone is thinking about going into healthcare or nursing, they have to understand why. Why are they doing it? The why behind it is so much more important. And also if you do something every day, the compound effect, what is your life going to look like in 20 to 30 years? And so I wanted health and I wanted a good marriage and I wanted God at the center and I want to be a good parent. But how do you do that if you're constantly giving your best self somewhere else?
[08:40] Michelle: Yes, and I think a lot of nurses are figuring that out right now. Nurses that maybe didn't plan as you did for the future, what's it going to look like in 30 years? We just start out in the profession and because of our varied interests and then we get to that point where the physicality of it is really more hurtful than it is helpful. And then we have burnout and it's like, no resources.
[09:15] Alisha: So it's really a fun thing when you're in a situation in like a global pandemic and someone tells you we don't have masks or gloves or Betadine and you have to pull your own saline syringes out of a bag. Oh, and guess what? We have a bunch of stuff that got donated to us from farmers. Thank God they did, because we wouldn't have had gloves otherwise. And so you want to dig your well before you're thirsty. And I accidentally did that, and I didn't even know that it was going to be such a blessing. But I had great mentors, and I always sought perspective from other people, which was so important.
[09:49] Michelle: That is so important. It's huge. And I talk about that all the time with my guests, because many of my guests, like you, have mentors through their professional careers in their personal life that are guiding them. And I don't think you can go it alone. I think you need that. And as nurses, we need to step up our mentoring game.
[10:19] Alisha: Yes, absolutely.
[10:21] Michelle: I like that you touched on that. So now you're a nurse practitioner. And so let's get into some of the nursing specifics. So talk about the schooling that you went through. What's that like?
[10:35] Alisha: Yeah. So in the Midwest, things are actually a little bit different. And so when I came to California, I was surprised to learn that there was a thing called a lottery system that doesn't really exist in the Midwest. You get your high school degree to get your bachelor's. I didn't even know that an associate's degree nurse existed. And it's awesome, and I'm so glad that it does, but that's just not the way that the Midwest, where I had grown up, wasn't divine. So went straight to a four-year university. And in that university, I got a chance to travel to Kenya, Africa, and do a whole month or two there, which was such an amazing oh, so amazing. Such a huge draw for the University of Jamestown, because you get to really humble yourself and realize that we don't hold the cornerstone on healing in America. In fact, there is a lot we can learn from other cultures.
[11:36] Michelle: Right, right. We're low on the list. Yeah.
[11:40] Alisha: But I was so glad that at the preparation because they are professors and I love them dearly and I respect them and honor them so much because I think I would be a statistic. I think I would be probably addicted to drugs and have been pregnant as a teenager if I wouldn't have people that just said, like, hey, let me help you. Right. And they made us do our ACLS. They made us do our PALS before we graduated. Oh, yeah. And so when you got your four-year degree, then you went on to take your boards. And I decided that I wasn't going to study for my boards, that I was going to travel around and couch surf.
[12:13] Michelle: You're like gap year.
[12:14] Alisha: Yeah. Boards.
[12:15] Michelle: What's that?
[12:16] Alisha: Exactly. So I actually did my boards in California, which is a trip, because that's a whole thing in itself. But I think that this is one thing, and this is what Rose and Chris taught me, is that the boards, people think that it's kind of this big accomplishment, but it's actually just like the smallest barrier to entry that you're scratching the surface, and everything else from there is, like, the real deal. Yes. So it's necessary. Right. Regulation. We have to do it. But I've seen this might sound kind of mean, but I've seen smarter people fail and dumber people pass. Because not everybody fits in a box.
[12:51] Michelle: Right? Yeah. And it's a test, and a lot of people are not good test takers, but amazing clinicians. Exactly. And as you said, it's a regulation. And maybe that's something that we can do in the future for the profession, is take a look at the NCLEX and how we could change that to make more I don't know, well-rounded.
[13:16] Alisha: Yeah. Practicality.
[13:18] Michelle: Because it's like you're teaching to the test, like what's happening in California school.
[13:22] Alisha: Correct.
[13:23] Michelle: But are they learning anything? Are they retaining anything?
[13:26] Alisha: Absolutely. Can it go from their head to their heart in a safe way that makes sense? Yeah.
[13:32] Michelle: And we know as nurses, it's all about that's just the beginning. The on-the-job training is where you're really going to come into your own.
[13:42] Alisha: Absolutely. 100%.
