Fertility Nurse, Cassidie Thomas

[00:00] Michelle: Cassidie Thomas is a ray of sunshine on a cloudy day. This week, I had a conversation with her about fertility nursing, which is a fascinating field that I knew little about until now. I learned that fertility nurses take care of a diverse group of patients, including couples who struggle with infertility, egg donors, individuals, surrogates, and cancer patients who want to preserve their eggs for future use. These patients often undergo hormone treatments and surgical procedures and they are going through emotionally challenging times. Therefore, if you want to pursue a career in fertility nursing, you need to have a high level of emotional intelligence. I could hear Cassidy's enthusiasm as she spoke about the importance of building rapport and maintaining relationships with people who are facing major life changes. And speaking of major life changes, Cassidy herself is a few months away from becoming a doctorate of nursing practice and a family nurse practitioner. She pursued this goal so that as a school nurse consultant, she'll be instrumental in educating school nurses on the mental health needs of students. In the five-minute snippet: Hot feet? She's got a remedy for that. Here is CassidieThomas. Well, hi, Cassidie. Welcome to the podcast.
[01:46] Cassidie: Thank you so much for having me.
[01:49] Michelle: You're welcome. It's my pleasure. My niece-in-law and fellow nurse, Liz (What It Is) Patty recommended you.
[02:00] Cassidie: Yay.
[02:01] Michelle: Yeah, she said, hey, I have a great nurse for you. She's done a lot of work in fertility and she wears a lot of other hats, too, and I knew that the recommendations from Liz, they're really spot on. She recommended one of my guests, Sarah Waldron, a midwife. Do you know Sarah?
[02:26] Cassidie: I do. I'm actually very good friends with Sarah. We've known each other pretty much as long as Liz and I have known each other. We all went to nursing school together, and Sarah and I actually still work together on a board for the alumni association.
[02:41] Michelle: Yeah, well, I thought you guys kind of ran in the same circles, and Sarah was amazing. So you have a lot to live up to.
[02:51] Cassidie: Yeah, Sarah, she is fabulous. I am not surprised. She really blew it away in terms of sharing her experience. She's a wonderful nurse, a wonderful human, and a great friend.
[03:03] Michelle: Yes, very cool. Well, I'm very appreciative of Liz for recommending you because I don't know anything about fertility nursing, IVF nursing, reproductive nursing, whatever the term is for it. And so, of course we're going to talk about that and then you have a very packed bio. And so we're going to talk about all those things, too. You've worked in a lot of the maternal child health realm, Ped ICU, labor and delivery, postpartum, antepartum. So I want to know all about that. And then you're a school nurse consultant, which I know what a school nurse is, but I don't know what a school nurse consultant does. So that really interests me. So let's just get to it. Why don't you start by just giving us a little bit of a history lesson? Like how did you get into nursing, and how did you get to where you are today?
[04:08] Cassidie: Great. Well, first of all, thanks for the amazing introduction. It makes me sound really cool and reminds me of all of the different areas that I've worked in because sometimes it's easy to get caught up in the weeds. So as far as my nursing journey, so taking it way back to when I was young, I actually grew up on a dairy farm. And initially I wanted to be a veterinarian because I spent a lot of time around the animals. And I just thought, oh, of course, this is the natural next step. But when I got to high school, I met the school nurse at my high school, and that was in northern California, and she was amazing. And I think she really had a great influence on me in terms of introducing me to different career paths in nursing and showing me the versatility that a nursing degree can give. You know, after going through my high school career and getting an opportunity to volunteer in hospital settings, I was really fortunate to get in as an undergrad at UC Irvine in their nursing program. And at the time, it was just a program of nursing science. Now it has grown into this amazing school of nursing. So it really continues to grow, which is amazing. But at the time, it was still in its earlier days as a program in nursing science. I had so many things to choose from in terms of how I wanted to develop professionally. I had access to incredible faculty who had tons of experience. And I'm kind of one of those people who, and as you can see from my resume, someone who can really find good and enthusiasm and motivation in different areas of nursing and can throw myself into something in a way where I could truly see myself doing so many different paths. And so I had a hard time deciding exactly where to take that, because when you're an undergrad, usually in your early 20s, it's hard to really say, this is what I want to do for the rest of my life. But I really found my passion in maternal and child health. Luckily, this is like half of the population that you'll care for in healthcare, so I've been able to stick with that population, but really find different avenues within that. So starting with my first job, and this was truly a curveball for me because I didn't necessarily see myself in the intensive care unit, but I took my first job in the undergrad residency or the new grad residency program at Ronald Reagan UCLA in the Peds ICU, and it was very challenging. I learned a lot. I think it was a really amazing program. There were some really strong nurses there and I learned a ton from that experience. But I kind of knew right off the bat that it was something that although I was learning from the experience and I was really growing as a nurse, it wasn't where I was going to be forever. And I kind of struggled with my nursing identity in that I didn't love bedside and I kind of knew that right away, but I really wanted to stick it out and try to try to make it work and see if maybe it was just the new grad in me that was hesitant. But after doing about two and a half years of that, I decided to try something else. And that's when I was introduced to fertility. And really I kind of just stumbled upon it. I didn't even know that this existed, to be honest. I knew that IVF treatments existed and that some individuals went through those types of therapies if they were having trouble conceiving or planning, doing family planning for the future or other circumstances. But I didn't know exactly how it was done. I didn't know there were clinics specifically dedicated to doing this. So that was incredible. And then, to be honest, I kind of went back and forth to fertility nursing over the years. A disclaimer, although I'm talking about it a lot today, I'm not currently working in this field, but who's to say I might not go back and dabble in reproductive endocrinology at some point in the future, but fast forward a few years. I ultimately found school nursing having a community minded perspective and approach to my nursing care has always been at the forefront. So it just made sense to go into a setting where I really got to see the daily investment, the outcomes of the investment of my nursing care and the students and the community members. So ultimately, working in school health has led me to go back to school. So now I am at the final five months of my doctorate in nursing practice and family nurse practitioner program. So I'm almost there. I'm almost done. It's been a three year program. I'm back at UC Irvine because it may not be a surprise that I love them in terms of family nurse practitioner, it's kind of all-encompassing. So I felt like I discussed this with my mentors, trying to figure out what is the best advanced practice degree for someone like me, who has a lot of passion in a lot of different areas. And family was the way to go. So that kind of leads you to where I am today, and so it gives you a little idea of what I've been doing lately.
