Lori Winchell 7.28.23

00:03 Hello. This is interview is part of the St. Kate StoryCorps nursing interviews. My name is Jocelyn Bissette Borland, and I am 64 years old. And today's date is July 28, 2023. And I am speaking with Lori Winchell, who is my colleague at St Catherine University, and I am recording in the city of St. Paul, Minnesota.

00:34 Okay, so my name is Lori Winchell, and I am 71 years old. And today I'm speaking with Jocelyn Borland who is my office partner at St. Kate's University, and we are recording this interview in St. Paul, Minnesota.

00:54 So, Laurie, thank you so much for speaking with us. We're so thrilled. Why don't we begin with just telling us a little bit about your decision to become a nurse and what influenced you? Did your community, your family, your faith, your health beliefs, or your culture impact your decision?

01:11 So I never knew I had a choice not to be a nurse. I guess that's the way I should start. I grew up in a medical family. I think my grandfather, when he came to this country, became a pharmacist. My dad, after World War II, went to medical school, and he was a general practitioner in a small community in California. So my first memories of medicine really was with my dad, because as kids, we would always have to go to the hospital and do rounds to see his patient, and he would be bored, and so he'd stick me in the car. I was the oldest child, and he'd take me down to the hospital. And he was. Because he was a gp, he also covered surgery, so he was always the anesthesia component. And so he would sit me on his lap in the or, and they had the little black ether bag, and I'd pump the little black ether bag and watch him do the surgery. So my first surgery was an appendicitis, I think. And then afterwards, my mom took me out for spaghetti dinner, and I thought, yeah, no, I'm not eating that. My next memory of really being exposed to medicine was watching a birth at 11 years old. I think my dad thought it would scare me so that I would not be sexually active. But, you know, at 11, it was pretty shocking to see that. And in those days, it was like the late 50s, early 60s, they didn't have Ocean HIPAA, so that was okay. The other part I remember about being exposed to medicine was that a lot of times my dad would be called to emergency surgeries, and I would be stuck in the doctor's locker room. So I would hear the doctors talking and be changing into their Surgical scrubs scrubbing their hands. And then I could see through the window what was going on in or as a kid. So I spent, I guess I spent a lot of years growing up in hospitals and surgical scrub rooms in my dad's office because he had his own practice in the small community. So I think that was really important. The other thing my dad did was house calls because it was a small community. So he took care of generations of families. He might deliver someone and then go visit grandma at the nursing home. And to this day, there's still people on my Facebook page that my dad has delivered them or their children that stay in contact, contact with me from that small community.

03:55 Did you go with him on the visits?

03:58 Oh, yeah, house visits. A lot of times I'd play with the kids while he was in there doing whatever he needed to do. And I really liked that aspect of medicine because my dad didn't teach me about increasing patient numbers or financial transactions like insurances. He taught me the art of medicine in a small community. And it was a combination of his knowledge, his skills, but there was also creativity geared to the person that he was treating. He knew their background, he knew their history, he knew what they were able to do and what they weren't able to do. And he really looked at well being and promoting health. I remember there was this couple and I think the husband was a machinist and he got metal in his eye and he couldn't continue in his occupation. So my dad just have had, he bartered, he had him come in and he would like wax the floors for my mother. And so, you know, there was that kind of thing going on too about really helping out in the community and being part of a community. So that, that's really what got me into it. And then as a teenager, it was kind of the troublemaker in the family. So he decided I needed to come and work in his office. So here I am, 13, 14, 15, and I'm doing the back room nursing, checking vital signs. I actually was drawing blood and running those little chemistries where you put the blood in there and it would turn different colors and then doing test results, which probably today, according to Clea, would be terrible. But I was doing that in high school during my school breaks and during summer. And then my last year, my senior year in high school, I was a switchboard operator in the small hospital. So I saw a lot of interactions in the hospital setting. So I guess that's why I never questioned that I would be a nurse. And in those days, women There was very few women that went to medical school or were accepted into medical school. And so it wasn't even a thought that I would go to medical school. It was always, I will be a nurse. Because that was what was acceptable in society at that time. Thank goodness we've grown past that.