[13:45] Michelle: Okay. So I talk a lot about certification, and I know that you're board certified in your specialty, and I was also well, I still am board certified in NICU care, and I think that's important and talk about the importance of that.
[14:03] Alisha: Yeah. So when you're about to graduate from your graduate program, you kind of have to decide, like, am I going to do? I think it's either AACN or AANP. And so there are two different entities that can kind of bless your ability to practice. And so the ANP, I would say, is more focused on clinical scenarios. The actual test that you have to pass, it's more like, hey, there's this patient scenario. Here are the labs, and what are you going to do about it? And now create a plan. And are you going to create a safe plan? Whereas the other entity seems a bit more leadership-focused, more like ethics theory, that kind of thing. I don't know for sure because I've never taken it, but that's just what my peers have told me.
[14:50] Michelle: Sure.
[14:50] Alisha: So you have the opportunity to kind of test in two different realms, but to be if you want to be in a family practice, where I'm at now, it seems that the ANP prepared me a bit better than if I would have gone through the other route. So it's good to have options based on their personality or their desire of where they want to go.
[15:10] Michelle: Yeah, exactly. And do you think you would be employed as an NP if you didn't have your board certification?
[15:19] Alisha: No, not a thing.
[15:21] Michelle: It's kind of a requirement.
[15:22] Alisha: It is an absolute requirement. Yeah.
[15:26] Michelle: I interviewed a DNP student the other day, and we were talking about this, and it was like, what is the benefit to yourself, to the community, to the profession in kind of knowing having that specialty certification?
[15:46] Alisha: I think it weeds out the ones that are doing it for the money. I honestly do. I have heard people say, I'm just doing this for the money. And I can guarantee you, Michelle, that the trauma and the things that we've endured in the last couple of years, there is not a dollar amount that you could have paid these people to continue to get up and go do what they do every day. And so, honestly, I think that in some ways, we're lowering the bar because you had to have two years, at a minimum, bedside to get into a program. And how can you build a safe practice if you don't have any actual experience? Does that make sense?
[16:26] Michelle: Yeah.
[16:26] Alisha: And so it's a regulation. It's an absolute necessity. And I think that well, it's also tied to reimbursement. So if I didn't have a certification through the ANP, I think Medicare is one of those that you don't get reimbursement.
[16:42] Michelle: Okay.
[16:42] Alisha: So you could be an NP, but unless you're a board-certified NP, nobody's going to reimburse you for your service.
[16:48] Michelle: You're not going to get paid.
[16:50] Alisha: I think that if you want to do it, you're going to put your mind to it and you're going to study. But if your heart's not in it for the right reasons, I think it weeds people out.
[17:01] Michelle: Yeah. I've talked to a lot of nurses because we had this conflict in the NICU. We had a boss who was very forward-thinking and very pro-certification and said, within three years of working in the NICU, you have to have your board certification. And so there were just two schools. Like, a lot of us said, that's great, I'm going to work towards that. And a lot of them said, Why? The patients don't care for board certified. They don't even know what that is. Are they going to get better care because you're board certified? Some of the research says yes. There are a couple of schools of thought there.
[17:49] Alisha: Yeah. And to me, it always leads back to the environment that you're in. And are we trying to look good on paper? What's the actual goal?
[17:58] Michelle: Yeah, well, I mean, we went through all the Magnet stuff, and I don't know if I'm a big fan of Magnet. Dr. Chris Patty would say people don't choose a hospital because it's Magnet.
[18:15] Alisha: Correct.
[18:15] Michelle: They go to the hospital nearest to them.
[18:18] Alisha: Absolutely.
[18:19] Michelle: Can you just hear him saying it?
[18:21] Alisha: Oh, I love it, yes. He always says, "Got to keep the first thing first." I was like, Chris, what does that mean? Tell me.
[18:29] Michelle: Yeah, stuff like that.
[18:34] Alisha: But I think people will go back for their certifications if they feel that they're in a growth environment. If they feel that they're supported, if they feel that. I think that's also on leadership. Help them understand why it is important. Right. Help them understand. And if we're not helping them understand, then to them, it is a task. I will go wing that test to get those letters behind my name, or I will leave.
[18:57] Michelle: And we had nurses leave because of that, right? Yeah.
[19:01] Alisha: So a lot of times, it's like, is it tied to a measure that leadership cares about? Well, if it is, then it's our job as leaders not to finger-point, scold, and enforce, but to help them invest in the vision and the mission. But loyal people will abandon employment if they don't feel that their time is contributing to a vision that is actually helping people.
