Oncology Nurse Practitioner, Lakeisha Falwell

[00:01] Michelle: Meet Lakeisha Falwell, an oncology nurse practitioner who is truly inspiring. Her passion and commitment to her craft shine through in her words as she shares insights about her work. She talks about the patients she serves, the collaborations she engages in, and the setting she works in. Lakeisha emphasizes the importance of active listening skills to improve communication with her patients. But what really sets her apart is her unwavering compassion towards those she cares for. She is not just doing a job but is truly making a positive difference in their lives. As a bonus, Lakeisha owns her own legal nurse consulting business, where she uses her nursing skills and knowledge to assist attorneys with a variety of cases, including medical malpractice and negligence. Due to her knowledge and experience, her services are highly sought after by attorneys nationwide. In the five-minute snippet. Is there a Planners Anonymous? Here is Lakeisha Falwell. Well, good morning, Lakeisha. Welcome to the podcast.
[01:30] Lakeisha: Good morning, Michelle. Thank you so much for having me today.
[01:34] Michelle: Well, you're welcome. I'm really excited to talk to you, and I want to thank you for answering the call that I put out on Instagram. And your friend of mine, Kirby Williams, who was a guest on this show, tagged you, and I just immediately scooped you up because I want to know everything about what you do as an oncology nurse practitioner. So thank you for being here today.
[02:04] Lakeisha: Sure, not a problem. I'm definitely glad that Kirby was able to connect us. It's a beautiful thing about networking and just having a community where you can connect with other people. So definitely excited for this platform and to chat with you a little bit more and to be featured. So thank you for the opportunity.
[02:21] Michelle: Yes. Well, we are just going to get started, and I just like to jump in and talk a little bit about your background and how you got to be where you are now.
[02:32] Lakeisha: Sure. So I was one of those rare people, I guess you can say, who went into college, just knowing that I wanted to be a nurse. From a very young age, I was exposed to the healthcare setting. My mom had some health challenges when I was younger, was hit by a drunk driver, spent a great deal of time in the hospital recovering, and also was going through a divorce at that time. So I did have the unique experience of spending time in the healthcare setting around nurses. And I just really, around ten years old, was able to see how well they cared for my mother and such great detail that they went to great lengths to make sure that my mom was cared for. I just always wanted to have that impact on other people. So fast forward to my college days, I got my Bachelor of Science in Nursing in San Diego, California, at San Diego State. Go Aztecs! And then I went on to work as a registered nurse for a couple of years at a local hospital in San Diego. Absolutely loved my time caring for patients. Being a registered nurse is definitely a noble profession and one that's extremely rewarding. And after a couple of years in practice, I just really realized that I wanted to do more for patients and I wanted to be able to advocate at a higher level. So then sparked the great idea of going back to school. So I then went on to get my master's in nursing. I traveled all the way to New York City and went to NYU in Manhattan, and I got my master's in nursing to become a nurse practitioner. So for the past about ten years now, I have been a nurse practitioner. My passion and my specialty is oncology. So I do work in an oncology setting here locally in San Diego at a very large cancer center. And working with oncology patients is very special and something that's near and dear to my heart. So I definitely have a great passion for nursing. Definitely involved not only clinically at work, but I do mentor at my alma mater both at San Diego State and at NYU, and just really giving back to the nursing profession. So in a nutshell, I am a nursing enthusiast and definitely grateful to be living my passion by being an oncology nurse practitioner.
[04:51] Michelle: Well, that is a very inspiring story and quite a background. What do you think attracted you to the field of oncology?
[05:04] Lakeisha: So it's a great question. I think a lot of times when people hear that I work in oncology, I either get bright smiles or I get kind of deep sighs. And I think that's just the awareness that people know. It is a challenging specialty. It's challenging in every way. Most of the time when you hear cancer, you hear cancer diagnosis. It does evoke very strong emotions, a lot of fear, a lot of worry. So as an oncology nurse practitioner, I'm right there with the patients going through the journeys as they get their scans, both good and bad. I'm there to help them work through side effects and make sure that they can manage their treatments. I just felt there was so much within oncology to give to patients. Definitely, within oncology, you need providers who are passionate, who are patient, and who really want to be there. It is tough physically, mentally, and emotionally and kind of taking a step back to my mom's experience. Also, around the time when she got hit by a drunk driver, she was also diagnosed with thyroid cancer. So that's really where my passion and inspiration for oncology came through because while she was getting care, it was not just recovering from the motor vehicle accident, but it was then a separate journey of going through surgeries and other treatments for her thyroid cancer. Definitely grateful my mom's still alive today and doing well, but that experience just always stuck with me, and I've always wanted to have that impact and to be there to care for patients at truly one of the most difficult times or the most difficult times of their lives.
[06:41] Michelle: Yeah, I've spoken with several nurses that had similar experiences to yours in terms of having a family member either become ill or be in an accident or get a devastating diagnosis. And as they went through treatment with their person, they saw the nursing community, they saw the medical community, and they derived or learned compassion, if you will, from those people who cared for their loved one and said, I want to do that. And I think that's a great message to nurses in that people are always watching, they're always observing, and we need to be aware of that. And the care that we give needs to reflect that always and show our compassion and our love for what we do. And I can certainly hear it in what you do. So take me through a kind of like a day in your life as an oncology nurse practitioner.