06:14 Roy, what town did you live in where your father.

06:18 Sunland Tuhunga. It was near Glendale and Pasadena in California. So Southern California. Yeah. I had wonderful role models as nurses because I'd go in my dad's office and there was a lot of nurses practicing. They had a little lab, they had backroom nurses. So I got exposed to a lot of wonderful role models growing up. I think at that time, when I graduated high school, I chose to enter a BSN program, Bachelor of science in nursing, and not work my way up the career ladder. And I was accepted at a state university in California, Cal State Long Beach. And I didn't realize at the time, but they were focused towards community health. I didn't even think about different nursing programs, had different focuses, but this particular program was focused in a community health setting. And so I took a lot of educational psychology classes. And when I graduated, not only did I get my bsn, but I also was able eligible to and did apply for my public health certificate in Southern California and my teaching credential. I was also eligible to obtain my teaching credentials, which I did. So. And I, you know, I never really thought about using those at that time.

07:50 Tell me more about your education. So you got your Bachelor of Science and then tell us more about that. What did you.

07:57 Well, so I graduated, and it was in Long Beach, California, and I got my first job as an RN at Long Beach Memorial Hospital. And I walked in and they decided that as a new grad, they would put me in the ortho unit, the ortho ward. So I'm clueless, right? I was clueless. And they were trying this experiment called primary care nursing, which I don't think exists anymore. But primary care nursing, they assign you 10 to 12 patients, and you, as the RN, are totally responsible for those patients 24, 7. And you have a team of nurses, and they can call you anytime with all these problems and crises going on. And ortho wards I had, most of my patients were in tractions. They had knee surgery. I mean, they were totally immobilized. It was horrible. I remember going home and saying, I ruined my life. I hate nursing. I don't want to do this. It was terrible. And then a couple people got a hold of me and they said, wait a minute, aren't you a public health nurse? Don't you have that background? Why don't you try home health nursing? So I did. So I, I worked in, I think it was north, North Long Beach. And I worked with a group of nurses, majority were women of color. And they sent me out to Compton and Watts, which were very high risk, high crime areas. It was the birthplace of the Crips and Pyru gangs. But in those days, in the early 70s, they didn't have the guns and the drugs and the mobility that they have today. They were street gangs. And I would be going to these houses in Compton and Watts and they would maybe didn't have any running water and grandma would be there with the granddaughter who just had a baby at 14. And I would be doing the dressing change or catheter change in. And you know, I thought I was in seventh heaven. I was like, this is it. I love this, home health nursing. The other nurses wouldn't even go to those areas. And I'm thinking, this is great. Yeah. And so then I thought one day I walked into one of the patients and he was having a heart attack. And I was like, my skills, I don't have the skills for this and I need to go back to school. And so he did survive. The ambulance came, everything worked out. So at that point, about a year later, I applied to UCLA to their, I think nurse practitioner program. I was the second waves of, second wave of nurse practitioners in the United States. So the first wave of nurse practitioners were the instructors. It was 1975, 76.

10:53 This is when you.

10:54 Yeah, when I, when I went to my nurse practitioner program at UCLA and it was a primary ambulatory care program with an education minor. And so a lot of my instructors were the people that wrote the books because they were like the new trend in the United States of advanced practice. And I love that too. I really loved it. So that was how I got my master's. I didn't get my later, and I'll talk about this a little later, I chose not to go to a doctorate of nursing, a doctorate for nursing. I ended up saying it's too tunnel visioned. And I really wanted to broaden my scope. And because of my undergraduate community health background, I really liked population health and I really liked at risk patients. And so I waited a long time, from early pre babies to when my children were teenagers to really find a program that I wanted to go back to school in. And it turned out to be public health, a doctorate in Public health, preventive care.

12:00 And where was that? In what year that was.

12:02 That, that was in what took me 10 years because I had to do it part time and I had to commute to another state. And so that was at Loma Linda University in California. And they're, you know, they're one of the blue zones where people live to be 100 years and older and they're very healthy and they're very conscious of diet and exercise and well being. And so I was really happy with that program. It was the right choice for me because instead of helping people who were sick, I wanted to teach people how to be healthy, how to prevent illnesses or how to stabilize what illnesses they have through healthy living and lifestyle practices. So that's, that's how I got to my doctorate program. That's the educational experience.

