Meet Danielle Sarik, a dedicated pediatric nurse scientist who is committed to improving the lives of our most vulnerable population. I always enjoy hearing about how nurses first entered the profession, and I was surprised to learn that Danielle was inspired to become a nurse after working on global health policy with a nurse leader. As the Director of Nursing Research for Nicholas Children's Hospital in Florida, she helps nurses engage in research and become change agents themselves. I have a great deal of respect for nurses who help other nurses, and Danielle has certainly earned all of mine. I have to admit, I nerded out a little bit reading her many publications, and I really hope the generous billionaire listening steps up to support her next project, which focuses on improving maternal mental health. In the five-minute snippet: Has anyone seen my phone? For Danielle's bio, visit my website (link below).
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[00:00] Michelle: Meet Danielle Sarik, a dedicated pediatric nurse scientist who is committed to improving the lives of our most vulnerable population. I always enjoy hearing about how nurses first entered the profession, and I was surprised to learn that Danielle was inspired to become a nurse after working on global health policy with a nurse leader. As the Director of Nursing Research for Nicholas Children's Hospital in Florida, she helps nurses engage in research and become change agents themselves. I have a great deal of respect for nurses who help other nurses, and Danielle has certainly earned all of mine. I have to admit, I nerded out a little bit reading her many publications, and I really hope the generous billionaire listening steps up to support her next project, which focuses on improving maternal mental health. In the five-minute snippet. Has anyone seen my phone? Here is Danielle Sarik. Well, hello, Danielle. Welcome to the show.
[01:20] Danielle: Hi. Thank you so much for having me.
[01:22] Michelle: Well, it's my pleasure. We met on LinkedIn, which has been such a great platform for meeting people in nursing and medicine, healthcare. And so I was really excited and I was a little bit intimidated when I saw your bio. I was like, wow, this girl, she is very accomplished. You have a very full bio. And so we'll talk about a lot of those things. But I'm really glad that we got to talk today.
[01:58] Danielle: Yes, thank you for your kind words, and I agree. LinkedIn has been, for me, a really good networking platform and a good way to connect with people who I otherwise wouldn't get a chance to meet. So I'm so glad we've connected.
[02:14] Michelle: So today we're going to talk about lots of things because you wear lots of different hats. But one of the things that really interested me is your current position. You are Director of Nursing Research and Evidence-based Practice and you're out there in Florida at Nicholas Children's Hospital, is that right?
[02:36] Danielle: Yeah. Nicholas children's.
[02:38] Michelle: Okay, great. That interested me because my brother is the Director of Research at his institution, and he works mainly with residents to help them with their research projects. He does work with some nurses and he's done some studies with some nurses. But I saw that you work primarily with nurses, is that correct?
[03:08] Danielle: Yes. So my role, I think, is fairly unique, but I think we are seeing growth of the nurse scientist role. So I am actually embedded within the clinical setting, so within the pediatric hospital, and I report up through our CNO. And a big part of my position is actually that direct support to our nursing staff to help them with their scholarship and help them to move forward with research and evidence-based practice. And so that is definitely a major part of my job description. I do work with our interprofessional staff as well. But as you said, there are sometimes other folks in that hospital setting who are maybe more closely working with the residents or the fellows or the attending physicians.
[03:58] Michelle: Okay, we're going to get to some of that in a moment, but every great nurse starts somewhere. So how did you get your start in nursing?
[04:11] Danielle: So, nursing is a second career for me. So I'll just briefly kind of share that I did not have a very straight path to nursing. I actually started in global health and working in health policy, and that's still something I'm very interested in. But when I was working in global health and health policy in Washington, DC. That was my first opportunity to work closely with a Ph.D.-prepared nurse who was leading one of our global health programs. And she was really the inspiration for me to go back and pursue a BSN and an MSN. And then eventually a Ph.D. in nursing. So I started nursing. I went back to the University of Pennsylvania to enter those second degree programs, and that was in 2009. I speak about her a lot because I really credit her and kind of her example of what a nurse can do outside of the walls of maybe a clinic or a hospital really inspires me to think about the profession and decide to pursue a career in nursing.
[05:31] Michelle: That's so interesting. I just always love to hear the backstory of great nurses because sometimes the reasons why we get into nursing are just not what maybe the public thinks, why we got into nursing. And yours is just a perfect example of that. So that's really interesting. So let's talk about your role as the Director of Nursing research. So who are these nurses that come to you? Are they advanced practice nurses? Are they working at the bedside and they want to do a quality improvement project for their unit? Talk about that.