[19:30] Michelle: Well said. Very well said. Okay, so now you're board certified. You're a nurse practitioner. Where can nurse practitioners work?
[19:41] Alisha: Yeah, there is so much opportunity for them, depending on the area that they're in. And I have looked at different jobs for the County. There's private clinics, there's hospitals, there's convalescent homes, there's day spas, and beauty. I think it's aesthetics. Yeah, aesthetics. That's one that's, like, super emerging.
[20:08] Michelle: Did not know.
[20:08] Alisha: Yeah. So I've got approached a ton of times, like, hey, do you want to learn how to do Botox this and that? And then I had a misunderstanding or misperception of what that looks like, and I thought, well, first of all, nobody wants me to be in charge of their face. So that is just like a decision that I'm making. This is the betterment for everybody. Right. Because people who are really good at detail should do those jobs. And it's just not me, but I always also thought for me personally, is that helping somebody, or is that just vanity? And I've come to understand by talking with my peers that it is not just vanity. It's when a person feels good about themselves and then they will thrive in every area of their life. Not everybody's cut out to want to do toenail removals and pessary fittings and cutting stuff off people's arms. You know what I mean? There's something for everybody.
[21:06] Michelle: That is so true. Something for everybody. So think of your practice, and do you have areas where you're really strong and areas where you're like, I don't know about that. Is it like pediatrics? Is it like cardiac? It'd be doubtful that's cardiac because you have a cardiac history in your work history. But what is it for you that you're like? I really love this part of my practice, but this one, I feel kind of iffy.
[21:42] Alisha: Yeah, I feel really comfortable with adults. I feel really comfortable with adults. And it's probably my bias as a mother that as a clinician, you have to be able to think objectively. And sometimes my fear is with these kiddos, is like, oh, my gosh, if I make a mistake. It seems that the stakes are so high. Right. But most pediatric clinicians, like in Peds, they'll say like, well, we actually feel like there's way more that can go wrong with an adult.
[22:18] Michelle: Isn't that crazy?
[22:20] Alisha: Yeah.
[22:22] Michelle: It's just your comfort zone or your experience or whatever.
[22:26] Alisha: And I think pushing past that comfort zone because I used to say, oh my gosh, I'm so nervous to see kiddos. But now that I've been doing it, I'm like, oh, I love them and I understand them now. I'm really good at being safe and building trust and connection. And I found that that's the most important thing because they might be coming to you for a sinus infection, but then you actually find out that there's trauma in the home, that there is food insecurity. They don't have access to the resources. And so once you build trust and connection with them, you realize that most of the time what they're coming for is just a symptom of a bigger problem.
[23:03] Michelle: Yeah. And then you can be so effective in helping the whole human those other things. Because we're not just a sinus infection sitting in your office.
[23:14] Alisha: Correct.
[23:14] Michelle: We're a living, breathing, loving, hurting person.
[23:20] Alisha: Yes.
[23:21] Michelle: And I think that's your superpower as an NP, honestly, my primary has been an NP for quite a few years now. And when I was going through cancer treatment for breast cancer, my oncology NP was so amazing. And I don't know what the difference is and I don't know why this is true, but as an NP, you spend more time, like physical time, and you are a really good listener. That's a skill that, I love physicians, but I don't think they have that honed in. I think some of them are focused on the words that come right out of your mouth and they're already thinking down the line instead of really listening. And maybe nurses have more of that empathetic nature where you are more geared to the whole person and not just parts of the person.
[24:29] Alisha: Correct.
[24:29] Michelle: So I'm a big fan of NPs for that. But how do you hone some of those skills? Like taking the time I know you're not any less busy than a physician. The time that you're spending, you're really listening. How do you hone those skills?
[24:47] Alisha: Yeah, that's a great question and I didn't know. I think you maybe have told me that you were a breast cancer survivor. So that's awesome.
[24:53] Michelle: Fourteen years.