[09:41] Michelle: Well, that is a very cool story. I love hearing from my guests how they got into nursing, and so many of us got into nursing just kind of on a fluke, and some of us had some really great mentors, and some of us chose other careers and then kind of nursing got into it by accident. So I love hearing the different stories of how nurses get into the profession. And while five months to go, who's counting, right?
[10:15] Cassidie: It's definitely not 143 days. I didn't know that.
[10:20] Michelle: I love it. That's quite a feat. So congratulations on that. Wow.
[10:27] Cassidie: Thank you.
[10:28] Michelle: Yes. And, wow. Starting out in Ped's ICU as a new nurse, that's brave, Cassidie.
[10:37] Cassidie: I mean, I feel like it was a challenging time, and I think a lot of us new grad nurses were just diving into the opportunities that would present themselves, and I felt so fortunate to get a position, so I was like, let's do it. Let's dive in. Maybe. Like I said, I'm pretty flexible, so I was like, maybe this is my passion and I don't know it yet. So there's only one way to find out.
[11:03] Michelle: That's so true, and I admire your bravery and your guts and your risk taking. I don't know if that's, like, a young person thing. I'm about to turn 60, so it seems like, really gutsy from my point of view. But, man, how do you get experience that you just sometimes have to go for it, right?
[11:28] Cassidie: Yeah, I agree. And they can be, like, major turning points professionally.
[11:35] Michelle: No, absolutely. Well, that's great. Well, thanks for that introduction into kind of where you are. Where have you been? All of that stuff. So let's talk about fertility nursing in particular for the moment. Who are your patients? Who are the patients that are coming to you and what are they coming to you for?
[11:57] Cassidie: Yeah. So it really depends on the population. I think there's a lot of different patient diagnoses that are seen in fertility clinics. You have the typical, I think what we think of firsthand is two partners that are struggling to conceive. And usually they have to go six months to a year, depending on the age, to be seen by a fertility specialist in those circumstances. But there's many different players in this world because then you can also have people who are egg donors. So those are typically, sometimes they can be through contracted facilities or they can be selected by someone who's trying to conceive. So you have the egg donors, you have couples, potentially, you may have an individual who is trying to conceive on their own. You may have surrogates. So those are also the patients that you'll see. And in that they call it third party fertility treatments. And what that means, essentially, is that there is some person outside of whoever the family or individual is that's trying to have a child or planning for conception in the future, that there's somebody on the outside that they're contracting to come in via egg donor, via surrogacy, via sperm donor. So those are just the more common, I would say, fertility treatments. But then you also have, on the other side of that, individuals who may have been affected by malignancies at a younger age, and there's fertility preservation related to that. So in terms of young males who need to freeze sperm for possible future conception, or someone who needs to freeze their eggs because they're going through some sort of therapy that is potentially going to damage their ability to reproduce in the future. So it's not just people struggling to conceive, but it can also be people who have had medical conditions or acute conditions that have made it. So there is a risk to them losing their long term ability to conceive or to be able to have a healthy child in the future. So I think those are the instances where it's really a powerful technology that we have to be able to give someone hope for the future when they're young, sometimes with younger individuals. If you're 18, 19, 20 years old with a really surprising diagnosis, then you may not be thinking 10-15 years down the road, you want to be having a child. But sometimes it's good at least so that they have an insurance plan if they change their mind later. Not everyone decides to do it, and that's absolutely their choice, but it's great that that opportunity is available if they are interested in it.
[15:15] Michelle: Well, thank you for delineating all those different reasons that people come to you, because I think you're absolutely right at the outset where you said, I think there's a misconception that when you talk about fertility, it's couples coming that are having trouble conceiving. And, I mean, you laid out all the different patients that you might see, and you mentioned surrogates and working in the NICU for many years. There's something about the Central Valley of California, where I live and work. We're like the surrogate capital of California. Yeah, it's really crazy. We have couples, we have individuals, we have couples from all over the world that come to the Central Valley. Yeah, we've had so many. Gosh, from Germany, France, Spain, the, you know, all over the US. And, you know, a lot of our surrogate moms deliver prematurely. So those babies are in the NICU for a long time, and we get to meet the surrogate parent or parents or family and hear about all the struggles that they've gone through with fertility and all that, too. So it's really interesting, and it's a pretty comprehensive list.
[16:46] Cassidie: Yeah. It really goes to show there's so much more that can be behind somebody's story. Right. You may see a child, but who knows what all the layers or all of the effort that went into having that child. It can be really complex, but it's pretty powerful.
[17:05] Michelle: Yeah, absolutely right. Well, in preparation for this interview, I was wondering if there were professional organizations for fertility nursing, and I saw the American Society for Reproductive Medicine. So do I have that one right? They also,  it looks like they offer a nurse certificate course, like for a special certification in reproductive medicine.