12:54 Tell me a little bit about all your work experience. And I know it's so varied and you've talked a little bit about that.

13:00 But yeah, okay, work experience. You're talking about 40 years.

13:06 That's a lot of years that you want to tell us about.

13:09 That's a lot of different things.

13:11 Responsibilities you have as a nurse.

13:13 Yeah, well, so at this point, so I was only a registered nurse for one year. And after deciding that wasn't for me and then becoming an advanced practice nurse, most of my career was as advanced practice in ambulatory care. I am not a hospital nurse at all. And my first job was in Central California in a rural community. I worked with a physician in general practice like my dad. And then all the general practice doctors would decide who was going to be the surgeon or the anesthesiologist. They weren't specialists in those days. I don't think that happened until the 70s, the 60s, 70s. So they kind of did that as their second part of what their responsibilities were. And in that setting, I treated the entire family and generations of family. So I would do prenatal, postpartum. A lot of women's health care. I remember at the time we did FAA physical exams, which I don't think they let nurse practitioners do anymore. A lot of the.

14:21 What does it stand for? Faa?

14:23 Oh, the Flight for Pilots. Okay, so they have a lot of rules. And then I was doing commercial drivers physical exams, which we don't do anymore without a specialty certificate. I did a lot of pediatrics. I took care of adult patients, including geriatrics. And I would round at the nursing homes a lot of times, once a month for the Medicare visits. So I loved doing that. And during that time, that's when I had my first baby. And so the general practitioner I worked for delivered my baby. And I remember this because it was a small community and everybody was at the Rotary Club and all the doctors had to come and do my C section and were really upset during the surgery because they were being fined by the Rotary Club. This was the big discussion during my C section. So. So that was like, you know, those things that stick in your mind as you're walking through this experience. I was there for I don't know how many years, maybe three or four years. And then my, my husband at the time got accepted into the Culinary Institute in Hyde Park, New York. So we moved to New York for him to go to school for two years. And while he was at the CIA, I got hired as the director of a small Catholic college, Maris Brothers. And I worked in student health. And I had a physician who oversaw my medical skills. And then I had. My boss was Father Lamort, a priest. I think he's since passed away. And he was wonderful because he basically said, you know, I know there's a lot of rules within the church, but when you go in and you see a patient, you do what you need to do, what's necessary, and I don't need to hear about it. You work with Dr. Dr. Gagan. It was Frank Gagan at the time who was my medical component. And I was there for a couple years. And during that time I had my second baby in a small town during a thunderstorm in Rhinebeck, New York. And they had an on call staff. So here I was in labor and they had to call the staff. It was a snowstorm, of course, and they delivered my baby. And then three weeks later, C section and all, we moved back to California. And while we were in California, I didn't work for about nine months because of the babies. But then I got a job part time because I was still nursing and my babies. And so I got a job at Kaiser Permanente in their locked psychiatric ward. I remember it was on College Avenue in downtown la. And the psychiatrist didn't believe in doing laying on hands. They felt that was creating too much of an intimate relationship where they're doing the mental health and then the physical component. So they hired nurse practitioners to do the hospital admission and monitor any of the medical problems that the patients had. And that was an interesting experience. And these patients all had insurance, so a lot of them were the dock workers. There was a lot of drug withdrawal. There was a lot of mental health issues going on in there. It was it was very eye opening and it was a little different focus than what I had experienced up until that time. And it didn't last very long because then my husband got a job in Santa Barbara. And so we relocated to Santa Barbara and I was hired for a one year temporary teaching contract in Santa Barbara Community College. And it was in their ADN program, associate degree nurses. And that was a great experience too because I got to teach physical assessment and then I took students to clinical settings and I would round at the rehab hospital. That was a different piece of what you could do in ambulatory care or primary care was rehab medicine. There's just so many facets, so many doors that open as an advanced practice nurse that you don't even think about. So between Kaiser Mental Health and then going up to the rehab hospital for