Host of the Up My Nursing Game Podcast, Annie Fulton

[00:01] Michelle: Are you an experienced emergency, acute, or critical care nurse who needs a refresher on some of nursing's most complex conditions? Then you need Annie Fulton in your life. 
Annie hosts the popular educational podcast Up My Nursing Game. Through it, she helps nurses level up their learning because, spoiler alert, learning doesn't end when you graduate nursing school. She collaborates with experts in their fields to answer common clinical questions so we can feel more equipped to care for our patients. And her discussions are never boring. 
Annie is a big fan of FOAM. Let me explain because I didn't know either. FOAM is an acronym for Free, Open Access Medical Education. The Up My Nursing Game podcast has over 75 episodes of high-quality educational content, which is absolutely free. 
I had a blast nerding out with Annie, a fellow nurse podcaster, and she gets my utmost respect as a nurse, helping nurses.
In the five-minute snippet. Dr. Dana Sculley has a nice ring to it. 
Well, good morning, Annie. Welcome to the podcast.

[01:36] Annie: Thank you, Michelle. Good morning. I'm so happy to be here.

[01:40] Michelle: You know, me, too, because we have a lot to talk about. First of all, you are an experienced nurse, and I love hearing your story about how you got into nursing and where you've worked, and then you are an advocate for FOAM, something that I was not familiar with, and that is free, open-access medical education. And that's really what your podcast is all about. You are the host of Up My Nursing Game podcast, a very successful podcast, an educational podcast for nurses and other health professionals. And it's completely free, and you have a huge library, so I want to talk about that. But let's just launch with how you became a nurse and where you've worked, stuff like that.

[02:37] Annie: Yeah, no, thank you. Yeah, I'm happy to share that. So, nursing is actually a second career for me. I started off with a degree in economics. I went to Bates College in Maine, and I actually spent most of my time after graduating bike racing in northern California. And I did some web development on the side to kind of pay for my racing lifestyle. And I eventually realized that I was ready to stop racing. And the thought of doing web development full-time was just not something I wanted to pursue. I didn't like sitting at a desk. I really liked just interacting with people. So I decided to go to nursing school. Also mentioned, I've been terrified of doctors and needles. My whole life, I frequently faint. I even still do faint sometimes. Like when I go to the doctors, I thought, well, I understand what it's like to be nervous and anxious about anything like healthcare related. So I thought I could really relate to my patients and help them through their journey. So I decided to go to nursing school, and luckily I found that me sticking other people, me looking at other people's blood doesn't bother me. It's just when it's my own blood that it bothers me. So I went to nursing school in my late twenties, and I've been a clinical nurse for ten years, mostly in adult, acute, intermediate-level care. I was part of the float pool at a large academic center, so I was cross-trained across 30 different departments. So I've really seen it all in terms of adult acute and intermediate care. I was also cross-trained to emergency at one of the hospitals that I worked at as well. I also am now a clinical instructor for the nursing school that I went to, which has been really satisfying experience. It's pretty new to me, but it's really neat to see things come full circle and to be able to see this next generation of nurses, to bring them up into the changed world of nursing that it is now. And five years into my nursing career, I started this podcast. I had been listening to podcasts on my way to work. It was kind of, I actually really enjoyed commuting, which I know is a pretty rare thing to hear, but it was like my me time in the car, and I would listen to medical podcasts, I would listen to a lot of physicians podcasts, pharmacists, and there was nothing really nursing. There was not a whole lot for nursing that was educational. There was a lot of resilience and burnout prevention, and so the non-clinical topics. So there were a lot of nurse podcasts that were non-clinical topics. And I decided in 2020 I was supposed to go to Italy, but obviously my plans changed and I had two weeks of PTO, and I decided to take that time to start the podcast that I always wanted to listen to as a nurse. So that's the genesis story of my podcast and how it came to be, and I just haven't stopped. So, you know, four years later, here I am, still making the podcast.

[06:15] Michelle: Well, it sounds like you're in it for the long haul, and most podcasters, they tell us, you know, you gotta be in it for the long haul because it takes a long time. And, and, and certainly I think if it's something that you love and you enjoy, that and that, you know, brings other people joy that you're going to stay in it. And I'm really glad you're in this space because through your podcast, you educate nurses and other health professionals. And I love your format. I love how you have different experts in their field on. And I really like the educational aspect of it. When I first started listening, it felt like I was going back to kind of nursing school in a way, but it was like elevated. It was like for the nurse that has been practicing for a while and maybe is rusty on certain things in their genre, in their specialty of nursing, and you're really drilling down on those things. So we'll get to your podcast because it's phenomenal. But one thing that you said in your bio is that you are really passionate about free, open-access medical education, and anybody who listens to your podcast will certainly find that out. I have to say that when I saw that, I was, I didn't know what that was, and I came upon an article and I shared it with you. So I just want to touch on that for a moment. This article came from Frontiers in Medicine, which is a medical journal out of Switzerland. And in it, the author talks about a couple different things. Makes a delineation between FOAM, the free open access medical education and MOOC's. And I was familiar with MOOC's because I just took a course from Yale through Coursera, and that was considered a MOOC. And those are called massive open online courses, and they're generally developed by universities, as this one was. And I'm currently taking one right now through Vanderbilt University on genetics. And it's completely free. And it's just amazing that these things are out there. But in the article, the author pointed out some of the four main concerns of free open-access medical education. And those were number one, a lack of motivation, skills and experience with the clinical educators. And a lot of that had to do around time, resources and motivation. And, you know, from being a podcaster, there's a lot of preparation in making your episodes. The second concern was best practice for instructional design. And I will say that this article was geared towards physicians, towards medical students, so it was not geared towards nurses. But I think some of the things, some of the same concerns still apply. So best practice for instructional design. Number three was evaluation of the foam resources. And the author pointed out that it might be difficult to verify legitimacy and accuracy of the information and resources produced online. And then number four was sustainability. And this is kind of, we touched on it a second ago when we talked about being in it for the long haul. It's not easy to do what you're doing to make a podcast to educate nurses and come up with all the resources, the guests, the, you know, the specialists in their field. So sustainability, and because people are doing this for free, altruistically, because they believe in it, like yourself. So just talk about these concerns and just what's your opinion on this?