[06:15] Danielle: So I would say all of the above and plus a lot more so in my role. That's one of the really fun things is that I get to work with everyone from our new-to-practice residents as they graduate from school and join our organization for their first nursing position, all the way up to our senior leaders, our directors of nursing, and our chief nursing executive. And so I have, I think, a really unique role where I get to see nursing research and evidence-based practice and quality improvement through this different lens and through these different experiences as well. So with my nurse residents who I work with, who are new to practice nurses, I have the opportunity to teach them an evidence-based practice immersion over six months, which is part of their orientation when they first join us. So over the course of six months, I get a chance to work with them. I teach them about the Johns Hopkins evidence-based practice model we develop a pico question, we develop a project or a program to move research and translate it into practice and then we work on evaluating it and then they present it at the end of their residency as they graduate from their orientation. I also work with our clinical nurses, our more seasoned clinical nurses at the bedside. So I think that, again, nurses are in this really unique position where they can see so acutely, where our gaps are in our practice and gaps in care. And they're also really well positioned and poised to act to improve those things quickly. And so when we have a clinical nurse that might see something that doesn't seem quite right or she went to a conference or read a paper, and she knows that there may be a newer technique to use or there's research that shows there's a better approach to care. They can then reach out to me, and I help to guide them through the process of deciding. Is this an evidence-based practice project? Are we going to do more of like a quality improvement project or do we need to actually study this in a little bit more detail? Do we need to create some research around this and actually build the evidence for a future practice change? And that's really, for me, also very fulfilling as well because often I think we sometimes feel when we see something that's not something that we feel as a gap, we can feel disempowered. And through scholarship research and evidence-based practice, I can come alongside our nurses. I can partner with them to give them the tools so that they can approach that issue and they can change practice.
[09:11] Michelle: Well, your mentorship is really crucial, and absolutely agree with what you said in terms of nurses being able to see those gaps and wanting to do something about it. It's just not enough to complain about it. I think we're more action-oriented and I think we're perfectly suited for research and quality improvement.
[09:39] Danielle: And also I learn a lot in the process because clinically, my background is in pediatrics. I'm trained as a pediatric nurse practitioner and all of my clinical life has really been in that primary care setting. And so while I've done rotations and I've done training in acute care settings, there is a lot that I don't know about acute pediatric nursing. And so I love when I can partner with our clinical nurses and they are the experts in their practice, they are the experts on their patients. And so they can bring that piece of the puzzle and then I can bring the research and EBP and scholarship piece and we can partner together to really be the most effective and really work in collaboration to improve. The care for our patients and our families that we want to provide the best possible care to these nurses who are in their residency.
[10:31] Michelle: This is part of the residency program or is this voluntary that they enter into your program?
[10:45] Danielle: So this is, I think, a huge benefit of actually being new to practice nurse in our hospital setting is that every nurse who enters, who's a new practice nurse, they all have this orientation and this residency program. So every single new nurse that comes in gets to go through this training. And so the evidence-based practice piece is just one part of it. There are clinical parts, there are IT parts, but they all go through the orientation. The length changes a little bit depending on what specialty they're in or what setting they're in. But they all have the same education and the same training on evidence-based practice, so they can come out without foundation and use it to build as they move forward in their career.
[11:41] Michelle: I love that. What is their engagement level? And I'm asking this because I've seen in my own unit different levels of engagement. So the new-to-practice nurses that are coming right out of school have been hired right into the NICU, which is a specialty area. And I'm really happy to see that nurses can get hired into the area that they want to work. And kind of gone are the days of you have to do two years of med surge even if you absolutely hate it. So I'm happy about that. And I saw a lot of engagement with those new nurses. The ones that held back when we talked about research or quality improvement projects were a lot of seasoned nurses. Some of my colleagues and I attempted to start a journal club for the NICU because we were interested in doing these projects, and we just heard crickets chirping. There was just no interest or engagement, and it was really frustrating. Have you seen similar behavior from seasoned nurses?
[13:01] Danielle: I in general, find that our nurse residents tend to be very engaged and active. These positions that they're filling, they've had to compete against multiple other people to have that one slot. And so I think that self-selects for people who tend to be very engaged and they understand the value of scholarship and they want to contribute in that way. That being said, I think everyone's different. Some of us look back on our research and evidence-based practice classes in school and we shudder. Some of us look back and we are like, oh, I was sleeping through them. And some of us loved it. So there are those individual differences, and that comes into play. But because we are the only standalone pediatric hospital in South Florida, we have a very strong reputation, and we attract the best of the best. So that's a huge positive. What I have seen to your point over the last three-plus years of the pandemic is that we have had in nursing, I think just some really huge challenges. And those challenges have kind of rippled through our profession and we see them in things such as nurses leaving the profession or transferring to maybe different nonclinical roles or having to drop down with their hours. But we also see those ripples in our nurse engagement. And again, this is just my own perception, but I think as I read more, I think that this is an experience that a lot of our hospitals and our health systems are seeing. I think the pandemic has been hard in many ways, but one of the things that our nurses had to deal with was kind of having those basic needs maybe not met. So for example, having staffing ratios that were not ideal perhaps at the beginning of the pandemic, not having adequate PPE and having to deal with the moral distress and the fear and the stress that came along with know, like you think about Maslow's hierarchy of needs, right? So if we don't have some of those basic things in place for our nurses, whether they're new to practice nurses or our seasoned nurses, our APRNs or just it doesn't have to be nursing, it can be our clinical staff more broadly when those things are missing or we have challenges. I think what we see is it's harder for our staff to get really excited and really engaged in things that maybe don't seem so immediately pressing. During the peak of the pandemic, really, we took a step back and we really were very, and by we, I mean my organization, we were very cognizant of what was even possible at that point and what we needed to just take a break on. And so we did pull back on a lot of our training programs. We pulled back on our fellowship because it just was not top of mind or what people our nurses needed at that point, as we have now kind of found our footing and our new normal. We've reintroduced all of those things. So within the last year and a half, we launched a research immersion program for our advanced practice providers, our APPS, and we have restarted our fellowships. We have once again started going to conferences and engaging by putting together podium and poster presentations and we have started doing a lot more of manuscript writing again. And so I think I can see that we are rebounding. We're starting to kind of regain that traction that we lost. But there are still definitely gaps and we saw some of our most engaged and seasoned folks. And again, this is not just in my organization, but I think across organizations, a lot of them either left or they maybe took new roles. And so that loss of kind of that institutional knowledge and that nursing expertise, I think it's going to take us years to kind of rebuild that. Because how do you turn around someone who's been there for 30 years and has been really engaged and knows all the systems you can't? It takes time and energy to have someone kind of build up to that point.