a year, I really would have liked to stay in teaching. But at Santa Barbara Community College at the time they had a clause where you couldn't be hired until five years after your temporary contract had expired. And I think that was to protect people who had gone on sabbatical or for 10. So I ended up applying and accepting a position a little bit south of Santa Barbara in Ventura county at the county hospital. And there I was a family practice nurse practitioner. I did ob gyn, pediatrics. And they circulated me to all the surrounding clinics, the outpatient clinics. A lot of it was undocumented patients. And of course in the county setting, you're working with the at risk population, which I love. So we had a lot of mental health issues, a lot of chemical dependency issues and undocumented patients. And after about a year, three years, couple years there, they ended up losing the contract to their jail. They covered jail medical services. And so they needed someone to just put their finger in the dike until the privatized company took over. So the physician who mentored me, who I love, I guess that was one of my mentors, Dr. Ashby, had me ask me if I would just cover that for a short period of time, run the jail medical services. So being very naive, I said, okay, sure, because I wanted, I was part time and I wanted to go to full time. And so I ended up agreeing to be the jail medical services coordinator. And I think I've mentioned in the past that here I am, never managed anything. And I have these jail nurses who have been there 20, 30 and 40 years are hardcore. And here's Nancy nurse walking, telling them, I'm your new boss, how it wasn't received. It wasn't received very well in the Beginning. So they did a sick call strikeout where they all called off. And here I was by myself. And as stubborn as I am, I was like, I'm going to cover every single inmate and sick call. So there's 800 people in the main facility and then there's an honor farm close to where I lived at the time, 30 minutes into Ojai. And so I said, well, I'll go by the, the honor farm and I'll catch the women's at the same time. So I was exhausted, but I did it. So I, I earned their respect and I didn't have to do that again, thank goodness. But I did get sick call covered. And I covered all the inmates medications and, and the psychiatry was separate from the medical services. There was a psychiatric service with a psychiatrist and a psych social worker. And they were there and they were supporting me and rooting me on. So it was like, not as bad as it could have been. So that was my experience with the jail nurses. And I'll talk a little bit more about that later in these questions. So I was there for about three and a half years and then they, the privatized company took over and I was floated back to the county clinics, which was fine. And then shortly after that, I ended up getting hired as the student health director at the University of Nevada, Las Vegas, because I knew I wanted to go back to school and my husband at the time wanted to go to school and advance his degree so he could go. We could go for $10 a credit at the time and my kids could go for $10 a credit. So I'm like, yeah, we're moving to Las Vegas, Nevada. And housing was so much cheaper in Nevada compared to California. So it was a good move at the time. And I, I started in this little health service. I just built a new building. One of the millionaires who was part owner in one of the casinos had donated money and they built this little health service. I think it had four exam rooms in an office and the front office setting, I had one RN who was retiring and a student worker and a front office staff who ended up leaving too. And I had a budget of $275,000. So here I am back in management again. So when you're a nurse practitioner, there's always this expectation that there's a leadership component to what you can do. So moving to Nevada was an interesting experience and obtaining my licensing. But at the student health center, I knew that we could. The university was growing and the health center was very limited in what it could do. And so working with the vice president who hired me, the vice president of student services, he and I developed what we call peer educator program because they had a public community health program, health education. So we got the students involved in the student health center and they went out and they did things like mock trials about drunk driving. HIV was very, very prevalent at that time. It was from 1988 to. I was there from 1988 till 2005, I think. And so the health educators, we developed safer sex kits and we talked about sexual health and being safe because of the HIV crisis. And I had patients in the clinic that had hiv. And so, you know, awareness was so important, prevention and awareness. And that was really what spurred me on into my doctorate program down the road. That that key piece of pre. And awareness.

24:49 You talked a little bit about the brothels in that area. Is that. Did you go into that or.