[17:38] Cassidie: Yeah. So I think it's really great. I personally do not have this certification, but it's a growing field, and the technology behind what is being done in these clinics is evolving. And because of that, I think it's wonderful that the nurses have the opportunity to be able to pursue a certification related to the specialty. It's such a specialized area of nursing practice. And so I think being able to be a part of these professional organizations, to be able to receive up to date information on what is changing best practice, all of that is super valuable, especially because infertility nursing, it can be very isolating sometimes because it is not a traditional role in terms of nursing. So I think having a community building, being part of a community in that network can be really beneficial.
[18:38] Michelle: So where can fertility nurses work? Am I working in a clinic? Am I in a hospital? Talk about that.
[18:45] Cassidie: Yeah. So I've had the opportunity to work in two separate clinics, and to be honest, they were both very different. And so I found it really enriching to see how fertility nurses could practice and use their skills in a similar way. But also have very different job descriptions and very different structures to their daily workload. So at the first one that I worked at, the nurses were IVF coordinators, and basically what the job entailed was a lot of patient education, and you would be managing a patient's journey through their treatment. And so what that would mean is from their very first consultation, you're the one guiding them through the step by step process of whether it's initiating medications, coming in for appointments, potentially going through surgery. If that's the pathway that they're needing to take blood work, every time they come in, they're going to check in with you and you're really making sure that they get the information they need, they get all of the supplies that they need, that they feel well prepared, emotionally supported, and you're cheering them along the process because it can be challenging. It's a really emotional type of treatment to go through for patients and for families, so it can be hard. And as a fertility nurse in that environment, then that is a big part of your role, is just being there for the patients emotionally and making sure they feel prepared, supported, and have everything they need. Now in this clinic specifically, in addition to that patient education aspect, there was some hands on in terms of supporting bedside procedures through making sure you're there for the provider and getting them whatever supplies they need, that sort of thing being present in the room for every scan. So I really loved that part because you get really good at ultrasounds. So you're not doing the ultrasound, but you're sitting there with the provider and the patient looking at these images over and over and over again and seeing what they're measuring and what they're looking for. And so it's really enriching, and you learn a lot about the female body and what is going on when you do fertility stimulation medications. So in addition to that, you also get the opportunity to stay up to date on your vital signs and your phlebotomy skills. I will say at every job I've ever been at, I think fertility nursing is the only one where I had regular phlebotomy that I needed to know and be able to use. So that was a great skill builder for me because I think sometimes we think when you leave the bedside, you lose your skills, but I think there's just different skills that you apply in a different way. So in terms of the other role, I will say that the other clinic that I worked at was probably the most dynamic in terms of being a fertility nurse because not only did I do that patient care management and walking them through the process and the emotional support aspect, education, et cetera. I also was trained to be a fertility operating room nurse, and so what that meant is that I would be periop nurse in the back. Sometimes I would open up the clinic on the weekends when the patients would come in for weekend procedures. Usually these procedures were egg retrieval. So what that means is that an individual has gone through fertility stimulation. So we're going in via a surgical procedure to remove the eggs for either freezing the eggs individually or for potential fertilization, either with partner sperm, donor sperm, and then you're collaborating with embryology. In that terms? In those terms. And that's when that handoff takes place.
[22:50] Michelle: So let's kind of unpack that because it was a lot for sure. First question is fertility OR were you familiar with the or from your labor and delivery experience?
[23:06] Cassidie: Actually, when I worked in this fertility, or it was before I was in labor and delivery.
[23:13] Michelle: Wow. Okay. Did you have to get trained and everything?
[23:18] Cassidie: Yeah, so they put me through training, which was really good. The nurses were wonderful there, and so they were able to kind of guide me through that, and I really enjoyed it, to be honest. I remember thinking, wow, if this alone were a job, I might be able to do this forever, because it was very rewarding. It was very fast-paced, so the days went by super quickly. The patients were lovely, the coworkers were fabulous. It was a really rewarding role. And I learned a lot. And I got to feel, I think as an or nurse, you're not doing procedures, obviously, but you feel really present for what's going on and such an essential role. And so I felt like that was something that was a great learning experience, especially because I hadn't previously thought like I wanted to go into or nursing, but it was just kind of part of the role that I was taking on. So I would usually do that one or two days a week, and then the rest of the days I would be working in the front in the clinic part doing patient education and coordinating fertility cycles. So that was interesting, to say the least.
[24:34] Michelle: Yeah, it sounds fascinating, and I want to go back to the clinic work. So kind of what you were describing there, is it like a primary nursing model where you would have kind of the same set of patients all the time?
[24:51] Cassidie: Yes. So it's different from clinic to clinic, but what I've seen and heard from others in different fertility clinic settings is that something that is a common structure is, yeah. Having that primary nursing structure in terms of when a patient comes in, they are assigned a nurse, and that nurse is responsible for making sure they have everything they need from start to finish. And of course, if they're out, there's always going to be someone who's arranged to be the backup individual or the backup nurse for that person. But really that feels great because you get to know your patient's story from the beginning and then all the way, hopefully through the end, when they get hopefully, you always cross your fingers for their desired outcome, whatever that is, and you can be there to support them through the process. Now, on the other hand, there are different structures in other clinics, and another clinic that I worked at had more of an all-hands-on-deck mentality. So there would be a lot of nurses working together as a team and it would just be, there's a lot of patients coming in and everyone would just jump in and everyone was kind of familiar with everybody and we were really clear with our notes and made sure that the plan of care was really obvious in everything and reflected in our charting so that it would be easy to jump in and pick up where one nurse had left off. Do I have a preference? I don't know. I think it depends. But I will say personality-wise, and if you're someone who likes to feel super involved with fewer patients, then maybe that primary nursing approach is a better format. But if you're someone who really likes to just jump in and work and have your day go by quickly, then maybe the latter is a better opportunity or a better learning experience for somebody. So, yeah, that was just my experience. There may be other formats out there that I haven't yet been exposed to.