[17:51] Michelle: Again, you hit the nail on the head. I'm so glad that your organization and I know many others are getting back on track with all of the things that we kind of put on hold during the pandemic. But I think as a whole, the profession is a bit traumatized from what happened over the last three years, and we're kind of trying to get our footing, and it definitely holds true for me. Two years after the pandemic started, I had 40 years in. I was like, peace out, I'm done.
[18:28] Danielle: Exactly.
[18:29] Michelle: Yeah. And I am certainly not the only one. Many of my colleagues and just hearing in the profession the loss, and like you said, it's profound. Right? You can't easily replace a nurse or a professional with that many years of experience. And those people are usually mentors to others. They're leaders. So it's a big loss, and exactly what you said is going to take a little bit of time to get back, but I'm glad you guys are back up and running. So how did you choose pediatrics? What was the interest there?
[19:15] Danielle: It's a little bit cliche to say I've always wanted to work in the pediatric field, but that is really true. You look back on, if anyone listening, has parents like me, and they've hoarded your schoolwork from when you were in elementary school. My parents moved during the pandemic as well, so they were cleaning everything out, and I was looking over journal homework assignments. You have to write, what do you want to be when you grow up? What's most important to you? And I have these homework assignments from when I was in elementary school saying that I really want to work with children and I want to provide clinical care to kids.
[19:59] Michelle: Wow.
[20:00] Danielle: Yeah. So I think I always have been very drawn to the idea of working with children, and now, of course, I have a more nuanced understanding of what that means, and that means working with families as well. And so when I was working in global health and doing policy and advocacy work, a lot of my work there was focused on programs that help support child survival and child health globally and then also maternal health and survival because that's a large problem in developing countries. So kind of as I look at the thread of my interest in my career, it's kind of been woven all throughout. But when I did decide to go back to nursing school, from the start of my program, I made the choice to submitriculate to the pediatric nurse practitioner track. So from day one of when I started my second degree BSN, I was already kind of enrolled to do the pediatric nurse practitioner track. So even though my career has been a bit winding in some ways, that's one thing that I really haven't wavered on.
[21:14] Michelle: Well, I share your love for it. As somebody who has worked my entire career with children, infants, and families, I just think it's the best type of nursing. I absolutely love it. So I share your love for it. And you were kind of Manifesting in your elementary school years, right? And you probably didn't even know it, correct?
[21:40] Danielle: Yeah, before Manifest was part of like exactly national dialogue. But yeah, I think there is something really special about working with children. I mean, we say all the time kids are resilient and they're enthusiastic, but those things, they really are true. And I think now pediatrics can be really hard, especially when you're in the acute care setting, because you see a lot of very difficult things. But the flip side of that is you being your career in the NICU, you know, this there are also these wonderful stories of healing and growth. I think that's really valuable. And then also in the primary care setting, kids are just hilarious. I mean, the things that little kids would do or tell me, you just can't help but smile. And it does bring kind of a little bit of levity. And then as I've gotten older I like to be able to teach and help support, I think, working with families and kind of learning how best to support families so that they can provide the best care for their own children and they can feel really confident in their ability to provide that care and to make good decisions for their child and the family unit. That also, to me is very fulfilling because I think sometimes in nursing and medicine, again, in general, we kind of forget that we have this unique knowledge and skill set that maybe other people don't have. And so when we're able to share some of that and just help share even anticipatory guidance in pediatric primary care like telling parents what to expect next or what milestones they should be watching for and how they can help their children meet those milestones. I mean, it's a small moment in time, and it's a little kind of piece of teaching, but that can have a really profound impact on that parent and on that child. Because if a parent doesn't know that their child is supposed to be doing X, Y or Z by a certain age, then they don't know to necessarily flag that or come back to the office or ask more questions about it. And so to me, I also really enjoy working with the families and being able to give them those pieces of information so that they can continue to be the experts on their own children, but also kind of bring that pediatric perspective to it.
[24:24] Michelle: Yeah. I will say that working with families is just one of the most absolutely fulfilling parts of my job as a NICU nurse. We would see them come in with their babies, their micro preemies that were 24 weeks, 23 weeks, 500 grams, and be completely terrified, not know anything, and they end up spending four or five months with us. And by the time they take their child home, they're feeling confident, competent, and knowledgeable. And it's just so great to see that transition and to know that you were part of that. So, yeah, definitely share that love. So in your bio, you say that you have cared for patients in China, Botswana, Nicaragua, and of course, the States, but in what capacity? Talk about that.