24:54 A little later. A little later. So I was at the university 14 years, and then my vice president left and I had gotten the health fee and then we added another health fee. So by the time I left, the budget was up to about a million five. And I was able to put. Set up a small pharmacy and we had a lab tech that came in with backup per diem so that they had support. So we now had a small lab we had where we could do basic lab tests. We had a CLIA compliant compliant and HIPAA compliant these days. And then we had the pharmacist who. Who actually he was the pharmacist from one of the first pharmacies in Las Vegas, Nevada, called White Cross on the Strip. And he had retired and agreed to come and work at the student health center and talked one of his other retired buddies into covering the pharmacy services at the university. I mean, there's so much history there. That was kind of awesome. So I got to work a lot with students and do a lot with peer education. I got to teach part time as adjunct faculty in the nursing program. When faculty was sick, I could cover a semester. I taught physical assessments. I kept my hands in teaching a little bit at the university. The husband graduated and got his degree. And actually one of my. One of my sons also took advantage of the tuition break and he graduated from unlv. And my younger one, I had already left, but he got the scholarship. They have what they call the Millennium Scholarship, so he was able to go for free tuition. So, you know, a lot of my family was educated at the University of Nevada, Las Vegas. It was a very positive move. We were Able to buy a house, which was probably 75% cheaper than California at the time. And then I really said I need to work on my doctorate. And I found a program at Loma Linda. I like the preventive care piece. I couldn't do it in my current position because when you're managing. And then I also had. I'd see patients in the clinic, students in the clinic, and I was teaching, it was too much. So I ended up accepting a position interesting enough for a lot more money at the county hospital in Nevada, Southern University Medical center in Southern Nevada. And I worked in the outpatient clinics, the adult internal medicine clinics, which was another wonderful experience. And they gave me the time to work on my doctorate. And then again they had contracts, specialists. And so one of the contractors had requested a nurse practitioner because they were only on site. They were more of a surgical urology specialty. So they asked me if I would go over there and run the clinic. They gave me an LPN and some front office staff. So I said sure. And I actually went down to ran the surgical center, the urological surgical center, and did all the pre ops, the post ops, treated, you know, did the BCG injections for the bladder cancers and renal calculus and did a lot of stress incontinence. They taught me how to do urodynamics so I could do the testing for incontinence. And it was real. I really liked it because it was a hands on and there was a lot of, of skills involved. It wasn't just sitting in an exam room and taking a history and doing a physical, coming up with a diagnosis. You got to do things there. And I became very close with the nurses, but. And I was just thinking about this backing up, backing up how I got recruited to go to University Medical Center. They had a rural health clinic at state line between Nevada and California. And they asked me if I would go and run that clinic. And so I agreed to that. And it was me and lpn, thank God he had military experience and he was used to trauma. And a lady that ran the front office that lived in one of the rural communities in Nevada near state line. And she would commute down. And so that was my. That's how I got recruited to the University Medical Center. And I was there for about a year and they had this small community called Sandy Valley where this front office lady lived. And she would talk me into going and doing vital signs with their volunteer fire department at their little, little community fairs. And I kind of bonded with the community because they would come down, I was the clo. I was closer to them at this little state line clinic than going all the way into Las Vegas. So I actually set up the clinic and I went to the nearest gas station, which was in that little area. And I said, what kind of over the counter meds do you carry here? And we found like the over the counter stuff for urinary infections, the aspirin, the Tylenol. And I made a whole list of things that were available, like a block down the road. There was a couple casinos there, older casinos at Stateline. And so I worked with the community to make sure that there was over the counter meds. And then we had a Pyxis. So we had some prescription meds, but we couldn't dispense the meds, which I should back up to that too. That was another. Well, I'll talk about that in a little while. One of my problems when I moved to Nevada, so we set up this little clinic, and then the people in Sandy Valley wanted their own clinic. And so I did this whole study and I got one of the state senators involved to find federal funds for a rural community. There was a lot of money for rural health clinics, but because of the casinos, they zone these casinos in a zip code that tied into Las Vegas, Nevada. So they were ineligible for the rural health funds. I think years later, since I moved here, they were able to tie in and get the rural health funds. But it took a lot of legislation and a lot of the state senators advocating to get the money to build a little clinic in Sandy Valley. But that was a. That was a great experience, you know, in trying to help the population I served. But they ended up closing the clinic. And so they floated me back to the internal medicine clinics and before the urology clinic, and then I was at the urology clinic. And then they floated me. After about seven years in urology, they floated me back to internal medicine because the county was having budget crisis and they decided to close the specialty clinics and not renew contracts. And I think the only two contracts that were left was the Coumadin clinic and the cystic fibrosis clinic for the pediatrics. I don't think they even kept the pediatrics clinic open. And eventually they closed our internal medicine clinic. But during that time I was able to get back into internal medicine. I was able to, you know, continue with my doctorate commuting to California. And, you know, there was a lot of changing and I was glad I was flexible enough and that nursing is flexible enough to give me the opportunity to grow in these different directions and learn these unique skills. So I think that answers my jobs. Finally, they closed the clinic, and I ended up getting hired at the VA in Southern Nevada as the health promotion disease prevention program manager with the agreement that I would see patients 16 hours a week, and then I could do the health promotion piece. And I worked with the psychologist in pain management. She and I ran the health promotion. There was a team, and we would do things like health fair, and we worked with the veterans, and that was. That was interesting. And I really liked that job. But that ended up. There was a position change, and then they wanted to float. So I was at a local clinic. Like, I could walk to my clinic. They wanted to send me to a hospital which was 45 minutes away, one direction. And by then I had started my retirement process between the state and the county physicians, and my mother was ill, so I just dropped down to part time. So then they decided I could still go out to the hospital, but they had two brand new nurse practitioners, and they had put them in women's health, and they really had never even done pelvic exams. And the gynecologist was saying they don't even know how to feel for a cervix. So they said, we want you to go out there and work with them. So I ended up going out there and mentoring the two nurse practitioners in the women's health clinic. And during this time, so you can see as I'm talking about all the positions I've had, how medicine was changing, and the things they addressed, such as HIV or relationship issues. So during this time at the va, they now decided that all of the male to female transgender patients would be treated at this clinic, at the women's clinic. But the problem was a lot of the women sitting in the waiting room were military sexual trauma. And then they had these males who are transgender to female sitting in the clinic. And it created this big political chaos within the va. And for me, I didn't have an expertise in the hormone regulation and that process. So endocrinology agreed to take on the hormone piece of it as long as we would treat the other parts of the. Of the human body, which was interesting. So, and then what brought you, what brought me to Minnesota? I decided I, my parents have both passed. I, you know, I have had pensions. I was like, why am I staying in Las Vegas? I have lived here a long time. My kids don't live here. So it was time to be near one of my sons, and one of my older son lives in Minnesota. So I decided to relocate to Minnesota in 2018. And it was a good move. And then I was kind of bored, so I said, well, maybe I could work part time. St. Kate's had an opening, so I applied for an associate professor position and got hired.