[26:56] Michelle: Well, I am a big fan of primary nursing, I'll tell you, we used that model in our NICU and it was just so effective for both parties. Right. For the nurse, I think it takes a special nurse. Every nurse doesn't want to be a primary nurse. Some of them prefer the model that you were talking about where they see a lot of different patients on a daily basis. But some nurses really like to establish that rapport and build that relationship and that trust. So for the NICU, it worked out really well. Did you use that in Peds ICU?
[27:35] Cassidie: I did, yeah. And I found, you know, in the Peds ICU, many of our patients would stay for quite a, you know, I think having that primary nursing structure as an option for us because it had to be mutual, right? Yes. It was really maybe the beginning of when I realized how much I love being an integral member of that patient's team and investing in that way. So, yeah, it was great. I think that in the PICU, it was a great learning process as well as a new nurse because it's less intimidating when you come in and you already know some things about your patients as a primary nurse. And so it helped kind of ease the nerves, the new grad nerves in the first year or two of being like, you know what? I already know their history. I know what's working so far. And yes, this story is unfolding still. They're still in the ICU, but I feel confident about this, this and this and whatever else comes my way, I can probably handle. I think, you know, for the younger nurses or newer nurses, that can be a really wonderful tool as well to start primary care nursing or primary nursing. Sorry, that's my family nurse practitioner brain.
[28:58] Michelle: Right. It comes through.
[29:00] Cassidie: Right.
[29:02] Michelle: Well, you touched on the emotional struggles that your patients have. So what specific things are they struggling with emotionally and how do you help them?
[29:14] Cassidie: Infertility nursing in particular? Okay, well, I think it's really complex and it depends on their story. Say we're talking about somebody who's younger and they're going through fertility preservation for some reason, whether they've been affected by a medical condition or early menopause or something in that nature. I think that there's a lot of emotions in terms of acceptance of what's going on. Also, in addition to whatever they're dealing with in terms of their medical situation, they're also having to deal with fertility treatment, and it's not a fun process to go through. I think people do it because they feel like it's their best option usually. I mean, there's always going to be those elective procedures that people choose to do, but generally speaking, it's uncomfortable and it really makes people more vulnerable and emotional, and it's expensive for most people. So there's just a lot of things at play in terms of that. So I think when you're dealing with a medically fragile or a population that's going through a life-changing medical condition, then that's a lot to unpack in itself. Now, in terms of an individual who's having trouble conceiving either whether they're conceiving on their own or they're conceiving in a partnership, or it's a couple who's using either a surrogate or an egg donor or sperm donor or all of the above, because that can happen, too. Then I think there's a lot of different dynamics and emotions involved with that. Sometimes there can be feeling of a failure from one or both partners or the individual. There can sometimes be a lot of surprises. Sometimes people come in thinking and hoping that whatever is causing the delay in conception is going to be a quick fix, and it may be a longer road than they expected. I also think that it can be challenging if you have a partnership and one partner maybe feels like they're carrying more weight than the other or maybe doesn't feel the support that they need from the other partner, and then you have individuals conceiving on their own, and that's a whole separate set of an emotional journey to go through. So I think from a nursing perspective, just being open-minded and being there for them and understanding that every individual's journey through fertility treatment and family planning in terms of that is going to be very different. They're going to be met with their different challenges, different challenges than other patients, and they may have factors going on outside in their personal lives that we have no idea about. And sometimes patients really trust us and they disclose some things, and that's really a sacred thing to share with us. But the truth is we have no idea what's going on in their personal lives. So as much as we can support them when they're there with us in the clinic, I think that's really powerful, and it can make a huge difference in terms of how they navigate their care and their experience.
[32:45] Michelle: Yeah, that's a wide range of emotional struggles, for sure. And you touched on some couples, or I guess women feeling like they're a failure, maybe that their body failed them and they can't get pregnant somehow. And I know that we dealt with that a lot in the NICU. The mom guilt, right? Like, delivering prematurely. Like, I'm a bad mom. I couldn't keep my baby inside, and they just would beat themselves up. And we spent a lot of time providing a lot of education and so forth to try to relieve some of that guilt. But we have social workers, too. What other disciplines do you work with in the clinic?
[33:39] Cassidie: Yeah. So it depends on the patient and what they're interested in. But I've seen everything from acupuncture to massage to, let's see, have I ever had. I might have had patients do Reiki. There's many patients who like to add in the element of some Eastern medicine in there to embellish their fertility treatments. And some of these providers and practitioners can actually have privileges at some clinics where they can coordinate it with their treatments. So, say if a patient's having an embryo transfer, then I've seen them have the ability to coordinate having an acupuncturist come in before their transfer and do a session before they actually have this embryo implanted. So it's really cool how the collaboration is taking place. And I think that it's becoming more and more open in terms of what is considered holistic care, that it's not just the medication, it's not just managing and monitoring their cycles, but also thinking of the physical, the mental, the emotional aspects of what's going on and what other things can we pull into this to help make their experience more balanced? But again, it depends on the individual, depends on their beliefs and their expectations. It depends on their time, their money, because those things can be expensive as well. But I think it's really wonderful that the tools that they have continued to expand.
[35:13] Michelle: I think incorporating those holistic modalities into the care of the patient really just helps them kind of manage everything. And one of the things I would imagine that your patients are going through is. And what they need really is like hope, right?