[10:49] Annie: Yeah, these are definitely valid concerns. I think in terms of sustainability, that's been a big concern for mine. Michelle, you can attest to this, that podcasting is more than just talking into a microphone for an hour and projecting it out into the world. There's a lot of planning that goes into the episodes, and especially mine, that are so educational and so much information that I need it to be a very high-quality product. I don't want to release anything that's incorrect or I have experts on my. On my podcast, like, I need them to sound very authoritative. So there's a lot of editing that goes on. So the time that it takes from recording an episode to releasing it, there's a lot of work in there. So the way I have made it sustainable is that I release episodes every other week. So it's a bi-weekly episode. I know most podcasts, there's much higher frequency, but to make it sustainable for me, I just do every other week. And I will say that I have monetized my podcast, and that helps me make it financially sustainable as well. That was a big skill for me to build. I think it's not marketing and accounting and taxes and building an LLC. This is not something you learn in nursing school. And that was definitely a steep learning curve for me. But along the way, I built those really valuable skills, and I'm thinking, long haul here. Big picture that I have gained a lot of skills from becoming a podcaster that I would like to. To use in the future for maybe a career pivot, like to stay within nursing. I'm obviously very passionate about nursing, but maybe to kind of pivot into more of an entrepreneurial position in the future. So one of the concerns that the author pointed out in the FOAM article that you share is that the concern regarding best practices for instructional design. And I have to argue that I don't think hospitals are doing a good job right now of instructing their staff via modules. Michelle, you've been a nurse for some time. I'm sure you have yearly competencies that are these really dry videos that you can often turn the volume down and just kind of click your way through them. I don't know about you, but I'm not learning a whole lot when I'm doing those yearly competencies. So then I think podcasting is a way to engage the learner more. It's such a great medium, the auditory medium, because you can think of podcasting as the companion medium. So you can be doing chores, you can be commuting. That was the activity I was doing while I was podcasting. And so you can keep someone's attentions for a long time with audio format, as opposed to, you know, like a module or even just scrolling through social media. For a podcast, you can keep someone's attention for hours. You know, I listen to some podcasts. The episodes are two to 3 hours long, and I'm engaged the whole time, and it's because I'm doing something else while I'm actively listening to the medium. So I know, for example, Sean, who hosts the Nurse Dose podcast, he actually created his podcast for the CBICU where he was working, and he noticed that there was some gaps in knowledge for some of his coworkers, and they were asking, hey, Sean, can you teach us about this? And he said, well, it's a little difficult because I work night shift, so I'll just record some podcasts for you. And then he decided to formalize it a little bit, and he made a, you know, a podcast that anyone around the world could, could download, and, you know, the rest is history for him. So I think, you know, he, similarly to I found that podcasting is a great medium for educating. So I would argue that YouTube, podcasting, these are great long-form ways of educating nurses in a way that drive modules don't.

[15:29] Michelle: Yeah, I have to agree with you there, Annie. I have found the podcasting medium, before I even knew that I wanted to be a podcaster, I was hooked right away with the auditory experience. And like you, I would, I didn't have a commute, but I would listen while I was walking or, like, doing other things. And it's amazing how much information you can retain by kind of doing a mundane task and listening at the same time.

[16:08] Annie: I wanted to point out that even if you don't retain it, like some educational podcasts I listen to, I'll listen to a few times. There's a great podcast out there called The Internet Book of Critical Care by Josh Farkas, and this man is brilliant. He's a fast talker, and he's talking as a physician. He's an intensivist, and listening to his podcast can feel like drinking water from a fire hose. And honestly, I'll listen to it a few times. Like, I'll come back to it a month later, and I'll gain something new each time I listen to it. So, yeah, even for something that is very dense and technical, podcasting can work as a medium.