35:45 And that's. That's what brought you to.

35:46 And that's what brought me to St. Kate's I retired to work at St. Kate.

35:52 We love having you. Did you experience any challenges on your path to becoming a nurse?

35:59 Yes, not really in my degree processes. But when I moved to Las Vegas, they had a very interesting process because it wasn't. It's not nationally recognized. Each state has their own rules and regulations for nurse practitioners. So at that time, Nevada, to become licensed in Nevada, you had to go through what was called a committee of review. So the committee of review was three nurse practitioners form a committee and then they ask you all these questions about your professional practice. In addition to. Even though I was licensed in California and I had a furnishing number, I wasn't prescribing independently. So I had to collect 2,000 hours of prescribing. And so between the 2,000, then we had to have protocols for every single medical thing that we were going to see. We had to have this cookbook of protocols. It didn't matter that each patient might have different problems, like one might be a diabetic and one might be on renal failure. You had to have these preset standardized medications that you gave for a urinary tract infection, regardless of what the other problems were. But it might not have been the best choices for the individual patients. So I had to develop a book of protocols. I had to collect my 2,000 hours of prescribing. And so I did that through the School of Medicine family practice, through unr. So University of Nevada Reno had the medical school and UNLV did not. And there was always like this turf battle of who got what because there was only two universities in the state at the time. And so they agreed to take me on, and later I got them to contract. So this was when I was working at the student health center. When I first got there, I had to go through this process. So because I was at an educational institution in the state system, the School of medicine agreed to take me on. And then I got them to agree to come and to contract with them because we were nurse directed. And that was also very unusual in the state of Nevada to have a nurse directed health center or state agency. And so I contracted with them to come in and rotate through a couple Days a week to see students. So it kind of, it worked out and we developed a nice symbiotic relationship and they could bring family practice residents through. And we had the nurse directed clinic. So we learned how to work as a multidisciplinary team.