[24:54] Alisha: Love it, girl. That's awesome. And it reminds me of a physician who does Ted Talks and he said that the absolute worst thing that's happening in medicine right now is that we no longer touch the patient. And it was a breast cancer patient that he had sent up to a specialist and they never once, it was the state of the art care, and they never once examined her breast physically with their hands because they said, "Why would they need to do that? They have all the scans." And guess what that patient did? She discharged herself from their care and went back down to the rural area where he found the breast cancer because she felt safer because he actually connected with her on a human level. And so to answer your question about how we prioritize our time, it's health assessment. When you get to feel the patient, you get to really hone in on what I call spidey senses. And the spidey senses, it may seem like you're taking more time on the front with the patient, but if you spend that extra 15 minutes and gain their trust, you're going to be able to help them in so many more ways that it just happened yesterday. I spent an additional probably 35 minutes that I honestly didn't have at that time, but I spent it connecting with her and talking with her and promising her that I was going to be as safe as I possibly could because she's had so many bad experiences that our subsequent visits they won't be so long. Yeah, they won't.
[26:29] Michelle: She's already got that trust, and a lot of the time is establishing it is that trust. And I got the chills when you were just talking about the hands-on and spidey senses and everything. That's an art that is rapidly leaving the medical profession.
[26:48] Alisha: Yes. Because we're hyper-focusing on the screen.
[26:50] Michelle: Yeah, we're so tech. And just like you said, why do I have to touch her? I have the scan of her breast right here.
[26:58] Alisha: Right?
[26:59] Michelle: Yeah. That's so sad.
[27:01] Alisha: And the medical errors go through the roof. What if they sent the wrong scan? Right? We see that all the time.
[27:06] Michelle: That never happens.
[27:07] Alisha: Right?
[27:08] Michelle: Come on. Okay. How do you diagnose patients? You guys are again, you're amazing to me. The vast knowledge that you have to have about the human body, anatomy, physiology, all of that. But do you use any special resources? Do you use algorithms or how do you go about making a diagnosis, especially when it could be different things? So you're like weeding out your differential, diagnoses and all that?
[27:45] Alisha: Yeah, so they always teach us to I might butcher the saying, but look for the horses, not the zebras. Right. So if you come in with a sore throat, we want to know, when did it start, what makes it better, what makes it worse, and what have you tried? Genetics, environment? What are your symptoms? The glucose monitor says my glucose is low, but it is not. That's why I keep speaking.
[28:12] Michelle: Just go with it.
[28:14] Alisha: So I use what makes it better, what makes it worse, what have you tried? And using my hands and my eyes and my skills. And it's looking at the vital signs, it's looking at the presentation. There is some research out. I don't know if we call it research, because research to me is supposed to mean that it's credible, but that NPs overorder things. And I'm not here to say whether we do or we don't, whether it's we overorder labs or X-rays or whatever because maybe we're feeling insecure or whatever. I think that we have to use all of those resources. Right. And so my mind is like, well, I'd really rather actually maybe take this a little bit more seriously than not, because I've seen what happens when you minimize things, right? And so the vital signs and the health assessment and the patient's subjective report, a lot of times people shut that down, but that's the most important part, right? That's the part where we don't let patients speak and then we come up with the wrong diagnosis. You think in your head you're going to have an idea, right? When I walk into a room, it's like a sore throat. You kind of have an idea of, like, okay, I have five things that most commonly will be. But that's when you run into trouble is when you think that, you know because it's so common and in fact, that you will just take yourself down a rabbit hole.
[29:42] Michelle: Yeah. And then there's an outlier out there somewhere, and they're like, got you.
[29:47] Alisha: Right? Yeah. But I use my resources. I'm never too egotistical to say, like, will you please help me? Like, Jared, Devin, Brian, whoever. I need you. But I think that that's a missing thing. People don't want to look stupid, but that's why they call it practicing medicine. It's a practice. Right. The guidelines change.
[30:06] Michelle: They don't call it perfect medicine.
[30:08] Alisha: Right. So using your resources, whether that's apps or algorithms or guidelines, but the guidelines, there's the oncology society. What does ARC say? What does the CDC say?
[30:20] Michelle: Right.
[30:21] Alisha: Yeah. We have tons of resources, and I think that if you're not scared to ask questions, what I learned is it's okay to tell the patient, gosh, Michelle, I'm a little stumped. I think they'd rather know that you're not 100% sure about a diagnosis, because then if you tell them, I know exactly what it is, and then hardly ever, you do, and it changes. They lose faith in you.
[30:43] Michelle: Yeah. Well, here so I'm going to turn this around because this is what happened a few months ago, and I'm sure you've encountered patients like this. So my NP is Devin.
[30:55] Alisha: I love her. She's my sensei.