[25:28] Danielle: So my first time leaving the country actually was when well, for an extended period of time was when I was in China. And that was during my undergraduate experience. And so I did essentially a medical internship there where I learned how to do some different traditional medicine techniques. And then I also got to do some different shadowing and rotations in surgery and OB and those sorts of areas. And so it was more of like an apprenticeship and kind of learning a lot of kind of just watching and kind of thinking about thinking and coming from the American culture and being steeped in the American healthcare system to go somewhere and experience what that looked like and how different it could be. That was really very fascinating. And I think that was kind of for me, it was very eye-opening, and it kind of set me on that path of really being interested in working in global health. When I went to Nicaragua, I was working at an organization called La Casa Materna, which is essentially you could call it like a waiting house. And so the area that I was in was a very rural area in the northern part of the country. And so there weren't a lot of hospitals or health systems. And so if a woman was pregnant and she wanted to be closer to a hospital to give birth, or she had some medical reason why she probably might need intervention and had to be at the hospital, what they would do is they could come to this waiting home and wait until they were ready to have the baby until they went into labor. And then it was close enough for an easy transfer to the hospital. And so in that setting, I did actually a lot of that anticipatory guidance. So this is where you are in the development now. And after the baby's born, these are things to think about. And this is how you can start breastfeeding. These are some different holds, just those very basic kinds of things. And so we would do fetal exams where we'd listen to the heartbeat and just kind of do measurements to see how mom was growing. Then after the moms delivered, they would come back until they had recovered enough and the baby was old enough to travel back to their home. And so we would kind of do some just very light exams, making sure everything seemed known, providing any support that they would need. And then when I was in Botswana, that was actually when I was at Penn at the University of Pennsylvania in my nursing program that was part of my community health rotation. And so we provided we went out to the community in a lot of child facilities, like daycares or schools, and we would do health screenings and provide education as well for children and families there. So very different experiences, very different health systems. And again, I think I personally grew up in a very rural area of Pennsylvania, tiny. You know, I didn't have a ton of what I would say is maybe perspective or diversity from my childhood and from growing up. But as I had the opportunity to go and work in these different places and learn from patients and learn about health systems in these different places, that really contributed to my own perspective on how I approach my families, how I approach what we think of as health care, what we think of as the role of the provider or the nurse here. Because let me tell you, it's very different in different places. It really helped me to question kind of my own deeply held beliefs about even how a patient should be and how a patient should act and what a provider or nurse should be and how they should act. So really wonderful opportunities to engage in patient care, but then also really learn myself and really open up my own perspectives.
[30:15] Michelle: What a wonderful experience. And I could just imagine that it would really just give you such a well-rounded perspective. Were there any major differences that you saw in these cultures with the children and the families versus the United States model?
[30:38] Danielle: I would say yes, in every one of these situations, very different. But I'll share kind of one anecdote, which is from my time in China and Shanghai. There was a very strong difference that I noticed in the way that children were treated or kind of the independence that children had there versus kind of what I had been used to here. And so, as you probably know, historically, there have been certain policies in place where families were only allowed to have one child for population control reasons. And that, I think, in a lot of ways changed the social dynamic there. And so the relationship of the parenting to the child, the grandparenting relationship with the child, and then some of the sequela from that, I think was something that was very noticeable to me versus you think about some other cultures where there's a lot of independence placed on children and kind of them being able to do things on their own. But when there's one child and there are two sets of grandparents and two parents, it ends up being a lot of focus on that one child. So that was just from a social perspective, I thought that was very interesting.
[32:14] Michelle: Sure. Yeah. Wow. What a great experience. Well, you are very published, and I had the pleasure of reading several of your publications. There are just a few that I just really stood out to me. So the first one was a telehealth nursing intervention to improve the transition from the neonatal intensive care unit to home for infants and caregivers. And you guys really made some huge steps. So it looks like you enrolled about 378 babies and had about 75% received follow-up services in the home. And you were able to decrease the 30-day readmission by 46%, which is really huge. So that was something that I said, oh, my gosh, our NICU needs that and talk about that.