[35:38] Cassidie: Yes.
[35:38] Michelle: It's like they need to hang on to something, that this is going to work or this is going to change whatever it is. And incorporating those holistic practices into that, I think that would be crucial. And I think as a nurse, to be open to that is really special. And it would be really special to the patient, too. Instead of saying, that doesn't work, there's no research on that.
[36:09] Cassidie: Yeah.
[36:09] Michelle: So just kind of keeping those comments yourself, right?
[36:13] Cassidie: Exactly, yeah. Because I think many patients are experiencing loss in this setting, and there's a sense of feeling really out of control of your body. And I think if you give them a menu of choices, of things that maybe they can consider adding in, then that's something they can have control over and they can choose what certain parts of their journey are going to be. And it's not just this kind of paternal approach to medical care in terms of we're telling you exactly what you need and this is everything you're going to get, and this is the desired outcome, and they're just along for the ride of their own health care. I think adding in those other elements, if they choose to, can help them feel like they're also doing something to take care of themselves and they're not just being told what to do, they can tailor it to their preferences and really what they need as far as their emotional connection to the process.
[37:12] Michelle: Yeah, I think that one of the best things that you can do with a patient is to find out what they believe or more about them is just to ask them to tell you what they want their goal to be, what they believe in, what their hopes are. I think starting with that and building the care around that is really like the heart of patient-centered care.
[37:39] Cassidie: Exactly. I could not agree more.
[37:42] Michelle: Let's take, I guess, the traditional quotes, air quotes, the couple that comes to you that are having trouble conceiving. And so they are having these treatments, the hormonal treatments, the egg. I'm sorry, what did you call it?
[38:01] Cassidie: The egg, like the egg retrieval or a stick retrieval.
[38:05] Michelle: Yeah. So what would some of those frequent questions or concerns, what would those look like from that couple?
[38:15] Cassidie: So I think one of the really common fears is, and this sounds really simple, and as nurses, I think it's second nature to us to give medications, but I think these patients have to give themselves medications oftentimes. And so this means teaching patients how to give themselves injections multiple times a day, usually. And I think for your average person, that's scary. I mean, I would not want to do that to myself. So I really feel for them in that. And I've never brushed that off as something light because I think it can be a really intimidating thing. So I'd say that's one of the more common fears is, am I doing it right? How do I know I didn't waste the medication? This is really expensive. Am I hurting this person? When I give them their injection? Is it working right? So they want to make sure they've invested months in this process just to get started with an IVF cycle can take a few months at times. I think by the time they get to the point where they're actually getting stimulated, getting the medications, then they're all in and they really want to make sure they're careful and they're doing everything correctly. So people are usually pretty timid and cautious at this time. Let's see. In terms of other things, I think there's a lot of fear about things that individuals are eating or drinking or activities that they're doing, which I think will come from families that have experienced loss, pregnancy loss in the past as well, of like, is there anything I can do to make sure this has a better chance of being successful? So making sure as the nurse that you're supporting them through that and easing some of the anxiety and letting them know they don't have to totally uproot their lives, they don't have to change everything they're doing, but we're actually infertility. Historically, providers have been really good about compiling lists of things that patients can do, whether it's supplements or activities to avoid supplements to avoid, medications to avoid. That way, patients know, okay, what's, like, the average thing that I should make sure I'm doing or make sure I'm not doing? That way we manage the expectations in that area.
[40:42] Michelle: Yeah, those are some heavy concerns. Right. And like you said, a lot of the couples that are coming to you have already experienced loss, and they're obviously trying to prevent another future loss. And so they're trying to cross all their t's and dot all their I's. That can't be 100%. We know that. But providing all that education, has to be a huge part of the job.
[41:16] Cassidie: Exactly.
[41:18] Michelle: So would you say that this statement is true? To be a fertility nurse, I have to have a really high degree of emotional intelligence.
[41:32] Cassidie: Absolutely. When I hear this, I think of the variety of patients that you see, the variety of patient backgrounds and experiences. And I think as a fertility nurse, you have to leave whatever your beliefs are or your expectations or your experiences, you have to leave your own opinions at the door, because you really have to just be there and be present for the patient. And whatever their experience is. I think in terms of emotional intelligence from the nurses, I think they are going to see some challenges, they're going to see hard things happen to some of their patients, and not every patient outcome is positive. And so you have to be prepared to be there for your patients because the losses that they experience are not just before they come to you, but it's also, at times during their treatment. And so you have to be prepared to manage that. Truly, it's an emotional job. The highs are really high. When you have a patient that you've been working with and taken care of for months, and they conceive and they are discharged, and you print out those final ultrasound photos for them and send them off to their Obgyn. That is one of the most amazing feelings, and it's extremely rewarding. But the losses that can lead up to that moment, the surgeries that patients may have to go through, the emotional turmoil, that can be really challenging. So you have to be able to be flexible in terms of, you might see two patients in a 30 minutes window, and one of them might be having the best day of their life, and the other one might be having one of the worst days of their life. So it's just really tuning into that and being present.
[43:31] Michelle: How do you manage your own mental health? I imagine if you're working with a couple or a patient, and they do suffer another loss that just devastates them and you formed a relationship with them. You experience some of that loss yourself. How do you manage that and your own mental health?