[07:57] Lakeisha: Sure. So working in oncology, I think every single day is very different. You may have similar patients that you see on a consistent basis over again, or you may see brand new patients. And I think even if you see your kind of typical panel or patients that you are familiar with, every day is so different. Right. And life in general, our day to days can be so different. We can have good days and bad days, and I think oncology is very similar to that. So in my current role, right now, I work in a large infusion center, so my day-to-day is very different. So a large majority of what I do is keeping patients safe. So when patients come into our infusion center, they are receiving chemotherapy, immunotherapy, blood transfusions, supportive therapies hydration, et cetera. So I would probably say the number one role is if a patient is having an infusion reaction or having some type of medical emergency, I am the first one to respond. And that's definitely an exhilarating component of my job because I can be sitting with one patient managing nausea and the next moment I'm pulled to manage a rapid response or a patient having a very severe allergic reaction. So those moments can be tense and intense. And those situations, I'm then giving the nurses orders to give either steroids or antihistamines to reverse the effects of the hypersensitivity reactions. And then with the more serious reactions, ones that are bordering on anaphylaxis, we are then giving epinephrine and escalating those patients to the emergency room. Outside of that role, I really see a hodgepodge of pretty much everything else. Patients coming in, reporting abdominal pain, and I'm working up their complaints to figure out, if this abdominal pain is just typical gassy bloating pain, or is more reminiscent of a small bowel obstruction where I need to order imaging and get this patient worked up. Sometimes if patients are coming in with abnormal vital signs, right, trying to look through and say, is this just dehydration and giving this patient fluids? Or does this patient look like they may be having symptoms of a pulmonary embolism or blood clot in the lungs, which also is emergent and requires scans and imaging? I also order a great deal of medications within oncology. A lot of what patients need is supportive care. So managing and monitoring them for nausea, for vomiting, if patients are having pain, just really trying to make sure that their symptoms are under control because the quality of life is a huge part of oncology specialty and making sure that wherever our patients are at in their cancer journey, that we can hopefully provide them the best quality of life as possible. So in a nutshell, I think my job as an oncology nurse practitioner in the current setting that I'm in is very robust. There's a lot of autonomy. I'm seeing patients and really just making critical but very quick decisions to help patients get the care that they need.
[11:08] Michelle: It sounds exciting and thrilling and just so interesting. And I want to say I thank God for practitioners like yourself. My listeners know by now that I have a breast cancer history and I'm 14 years out, so I thank God for that all the time. And I had an experience exactly like you were describing. I had an anaphylactic reaction to Taxotere on the second infusion. As someone in the medical field, being on the other end of it, it was really scary. I'm laughing now, but it was terrifying. When everything just goes black and you can't breathe, it feels like an elephant is sitting on your chest. It's super, super scary. And my sister, who was an ICU nurse at the time, was sitting next to me as I was getting my treatment, and she told me later she was even scared as an ICU nurse. So I just thank God that everybody responded in the way that they did. And I did fine. I didn't even have to go to the emergency room. I had steroids and I had Benadryl. And once I was able to breathe again, I fell into a nice little sleep. And of course, they discontinued that Taxotere and it changed the course of my treatment a little bit, but super scary. And so thankful for people like you that do what you do.
[12:48] Lakeisha: Thank you for sharing that. I'm sure that was a very scary experience and I'm glad that the medical team there was able to reassure you and care for you. And congratulations on your survivorship. That's huge. Obviously, as an oncology nurse practitioner, that always puts a glimmer in my eye and warms my heart that's what we're all doing this for providing care, pushing the envelope with research, and trying to get better drugs, better supportive care, so we can help more survivors and more people living longer without a cancer diagnosis. So kudos to you.
[13:25] Michelle: Thank you, Lakeisha, I appreciate that. And one of the things I was really impressed with was just the team going and getting my infusions every two weeks. I had been at it for a few months already, so I had already seen the team in action and was just so impressed from the start. And I was so lucky to have my chemo nurse the entire time and we just really formed a bond. And when I had that episode, to see that the team just sprung into action, and all of a sudden there were ten people at my bedside, because Katrina, my chemo nurse, just raised her hand. She saw it happening and she just raised her hand, and that was a signal for everyone to come. And it worked so nicely. It was just such a well-oiled team. And as a medical professional, I just so appreciated that.
[14:23] Lakeisha: That's amazing. And honestly, as you're recounting your experiences, it reminds me of what I do day to day and just exactly what you're saying, that the team just shows up so quickly. By the time I'm called as the provider, it's always incredible to see that there are nurses who have left their patients because they're stable and they're just stepping in just to help to do whatever they can because they see that another patient's in need. And it's tremendous as a provider to be running those codes and rapid responses and to have so many skilled professionals just ready to go and ready to do any and everything to get that patient stable and also to kind of like you were saying with your sister. I think oncology professionals just get it. It's about the patient, but it's also about the family and the experiences that they are also going through. So a lot of us also have the awareness to not only care for the patient but if we're free to pull the family member aside and to explain what's going on. Because we understand the cancer journey. It's usually never in silence or solo, it's usually a family and a team of loved ones that help you through it. So I'm definitely glad that they were able to be there and support you in such a really instrumental time.
[15:42] Michelle: Yeah, absolutely. And that's exactly what they did. As they were working on me, they pulled Jen aside and explained everything. And here's the thing that I, another thing that I appreciate about these medical professionals is that they treated me and my sister, and they knew I was a NICU nurse. They knew she was an ICU nurse, and they never once just assumed that we knew what was going on or what the treatment was. They really talked to us like lay people. And that was so important because, of course, I had a long nursing history by then, pediatric, and NICU nursing, but I didn't know anything about oncology nursing and I had never had a cancer diagnosis before. So for them to break it down to the basics and start like I knew nothing, which was pretty true, was just so refreshing. Because I think sometimes in nursing and I've done this personally, where I've encountered I've taken care of a doctor's child or a nurse's child, or a physician or a nurse, and maybe I have just assumed that they knew what certain education or about a medication or their condition. And maybe I haven't provided the information that I would have had it been somebody that didn't have that background. So I think as medical professionals, that's another thing that we can do is just and they started with an apology. I know you're a nurse, but I'm going to give you lots of education. And if I'm saying something in a way that you don't understand, then ask me to explain it again. Or if I'm saying something that you totally know about, then you can just say, got it. So that was just a great relationship and a great experience to be on the patient end as a nurse.
[18:00] Lakeisha: Sure. And I think that's another beautiful part about nursing is that our specialties can take us on a wide range in different settings and we have some core skills that are very similar and do overlap. But the beauty of nursing is just how diverse our specialties and our background and our skills can be. So I so much appreciate that the nurses there really wanted to make sure that you were provided the education that you needed and the support that you needed to make sure that you understood everything rather than assuming. And I think sometimes it is really easy to get into that you're like, oh, well, she's a nurse, or she may know this, but it is really important and it's an essential part of your care to provide you that education and that advocacy to make sure that you have all of your needs met. So that's wonderful to hear.
[18:52] Michelle: Yeah, it was really fantastic. So Lakeisha, what disciplines do you work with there in that setting?