38:43 It's really interesting.

38:45 So I did get my license, I did pass that oral interview. But the people that were interviewing me, one lady in Nevada had two weeks experience under the supervision of a doctor and got her license as a nurse practitioner and she was the person interviewing me. Another lady worked at the va, which, you know, she had a lot of experience and I appreciated her input. And the third person was, I think she was a nurse midwife. That was my committee of review. And they if, even though I had everything else in place, they would decide whether I could practice in Nevada. And they did blackball another nurse practitioner coming from California while I was going through that process. So I was pretty nervous. But. But it did work and I was able to practice as a nurse practitioner.

39:33 Talked about a time when you did something with a pharmacy that was very challenging.

39:37 Oh yeah. Could you tell us a little bit? So that was the other thing at the student health center.

39:43 Yeah.

39:45 The little old nurse that was retiring, she was buying stock bottles of medicine and then she was repackaging it and handing it out to students without any protocols or anything. And so nurse practitioners in the state of Nevada have to get licensed or certified through the board of nursing. But to prescribe you have to apply for certification through the pharmacy board. So I was applying for certification through the pharmacy board and luckily one of the pharmacists, I had contracted with him to help me set up our pharmacy. He was on this board and it's illegal for nurses to dispense medication in the state of Nevada. I didn't have a pharmacy license and so that was a bit, that was a big thing. I had to get the university attorney involved and I had to go before the board of pharmacists twice. And they said, well, what are you doing? Because I was just going for my licensing. They said, well, what are you doing? And I very naively said, well, we have these bottles and I repackage it and I have my cookbook, my cookbook protocols in there and that's what I give them. And they were like, do you know you're breaking the law? And I know, I'm sure they really enjoyed it. So they ended up rebel that I am in all that I do. They ended up deciding because they didn't want the University of Nevada Regents against them, and it was political that they would grandfather me in and grant me dispensing because I said, well, the county, Clark county, lets the nurses dispense medication, and they're a government agency, and this is a state university, and we're a government agency. So it was real gray zony. So they couldn't really not agree with it. So they grandfathered me in, allowed me to dispense, and they put me on a committee to pass regulations that nurse practitioners and PAs could dispense medication, but they had to pass an exam, a dispensing exam, and I had to help them create the written exam. So, yes, I changed the law in Nevada.

42:06 Congratulations. Lori, what have been some of your best experiences or moments being a nurse?

42:16 Well, I guess one of my most interesting experiences was working. So when I worked at UMC in the county clinics. There's legalized brothels in Nevada. So under Nevada, under Nevada law, any county with a population up to not over 700,000 was allowed to license brothels. And so currently, like in 2018, there were seven out of the 16 counties that had active brothels. And those were all rural counties, of course, and there were 21 legal brothels in the state of Nevada. So Nevada requires that all registered brothel sex workers be tested weekly by a cervical specimen for gonorrhea and chlamydia and monthly for HIV and syphilis. And so condoms were mandatory for all oral and sexual intercourse. And brothel owners could be held liable if their customers became infected with HIV after a prostitute tested positive, because they would have to notify then and they didn't use a condom.

43:33 About what year is this? Just approximately, you think?

43:35 Well, that's in 2018, but I had. That was at least 10 to 15 years that I knew of. So. So with the. The women could work legally a mandated minimum of nine days for each work period. So most of them work three weeks on, three weeks on, and then they would come in for testing. So one of the things I didn't mention when I was at the University Medical center, there was a period with the budget crisis where the physicians lobbied to push out all the nurse practitioners to save money. So all the nurse practitioners in the university system were laid off. So the county, the county health department agreed to take me on for the period of time until they could renegotiate and get us back, which was about six months. So I went and worked in Clark County Health District, and I was in the family planning clinic and the sexually transmitted disease clinic. So, you know, again, another really Interesting experience working with at risk populations and low income families. So those social determinants really affect people. And that was. I learned a lot. I learned a lot from that experience. And later, because of that experience, I got invited to sit in Clark county health districts. They had a health committee that would review all of the things going on in the health district. And they had a nurse representative. So I got invited to be the nurse representative for two years.