[43:55] Cassidie: Yeah, so I think all of us nurses, we've experienced something like this, right, in terms of our patient interactions and that attachment. And, yeah, I think when you see a patient regularly, the level of investment in their outcome is probably higher because you've really gotten to know them. So over the years, I've really found caring for my own mental health and encouraging nurses around me to find ways to release whatever happened at work once you get home. And that can be really challenging. I mean, self-care, as cliche as it sounds, is vital. And finding hobbies outside of work that help you blossom in your personal life and realizing that work is work, but it doesn't have to be your whole identity. And it is critical that there is an identity and a whole world outside of work that can kind of foster emotional growth and healing when you're not there. Because, yeah, there are going to be really hard days, and sometimes it's super challenging to leave what you saw at work at the door and be able to just enter your personal life at 100% bright and shiny and ready to start the day. And that's just not realistic. Right. But I think over the years, too, I've learned tools to kind of reframe these thoughts that come up in terms of feeling bad for different patient scenarios that may have come up or wondering. Right. The lack of closure with certain circumstances that can be really just gnawing at your emotional stability. But I think realizing that as a nurse, this is just a fact of the job. And there are going to be times when there's no closure. There's going to be patients that I'm never going to know what happened or if they're okay or if they're happy, but I just have to be okay with that and focus on taking care of myself.
[46:03] Michelle: Well, that was so well said, and I really love that you touched on the nurse identity. I think there's so much buzz about that right now, and I don't know if it's something that is for the OG nurses like myself that have been in it for a long time, that we have more trouble with that nurse identity and turning that off and not being as well rounded, because what I see coming, the new generation of nurses, they are forming an identity outside of their nursing profession. And it's so great to see that well-roundedness. So you put that really well, and, man, Cassidy, you have really given me and my audience so much insight and information about fertility nursing. I learned so much that I had no idea about. So thank you.
[47:05] Cassidie: Oh, of course. Thanks for having me. I'm so glad that it was helpful, and it's really nice to be able to share it with the community and maybe we'll get some fertility nurses out of this.
[47:13] Michelle: Yes. Well, we're going to switch gears because I want to know about your work as a school nurse consultant and how it kind of led you on the path to your DNP.
[47:25] Cassidie: Great. Let's see. In, I guess it was 2018. 2017, I made a major career change that was from labor and delivery to school nursing. And I think I figured, you know what? I want to deal with some patient scenarios that are more in the community setting. I was always really interested in school nursing or public health nursing growing up in a small town. I think that having access to communities and being able to see patient progress was really important to me, as you can probably tell by what I've talked about in the past. So I started out as a school nurse in Los Angeles, and I still work as a school nurse. So I do a little bit of both. So essentially what I do is because I'm in school, I'm full-time in my DNP- FNP program. So that comes with a lot of clinical hours sometimes that can even equate to, like, a full-time job. So I'm really working pretty much at this point. But I worked as a full-time school nurse for several years, and I loved it. And I thought, okay, this is my calling. I've figured it out. I love watching the kids grow up, and I love helping them as they're navigating potentially new medical conditions and helping coordinate with families and teachers and really fostering their growth and development and success in a school-based setting. So, like, a lot of nursing stories in terms of some big changes that were made, Covid-19 happened, and I was a school nurse during that time.
[49:07] Michelle: Oh, wow.
[49:08] Cassidie: I know. And I remember the first weeks, I was just thinking like, oh, no, am I going to be like, nobody's going to need a school nurse if schools aren't open, right? And I kind of struggled with that because I was like, what am I going to do? But then I realized, you know what? Actually, schools are going to open again, and then we're going to be critical. And I think the more I went through that process, I realized there's so much that school nurses can do, and I think that they weren't really tapping into their full scope and full potential prior to the pandemic. And the pandemic really brought them to the forefront and let them shine. During that time, I personally took on a lot more responsibility in my role, but also in collaboration with other nurses in the community that I work in. We realized that there was a lack of support in policies and procedures and just having representation from public health to help us navigate the process. So we really banded together and helped one another during this time. And I remember thinking, I'd really love to do more for this community of school nurses, and we're really lacking the professional support that we need. I work in an independent setting, and so because we're not associated with districts, it was even more isolating. So sometimes you feel like you're on an island in these settings. So having a community to reach out to is wonderful, but we're all just kind of passing ideas around in our community, but there's not a lot of concrete information. So this is really what led me to go back to school because I started becoming more interested in health policy. I was interested in finding a way to bring professional development to these communities of nurses to help support them in their roles and find ways to bring evidence-based practice into school nursing. So I applied to the DNP F P program. The FNP aspect was known to add to that through the recommendation of a great mentor of mine. It seemed now it was the perfect fit because it kind of allows me to do a lot of different things, but it also has given me a lot of information to help inform my future practice working in schools. So throughout my program, I've transitioned into new roles. So I have become a clinical instructor for UC Irvine, which I did for two years at the beginning of my program. And I worked with a group of students at an elementary school in Orange County, which I really loved. And then I also have been working as a per diem school nurse. So I've substituted for people in my community, nurses in my community for the past few. You know, when we've had spikes in Covid cases in LA County and schools need more help, then I've just kind of jumped right in beside my colleagues to help them out. And that's been a wonderful experience, and it's taught me a lot about how schools function in different settings and helped me understand what we're working within school health and then in terms of school health consulting. So that has developed through one of my prior roles. So what I do in that role is help train new nurses. So like I mentioned, these schools are pretty isolated and they're not affiliated with the district. So what I've done is when there are new employees hired and I've come and I've helped them kind of with their onboarding process, doing basic training, doing weekly follow-ups to make sure that the nurses feel supported. I remember when I first started graduate school and I was thinking, I really want to create a new school nurse residency program that is applicable to a lot of different settings that can be accessible to these nurses who feel like they don't really have a mentor. And that's still something that's in the back of my mind. So maybe someday, maybe someday when I graduate. But that's basically what I've done in this role with consulting is supporting nurses as they're transitioning to a new role, making sure that they have someone to help them with the development of their policies and procedures in their health offices, and just being there as a resource person with their medical record systems and helping them navigate new student diagnoses, well, that's really cool.