[33:15] Danielle: Yes. This is our Baby Steps model, which was started when we received funding from the Florida Blue Foundation in 2019, and we actually launched the program in 2020. This program was developed as really it came out of some conversations that my friend and I had. My friend Dr. Yui Matsuda, who's a professor at the University of Miami, had a baby, full-term, healthy pregnancy, but needed a little bit of you know, a few days in the NICU after the baby was born. And she is a nurse by training. She is highly educated. She's a professor. She has worked in community health settings. And she still felt when she was ready to go home from the NICU and was discharged, that gap, that disconnect between I'm in this setting where the nurse is there 24 hours a day, I have all of this support, and then I'm at home, and it's just me and the baby. And that's very jarring. It's a very acute period of time when we hear from families, and I'm sure I'm preaching to the choir here we hear from families. They almost feel abandoned in some ways because they've gone from this very nurturing, very hands-on NICU to the home setting. So even though that's often the end goal, that's what they want. No one really wants to stay in the NICU. Sure. But even when there's that joy, we're going home, we're home. We have our baby with us. There are all of the normal baby things that they are then responsible for. And then for a lot of our babies that leave the NICU, especially if they've been there for an extended period of time or had congenital issues or had to have surgery, they may be going home with medical needs. So they may have technology, they may have oxygen, they may have medications, they may have therapy, follow-up specialists. And so in my friend's case, really, she was just going home and just had to follow up with the pediatrician, but she had all of those normal newborn things. The baby has trouble sleeping. How do I nurse correctly? Is the baby getting enough milk? Is this what the diapers are supposed to look like? All of those normal things. And so we were able to kind of talk through that. With my clinical background, I was able to provide some unofficial support. And she said, why don't we have this for all of our parents leaving the NICU? And so we worked together, and we thought, know this idea. We worked with the NICU at my organization that had tried to launch a telehealth kind of follow-up for NICU babies, but for various reasons, it wasn't able to kind of launch successfully. And so we kind of took that idea. We built upon it. We used our clinical expertise and our research expertise and our NICU nurses' expertise, and we developed the Baby Steps program. At its core, Baby Steps is very simple. We approach the family at the bedside. Once we know that they should be going home within a week, we enroll them in the program. We help them to download the application, make sure they know how to use the technology, and make sure they have a smart device to use it on. And if not, we can give them one. And then we set up a visit for them, a telehealth visit with our NICU nurse within 48 to 72 hours after they're discharged from the NICU. And so they have this appointment set up where they can talk to the NICU nurse who they've already met, has already been caring for their baby, knows our health system, knows the clinical piece really well. And those visits can range from just really the anticipatory guidance of making sure we're always having the baby on their back. We have nothing in their crib. We don't have any if the baby has oxygen, we don't have candles around them or any smoking around them, all of those pieces are just general new baby stuff. Or if needed, we also have telehealth so we can look at the G tube. If there's something on the skin they want the nurse to look at or if they want them to see, okay, this is how I'm bringing the baby to the chest to feed. Like, how does this hold? Look, we are able to do that as well within the nursing scope. And then if there's a larger issue or if there's a clinical concern that's identified, we can escalate that. As we move forward with this program, we've learned that one of the big challenges, which shouldn't be surprising, but one of the big challenges we have found is the maternal mental health piece after going home. And so as part of the call, we always assess for coping, assess for we're not doing a formal assessment at this point. It's just, are you having any feelings of wanting to harm yourself or those sorts of things? And if we identify something that is a trigger, like a crisis trigger, we'll connect with appropriate resources. Or if it's just they need to see a specialist or follow up with an adult provider, we can also give them resources for that so we just finished up not just we are over three years of the program now. We started in April of 2020. So in the first three years of the program, we have been able to serve over 700 infants and families across the state of Florida. We are geographically bound to Florida because of telehealth rules, and you can't go across state lines unless you have a license in the other state. So we are right now just within the state of Florida, but across the three years, we've been able to reduce our readmissions by about half. Same with urgent care or emergency room visits within the first 30 days. And our parents tell us that the program is very highly satisfactory to them. They're very happy with it. They're very satisfied with the service. And so, all in all, we're at the point now where we are actually writing up our three-year results. So that will be coming out. And then we are looking for ways that we can really scale this up and spread it to other organizations. Yeah, so that's where we are. We've been able to disseminate it at a lot of conferences. We shared it at the National Academy of Neonatal Nursing. Actually, next week we're going to be at the Magnet Conference. We have a podium there, an hour-long podium. And we've published and we have a couple of, I think, really nice videos that kind of explain the program and the impact of the program as well. For anyone who's interested in learning a little more.
[40:46] Michelle: It's just fantastic. And if I had a dime for every NICU parent who said, can you please come home with me at discharge? Do they have the terror? Like, the simultaneous joy and terror that they feel? It's just so profound. And to have a program like this, I imagine just alone, probably some of the reasons for readmission are just that parent terror. They're not sleeping. They're watching their child. 24/7, they're sent home with a baby that's like your friend, that's supposed to be just a normal newborn. Now, after this, stay in the NICU and yeah, get the message out, because that's something I feel like it's not difficult to set up a program like that. And the benefits are just so numerous. So bravo on that.