[19:00] Lakeisha: So in my current setting, because I work in the infusion center, I really see pretty much every specialty that can come through subspecialty. So we do have a separate bone marrow transplant infusion center, but a lot of those patients do overflow into our infusion center. So we can see leukemics, we can see our patients with lymphoma, those that are getting conditioning chemotherapy prior to a bone marrow transplant, or those that are receiving cart infusions, which are really innovative and really on the cutting edge of treating different hematologic malignancies. I also see a lot of solid tumors, so breast cancer, ovarian cancer, and lung cancer. We do have a good amount of head and neck cancer, so a lot of tongue, oral, thyroid, parotid, gland cancers, and pretty much we see melanoma, we definitely see a wide range. And then we also have a large amount of patients that are on clinical trials as well. So that really kind of opens up a broad base of different patient populations. In my previous experience when I was in the New York City area, I did work specifically with breast cancer patients. So I do have a great affinity, a lot of warm spot in my heart for breast cancer patients because I spent a great deal just working dedicated to that community.
[20:29] Michelle: Wow, okay. That's fantastic. And so do you work with in your clinic there? Do you work with other nurses, other nurse practitioners, physicians? Do you have social workers there? How does that work?
[20:44] Lakeisha: That's a great question. In my setting as an oncology nurse practitioner in the infusion center, it is a bit of a unique, kind of rare role. I would say most oncology nurse practitioners are working either inpatient in acute care setting like a hospital. Others are working in a clinic where they're working directly with a medical oncologist. So working in the infusion center is a little bit of an interesting role, but it's great because we work it's a very big infusion center. We see probably over 200 to 250 patients a day in our setting.
[21:19] Michelle: Oh, my God.
[21:20] Lakeisha: Yes. And we see patients that come from the local areas New Mexico, Arizona, the Bay Area, and Nevada, because we do have such a skilled, highly-resourced cancer center. So in my role, I work very closely with the nurses in the infusion center. So a lot of the nurses who are either giving chemotherapy to patients or bringing patients back, accessing their ports, drawing their labs, a lot of times those nurses will be the first ones that will see patients coming into the healthcare setting or coming in for treatment. And so their intuition, their spidey sense, as we like to call it, with nursing, sometimes just cues them that a patient just doesn't look right or something may be going on. So a lot of times I will get called over by the nursing staff to evaluate a patient who just doesn't look well and order some additional testing, some additional lab work, and other interventions to help to see what we can do to help the patient. We do have social workers. I think social workers do a great deal within the oncology community, whether it's depression and anxiety screening, whether it's community resources to help with bills, or to help with family support. Child life advocates for patients that happen to have younger children, just really trying to explain to them what is cancer. What is cancer treatment in a really understandable way, depending on what age the child is. And social work just has so many resources as well to connect patients to other disciplines, other interventions, and other physicians within the community that can help them as well. I do work with other physicians. When our patients come into the infusion center, they obviously have their main oncologist who is caring for them. So when the patients come into my setting in the infusion center, I'm pretty much,  I like to think of it as the eyes and ears of that physician. So your patient is here, Doctor so and so. And, you know, they're exhibiting this vital sign or this symptom, and this is what I'm worried about. So there is a great deal of collaboration, which I appreciate a lot, especially being a nurse practitioner and being an advanced practice provider. To be able to work with physicians, let them know my concerns, my differential diagnosis, or what I think may be going on with the patient, and then to inform them or develop a patient care plan, either together or by myself, is very rewarding. And we also have speech and language, pathologists. A lot of our patients who have had neck cancer, they will have surgeries or sometimes the tumors will cause speech changes. So not only helping the patients to refine their speech and to give them skills and tools to help them communicate with other people but also making sure that they can chew and swallow safely and making sure that they're not aspirating or choking. So there are a great deal of other disciplines. We work with dietitians and nutritionists as well. Obviously, nutrition is very important for any citizen. But especially when you're undergoing a cancer diagnosis and treatment, making sure that you get adequate nutrition is really essential to recovering from not only chemotherapy, but also surgeries. So that's another beautiful thing about being in oncology, is there are so many really specialized professionals that we can really utilize and leverage the skills of each discipline.
[24:57] Michelle: Oh, yeah, it sounds like you have such a comprehensive team of just support for the patient. That's fantastic. Do you see any pediatric patients where you work?
[25:09] Lakeisha: I do not see pediatric patients. The youngest patients that I will see in my setting are 16. And those are usually patients that may have a pediatric diagnosis or pediatric cancer and then are kind of aged out, so to speak. And then now they're going to adult facilities. So no children and no little ones at my facility. They're all adults.
[25:32] Michelle: Okay, I don't know how to describe this. Is there a certain type of patient that you enjoy working with? A certain diagnosis? Like, do you love working with the elderly or do you like working with the teens? Talk about that.
[25:50] Lakeisha: It's a great question. I truly enjoy working with diverse patient populations. I think the interesting thing about being in healthcare is obviously what patients they're my patients and they present because of a healthcare diagnosis or a healthcare issue or they're needing care. But the beauty of how I view being a provider is really trying to understand that patient and that individual at a different level, understanding who they are as a person. Because when they come in, right, they may be a wife, they may be a husband, they may be a father, they may have just gone through a divorce, they may have just lost a child to cancer or to a tragic event. Their sister may be in the hospital getting care as well while they're going through their diagnosis and journey. So I really like to get to know patients as much as I can, just a little bit more about them outside of their diagnosis, because that also helps to understand what supportive resources can be recommended, but also what may be going on that may be preventing them from getting the care that they need or maybe impacting their care. And I guess kind of to your point, some populations that I truly enjoy working for are patients that are either underserved or underinsured. There are unfortunately a lot of patients in our settings that just do not have enough insurance coverage to provide for their bills or their medication or their treatments at an affordable cost. So I really enjoy caring for those patients because I think those are the patients in my eyes who sometimes need the support, the resources, and the advocacy more than others. Those may be the patients whose English may be their second language where their educational level may not be past a certain level, but that obviously they deserve and should have the care that all other patients should get. But sometimes I think within the healthcare setting it is a little bit forgotten that there are some patients that don't have as many resources as others. So I really genuinely like to spend if I have some extra time in minutes with those patients because, within those minutes that I'm able to spend with them, I often uncover very easy, very tangible ways in which I can impact them and help them. Because unfortunately for some communities and some patients, their social issues or where they're living or their access to insurance or their ability to pay for copays or medications can be the building or can be a barrier for them to receive the care that they need. So sometimes uncovering those barriers and helping them work through it or providing a step in the direction that they need can be truly rewarding. And I do like I mentioned before, I do truly have a soft spot for patients who are undergoing breast cancer treatments. And therapies I think there's a lot of things that I can resonate with and just understand a lot of that patient population, a majority anyway, are professional working women. And so to see those professional working women or women in whatever setting they are trying to either care for children or care for loved ones going to work and not wanting to tell coworkers that they're undergoing treatment. But having to cut their hair and wear a wig and just think the strength and the ability to move on despite what they are going through is truly inspiring to me. I think as a young professional woman, I think that there is so much power in seeing women endure in different capacities and in different ways. So I definitely think that's one population that I tend to learn a lot more from.