[16:50] Michelle: Oh, absolutely. I am witness to that for sure. So you're on LinkedIn, and I included that in the show notes. Your LinkedIn, which is the Up My Nursing Game on LinkedIn. And there was a post that I saw that was getting a lot of buzz. Does my patient need to be sedated, or do I need my patient to be sedated? This really resonated with me, because as a NICU nurse, our patients were often sedated that were on ventilators because neonates, we didn't want them to extubate themselves. And sometimes babies would get agitated, or maybe they were getting to the point where they were not as sick as they once were and getting hungry, tired of laying there, whatever the issue was. But I think a lot of times, nurses want their patients sedated because of these fears of all these things. And I would imagine adult patients even more difficult to manage, maybe without sedation and becoming agitated. But I just thought it was a great point that you brought up, because sometimes we do things as nurses, that we do them for our benefit instead of the patient's benefit. And these instances are few and far between. But I think what your question asked was, before you jump to say, my patient needs sedation, just ask yourself, okay, take a pause. What's going on here? Does my patient legitimately need this, or is this something that I'm feeling uncomfortable with? And I would prefer this. So, I love that you asked that question, and it just created a lot of, I guess, introspection on the respondents parts. So I like that conversation.

[19:12] Annie: Yeah. So, since I've hosted this podcast and I've interviewed, you know, up to 70 experts now, I have become aware of some things that I was not privy to before. Something that, for example, I interviewed a nephrologist who opened my eyes to the fact that we probably put too many patients on hemodialysis, and that's just for our comfort, because we like the ability for tight control of hemodialysis, when, in fact, often peritoneal dialysis would be a great alternative for many of our patients. Another such eye-opening moment for me was interviewing this amazing woman and pioneer named Kaylie Dayton. And she opened my eyes to our faulty sedation practices in hospitals. And I'm mortified to know that that is also a thing in NICU, I thought babies just sleep all the time. I'm sorry, I'm not privy to much at all that happens in the NICU. I'm just thinking about my newborn. Babies have slept all the time. But in adult care, we have this false connection that intubation is an indication for sedation, that because our patients are ventilated, they're on a mechanical ventilator, that they need to be sedated. And that is not true. That is true. When you start intubation, when you're doing induction and that you're passing tube through someone's throat. Yes, you do need to be sedated in that instance, and maybe some time afterwards while you get used to having a tube down your throat. But after that, you can actually turn the sedation off and you can teach the patient that this is their lifeline, that the tube down their throat is their lifeline, and that, in fact, ventilators aren't as uncomfortable as we think they are, that often the ventilators will work with the patient. So while we see patients in the ICU who are sedated, they're on propofol drugs, they're on fentanyl, and they look peaceful. If you throw an EEG on these patients, you're not going to see sleep. They're not sleeping, they're not getting REM sleep. They are having dreams. They can probably hear some of what you say they're having, probably nightmares. Post ICU, PTSD is rampant, and they say up to 80% of patients who are in the ICU experience delirium, which is acute brain dysfunction. So we're doing a huge disservice to our patients in the ICU by sedating them just because they're on a ventilator. A ventilator alone is not a reason to sedate your patient. And I know that is a huge frame shift, and one that honestly took me some time to kind of figure my way through. But it's something that has been a huge eye opening experience for me to learn about how horrible delirium is for patient outcomes. It is an independent predictor of mortality and how we just simply over sedate our patients because, you know, as nurses, we think we're doing the right thing. We think we're. We see our patient seemingly calm and comfortable on the bed, but what's actually going. What's actually going on in their brain is anything but comfortable. It's often terrifying. And if you listen to patient stories of what dreams they were having while in the ICU is mortifying. So having Kaylie on my podcast has been a hugely eye-opening experience. And that LinkedIn post was something I posted while I was at an early mobility conference. And it's this conference where Kaylie was there, I was there. All the kind of movers and shakers in this ICU. Revolutionary movement here where we want to have awake and walking ICU's, we want to promote early mobility. We are there listening to each other. It was a wonderful, wonderful conference that was multidisciplinary. Doctors, nurses, PT, OT speech, ICU survivors, they're all there. And we're talking about how can we break this myth that intubation is an indication for sedation and that sedation is sleeping. If we can get rid of these two myths, we can produce so much better patient outcomes. And, you know, I'll kind of leave it at this. We can easily argue that would create less of a nursing burden if we can prevent delirium in the first place. And I know that's a huge frame shift because we think we're making it easier on ourselves, right? If we are patient sedated, that's easy, right? But in fact, think about all the work it takes to pull fentanyl out of the pyxis, to pull propofol, to waste it, to get a four-man team to change and reposition a patient who's sedated with a ras of minus three, minus four. That's a lot of work. And when you lift off the sedation and they come out swinging, a patient who's in a hyperactive delirium, that's a lot of work. But if we hadn't put sedation on in the first place, they wouldn't be coming out swinging. So it's something I invite all nurses to think about, is to really question your sedation practices when it comes to your patients. And how can we incorporate mobility, early mobility, in such a way to improve patient outcomes, to decrease deconditioning and to really humanize our patients so they're not just bodies laying in a bed talking to Kaylie. Being a part of this early mobility movement has been so energizing for me and something that I wouldn't have known about without having hosted this podcast.