[30:57] Michelle: She's so awesome. But I was having symptoms of mono, which I never thought was mono. It wasn't on my radar at all. And I went to see her, and she says, so she prescribed some stuff because I was having a lot of respiratory problems. And so a couple of weeks later, I'm still not good.
[31:17] Alisha: Kind of punky.
[31:18] Michelle: Yeah. Go back to her. She says I think you have mono.
[31:22] Alisha: You're like what?
[31:23] Michelle: I said no, I don't.
[31:25] Alisha: Right.
[31:25] Michelle: Typical nurse.
[31:26] Alisha: Yeah.
[31:26] Michelle: I already know what I have before I see you.
[31:29] Alisha: That's. Right.
[31:30] Michelle: Yeah. So gave me some more stuff and told me to do some more stuff, which I did. Went back two weeks later, and I was not any better. I'm testing you for mono. Then I get the phone call. You've got mono.
[31:46] Alisha: Yeah. What?
[31:47] Michelle: I mean, I was blown away. So how do you deal with patients that, this was one of my questions, too, is because my parents my dad's deceased, but my mom kind of old school in that they don't really understand the nurse practitioner model. They are more familiar with the physician model. And so as a family of nurses, we had to convince them that it's okay to see a nurse practitioner. In fact, it might be better for you, and these are all the reasons why but have you run into that with patients that are like, I want to see a doctor?
[32:26] Alisha: Yeah.
[32:27] Michelle: How do you handle that?
[32:28] Alisha: Yeah, I see that frequently. And number one, nurse practitioners, I think we need to understand and respect the physician model. Right. But there's a time and a place and a scope right? And access to care. And we feel a need, but we also need to understand and be able to say, based on my experience, based on my training, if the situation becomes so complicated, we actually need to be able to say at this time I feel like I am tapped out on what I can do for you and to maybe punt them over because that's where the PA/NP/MD clash happens is that we aren't physicians but we are trained in a similar fashion. Right. And we have to help them understand what we are and what we do, and that if they want to see a physician, I think we should help them if that's really what they want. But what ends up happening is a lot of times the physician, their schedule is full, and it would be better for you to get seen if the option is not at all. Right.
[33:47] Michelle: Right.
[33:48] Alisha: Because if no care is certainly not going to be better than seeing a nurse practitioner. And so, yeah, we've seen that a lot. But I actually have seen that they will say things like, wow, you took a lot of time to talk to me. Thank you so much. You asked about my family. You asked about how my grandkids are doing. Thank you so much.
[34:07] Michelle: Yes.
[34:08] Alisha: Right. And I've met amazing physicians, and I've been under the tutelage of their mentorship, and amazing. However, we fill an important role, especially in rural areas. What would the Valley do without?
[34:27] Michelle: Well, since we're talking about physicians, tell me what your opinion is on the California AB 890. So that's the bill that is going to remove the requirement that nurse practitioners work under a physician. So the scope of practice will be, I guess, widened.
[34:53] Alisha: Yes.
[34:53] Michelle: And what do you think about it? What's your opinion on it?
[34:57] Alisha: Yeah. To be completely transparent, I haven't spent too much time thinking about it, but I do know that my colleagues and my mentors, are actively seeking on getting that certification approval in their practice area. And I think that it's going to be great for access to care. And honestly, the supervising physician, they're not really supervising if we're really being honest. I see 20 to 25 patients a day, and I consult other NPs who have been doing it longer than me, and we will call the physicians if we need them. But the "supervising physician" and I'm doing air quotes, and I know our listeners can't see them, they just maybe will sign some charts off. And so the public really needs to know that what they think is happening was actually happening, is totally different. Does that make sense?
[35:56] Michelle: Perfect.
[35:57] Alisha: Yes. So I would probably punt that question to probably somebody who knows more about it. But I do think it's so, so important that we preserve the relationship between NPs, P,As and physicians.  And DOs, MDS, do, whatever, because we're all a team, and it's important that we put our egos aside and say what's best for the patient. And so that might look like increasing our scope in certain areas.
[36:28] Michelle: Well, like you said, access to care is a big one. We're having a physician, like a severe physician shortage.
[36:37] Alisha: I got referrals punted back because they said we do not have any physicians. My referral got punted back, so now I have to go find someone.
[36:45] Michelle: Wow.
[36:45] Alisha: My patients just need to see somebody.
[36:47] Michelle: Yeah.
[36:48] Alisha: Especially when they're desperate and their kids are dying of cancer or some crazy thing. They just need access.
[36:53] Michelle: Yeah. So that might drive a lot of it.