[29:45] Michelle: Well, I definitely echo your sentiments on the underserved population, they are experiencing stressors that some of us have never experienced and with fewer resources. And a lot of the success of treatment healing comes with reducing those stressors. And so people that are on the lower economic scale or they don't have health literacy, those people need I think they need more time, more education, more resources, and I think ultimately it could really help them in their fight against cancer, just to get them in that right frame of mind and to know that they're supported. So that's very important.
[30:48] Lakeisha: I agree. I think as well, there are barriers and things that patients are going through that really it's just heartbreaking and disheartening. So as you mentioned, you just never know what somebody else is facing. And a lot of times the things that we hear our patients going through is heartbreaking. But kind of looking back to the team and also just thinking about the passion and the real compassion and the love that oncology professionals have, it's always to share, to give, and to be there as a supportive person. So I've seen a lot of my coworkers pull together and get gas cards for patients who can't afford it or during the holidays, families who don't have much but have a lot of children, just making sure that they can have a Christmas while the patient is undergoing their treatment and not having the expenses to pay. So of course, way above and beyond the call of duty, but when you're a nurse and you have a heart for people, sometimes you want to help as much as you can. So yes, the underserved population and the communities, I think just need more access, more resources, but also just more awareness. And I think as I go in as a provider every single day, that's why I like to ask a lot of open-ended questions and really present myself as a person who's there to help. No judgment, no questioning, just really trying to understand where my patient is at so I can meet them where they're at and help them as much as I can.
[32:29] Michelle: Yeah, I think nurses are really good at just what you described, helping people through different ways and whether that's my NICU tribe, we were those people. I loved it because we would have families that had nothing and we would do like a little mini shower and get them clothes and car seats. I think nurses are so giving and we love doing that, we love helping people that really need it. And nurse practitioners for me personally have really been a staple in my life. My primary has been a nurse practitioner for many years and of course, I had a wonderful oncology nurse practitioner who really helped me through that time of my life. And one thing I've noticed about nurse practitioners is that they are very good at active listening. So how do you hone this skill?
[33:40] Lakeisha: I feel active listening is really it is a skill, but to me, I feel like it is an art form as well. I think it's something that over time and with more comfort that you develop in your practice, you learn skills that are helpful, not only for you to retain information when you're talking to your patient, but to put your patients in a comfortable situation and scenario to where they feel that they can open up and that they can let you know. I think there are certain things that I've learned along the way that help me. One of the main things that I think portrays an active listener is to sit down. I think a lot of times in healthcare we're ripping, we're running, we're very busy, we're trying to move on to the next thing. But I think even if I have two minutes, I try to give my full attention to the patient. And a large part of that is simply pulling up a chair and sitting down. I think that conveys to the patient that I'm there and the time that I have is theirs and I really want to listen and I want to be with them. I also think body language-wise, being at the same level as somebody, I think it just conveys a lot of understanding but also patience and tenderness rather than just standing over somebody and continuing to talk. I think eye contact is extremely important, obviously with appropriate breaks, so it's not too intense or it doesn't feel too intrusive, but just letting the patients know that you're there, that you're connected in that you're hearing them. I think affirmative language, whether it's a head nod or saying I understand, is important as well. I also think limiting the distractions, as a nurse practitioner, I'm very keen on that because sometimes I'll be sitting with the patient and I'll have other nurses that need me for something else. So within my leadership role there, I've really kind of cultivated an understanding that if it's an emergency, please come get me. But if not, I try to let the nurse know that I see them but also keep my attention on the patient. Because I think as patients are sharing, the last thing that you want is for them to feel rushed or to feel that they're interrupted or that something else is more important. Another thing that I do that's really important with active listening to is I'm very particular about what I say to patients if I tell a patient that I'm going to come back, I will do everything within my power to come back. I think if I tell a patient I'm going to bring them a glass of water or I'm going to bring them a phone number, I do that. I just think honoring your word and I think cultivating that relationship with the patient. If you say that you're going to do something, I think that that really helps a patient to understand and to know that you really do value what they're saying and that what you're offering. You really want to make sure that the patients get it. So definitely try to make sure that whatever I promise or whatever I tell a patient that I'll be doing for them, I carry that out. I always like for patients as well, if there is an opportunity where a patient is feeling open enough to share feelings or to share how they're to share that they're upset about something or they're happy about something, within oncology, we try to honor emotions. There are a lot of emotions in oncology, and I think sometimes patients feel whether it's cultural, whether it's a coping mechanism, whether it's they don't know they feel that they have to mask or hide or can't share these feelings. So when patients are in a setting or in a situation or a moment where they want to share their feelings, I'm definitely there to help and support them. Whether it's tears because they're upset or just frustrated because this is the 10th treatment that they've had to come to. I sit with them. I can't tell you how many hands I've held, how many hugs I've given, how many shoulder caresses I've provided. And I do think that therapeutic touch is something that really can help be effective, obviously depending on the patient, but can be very effective in those moments when patients are just so raw and you can only imagine how much patients are going through. And so when they have those moments when they share, I just want to be a supportive and listening ear and also validate their feelings. There are a wide range of emotions that patients go through, and I know it's very hard for them to sort through what it all means, what it all feels, and how to move forward. So I think active listening is a huge part of relationship building. And within oncology, you do have the beautiful part of being able to connect with patients and build relationships. And some of my patients I've seen every week for three years, and some I see every six months. But you start to build and cultivate those relationships. And the biggest thing is I just want patients to know that I'm there for them. I want to support them, I want to keep them safe, and I want to do what I can to help and support them through their journey.