[25:50] Michelle: Yeah, it's such a benefit when you have experts on like that and you learn so much, right? And I just loved, I loved that post because I felt like it needed to be said. It was something that, you know, hey, nurses, let's. Let's take a pause and reevaluate this. And then you provided, you know, the education, the literature behind that. And I love the pictures from the early mobility conference where you had an adult woman that was intubated and she was up walking with physical therapy. And as an ICU patient, and that is a lot of work. But if we're going to provide patient-centered care and we're going to prevent some of these things like ICU psychosis and PTSD, it's so worth it, right? It is so worth it. And we have this conversation in the NICU, and the conversation around the NICU is usually about pain and sedation. If your patient, if your neonate is having pain, they need analgesia, they don't necessarily need sedation. We've seen lots of studies now that have come out on babies that were actually experiencing pain but were sedated, and the outcomes are just, are so poor. And so that's kind of in my NICU world, and I don't do adults, so, like, I don't know how you guys do it. And I hear from so many nurses that are like, I don't do babies, but we all have our thing, right? And we all have our controversies within our specialties. And so that post really was like, oh, yeah, that speaks to the NICU part of pain and sedation and separating those things and how important your assessment skills are of is this patient having pain or does this patient just need some sedation? All of that stuff. So I just love it. I love that, that you're bringing those issues to the forefront and causing kind of a ruckus and causing us to reevaluate the things that we do so kind of routinely and really without thinking. So thank you for that.

[28:36] Annie: And I want to point out that I'm coming at this from a pro-nursing perspective because I've been there, too, with a patient who has hyperactive delirium, and these patients require so many resources. It is acutely stressful as a nurse to be dealing with a patient who's agitated. And what I want to convey is that if we are going to successfully decrease the amount of sedation that we're giving our patients, and maybe this also echoes a NICU, too, is it's going to be a full team approach. This is not going to be just nurses. This is going to be physicians. This is going to be PT OT. This is going to be family. You know, family plays a huge role in the ability to reorient a patient and to even mobilize them to participate in that. And so I think I can't. It's important to not paint this as a nursing problem, to lay it on us as nurses, that this is going to be a team effort, and this is not something that nurses can do on their own. Although I will say that we are often the linchpin when it comes to direct patient care. So our role is very important, but it's not going to be us alone who's going to fix sedation practices.

[30:04] Michelle: Yeah. Thank you for that distinction. And I echo that. It is a team. It's team concern. It's a team challenge, and it takes all the players on the team, definitely. And in the NICU, our parents are like the number one caretakers. They're number one on our team. They know their baby, they understand and talk about PTSD. Lots and lots of literature coming out about parents having PTSD from their NICU experience. So, you know, it's definitely challenging, and I love that the discussion is happening.

[30:47] Annie: My son was three weeks old when he had an apneic episode, and he was in the NICU for a few days. And I am definitely still reeling from that experience. And I can absolutely understand the PTSD that parents go through. And to be quite honest, it's popped up in my nursing practice, too, when I had a young male who had a cancer diagnosis with a very poor prognosis and hearing his parents get the news of it, and it just brought back all those memories of my son being in the NICU and thinking about losing your child. So I can absolutely understand the PTSD that. That parents go through in the NICU. Absolutely. Still. Still reeling from mine, still working through it.

[31:42] Michelle: Yeah, it's real, and we hear it from them all the time, and there's a lot of literature on it. And so in the NICU, we're very now taking a trauma-informed approach, you know, understanding the things that create trauma and taking a preventative approach to, you know, trying to prevent some of those things or at least educate on these things that may be troubling to you. But, like patients in the ICU, and I would imagine a lot of family in the ICU, you're dealing with sleep deprivation, you're dealing with stress. And I've heard this from so many nurses whose children have been in the NICU or born prematurely, that they were not, you know, they felt like, man, I'm a nurse. Like, I should have been able, like, why do I feel this way? You know, years after my baby was in the NICU, it was really traumatizing, and I'm a nurse like, why is this happening? Like, I guess we think as nurses that things. I don't know. Like, we have this superpower. Like, things should not affect us. But if your baby is in the NICU, you're a mom first, you're a parent first, right. It's like you are not really coming at it from a nurse standpoint, but I think a lot of nurses struggle with that. So. Yeah, thanks very much.

[33:11] Annie: That speaks to me what you're saying, Michelle, because when my son was in the NICU, I was just beside myself with anxiety. And, gosh, I don't even know how to explain the emotion. But helplessness, I think. And I didn't want to say anything about it because as a nurse, I realized this is not a helpful thing to feel. And it was probably an overreaction and irrational, but as soon as I let it out, I said something along the lines of, how can I ever take my eyes off my baby again? The nurse just rounded the troops. He got the physicians, he got the nurses, he got everyone there, and they all just said, this is important that we talk through this right now. And I forgot that what a great model it is in pediatrics and the NICU, that the family is the patient. Right. This is not something we practice in adult medicine, and I think we can do a much better job of doing it. But it was absolutely what I needed in that moment to have everyone there and to reassure me, yes, what you saw, you know, with your son not breathing, is terrifying. But, you know, the study, you know, research has shown that it's okay to take your eyes off your baby and to not go down this rabbit hole of having, like, oxygen monitoring. But I was just so impressed with the willingness of everyone to take their time to talk to me as I was not the patient, I was just the family member here. But they absolutely prioritized my experience in that moment.