[41:53] Danielle: Thank you. Yes. I mean, at its core, like said, very, very simple. I think the thing that makes it successful is that the NICU nurse who is dedicated to meeting the families, connecting with them in the NICU, and then being able to call them once they're home and dedicated to doing those calls because, as we know, it's a busy place. The NICU is a busy place, the hospital is a busy place. And if you don't have someone who's kind known, and dedicated to doing this work, it can easily fall through we have we have a NICU nurse who has been with us who is our lead. We have about eight of our NICU nurses trained to provide telehealth follow-up. But we have one lead nurse. Her name is Melody Hernandez, and she is absolutely amazing with our families. And one thing I guess I should mention is that we have a very diverse patient population at Nicholas. So we have about 70% of our families whose primary language in the home is Spanish. And about 70% of our families also access health care through public health insurance like Medicaid. And so we already know that those two things are barriers to accessing care. And so one of the wonderful things that Melody does is she is bilingual. So she is able to connect with the families, she's able to speak with them in their language that they're most comfortable with. And if we have families that don't speak English or Spanish, we are able to have in-app translation so that it's kind of simultaneous, it's not a Blue phone or whatever that you have to do, wait and have it translate back. And so that way we're able to have meaningful and important conversations and have them in the language that the family is most comfortable in. We also know with telehealth that age is often a barrier. So people who are younger and more kind of versed in technology tend to be more comfortable using things like telehealth. Also, we know that language, as I said, is a barrier to using telehealth because often services are provided in English and we know socioeconomic statuses as well. If you don't have access to a smart device. Or maybe you have access, but you have prepaid minutes, and so you don't want to use those minutes for a half an hour telehealth call, because that means they won't be available to get a call from your child when they need to be picked up or to call the doctor. And so we've tried to think about those pieces and from an equity perspective, think about how can we address these so that everyone has the same access to these services. And so language is one piece. With the interpreter services, we have devices on loan. If our families either don't have a smart device or they have prepaid smart devices, or maybe they don't have WiFi service, whatever it is, through the grant, we're able to give them a loaner device. And then from the socioeconomic perspective, because this is currently a grant-funded program, we are able to provide these services free of charge to all of the families. And so that takes out of the equation, is my insurance going to pay for it or do I have a copay for this call and makes it so that it's an equal playing field. And anyone within the first two weeks after discharge who feels that they could use the support of a NICU nurse, we have that initial phone call. And then if they wanted, they could set up a call a day or even more up to two weeks after discharge, so they don't need to worry I'm going to be charged $20 per call because we've kind of removed that variable.
[45:52] Michelle: Well, I'm glad that you touched on grants because that was one of my questions. So how important are grants for your research? And have you ever been involved in writing a grant?
[46:05] Danielle: Grants, I would say, are often the catalyst to be able to get a really good idea from the idea stage to the development and implementation stage. I have had the opportunity to write many different grants, and I've luckily been able to be awarded some grants. So, for example, with Baby Steps. Our first grant funding was from the Florida Blue Foundation, 300,000 over three years. And then we were able to kind of leverage that grant and the work that we were doing to compete for several other grants. We were also funded by the Nicholas Children's Young Ambassador Foundation as well as the Cain Crusaders Foundation. And we are currently even looking for more grants to help continue this work and scale and spread it. Grant writing can be a really challenging process. And so if you're someone who's interested in doing research and you think, I need some funding to do this research, if it's your first time, I would highly encourage you to find someone like me in your health system. So a nurse, scientist, or, if you're in school, maybe one of your professors in school to help you to go through that process for the first time, because it can be challenging. And there are lots of different types of grants. There are small grants that are through organizations. So, for example, one of the first grants that I got after going into nursing was a small, I think, $1,000 grant through my local National Association of Pediatric Nurse Practitioners chapter. And that grant was big enough that it helped me to do some of the data analysis and have a little bit of time of a statistician and be able to kind of get that research out. And then once you get your first grant, the fun thing is then you kind of get a better sense of how to do it and you can keep applying for other grants and build on kind of the success that you have. And that's the process I will share because I think sometimes people can get discouraged. But often, depending on what type of grant you apply for, there could be a hundred different applications for a single grant. And so those would be very difficult to get if you're looking for federal funding, like an NIH grant. Those are incredibly long, incredibly intense grant processes, and usually, only someone with a Ph.D. who was doing research work would apply for them. But that being said, a lot of our organizations, our local organizations, and our national nursing organizations, have grant applications, and those tend to have a much better success rate, and they also tend to be more accessible to nurses. So I would start there if you're interested.
[49:14] Michelle: That's really good information about grants, and I think they're so important. One of my local claims to fame, I guess you could say, is as a pediatric nurse, we had an organization here in my town, 403 C. Is that what they're called? 500. And I forget it, but it's a nonprofit. Nonprofit, yes. And so I was volunteering with them. They're called Read for Life, and they're an amazing organization. They provide books. They have a Books for Babies program, and they put books in doctors' offices and clinics, and it's all volunteer, but they asked me to write a grant for them. And so this is back in the day, Danielle before you were born. I had no idea how to write a grant, so this new thing was on the computer called Google. That's so funny, right? So I Googled how to write a grant and ended up writing a grant for this organization. And it was a small grant, so it was $7,500, which was a lot of money for them.
[50:29] Danielle: I was going to say that's not that small.
[50:31] Michelle: Yeah, they called it small if it was under $10,000, I think. And man, when somebody knows that you've been awarded money from writing a grant, I got multiple requests to write grants, and I never wrote another one, but I figured out how to write that one, and I was really proud of that.
[50:55] Danielle: You should be. Like I said, I would say that's not like a small grant in my eyes. And that's maybe another point we should make, is that there are nursing grants that are $500, and that might just be enough for you to be able to have some statistician time to help you kind of go through your numbers and your analysis. So don't be discouraged if you are going for a $5 million grant, you can still do a lot of good with smaller grants.