[38:57] Michelle: Yeah, that hand on the shoulder. It can just convey, it's kind of like a picture is worth 1000 words. It's like that hand on the shoulder is just worth 1000 words sometimes. And those are great techniques for active listening. And I think we could really practice many of those techniques and kind of up our game as medical professionals in active listening and just really in life. Like, imagine if we were all active listeners in every part of our life. That would just be amazing, the change that we would see. But especially we need to do that as we're working with patients. So let's talk about hope for a moment. You know, when patients are diagnosed with cancer, the first thing that goes through their mind, and certainly mine, was, I'm going to die. It's a death sentence. And of course, we know that's not true in every case. But how do you convey hope to your patients kind of without giving them false hope? Like, do some of your patients ask for statistics, or do you provide those? Do you caution patients not to go home and Google things, talk about that.
[40:31] Lakeisha: I think hope is essential in life. Just my own personal mantra and thought. The hope of being successful, the hope of leaving a legacy for your family, the hope of being able to go on a vacation. And I think that obviously within oncology that hope to live longer and for health is probably the number one optimal goal for us all. And sometimes we just don't realize that. I think a lot of us do take our health for granted. So hope is something that I think is essential to all human beings. But within oncology is a very powerful force and something that I think is important for patients to hold on to. And it does look different and feel different for every patient. I went to a conference, an oncology conference, a couple of years ago in Chicago and there was a palliative care doctor who spoke and he gave a wonderful presentation on palliative care and how he explains the journey of caring for patients and getting their symptoms under control. And he really likened it to a car ride, to a road trip. And along the road, you may encounter different detours. We may say we're going to take the 5 North, but hey, maybe the 5 North is cut off and we have to take a detour to a different road. Or maybe we're going to encounter some bad weather and maybe the bad weather for that patient is the treatment is no longer working and so we have to take a different route or take a different treatment. And he also talked about, well, what if we realize that we may not be able to get to Miami if that was our ultimate goal, but we can get to Texas? Would that still be something that would be desirable? And some of my takeaways from his beautiful illustration and what he was trying to convey was the journey is changing for patients and sometimes that journey is from day to day, sometimes it is literally from minute to minute. But just understanding what is important to your patients has become so critically valuable to me because I think as providers, sometimes we know the guidelines, we know the treatment, we know what we would recommend, but what's important is to know is the patient understanding what our recommendations are and what is important to them. And for patients, that hope can be different things,  that hope can be, "I know I'm not doing the greatest right now. I'm feeling very weak, but my daughter is getting married in six months and I want to be at her wedding." So for me as a provider, that becomes a very high goal. Of course, treating the cancer is important, but making sure that I can do everything that I can, whether it's do we sometimes have to change around the treatment schedule so that the patient can make it to the wedding? Or does the patient need more nausea medications, do we have to get the patient cleared to get on a flight? So just really understanding what is important to our patients, but what provides hope for some people that is family, that is life experiences. Some of my patients will say, hey Keisha, I want to go to Disneyland with my family. And the thought of planning and preparing for going to Disneyland with my family is my primary goal right now. And that keeps me going. And I'll follow up with patients and see what I can do to help. But also what are they doing, how successful have they been along their journey? And obviously, for a lot of patients, hope is sometimes a source of faith and that can be religious-based, that can be spiritual, that can be mantras, or positive affirmations. And if I can provide those resources to patients, whether it's clergy or whether it's just listening, I've had patients come in and share scriptures with me. And as a provider, if that's going to provide hope to my patient and provide them a little bit more fuel, a little bit more energy, a little bit more strength to move forward, then I'm all for providing what I can to help them get there. And I think your question is well taken about providing false hope and not wanting to overstep that. So I think a large part of not kind of tying together active listening to this is really being as honest as you can with patients. And I think within healthcare, a lot of us as providers, as nurses, we know a lot about devices, about different organ systems, but sometimes we may not know to a T how to precisely estimate if this patient's asking you how much longer do I have to live? A lot of the more recent and researched estimation tools really show us that we're not the best at estimating the length of life for patients because there's just so many variables and so many factors. But what I like to tell patients and not providing false hope, but letting them know what's going on, is, first of all, understanding where the patient is. How much information do they want, and how do they prefer that information? Is it talking? Would you like me to get back to you? Can we talk at the next meeting? Do you want to talk now? And it's also explaining what I'm concerned about. Hi, Miss so and so when we met last time, remember we talked about this treatment and we were going to try it. But I'm concerned now because looking at your lab work, it's showing that your tumor markers are rising, which could be an indicator that the cancer is progressing. So I think we should order some scans and take a look at that. And I think every patient is going to be different in terms of how they manage those thoughts and how they're able to incorporate what is going on and how to move forward with different decisions. But I think a key part of hope is also providing patients with the information so that they can make the best choices and decisions for themselves.
[46:50] Michelle: Yeah, I absolutely agree with that. Okay, hearing you talk right now, you're so compassionate. You have these skills, these people skills, which are so important. How do you get the information? Like, do you subscribe to Oncology journals? Who do you go to? You mentioned that you went to a conference, so how do you keep updated on everything that you need to know to be able to convey that to patients?