[34:57] Michelle: That is really heartwarming to hear and validating, because I feel like that is our superpower in the NICU or pediatrics, we have to see the patient more holistically, and the patient always comes with the parents and the family. To recognize it as such is really empowering for the parents. So thank you so much for talking to that. There's an episode that I listened to that I really want to talk about, and it was emotional for me, the listener. And that was the episode that you did on AFIB management with Doctor Megan Colewright and your wonderful nurse, the cath lab nurse Danielle. And in that episode, you yourself said that you were experiencing some emotion or that it was important to you to talk about this because of losing your father through him experiencing Afib, but give us an overview of that and talk about the emotional aspects of some of these really personal and deeply felt interviews.

[36:18] Annie: Yeah, yeah, yeah. Thank you for bringing up that interview as one of my first episodes that I did. And so Danielle, the nurse, the second nurse on that episode, is my cousin, and she actually lost her father to acute MI to a heart attack. And she is now a cath lab nurse. And working in the cath lab and seeing someone be treated for an acute MI and bring them back and give them life again is just so satisfying for her. And to hear that my cousin Danielle is very quiet, but to hear that passion that she has for her job, it was just so beautiful. So, in addition to having my cousin Daniella on, we had an interventional cardiologist, Megan Coylewright, and she talked about all that goes on in the cath lab, and it's not something that, you know, nurses on the floor are very privy to. You know, we just send our patients off to cath lab, and we get them back, and we kind of don't really fully understand what's going on there. So I brought Megan on to talk about, like, okay, let's. Let's connect these dots a little bit. And in the process, you know, we talked about Afib. That's something that is often treated in the cath lab. And I brought up the fact that my dad had Afib undiagnosed when he was 64, and he had a massive stroke as a result of it, and he passed away from that. And as a nurse, it is hugely gratifying for me to be able to help patients with Afib live with it, to be able to educate them on the procedures that are available to them, or the life saving medications that we're able to offer them. The importance of being on blood thinners and that management is what will save their lives. And it's something that my dad never had the time to or the diagnosis to act on. So to be able to share that with my patients is just hugely gratifying. So, yeah, that was a very, very emotional episode about something as technical as interventional cardiology and Afib, but I think it's very therapeutic. And it was so wonderful for me to connect with my cousin on this shared topic.

[39:02] Michelle: Yeah, I really loved listening to it, and it was very educational. And the emotional aspect was, I could feel where you were coming from, having experienced that yourself, that deep loss and the helplessness that comes along with it in terms of if we had known this sooner and so forth, and then really paying that forward in terms of educating nurses, and there's probably some regular people that maybe are not in the medical profession that are listening to your podcast as well and kind of paying that education forward. But I felt the emotion, and I think sometimes that it just makes for such an engaging discussion. I think that's another testament to nurses having experienced things either themselves or through their family, and saying, I want to help other people with this or I want to prevent this. That kind of altruistic just, I guess, like, paying it forward is the best way that I can describe it. But thank you for speaking to that, and I'm sorry that you lost your dad.

[40:19] Annie: Yeah. And to actually bring it full circle here, from what I understand, that when in the process of learning, you have to attach a fact to an emotion. And I think something that podcasting can do, for example, as opposed to reading a textbook or, you know, modules, is that we are able to create those connections between, you know, the material and emotions. And for me, Afib has always been close to my heart because of my father and because of that loss that I experienced. And I think that it makes me all the better of a nurse. So I think that's where podcasting can play an important role in education, is being able to make this a real story. Make this a story. It's not just facts. It is a story now. It is a life. It is something so much richer than facts and statistics.

[41:29] Michelle: Yeah. And I feel like some of the best podcasts are, they're all about storytelling and. Yeah. And making that connection is really important. And it totally had me. I was very somber through the episode and just thinking about you losing your dad and Danielle, her uncle, and, yeah, it really touched me.

[42:00] Annie: Thank you.

[42:01] Michelle: So I want to get into some of the particulars about your podcast. And you may have said this in the beginning, but why did you start it and why do you continue to do it?

[42:16] Annie: Yeah, so my podcast, I started it because five years into my career, I felt like I still didn't understand everything. And that's such an obvious statement. Now that I verbalize, I'm like, of course I still don't know everything, but if I don't understand something after five years, I'm going to guess that other nurses don't either. And we are all so busy in the hospital that we don't have time to ask, or we don't have the confidence to ask, especially physicians who are, you know, also really busy. Like, hey, can you take your time, like, to stop and explain, like, why did you order this medication for someone? We don't have time for that. So I created the episode as kind of a safe space to ask these clarifying questions or, quote, like, dumb questions. And it's something that I've had to, you know, work through, like, being very open and public with the fact that I'm asking kind of quote-unquote dumb questions. But I just do it because I know that if I have that question, I think other nurses are, too, and it is a huge benefit to those who are afraid to ask. So I just go ahead and do it, and I hope that other nurses are able to benefit and find value in that.