[53:55] Michelle: And I would think there would be a high need for that and for all school nurses to have someone like you as a mentor who is tied into all of the different needs that they have. And you have all this experience from being a school nurse yourself. I was really interested in your DNP project, and so, Preparing School Nurses to Address Student Mental Health Needs Through Continuing Education. So talk about that and the presentations that you're going to do at these national conferences.
[54:32] Cassidie: Great. Yes. I'm so excited. So this is the fruits of my labor for the past three years, and I'm really happy to see it manifest into something real because I think when you're going through school and working on a project like this, it can seem like it's just a concept at times. And so I am now at the, I guess, third month of my project implementation. So basically, this project is designed to be remote training for schools. You know, given that it's a DMP project, it has to be specific to a smaller population. So I've selected my Los Angeles County independent school nurses community to implement the project. So the training itself is from the University of Baltimore and, sorry, excuse me, the University of Maryland, Baltimore. It was a program that was developed several years ago and has been implemented in some other school nursing populations. And so what it is, is it's a comprehensive mental health education for school nurses, and it's self-paced. So nurses can sign up and complete it however long they want, to take is totally fine. So we've given them about eight weeks to complete the training, and it teaches them not only about the backgrounds of different mental health conditions, but how to identify signs and symptoms in students, how to actually implement screening options that they have for things like anxiety, depression, screening. And then they actually show you how to use these tools, how to have hard conversations with families and the utility of that. So my project itself is measuring if this changes, if implementing this intervention and having my group of school nurses go through this training changes their ability to feel confident in approaching student mental health needs. Because the reality is approximately a third of every student that visits the school nurse is related to some sort of mental health condition. So there's really a need that's been identified. It's just there's really not a ton of training programs available out there. So this is one that has been used for quite a while and it's done really well and it's been well disseminated across the United States, but I would argue that it could be even better disseminated. So that's why I'm trying to bring it to the populations that I have access to. So I'm just about done with data collection. So that'll give me a chance to look over everything and see what the impacts were of the training, see if my nurses feel more prepared to address student mental health concerns in their settings, and then the conferences, which I'm so excited about. So I have been accepted to present at the Western Institute of Nursing conference that is coming up in April. And that presentation will be on my DNP project. So it's time to hustle and start reviewing that data and turning it into something that I can visually share with the community at that conference. So that is on my DNP project. And then the National Association of School Nurses is a conference that is going to take place in late June, or early July. And that presentation is actually a literature evaluation or a literature review that I did related to the available mental health training programs for school nurses. So, like I mentioned, there's really not a ton out there. They are happening, it's just not a lot of people are writing about it. So there's really limited literature in terms of this topic. So the idea was to get an idea of the landscape of adolescent mental health preparation for school nurses. And this ultimately informed my DNP project, which is what I'll be presenting at the WIN conference. So I'm excited. I feel really rewarded in the fact that I can take what I've been doing the past few years and share it with the world and hopefully continue this project in larger groups of nurses in the future.
[58:54] Michelle: It must feel so good to see it coming to fruition, right?
[58:59] Cassidie: It does, yeah. I remember coming across this program, oh, my gosh, almost two years ago, and I just thought, I wonder if I could do that. And there's a lot of self-doubt, right? That impostor syndrome that creeps in.
[59:13] Michelle: Yeah.
[59:13] Cassidie: Especially when you're a student, right? You're trying to prove yourself and figure out what death is. But, yeah, it's really rewarding. And this is a topic that I'm really passionate about, and I really am invested in improving student mental health care in schools. So I feel very fulfilled doing something to help better that. Yeah.[59:37] Michelle: Student mental health is huge. And you're feeling a need that is so desperate right now, and it's not right now. Right. We know there's just a lot of press on it right now, but student mental health has always been a thing. And I just love that about nurses that see a need and they say, I'm going to fill that need. I'm going to do this. I'm going to make it happen. So you have all my respect, and admiration, and you're doing great things, Cassidie.
[01:00:15] Cassidie: Thank you. I really appreciate you.
[01:00:18] Michelle: Yeah. Where can we find you?
[01:00:20] Cassidie: So I am on LinkedIn. So you can find me on LinkedIn.  I am not yet fancy enough to have a website, but know I'll manifest that in the. And, you know, if anybody's going to the wind conference or NASN, then I'll see you there. Come swing by my presentations. I'd love to see you.
[01:00:50] Michelle: Yeah. So I'm going to insert those links into the show notes for both of those organizations and conferences. And I'll put all your contact information, too, because I know people are going to have questions. Because you're so fabulous because you were recommended by @Lizwhatitis.
[01:01:08] Cassidie: Oh, she is the best and inspires me every day.
[01:01:12] Michelle: I know. She's pretty awesome. Well, Cassidie, thank you so much. I really appreciate you coming on and talking all about fertility nursing and just sharing your journey into your DNP and all the things you're doing with the schools. And it's amazing. I just get so inspired every time I talk to nurses who are doing great things, and that's certainly been you. So thank you so much.
[01:01:42] Cassidie: Thank you so much, Michelle, for inviting me to share my story. I hope this makes an impact on someone, and I appreciate you letting me share all about my wild career.
[01:01:54] Michelle: Well, I'm sure it will make an impact on. You know, you can't get out of the five-minute snippet. We always do it at the end. It's a bunch of fun. So I'm going to put my timer on, and I already have my questions here. And so today we're doing a little bit differently. So I do would you rather? And then today I'm throwing in some this or that questions. Okay, ready?