[36:57] Alisha: Yeah.
[36:58] Michelle: Okay. Professional organizations, I love those as well. I talk about those a lot. And for NPSs there's the American Association of Nurse Practitioners and the California Association for Nurse Practitioners. Do you belong to any of those? Are you aware of any other professional organizations? What do you think about that?
[37:20] Alisha: Yeah, so I used to be a pretty integral part of the Med Surg Nurses Association when I was working at the hospital, and we were super involved. And it was awesome because it was good for the healers, too, to have fellowship and camaraderie and espri decore among each other. Just a time to decompress and say, hey, what are you doing over there in Hanford? Hey, what are you doing over there in Porterville? Hey, what are you doing in Fresno? So that was really cool. I find that they don't exist as strongly in the provider role because I don't know if it's just hard logistically, to get people together. And there are a couple of folks in the Valley that try so hard, but it's like that's carving out that time to actually have fellowship. A lot of times it's like email. After a while, it becomes white noise. And so I think we need reform in that area. It would be great if somebody could actually create that if that makes sense on a local level.
[38:19] Michelle: Okay.
[38:19] Alisha: Yeah. There's opportunity there. Yeah.
[38:21] Michelle: I mean, you're totally right. It is really hard to find time to go to a meeting. Those things are all difficult, and I know they send out a lot of newsletters. And again, time is a really rare commodity, and you have to be really discerning about how you're going to use that.
[38:45] Alisha: Right, yeah. And some of the things we get invited to is it's like a, hey, you should use this drug, or hey, you should do that. And I don't necessarily find value in that. I think that we need reform on a level, on a greater level than most people understand. I mean, healthcare workers are committing suicide on shift. That happened twice in the last probably year or two. And if the community actually knew what was happening in the walls of hospitals, in the walls of places that are supposed to be safe, they'd be outraged. They would be outraged. And we should be outraged because we could have more time for important stuff like you're talking about if we were given the resources that we actually need to do our job, and we don't have those resources, and more people need to talk about it.
[39:37] Michelle: I agree. Well, you know what? We're going to save that question for a minute because that was one of my bonus questions. I love it, and I want you to weigh in more on that. So we're going to go to I'm a nurse. I think I want to become a nurse practitioner. What can I do right now to get me on that road to do that?
[40:00] Alisha: Yes, if you are interested in becoming a nurse practitioner, whether you're a nurse already or not, if you're not a nurse, I would say go talk to nurses. Go buy them lunch. Go shadow them. Get all of them. Grab a Michelle, grab a Chris, grab a whoever from all the different areas and ask them, what does the day look like for you? Are you happy? Are you fulfilled? What do you like? What do you not like? Because I think we ask kids the wrong question. We say, what do you want to do? Instead of asking them, how do you want to live? How do you want to live?
[40:32] Michelle: I love that.
[40:33] Alisha: Yes. And I learned that outside another in a different mentorship capacity that I'm in a different company that's not health-related. How do you want to live? Because why do we ask 18-year-olds, what they want to do? What do 18-year-olds want to do, Michelle? They want to go drive cars and do crazy things like I was doing when I was 18. Right, but what's the kind of life you want to live? Right. Do you want to live a simple, quiet life where you get to meditate every morning and have your coffee for 2 hours and garden? Well, then you may not want to work in a trauma ICU. You know what I mean? You may want to choose a different setting. So how do you want to live?
[41:06] Michelle: So that's the second time I've heard that. The first time I heard it is Ryan holiday. He's an author. He talks a lot about the stoics, but I get his newsletter called The Daily Dad. I'm not a dad, I'm a grandparent to two grandkids. And it helps me be a better grandparent. But one of the things he says that we need to stop doing with our kids is asking them, what do you want to be when you grow up?
[41:35] Alisha: Yes.
[41:36] Michelle: And so I love how you just rephrased it and you're like, what kind of a person do you want? Instead of tying everything to an occupation. Because then you get to be me. When I retired and I was tied to my nurse identity and it was so hard because I was like, who am I? I'm not a nurse anymore.
[42:04] Alisha: Right.
[42:04] Michelle: I don't have value, right? Yeah.
[42:07] Alisha: And then we just set ourselves up for complete failure. Or when the place that you work tells you with a 30-minute notice that you no longer work there. And so how do you deal with that? And so how do you become an NP? I would shadow those people. I would ask them questions. I would ask yourself, do you like blood? Do you like poop? Do you like to potentially get yelled at and assaulted? Because that happens. There's much more blessings than there are bad things.