[43:41] Michelle: Well, first of all, there are no dumb questions. I think a lot of it could be ego, definitely. And then when you say you were a nurse for five years, I think, like, oh, God, that's like a baby nurse to me. You know, I don't know why. I think five years is a good amount of time to learn things. There are constantly new things coming out and new literature, and to think that you could possibly know everything. Five years is just crazy. And there's things that, after 20 years in the profession, that I was still learning. And I just love that you're kind of taking the pressure off of us, whether it's ego or whether we're embarrassed to ask or we think it's a dumb question or whatever you're saying. I'm here to answer these questions that maybe you have had, but you've put on the back burner, and we're going to talk about him, and then you get the specialists to come in and talk about him. And so now we're learning guilt-free, right? Because you're kind of like, I'm asking for a friend. That's what I like.

[45:02] Annie: I love how you frame that, Michelle. Exactly. Guilt-free learning. I love that. That should be my tagline.

[45:13] Michelle: Okay, well, let's talk about who is your audience? Who's your target audience Annie?

[45:19] Annie: Yeah. So my target audience, and this is a little bit unique for nursing education content is experienced nurses. You know, there's a lot of content out there for new nurses, new grads, nursing students. But what about us who are experienced? We don't necessarily need all the nuts and bolts, and we don't need every little thing, you know, explained from the beginning. So my podcast is definitely geared towards nurses who have some experience, so I assume some level of competency, I guess. But that being said, nursing students and new grads listen to my podcasts as well, even non medical people. And I think that you can definitely run with it. If you don't have nursing experience, you can still hang on and still learn a lot from the podcast. But, yeah, so anyone who works in adult acute critical care or emergency, that's my target audience.

[46:21] Michelle: Great. How do you vet your guests?

[46:25] Annie: That's a good question. There's been definitely an evolution. I think as I started, it was like, who do I know who'd be willing to be on a podcast? And then I eventually had the confidence to reach out to physicians and nurses who I'd been listening to, like phone producers, and I been listening to them for years. And then I finally asked them, hey, can you come on my show? So, Doctor Joel Toff, for example, is an example of that. He's a nephrologist I've been listening to. Yes, I listen to nephrology podcast. I am that nerdy. So he came on, and then as of late, I have people reaching out to me saying they want to be on my podcast because it is such a powerful platform to be on, to talk about their experience, to talk about whatever they're passionate about in healthcare. So it's quite a mix. I tend to reach out to people who I feel like they have a message to share. They're well spoken, they like teaching, they're nurse friendly. This is for nurses. Let's make sure they have a message that is pertinent to nursing and that they have. So if they're passionate about something and they're nurse friendly, I want them on my show. And of course, if it meets the criteria of adult acute critical care in Emergency.

[47:57] Michelle: Yeah, you have a wide range of experts, and I love that. And I love how you said you're. I listen to nephrology podcasts, like, you know, like you should be. Hi, my name is Annie, and I listen to nephrology podcasts, you know, please help me.

[48:19] Annie: I think it says a lot about me. These kidneys are fascinating. I mean. Yeah, yeah, yeah, necessary.

[48:27] Michelle: Do you produce your podcast yourself?

[48:33] Annie: Like, do I have an editor?

[48:36] Michelle: Yeah. Like, do you do all your editing and post production and all that?

[48:43] Annie: Yeah, good question. So I do the initial editing, like the, what I call the content editing, because I want to have tight control of that. I want to make sure that my guests come out sounding very smart and authoritative. So I do what I call the content editing, and then I have post production work, someone who knows a lot more about sound and audio kind of comb through it and make it sound really nice.

[49:08] Michelle: And it does. It's great. That's what I always wonder about podcasts, because I do everything myself cause I'm a control freak. And so I have thought about, like, giving some stuff away. I'm not there yet. I'm like, no, I don't want to give it away yet. What do you love about podcasting?

[49:35] Annie: What I love about podcasting is the doors that has opened for me and the connections that I've made. I once heard someone describe podcasting as, like, networking on steroids, and it really is right. Like, if it hadn't been for this podcast, I wouldn't have met you. And this. Had this discussion about NICU and sedation and NICU and PTSD and NICU, like, how wonderful it is that I got to have this opportunity. And it was, you know, only afforded to me by my podcast. It has given me a platform to talk about things that I'm passionate about. So especially, like, early mobility. And in some bizarre way, it has given me some legitimacy, even though I ask experts the questions that I'm somehow now seen as being like, an authority on nursing, if that makes sense. I don't know, Michelle. You can take that.

[50:34] Michelle: Yes, it does. Absolutely.

[50:35] Annie: But actually, the position that I have now as a clinical instructor was made because the professor of the school I'm now teaching, I was listening to the podcast and found out I went to that nursing school, and she said, hey, we'd like to have you on as a clinical instructor. So, like I was saying, cut networking on steroids.