[01:02:22] Cassidie: I'm ready.
[01:02:27] Michelle: Cats or dogs?
[01:02:29] Cassidie: Dogs for sure.
[01:02:31] Michelle: I feel like I knew you were going to say that.
[01:02:35] Cassidie: It's my cute puppy, Itty.
[01:02:37] Michelle: I know, right? Okay. Would you rather be able to speak every language in the world or talk to animals?
[01:02:46] Cassidie: Oh, every language in the world, definitely.
[01:02:49] Michelle: Gosh, wouldn't that be such a gift to have?
[01:02:53] Cassidie: Yes, and it would have saved me a lot of time in language classes.
[01:02:59] Michelle: Okay, summer or winter?
[01:03:02] Cassidie: Oh, that's not hard. Definitely winter.
[01:03:06] Michelle: Wow, you're winter, huh?
[01:03:09] Cassidie: Yeah.
[01:03:09] Michelle: I don't like being cold. I don't like being hot either. I think I need to live in San Diego.
[01:03:14] Cassidie: Yeah, well, there you are,  that's the ticket.
[01:03:19] Michelle: Would you rather always feel hungry or always feel tired?
[01:03:25] Cassidie: That might be the hardest question I've ever been asked.
[01:03:28] Michelle: Don't you always feel tired being a DNP student?
[01:03:31] Cassidie: Yes, but I also really don't like being hungry, so, yeah, I guess I'll choose always being tired because there's always coffee, right?
[01:03:40] Michelle: There you go. Okay. Cash or cards?
[01:03:44] Cassidie: Cards.
[01:03:46] Michelle: I know. Who carries cash anymore?
[01:03:48] Cassidie: No, it's too complicated.
[01:03:50] Michelle: Right. Would you rather listen to an annoying laugh for a whole day or get tickled for 1 hour?
[01:04:01] Cassidie: Tickled.
[01:04:02] Michelle: Tickled. Okay. You like to laugh.
[01:04:08] Cassidie: Mental control.
[01:04:11] Michelle: Text or call?
[01:04:14] Cassidie: Text.
[01:04:16] Michelle: Yeah, I say text too. And my daughter. Mom, why didn't you just call? Like, don't spend all this time texting. I'm like, that used to be me. How did I turn into someone who just texts all the time?
[01:04:30] Cassidie: Right. Well, I feel like calling these days. Feels like you show up at someone's door without calling.
[01:04:36] Michelle: It's intrusive.
[01:04:37] Cassidie: It is, but it's weird because we don't have to answer.
[01:04:44] Michelle: Okay. Would you rather spend the day wearing wet socks or with a popcorn Kernel stuck in your teeth?
[01:04:52] Cassidie: Wet socks.
[01:04:54] Michelle: Yuck.
[01:04:56] Cassidie: I know, but my feet are hot, so it's fine. I'll survive.
[01:05:02] Michelle: Would you rather be the cowboy riding the bull or the clown who distracts it?
[01:05:09] Cassidie: The clown.
[01:05:10] Michelle: Clown. That's the most dangerous part.
[01:05:14] Cassidie: I know, but I don't want to fly off the cow or the bull.
[01:05:20] Michelle: Okay. Driver or passenger?
[01:05:23] Cassidie: Driver.
[01:05:24] Michelle: Oh, God, me too. I'm too much of a control freak. I'm a horrible backseat driver. Yeah. Dine in or dine out?
[01:05:36] Cassidie: Dine in.
[01:05:37] Michelle: Dine in?
[01:05:39] Cassidie: It's one of my favorite things to do. LA has good restaurants.
[01:05:43] Michelle: Yeah. Wow. Okay. Would you rather have a food fight or a water balloon battle?
[01:05:50] Cassidie: Water balloon. We can't waste food.
[01:05:53] Michelle: Yeah. And it sounds more fun, right?
[01:05:55] Cassidie: Exactly.
[01:05:57] Michelle: Salt or pepper?
[01:06:01] Cassidie: Pepper.
[01:06:02] Michelle: Pepper, yeah, pepper. The big, crunchy peppercorn.
[01:06:07] Cassidie: Pepper.
[01:06:08] Michelle: I love pepper.
[01:06:10] Cassidie: Same.
[01:06:11] Michelle: Would you rather team up with Wonder Woman or Captain Marvel?
[01:06:17] Cassidie: Okay. Actually, I have no idea because I'm not a superhero girl, but I'm going to say Wonder Woman. I guess that was the wrong choice. Don't judge me.
[01:06:25] Michelle: Oh, no. I could see you and Wonder Woman doing great things together.
[01:06:31] Cassidie: Fabulous.
[01:06:32] Michelle: She was my childhood hero, or heroine.
[01:06:35] Cassidie: Okay, I'll go with that.
[01:06:37] Michelle: Okay, last question. Would you rather have universal respect or unlimited power?
[01:06:46] Cassidie: Oh, I think respect.
[01:06:50] Michelle: I think those go hand in hand. Right. It's like if you have universal respect, then you're pretty powerful.
[01:06:58] Cassidie: Yeah. Yeah, exactly. But I feel like both. Yeah. There we are.
[01:07:05] Michelle: Oh, Cassidie, you played along with me and I appreciate it. We've had a lot of fun today.
[01:07:12] Cassidie: Thank you.
[01:07:14] Michelle: And we've learned a lot and gotten to know you. So thanks for sharing everything, fertility nursing, with my audience. I really appreciate it.
[01:07:23] Cassidie: Thank you so much for inviting me. And it was great chatting.
[01:07:28] Michelle: Yeah. Well, you have a great rest of your day.
[01:07:31] Cassidie: Likewise. Take care.