[47:27] Lakeisha: It is important. As you know, as a nurse, it's so difficult to stay on top of everything. Medicine and nursing and health care are rapidly changing just the moment we get everything together. And even the cancer center I work in, it's pretty much outgrown itself by the time it was built just because there's so many patients who need the resources and so many different things that we need to provide patient care. I definitely try to attend at least one or two conferences a year. I am a member of the Oncology Nursing Society, which definitely helps to provide very relevant information as it relates to cancer care, cancer treatment updates, and technology. And that's been really helpful because there's modules on there. They have a conference every single year that you can go to and not only get up to date with knowledge but meet other professionals, which is very exciting and very helpful. I definitely read journal articles. We are living in a very exciting time with cancer drug development and cancer care. So there are always new drugs being researched and approved. So really just trying to stay on top of that, just reading any articles that come out with compelling data or information. Also, every June there is ASCO, which is the American Society of Clinical Oncologists, and it's usually the largest Oncology conference in North America. So they have, I don't know, upwards of 10,000 Oncology professionals that go to Chicago. And it's really just a robust time where information from clinical trials or data or journal articles are published and findings are discussed. So I'm just reading through some of the information from ASCO, which was earlier this month. And to me as well, as I mentioned earlier, I do mentor, and that has been a refreshing way to stay very up-to-date with nursing practice and also the best-utilized journals or the best-utilized textbooks, because, of course, that's changed so much since I was in school. So mentoring nurses who are just entering the profession, they definitely keep me on my toes and they teach me quite a bit. I know that they look to me for my experience and wisdom as a professional and being in the field for so long. But there is a great deal that I learned from my mentees, just their enthusiasm, their excitement, but also what's new and what's out there, but definitely very important to stay up to date, and to try to go to conferences. It's just a really great way to advance your learning and stay up to date on what's out there.
[50:24] Michelle: Yeah, I mean, what better way to stay on top of everything and stay up to date than mentoring someone who's asking you all these questions, right?
[50:35] Lakeisha: Exactly.
[50:36] Michelle: That's great. And there's quite a few professional organizations for nurses. And you mentioned the Oncology Nursing Society. And of course, there's the American Association of Legal Nurse Consultants, which we'll talk about. And there's the American Association of Nurse Practitioners and the Sigma Theta Tau  International Nursing Honor Society. Again, professional organizations are important for so many reasons, but the resources, the publications, and the networking, are crucial. I'm a big fan, and I saw that you also have your Advanced Oncology Certified Nurse Practitioner Certification. And then are you board certified in adult gerontology acute care?
[51:29] Lakeisha: Yes, as well, I am board certified as an adult acute care gerontology nurse practitioner. And then, yes, I did go on to get my certification for Oncology, as we discussed so much at length already. Oncology is my passion, and for the foreseeable future, I see myself being in oncology. So I definitely took the time to utilize all of my knowledge and expertise and to sit for the board certification. So that's exciting to have that designation just kind of signifying that I am an expert in all things Oncology.
[52:05] Michelle: Yes, I think those certifications are so important, and I'm certified in NICU care, the RNC-NIC and I just feel there are so many benefits to that, to yourself, to the profession, and certainly to the patients and patient care. So I'm a big fan as well. My listeners know because I talk about it all the time. So one of the last questions that I have for you about oncology nursing is what kind of schedule do you work, like, what is your typical week look like?
[52:47] Lakeisha: So in my current role, I work 3, 12-hour shifts, which is an incredible schedule. Yes. They're very long hours. 12 hours in a healthcare setting is a long day, but it definitely goes by fast. And the thing that I really like about working twelve-hour work days is the amount of time that I have off every week. I work three days and then I'm off four days. And I just think that it allows a lot more balance for personal life. I think there's a lot more work-life balance and being able to have days off. A lot of my days off are consecutive, so I definitely feel rested. I'm a big fan of working out, so I'm able to get my workouts in. Like I said, I mentor. I'm part of some community service-based organizations, so I'm pretty busy outside of work. So just having the ability to have that downtime spent with my husband and travel is really valuable to me.
[53:47] Michelle: Absolutely. That is the work-life balance that we all strive for, right?
[53:52] Lakeisha: Absolutely.
[53:55] Michelle: Well, you do this other thing and you're a legal nurse consultant. Yes, and I interviewed Leah Elliott on this show and she also is a legal nurse consultant. I learned so much about that whole field that I didn't know about. But you have your business, Next Level Nurse Consulting and I'm going to put all these links in the show notes so everybody can find you, but talk a little about that. What do you do as a legal nurse consultant?
[54:31] Lakeisha: Yes. So last year I started my own legal nurse consulting business. And it was after some time of kind of ruminating and thinking about it for some time, but the thought and the interest has kind of been around for several years now. And so last year I finally took the plunge and started my own business. So essentially, what I do is I'm able to utilize my nursing skills, my nursing knowledge, and experience, and I'm able to assist attorneys nationwide by helping them with their cases, particularly medical malpractice, medical negligence, some of the mass tort claims big, big lawsuits against manufacturers, pharmaceutical companies, and also personal injury claims. Patients either getting into car accidents or other types of injuries and also workman's compensation. So with those types of cases where clients are claiming some element of medical negligence or medical injury, there's a great deal of medical records that need to be reviewed. And there's also a great deal of medical diagnoses and treatments that need to not only be read through, but analyzed, and understood to really piece together the true story of what happened to this patient or client in their setting, to truly understand what happened and were there any breaches in the standard of care that the patient received. So within my business, I do a lot of work with attorneys and legal teams, and I spend a great deal of time with them, either reviewing the records, preparing what they call medical chronologies, which is essentially a timetable format of everything that's of great importance that happened to the patient. So really just trying to dig through, say, thousands of pages of a medical record that can be dense, as we all know, and parsing out the important key points and the time points and putting them in an easy-to-understand way so that when the attorney wants to kind of look through the highlights of the case, so to speak, and the medical facts that he or she has had a well-versed healthcare professional kind of make that information readily available and visible to them. Also, the work that I'm actually enjoying the most right now through my business is being an expert. So essentially, looking at these cases, this would be more of a role within my business that I would take on that would be not behind the scenes. So the chronologies would be what we call kind of behind-the-scenes work. But being an expert would be an attorney looking for a nurse or a nurse practitioner. Let's just say that the case is about a failure to diagnose a patient that did not, unfortunately, get the cancer diagnosis in a timely fashion. So the attorney