[42:38] Michelle: Right?
[42:38] Alisha: And also, do you think you're more administrative? Do you think you're more like leadership, teaching, or coaching? Or do you want to be in the field? Do you want to be actually there doing procedures hands-on? Because not everybody fits in those boxes. But also, do you have the time and the money to go to school? And are you going to put yourself in debt? Make sure it's a game plan and you're not just making a knee-jerk reaction. Make sure you're choosing a school that has accreditation. Because there are schools that people are going to and I feel sad for them because when they tell me they graduated from there, I then have to say like, wow, did you know that they're not actually credentialed by this certification entity? And then they just wasted six months. So I think just being really smart about making that decision yeah, that's really.
[43:26] Michelle: Good advice from someone who was thinking 30 years into her future, what I'm going to do, how I'm going to do it, what I want my life to look like. So that's really good. Okay, we're going to take that bonus question, what are we doing well in the nursing profession and where can we improve? That's a loaded question. I know.
[43:54] Alisha: What are we doing well? I think that the people that are there for the right reasons are still showing up for the patients. Unfortunately, I think that what we're doing not well supersedes anything that we are doing well, unfortunately. And the reason I know that is because I treat them in the clinic, and I have had to put so many people on stress leave because they want to kill themselves because they feel like they're failing because the system is broken. And that's really tough. I think that we need to have a larger conversation about how do we support healthcare staff. And unfortunately, it's going to have to happen, like at a congressional level, or else people are going to continue to die because we're not preparing nurses, we're not orienting them, we're not giving them time. We're not putting time and effort into quality measures. And unfortunately, it's something that I cry about just about every single night.
[45:04] Michelle: Not good. No, not good. All the bad erases all the good. And I think some of the bad outweighs a lot of the good.
[45:16] Alisha: I see it from an academic standpoint. We have enrollment into schools is low. What they pay teachers at a DNP level is insane. It's actually, you're more so just volunteering at that point. You're just giving your services away. And I wish I could do that. I wish I had enough money to be able to do that. But the system feeding. The system is broken. So the academic system is broken. The healthcare system is broken. I mean, all of it. And so I don't know. All I do know is that the logic that we applied pre-pandemic was not working because we focus on what the person did wrong in the mistake, and this is what Chris taught me, is that it's not the person that made the error, it's the system. And we need to focus on the system, but that takes time and money and making sure that we don't just make band-aid decisions. We need to address it at a foundational ethical level, and we need complete reform.
[46:17] Michelle: We need health care reform.
[46:19] Alisha: Big time. Big time. We need people to speak up. We need people to speak up because they think it's so normal, but it's not normal. And we should take a stand and say, I'm not okay with this.
[46:31] Michelle: Well, we need to talk more about this because I feel like an hour wasn't enough.
[46:35] Alisha: It wasn't enough.
[46:36] Michelle: And so maybe we need to pick some things that we really need to discuss and get other people in on the conversation.
[46:45] Alisha: Agreed, because there's some really awesome people that are so smart and so brilliant that if we put all of our minds together, all it takes is a few good people not to do anything, to let evil prevail. And so I'm not down with that. Whatever it takes is what we need to do. But it starts here in a closet like this. And so thank you for having me, because this is beautiful, and I'm so proud of you for doing this podcast, and I've just enjoyed all the people you've had on. You should be very proud of yourself, Michelle.
[47:14] Michelle: You are so kind. It has been a lot of fun for me.
[47:18] Alisha: Can I ask why really quickly, why did you start this?
[47:21] Michelle: Because I knew I was going to have trouble retiring.
[47:25] Alisha: Because you still have value to give.
[47:27] Michelle: Yeah. I wanted to be connected to the nursing community. They're my people.
[47:33] Alisha: I love it.
[47:33] Michelle: Yeah.
[47:34] Alisha: Pioneer woman.
[47:37] Michelle: Thank you so much for being here, too. And I think we have just enough time to do the five-minute snippet.
[47:44] Alisha: Okay.
[47:48] Michelle: What do you feel people complain too much about?
[47:53] Alisha: I think that people complain too much about what they don't have, and they're living a scarcity mindset. They're living a victim mentality that this is happening to me. But you know what? What are you doing about it? Because I'll tell you what, the conditions that I grew up in, everybody, when I went back about ten years ago, they said, you're a nurse? And five years ago, you're a nurse practitioner? How? I grew up in such a high-risk situation that most people are like, I can't believe you made it.