[51:00] Michelle: Yeah, I love that. That's an accurate description. First of all, you can meet so many people and through networking and just through the podcast, and. And then you can reach so many people. So that's the other thing. I love it. So the other flip side of that question is, what do you not like so much about podcasting, or what would you change about it?

[51:27] Annie: The only thing I can say is that it's a lot of work. And I would say that I do have some frustration about the fact that more and more podcasting is going visuals. So you need to have. You don't need to, but it's very helpful to have a YouTube channel associated with your podcast. And I don't really want to get into the visual medium. I really like audio. So, yeah, I think between it just being like, a heck of a lot of work to produce episodes, also, the push, the increasing pressure to be on video is something that. That I don't really want to do. And I hope that. I think I'm just going to keep it an auditory medium.

[52:14] Michelle: Yeah, I'm like you. I'm going to stand my ground on that as long as I can. You know, the advice is for growth and all that to go into visual, and I'm just not there yet. So I share that frustration with you as well. So we have to stand united, Annie, and not do it.

[52:37] Annie: You know, we talk about playing the long game here. I think the thing about podcasting is it doesn't go viral in a way that, you know, YouTube videos can or TikTok or Instagram reels. Like, you can really have, you know, experience growth by going viral on those mediums. And there just isn't anything like that for podcasting. So it's slow growth. Yeah. But, yeah, I'm like you, Michelle. I'm going to stick to my guns here and stay almost exclusively at auditory.

[53:11] Michelle: What is some of the feedback that you've received from people about your podcast?

[53:17] Annie: Yeah, I think most of the feedback I get is that listeners have a sense of confidence after listening that. Maybe they were shaky on a clinical topic, but after hearing an episode and having kind of their quote-unquote dumb questions answered, they're like, okay, I got this now. And so they can approach a situation with much more confidence than they did before episodes. I have done about sedation and early mobilization. What we've talked about, I've had some amazing reviews or DM's from listeners about this has opened my eyes, and I've had some very direct, specific stories where nurses have said, I think I've changed this patient's outcome because I listened to your podcast about sedation practices. And that, to me, is just so satisfying to know that, you know, through the podcast, I have kind of indirectly changed a patient somewhere in the country, somewhere in the world, changed their trajectory just by sharing education. So, yeah, that is just so satisfying to hear that I can, you know, be the source of confidence for nurses and to really improve patient outcomes.

[54:46] Michelle: Yeah, that's amazing. And that's the goal, right? I mean, that's why you're doing it. And to hear that you are achieving that goal, you're helping nurses feel confident you are changing their practice for the better, for better outcomes. It just has a, like a snowball effect. It's like that one nurse that changed the practice and created a different, better patient outcome is now going to share that with other nurses. And it's like, that's how we start this whole revolution, right? We just one episode at a time, one nurse at a time. We say something, we do something, we provide something that changes what they do, changes patient outcomes, changes their outlook on things. And then we hopefully would, you know, we would love for them to share that with their colleagues, with their friends, with their family. You know, I, my daughter and I are both big podcast fans, and we're always talking about, oh, I heard on this podcast, we're relaying the information, and I think as podcasters, like, we love to hear that from people. First of all, we love feedback and to hear that our efforts are being noticed and that they're changing people. I think super, super powerful and very gratifying.

[56:22] Annie: It is. And going back to the early mobility conference I was at, one of the speakers was an intensivist, and he was saying that usually all it takes is one story. It takes a physician or a nurse or RT to hear one story about sedation practices from an ICU survivor to change their practice, to open their eyes, to illuminate this alternative way of thinking about sedation. And that's the power of podcasting is right. You're able to provide these stories, and I'm so grateful that I have found podcasting and I'm able to help create this content, create like, get these stories out there to change the hearts and minds of nurses and providers as well. And it's so powerful in such a way, kind of going back to what we were originally talking about, that statistics aren't necessarily going to help change people's practices. It's the stories.

[57:32] Michelle: Yep, you are right. It's the stories. And I'm so glad you're in this space. So, as we get ready to close, and before the five minutes of fun, I have a question for you, and just recently started asking this. Is there a guest that you recommend on this podcast?

[57:51] Annie: Yes. Yes, I can think of two. Can I share two?

[57:56] Michelle: Sure.

[57:57] Annie: Okay. So in the spirit of this episode, I have to recommend Kaylie Dayton, who produces the podcast Walking Home from the ICU. She is just such a powerful, engaging speaker, and I think her message is an important one to share. Additionally, Sarah Lorenzini from the Rapid Response RN podcast, talk about storytelling. She goes through various rapid responses that she has participated in as a rapid response nurse, or she has guests come in and talk about their rapid response experiences and kind of uses those as opportunities to teach clinical topics. So both Kaylie and Sarah highly recommend as podcast guests.

[58:49] Michelle: Thank you so much. And I will reach out to them.

[58:53] Annie: I'm happy to make a connection too. I know both of them very well so I'd be happy to.

[58:56] Michelle: Love it. Thank you so much. Yeah. Well, thank you, Annie, for being here. I love what you're doing. I have loved speaking with you and nerding out on all your processes and just really learning your why and just really appreciating what you do. I've really had a lot of fun today, so thank you for being here.