may ask me to review the records, and once I review the records and make my unbiased opinion or judgment, what they want to know for me is what breaches in the standard of care can I see, if any at all? And depending on what my opinion is, then they will utilize my opinion as part of their case. So it's a very exhilarating part of legal nurse consulting. I would definitely say a bit more stress, a bit more pressure, just knowing that you have to be able to be well versed in not only nursing care but standards, joint commission regulations, things like that so that you can really use your opinion and have some elements to support what your opinion is on that case. And interesting, with the expert work, depending on the life of the case, it can lead to being deposed, having a deposition, and having an attorney really question your opinion from all angles and for you to be able to buttress it and really support it. And it can also lead to you going to trial and testifying on a stand about what your opinion is and why you feel or do not feel that there was an issue in the standard of care in a case. So I actually really enjoy that piece of the work. I think public speaking is something that I enjoy and high-pressure moments, I think for people who may not enjoy those moments of being in the hot seat, it may not be as exciting, but I think it's also just interesting. An interesting way to advocate for patients and then also within healthcare settings. And then lastly, within my business, I mean, there's a lot of other services that I offer, and definitely appreciate you sharing my business website and contact information for those who may be interested. But I also attend defense medical exam evaluations. So for patients or clients that have injuries, whether they say they fell in an office space and they're claiming that they have a back injury, they will have an exam. And usually with that exam, the defense will hire a physician to provide that physical exam, which will then be utilized in the court case. So there's always a question if the defense is hiring a physician to perform this exam, is the exam unbiased and can we make sure that this is an objective viewpoint of what happened? So in that case, plaintiff attorneys, some of them attend these exams themselves, where they'll send a paralegal or representative. But within California, there's been a great push to have nurses attend. And it makes perfect sense, quite honestly. And I think in my situation as a nurse practitioner, I think I'm also uniquely positioned because I perform these physical exams on a constant basis. So I can really speak to what elements of the physical exam may have been left out, and which items were included. And then it's also important to just note how the client went through the exams if they had any pain or any difficulty performing any of the issues, and then I submit my report. And then the attorneys that way have not only the findings of the physician or the provider who's doing the exam, but they also have mine as well, so they can review both. And if there's any discrepancies I can speak to, any discrepancies I may or may not have seen. So I think legal nurse consulting is a very exciting subspecialty of nursing. As you mentioned before, the American Association of Legal Nurse Consultants is a wealth of knowledge. It is a robust organization, and a great website. There's webinars, there's on-demand teaching, there are some course modules, there's a lot of tools and toolkits that you can utilize to get your business started. And actually this year I am part of the inaugural mentorship group. So that has been amazing. To have a more seasoned, more experienced legal nurse consultant just kind of walking me through the ropes and sharing her knowledge with me, letting me pick her brain, has been absolutely amazing. And I do think legal nurse consulting is great. Sitting down with attorneys, I'm always intrigued and interested because they're so curious and they want to know what our experience tells us about this case and how we can help them to understand their clients' case better. And they think, who better suited than someone who does this for a living and still does this and is passionate about all the details?
[01:02:28] Michelle: Exactly. And I would think that curiosity goes both ways. Nurses, as you said, attorneys are kind of curious about what we do and how we come to our conclusions. And I think it's the same with nurses kind of being curious about what attorneys do. I certainly was when I was telling Leah I had one deposition in my life and that was enough. But I was very curious about just what their life is like and how they come to their conclusions and their questions and so forth. And it's been a saying since the beginning of time that if you didn't chart it, you didn't do it. And do you think that still is true?
[01:03:21] Lakeisha: I think that is a very tough one. I think documentation is very important, right? It objectively should tell us what happened in a patient's case and can let us know critical elements in terms of changes in patient's condition, when results were communicated, and what interventions were done. But I would say medical records don't tell the complete story. And I'm definitely learning that as well. As a legal nurse consultant, obviously, vital signs are important as well, documenting and charting that. And it is harder to substantiate claims when it's not documented. That's kind of when you go down these avenues of needing to subpoena the healthcare providers that were involved in really asking them to recall an event that may have happened six months ago or three years ago, which can be a true challenge. So I would say for the most part, careful, meticulous, objective documentation is always a good thing. But at times there are situations in which the documentation may not tell the complete story. And I think that that's where nurses can come in to really provide additional details, additional information, additional perspectives to be considered, which is important.
[01:04:46] Michelle: Yeah. Again, I think it's just such a fascinating specialty and one that I regret not getting or knowing about or getting into earlier, certainly. So what's in your future with legal nurse consulting? Where do you see yourself going with that?
[01:05:09] Lakeisha: I love legal nurse consulting. I think it has been a wonderful complement to what I am doing full-time at the bedside. My business does keep me busy. I'm definitely able to manage both right now but with ebbs and flows. And the concern always is the balance and the juggle when you have your own business and when you have a full time job. And I know many of us know that, but it's an exciting avenue to have your own business and to be able to market and be successful with your own skills and to work for yourself. So I truly am grateful for my business and all of the hard work that I've put in to get it to where it is today and to getting referrals and to be connected with other fabulous legal nurse consultants has really been quite refreshing and exciting. Being a small business owner and just having to think about all of the elements yourself and whether it's. Social media or logo or a brand, just making sure that I just always want it to be authentic and for it to look and feel like myself and for it to be genuine. So I'm grateful that I've been able to take the time to build my business the way that I want and to keep it going in a positive way. I am hopeful that business will continue to pick up and I'll continue to have more clients and continue to be able to do this work on a more consistent basis. I think I'm definitely all ears and hopeful that this just continues to spring forward. I've definitely met and exceeded all of the goals I've had for myself. So I'm quite optimistic for the future and hope that I can continue to have a successful business and continue to work with other legal nurses, consultants, and attorneys around the country.
[01:07:09] Michelle: I checked out your Next Level Consulting Instagram and it's fabulous.
[01:07:14] Lakeisha: Thank you.
[01:07:15] Michelle: Yeah, one of the things, and that's not easy, I know that just from having my podcasting Instagram, it's challenging to keep on top of everything and to create all that content. But one of the things I loved about your Instagram is you provide so much education just for the general public. And I think that's fantastic.