[48:30] Michelle: They had no faith.
[48:31] Alisha: They had no faith. But when you watch your mother die because of the health care system and you watch her become 70 pounds and you see that what is happening to people is not right, that will fuel you more than anything in the world. And so don't tell me you don't have enough time, because we all have the same 24 hours in a day. So get your butt off Netflix, get your kids off the iPads, find what keeps you up at night, and do more of that. I am tired of people complaining about what they don't have because we have way more than what other people yeah.
[49:10] Michelle: Look at it from abundance.
[49:11] Alisha: Exactly. Abundance. And that you're stronger than you think. I don't know who told you that you were weak, but you're not. Find somebody who is strong that will speak to you, that will love you and encourage you and actually tell you what you need to hear, not what you want to hear. Start doing things differently. Don't go and spend that $6 at Starbucks every day and invest that into maybe a podcast or a book. How about them apples? How about that?
[49:34] Michelle: I love it. If I wasn't a nurse, I would.
[49:38] Alisha: Be, oh, gosh, probably just a hippie. I'd just be a hippie. I'd just garden, and I would make hemp bracelets, and I would just, like, hang out with cats and hang out with my babies and go camping. I would just be chillin in nature.
[49:56] Michelle: The oddest job you ever took to earn a buck?
[50:00] Alisha: Oh, probably my bartending days at the Sturgis rally. If you have ever been to the Sturgis rally.
[50:07] Michelle: I've seen it on TV.
[50:09] Alisha: Yeah. It's wild. That's where I grew up, and I just wanted to be a bartender, but then I didn't realize that in order to be a bartender, you have to get now, I don't want this to be taken out of context, listeners. When you're a bartender in Sturgis, you have to have what's called an exotic dancer's license. And not that I was, because I was not, but if you get one foot off the ground while you're reaching over to serve somebody a beer, that means that you are now a dancer because you don't have both feet planted on the ground. I'm not making this up.
[50:41] Michelle: Wow.
[50:42] Alisha: I know. Crazy. I made a lot of money, like, thousands and thousands of dollars, by the way.
[50:45] Michelle: That'll pay for nursing school.
[50:47] Alisha: Yes, it would.
[50:47] Michelle: And a lot of other things.
[50:49] Alisha: And bikers, they actually are the ones that are like, the lawyers and the physicians that have a lot of money.
[50:55] Michelle: Spending it on the toys.
[50:56] Alisha: That's true. Yes.
[50:58] Michelle: Okay, last question. Convince me to visit South Dakota.
[51:03] Alisha: Oh, my gosh. South Dakota is the most beautiful place. It's sacred. The people are the salt of the earth. There's two different climates where I'm from. It's like beautiful black hills, snowboarding skiing, gold panning, going out on the lake, going snowshoeing, going hunting, going fishing. Do you want to visit the medicine wheel? I think that's in Wyoming. There's so much sacred history there. And then if you go to the other side of the state, it's agriculture and farming, and the people are what make the state, and it's two different climates. I mean, it's crazy. It's like Yosemite.
[51:43] Michelle: That is crazy.
[51:44] Alisha: Yes. And people think it's just a flat, barren nothing.
[51:47] Michelle: Yeah, I ignorantly thought that.
[51:51] Alisha: Did you think that, too?
[51:52] Michelle: Yeah.
[51:52] Alisha: Good.
[51:53] Michelle: And you convinced me. I think I want to go.
[51:56] Alisha: You should go because people are special there, and they don't have this hustle-bustle mentality like people do in California, and it's beautiful. And more people need to just honor nature and these quiet things in life, and I think that's what they do really well there.
[52:13] Michelle: I love it. I want to go.
[52:16] Alisha: Okay, let's do it. Deadwood, South Dakota.
[52:19] Michelle: Deadwood. Well, people from South Dakota must be special because you came from there, and you're certainly special in so many ways.
[52:31] Alisha: Thank you.
[52:32] Michelle: I'm blessed to have you sitting in my closet and really sharing just your blood, sweat, and tears with my audience and giving them a perspective into the life of a nurse practitioner and just a good human. Well, thank you for that.
[52:51] Alisha: Well, thank you for having me. I so appreciate you.
[52:53] Michelle: You have a wonderful rest of your day.
[52:56] Alisha: Until next time.
[52:57] Michelle: That's right.