[59:23] Annie: Yeah, thank you for having Michelle. This is so. It's so nice to talk to another nurse podcaster.

[59:30] Michelle: Right? We got to stick together. All right, well, we're ready for five minutes of fun. So are you ready for the five-minute snippet?

[59:40] Annie: Yes. Let's do it.

[59:42] Michelle: Let's see. What would you do if you found a briefcase full of cash in a different country?

[01:00:34] Annie: Slowly walk away? Yeah, I think I don't want to get in any trouble.

[01:00:42] Michelle: No trouble here.

[01:00:44] Annie: Yeah. Yeah.

[01:00:45] Michelle: Would you rather spend a year working in a top-secret science lab or on the International Space Station?

[01:00:55] Annie: Oh, that's easy. Top secret science lab. I think I've always been drawn to top-secret missions. Ever since I watched X-Files as a young girl, I wanted to be a CIA agent and work in classified projects. Going into space sounds really scary and dangerous. So I'll take a top-secret science lab.

[01:01:16] Michelle: Yes. I'm an X-Files fan, too.

[01:01:19] Annie: Yes. Love it.

[01:01:20] Michelle: Okay, if you could add one feature to airlines, what would it be?

[01:01:26] Annie: How about more space in the aisle way so it's easier to get up and walk? Because anytime I walk in an aisle way of an airplane, I feel like I'm doing everyone a dessert service. But if I can feel like I'm not bothering anyone by getting up and walking, if you can even have, like, two people walk, enough space for two people to walk side by side, that would be amazing, especially as a mom when your kid just needs to run around.

[01:01:50] Michelle: Oh, my gosh, that is amazing. And, I mean, it's so good, like, health wise, too. To get up and walk during a long flight, right?

[01:01:59] Annie: Yes. So many.

[01:02:02] Michelle: Would you rather discover the bones of the world's first human or the world's oldest living reptile?

[01:02:11] Annie: I'll go with the oldest living reptile. That's a close call there, but I think I'll go with the reptile. I think there's already so much interesting work or famous early human discoveries. I'll go with a reptile.

[01:02:32] Michelle: I'm a big fan of reptiles. Yeah, I'm in that way.

[01:02:37] Annie: Yeah.

[01:02:38] Michelle: Okay. Would you rather create an app that locates missing pets or predicts the winning lotto numbers?

[01:02:47] Annie: Oh. That locates missing pets. As a pet owner myself, I know that. Oh, it would be awful if I couldn't find my dog. And so I don't need more money, but I need my dog.

[01:03:00] Michelle: I love it. There's priorities there. That's great. What's the most hipster food you've ever eaten?

[01:03:10] Annie: Oh, my gosh. What's hipster food? I'm trying to think hipster food. I feel like I. It's probably, like, half of what I eat because I live in the Bay area, right? Yeah.

[01:03:21] Michelle: Very hipster. Yes.

[01:03:25] Annie: I don't know, Michelle. Like, what is hipster food? I'm trying to think. So there was a bar in San Francisco I used to go to, and there was a tamale lady who would go to the bar, and you would always know, like, if you go to this bar, you can get tamales. And for some, it was a very. It was a very hipster bar. So I'm gonna go with, like, street food tamales at a San Francisco bar.

[01:03:50] Michelle: That's so random. Oh, my gosh, that's hilarious. Yeah. Okay, last question. Would you rather watch a solar eclipse or a meteor shower?

[01:04:02] Annie: A meteor shower? Yeah, I'll go with meteor shower here. I think it would just be more brilliant than a solar eclipse, which is kind of slow moving. Yeah, meteor shower.

[01:04:14] Michelle: I'm with you. I am. All of a sudden, I'm all about space and the galaxies, and I'm reading books by Neil Degrasse Tyson. And, you know, it's just like, I don't know where this came from because I've never had this before, but I love it, so. Yeah. And I watched all the solar eclipse stuff, which I thought was very fascinating, but you're right, it's really slow, and I just feel like there's a lot of press on it, whereas maybe meteor showers, you know, we need some more, like, meteor shower YouTube videos or something.

[01:04:50] Annie: Yeah. Yeah. And a lot of what I heard from the solar eclipse was, oh, it was cloudy. We couldn't really see it, or, I don't know, it was a little anticlimactic. But if you're talking about a meteor shower, like, that's very exciting.

[01:05:04] Michelle: Yeah, that's pretty awesome. Well, you've been awesome. Thank you so much, Annie, for being my guest today. I have really appreciate all the education and. And knowledge and expertise and experience that you've brought to my audience, and I just appreciate what you're doing as a nurse, as a podcaster, just a good human.

[01:05:29] Annie: Thank you, Michelle. This has been great, and, like, what a cool experience for me to listen about, you know, NICU as something that I think is, you know, a whole different world. But now my eyes are open to how many parallels there are between NiCU and adult medicine, and, yeah, I love it. Thank you so much for having me on your show.

[01:05:54] Michelle: It's been my pleasure. Have a great rest of your day.

[01:05:58] Annie: Thank you. You, too.