[51:25] Michelle: Yeah, and you're absolutely right. And it provided, actually three years' worth of their Books for Babies programs, where they would make packets for NICU babies with developmental cards and songbooks and yeah, it was fantastic. So I felt very accomplished with that, but definitely not easy. And that new thing in town. Google helped me out on that quite a bit.
[51:55] Danielle: And now look at right, right.
[51:58] Michelle: How long does it take to publish your research after you collect all the data and everything?
[52:06] Danielle: That is a good question. I wish it took me less time.
[52:12] Michelle: Right.
[52:13] Danielle: So there are people who are very prolific writers, and they are very good at turning things around quickly. Because of my role, I'm embedded in a clinical system. My time is kind of split up between that hands-on teaching, providing support to nurses in their own research, providing kind of infrastructure at the system level, for research and scholarship, and then my personal research. And so what sometimes happens is when those former categories expand and take up more time, time for my own personal research kind of shrinks because you have to keep the needs of the organization at the forefront. So once you finish collecting your data, it's been three years for us. We have three years worth of data. We're analyzing it now. Once you actually start that writing process, after you've done all of your analysis, it depends on how quick you are and how big your team is. But for me personally, it takes several months. Again, I'm sure there are people who can do it a lot faster, but for me, several months. So three to six months easy to really write up a paper and have it in that perfect place where I want it to go out to the world. I think that often surprises nurses that it takes that long. And so, again, just like grants, I'm here to kind of level set for you and say if you have a project and you want to write it up, don't be discouraged if you're at the three-month mark and all you have is maybe your results section. That's okay. Just keep chugging little bit by little bit. And it can also sometimes take a long time for papers to move through the review process. So after you write up a manuscript and you submit it to a peer-reviewed journal, it will go through a review process where you get feedback from people who are reading it anonymously, and then the editor will give you feedback. That process can sometimes take a year. So the longest I think I've had a paper under review has been like a year and a half. So that's kind of the extreme end of things. Usually, you'll hear something back in a few months, but again, just kind of realizing that it can be a slow process, but it's slow for a reason. Often we want it to be evaluated by other people who are experts in the field and can give you feedback on it and can make sure that it's a high-quality paper before it's published because we don't want to put something out into the world that maybe isn't ready for primetime.
[55:01] Michelle: Sure. Yeah. And that feedback is so important. And I imagine as a researcher that that time delay is a little bit frustrating because especially if you have great findings or results of your study, you want to get that out there. You know how much value it has. And to be in that process for years, I would think it would be really difficult.
[55:34] Danielle: Yes, it can be. But again, I think the pace of research can be really slow. But I still think if you can share it in other ways, you can disseminate it through a conference presentation, or you can share it for like a grand rounds at your organization or if you have a local chapter of your nursing organization, you could maybe go and hand out some information there. There are lots of different ways to get it out to the general public. And I would argue that in academia, papers are kind of the medium, right? Everyone wants to have their publications. But if we really want to have an impact on the public, the general public, our families, our patients, papers probably aren't the best way to do that because not many of our families have access to PubMed or a paywalled paper. Sure. So sometimes there are other ways that we can share information that's really very helpful as well.
[56:48] Michelle: That's a good point. Well, if you had unlimited funds, what do you think would be your next research project? Some billionaire comes to you and says, I want to fund your next project. Money is not a problem. What do you think you would do?
[57:08] Danielle: I hope the billionaire is listening. I really and truly believe in this intervention with baby steps. And I think one gap that we have found throughout the process is that maternal mental health piece. And we know from research that our moms and dads, our parents who have infants in the NICU are at increased risk of mental health concerns. We know that the mom or yes, I'll just say the mom for shorthand. The mom and the baby, that dyad is so important and that the health of the mom and that means physical and mental health has a direct impact on the health of the baby. And so what I think is really needed and what's come out of the research we've done over the last three years is I think that there is a very strong need to evaluate maternal mental health in that acute time period after NICU discharge to find a way to adequately screen and provide support for moms during that time period. And so that would be, I think, the next stage I think of this work would be, one, to scale and spread baby steps so that it could be in any NICU that feels it would be of value to them. And two, to extend the intervention not just to the telehealth transition of care calls and being mostly infant focused, but to also have an additional focus on maternal mental health and to build a support system and a referral system for maternal mental health because we do have a huge issue, I think, in the United States.
[58:59] Michelle: Well, that would be a very worthy project. So all you billionaires out there listening, get in touch with Danielle. She needs your money. So that's, you know, as we close, I want to reflect back on my interview with my brother, Dr. Chris Patty. And when I interviewed him, the question I asked him was how can nurses get more engaged with research? And he says, "My experience has been with mentorship and simplification of the process. Every nurse can get engaged in discovery. Every nurse can be a researcher." And I thought that was profound just because he's my brother, and I always think he's a really deep thinker. But at the unit level, how can we get nurses more engaged with research Danielle?