[01:07:39] Lakeisha: Thank you. Yeah, I think a large part of what I like to do with my business right now is not only spread positivity because I think mindset and being positive and just remembering and knowing your worth and your capabilities are so important not only in nursing but as a business owner, as a woman, et cetera. There's so many ways in which we can doubt ourselves and doubt ourselves. So just remembering to have a positive mindset and frame and reframe is really something that I try to push forward on my social media platforms for my business and also my personal pages. But as well, I think education is really key. And actually funny you should mention my Instagram page because this morning my post on my business page was about learning something new every day. And I think not only with my content and what I try to post, educational components, different things you can learn about nursing or healthcare, patient rights or different diseases, medical emergencies. But I've learned a great deal, not only from Instagram but from LinkedIn, just really networking and engaging with people from completely different disciplines. Obviously, a lot of attorneys, like you said before, I'm learning so much about the legal profession and law and what it takes to really successfully try a case and am definitely impressed by attorneys. It's definitely not an easy job per se, but it's definitely something that's really important to bring justice for patients. But as well, I've learned so much. Like even talking about yourself, you are used to caring for pediatrics and young children. I really do not know much about pediatrics, so I'm always learning from other colleagues who may want to learn about oncology. And I think the transfer and the exchange of information is something that is so golden and something that is really important to just take every opportunity to learn and to find something else about somebody else or about a different specialty.
[01:09:52] Michelle: Yes, that was my purpose for creating this podcast. I had such a limited career in pediatrics and NICU, and I just really wanted to find out about what other nurses did and what they loved about what they did and to bring that to the nursing community, the healthcare community. So I think that's so important, and you have definitely added to that today. Lakeisha, I so much appreciated you being here sharing your oncology practice and your legal nurse consulting practice, because I think they're both inspiring, and I just think you're phenomenal in what you're doing.
[01:10:42] Lakeisha: Well, thank you. I truly appreciate those kind words and appreciate the opportunity just to talk just a little bit about myself and my passion and my business and definitely love making connections and meeting other professionals. And I love your platform and your podcast just really elevating what other professionals are doing, and I think that's an amazing way to elevate the practice, but also provide us opportunities to get to know other professionals.
[01:11:14] Michelle: Well, thank you for that. I appreciate that. Well, you know, I warned you at the end, we do the five-minute snippet. Are you ready?
[01:11:25] Lakeisha: I'm ready.
[01:11:28] Michelle: It's fun. We get to see your off-duty side. So I'm going to start my timer and we'll just go.
[01:11:36] Lakeisha: Sounds good.
[01:11:40] Michelle: Okay, what or who has made the biggest impression on your life in the last year?
[01:11:49] Lakeisha: I would definitely say, my mother. My mom is, we're very close. She's my best friend, and I talk to her every single day. As I mentioned before, she went through a divorce. She's a single mom and just made so many sacrifices for me and my siblings. Growing up really put upon us the importance of education, the importance of believing in yourself, and pushing forward. So as a military veteran and somebody who really changed the game in terms of women in the military, she's always been an inspiration to me. So when I think I'm tired and tapped out, I look at my mom and I'm like, no, got to keep going. So definitely my mom.
[01:12:36] Michelle: I love that. What is the one thing you wish you had the money to pay someone to do for you?
[01:12:45] Lakeisha: It's a close one. Between laundry and cooking, I think I would probably edge out the cooking, so I think I would want a personal chef. I do enjoy cooking. I think you're able to put love and care into the food, and I truly believe that. I think when you're eating food, it's a representation of so much, but it does take time. So I think the time and the preparation to have somebody else do it would be awesome.
[01:13:16] Michelle: My daughter and I live together right now and we have seriously considered that. We both love food. We're both foodies. But sometimes, like you said, the time commitment, it's the deal breaker for you, right? Yeah. Would you rather start a movement or a revolution?
[01:13:40] Lakeisha: I think I would rather start a movement and I think for me, I think to me movement and revolution could be close. Like I think a movement could lead to a revolution and I think that's where I would kind of feel. And when I think of movement, I also just think of more of like grassroots efforts, a cause that is usually something that is noble and something that is important to the people. So I think a movement would probably be something I'd want to start.
[01:14:13] Michelle: I'm with you on that one. Do you like to plan things out in detail or be spontaneous?
[01:14:20] Lakeisha: Oh, this is a very timely question. I like to plan everything out and this is something that I'm working on. I definitely feel like I do have a spontaneous side to me, but I am a planner queen. Like everything's in my planner. If I lose my planner, forget about it. I'm going to be so confused about what the day holds. But I just think having an understanding of my days may just be because I am quite busy professionally and personally. So I think I would like to plan things out. But I also am really embracing and appreciating just having days where there's nothing planned or kind of just making plans on the go.
[01:15:01] Michelle: I'm a planner to a T and I'm trying to be more spontaneous, but that definitely takes practice for sure. If you had to give up one of your senses, which one would it be? 
[01:15:19] Lakeisha: That is a hard one. I think I would give up my sense maybe of smell. I do have a strong nose so I'm able to smell things very easily and it's a hard one because I think smell is so closely tied to taste for me. But I also think the smell of cookies is great, but I think the taste of it is probably better and I wouldn't want to lose my sight or anything like that. So, yeah, I think I would say smell.
[01:15:58] Michelle: My daughter said exactly that and I was shocked because like I said, she's such a foodie and she smells everything. And I go, but you smell everything. And she said, yeah, but the taste is really what you're going for. Exactly. I love it. I have really loved talking to you today, Lakeisha. I so appreciate you coming on and answering that call. And again, just a shout-out to Kirby for referring you. You've just been wonderful and I think you've given our listeners so much to think about and so much to reflect on and for that, I am so appreciative.
[01:16:40] Lakeisha: Well, thank you. Thank you again for your time. And, yes, thank you to Kirby for connecting us in this large, beautiful world, making it so much smaller and more connected. And I appreciate your time and definitely appreciate being featured and happy to be a wealth of knowledge or support to anyone that may have any questions or in any way that I can help. I definitely feel that the ripple of life is helping other people and leaving your mark, so definitely want to make sure that I do that.
[01:17:10] Michelle: I think you have absolutely done that today, and we'll continue to do that. So thank you and have a great rest of your day.
[01:17:19] Lakeisha: Thank you so much. And I hope everyone enjoys their summer, and I hope the weather stays nice and a little bit warm, but not too warm for us, so we can enjoy these summer days. All right.
[01:17:31] Michelle: Take care, Lakeisha. Thank you.
[01:17:33] Lakeisha: Thank you so much.
[01:17:33] Michelle: Take care.