[59:55] Danielle: I think that we talked about before how nurses are poised to see our gaps in care and to have ideas about how to address those gaps. So I think that part of having nurses be more engaged in research and scholarship at the unit level is really giving them the tools and giving them the support that they need to engage as the experts that they are. So our nurses, our clinical nurses, are experts in the care of their patients and their families. And so we need to acknowledge that expertise and then come along beside them and help to support them as they learn how to translate that clinical expertise into scholarly projects. So on a very kind of real, what are we going to do? From a budgeting or a strategic plan perspective, what that looks like is we need strong support for nursing research and scholarship from our nursing executives. Research has shown that's incredibly important. To have that leadership in place, we need to invest in nurse scientists or nursing scholarship experts who can be collocated with our nurses and be able to educate, support, and mentor. And then we need to invest in our nurses themselves in creating the time and the space for them to do this work. And what I mean by that is that in a lot of health systems, medical staff will have administrative time or scholarship time, or research buyout. And unfortunately, I do not see that often extend to our nursing staff. And so what I think we need to do to really create that time and space for nurses to engage is to think about how we can be creative. Do we have a fellowship that maybe offsets 12 hours for every two-week time frame that that 12 hours? Instead of being in clinical care, a nurse can engage in a scholarly project. Do we have a fellowship that provides resources or funding so that nurses can go and do an online evidence-based practice module, and get the training that they know? Like many things, it often comes down to funding.
[01:02:48] Michelle: This was so fun, Danielle. Thank you.
[01:02:50] Danielle: Thank you. I like talking about it, obviously.
[01:02:54] Michelle: Well, you are great at what you do and such an asset to the profession, to your organization, to kids and families everywhere. We're just lucky to have you on our side. So thank you so much.
[01:03:13] Danielle: Thank you.
[01:03:14] Michelle: Well, you know, at the end, we do the five-minute snippet. So are you ready to do that?
[01:03:19] Danielle: I think so. I'm a little nervous.
[01:03:22] Michelle: Oh, I know. It's just a lot of fun. We get to see your off-duty side when you're not doing research. Projects and all of that, and it just takes five minutes. So I will bring up my timer and my questions, and we'll just get started. Would you rather have tea with Queen Elizabeth or a beer with Prince Harry?
[01:03:52] Danielle: Tea with Queen Elizabeth, because I would love to hear her perspective on all of the changes that have happened, and I think that historical viewpoint would be fascinating. And then also, I'm not really a beer person.
[01:04:12] Michelle: Same. I love it. Okay. Was there a life lesson that you learned the hard way?
[01:04:22] Danielle: Many life lessons. I guess in keeping with the theme of today and talking about kind of career paths and all of that, I will just share that when I made the decision to go back to nursing, I was kind of turning away from a different career option, and that was a really challenging decision for me. And in that process, one of the things I kept thinking was, am I wasting time? I'm going to go back and do a second bachelor's and start this process all over again. But I think what I came away from with that is time will pass either way. And so if you feel a calling to do something or if you feel that there's something more for you but you're afraid to do it because you are afraid it's going to waste time, or you've already invested so much in some other choice, I would just say time is going to pass either way. So listen to what your heart is telling you and make a decision to do what you want to do as time passes.
[01:05:41] Michelle: That's great. And I've used that many times in my life. Time is going to go by anyway. You might as well just do it. Yeah, that's great. Would you rather be colorblind or lose your sense of taste?
[01:05:55] Danielle: Oh, this is a tough one because I love spending time outside and kind of seeing all of the different colors of the woods and the blues of the water. But when I had COVID and I did lose my sense of smell and taste, that was really disconcerting.
[01:06:15] Michelle: Yes.
[01:06:18] Danielle: I think I would have to say taste.
[01:06:23] Michelle: I think, yeah, I'd rather be colorblind on this one. But that's a hard decision. Would you rather live in a home with no electricity or no running water?
[01:06:41] Danielle: I have lived in a home with neither, and what I would say is I would probably choose the running water over the electricity because you can always have, like, a lamp or something like that.
[01:07:00] Michelle: Fire.
[01:07:01] Danielle: Yeah. But running water, it's incredibly difficult to get into the home. And then from a safety perspective and also showering out of a bucket is very difficult.
[01:07:15] Michelle: Let's see. What do you wish you spent more time doing five years ago?
[01:07:22] Danielle: So five years ago, my daughter would have been one year old, and we were living in Miami and you know, I wish, looking back, I had spent more time just really, truly just, like, enjoying being with her instead of all of the list of things you do and think of as a new mom, but really, people always say it goes by very quickly, and I would definitely echo that. So just more time just being in the moment and just enjoying the little things that she did.
[01:07:59] Michelle: That's what I'm trying to do with my grandkids. I put away my phone, and I don't look at it when they're here. I just try to be present. I think that's so important. Okay, last question. Would you rather lose your keys or your phone?
[01:08:19] Danielle: Easy. My keys, my whole calendar schedule, life, passwords, and every single picture I've ever taken is in my phone, so that would be devastating.
[01:08:32] Michelle: You could make a new key. That's a real sign of the times, right?
[01:08:39] Danielle: Yes.
[01:08:40] Michelle: But we are a little bit dependent. Danielle, thank you so much for coming on today and talking about research and the importance and just I feel your energy, and I just really appreciate you sharing your knowledge and your motivation with me and my listeners. So thank you so much.
[01:09:05] Danielle: Thank you so much for having me. It's been really a lot of fun, so thank you.
[01:09:10] Michelle: Yes, well, you have a great rest of your day.
[01:09:13] Danielle: Thank you.