45:21 That's fascinating.

45:23 So that was very interesting because then I got to hear about all the restaurants and why they were closing them and why I decided I wouldn't eat out very much in Las Vegas and, you know, what infections were running around town and who was bringing stuff in from other countries and what we were spreading to other people. It was very, very interesting. And then the grants that they got for maternal child. Yeah, that was a good experience.

45:53 So, Laurie, how has nursing changed since you first started, both the positive and negative? And I'm curious about how computers in the healthcare setting has influenced you.

46:06 Well, for me, I learned that nursing is a healing tradition and that I feel like we're losing the art of medicine. And as we move into a transactional healthcare system and away from the relational health care that I grew up with, you know, visiting the person at the home, playing with their family members, you know, being a part of the community, we're losing that connection and we're moving to. And maybe it's more in the cities and not rural health, but we're losing that sense of. A patient comes in and you know them and you know their history. They're there for 20 minutes, five minutes, you do the history and physical, and then you spend the next 15 minutes typing stuff in the computer and not. And a lot of times not even paying attention to the patient once you hear the history. So I think that art of medicine is, which is knowledge, skills, creativity intertwined to affect a person's overall well being. Because it's not just that disease that they're sitting there in front of you, it's a whole person that you need to treat. And I feel like we're losing that. And I feel like healing is multilevel. So when we talk about healing, you have this, at least in the people that I have worked with, the nurses at St. Kate's the faculty at St. Kate's we have that intuitive sense of what a patient needs, beyond what the tests and everything else is saying. I mean, you can walk in a room and you can smell cancer, you can smell diabetes. You kind of get that intuition that this patient is going to pass away, you know, and there's not any tests that can tell you that at that moment, but you just get it. Or this, you know, this person's crashing, even though it might not be showing with all the testing that you do. And I think that that's the art.

48:05 Do you think that's going away? Are we losing?

48:07 Yeah, because we don't even touch our patients anymore. At least that's what I've seen with younger people. I think that healing is intuitive and it's an act of empowerment and I think we're losing that skill.

48:18 What do you mean by that? It's an act of empowerment.

48:20 So in a physical sense, a patient may need a medication or a procedure. However, an intuitive healing, it encompasses the whole person and not just the immediate. So it might be simple as accepting the person without judging them and saying it's okay. Like you might have a patient sitting there saying, hey, I'm ready to die. But all their family members are saying, you got to do everything you can to keep this person alive. So it just accepting them, okay, this is where you're at. Respect or providing the right for them to choose their care, even though you might not agree with it. I had this patient in the urology clinic who had prostate cancer that was metastasizing. And that patient did not want any treatment. They only came in for their Viagra. Their sexual functioning was the most important thing to that patient. And being able to have relations with his young girlfriend, I mean, he was probably in his 70s and he had a young girlfriend. He did not care about the cancer. He didn't care if the cancer spread. And he declined all treatment. And I had to respect that decision. I informed him, I said, here's your choices. He said, nope, I just want the. I just want my prescription for the Viagra.

49:32 Do you think that, how is that changing now?

49:34 Well, I don't. I think that we judge people as non compliant and I think that we just look at the immediate situation, but we don't know their background or their history or what's going on. I mean, maybe you have a patient that isn't showing up for appointment, they miss a lot of appointments and we're like, oh, this patient's really bad. But did we ever consider that maybe they're riding the bus and they have three changes and the bus might have had a flat tire? Or that maybe there was a problem with their kid at school and they couldn't make it? Or they don't have a phone, Their phone's been disconnected. I mean, we don't, we're so quick to judge without looking at the whole situation that this person is in or maybe their mother's in the hospital or, you know, whatever. So I think that's what's changing. We don't, we don't look at the whole person and their situation and what will work for them in their health care, not what we think we should do. Or here's another one, here's a prescription for insulin. Oh, insulin's $500 a month and you don't have insurance to cover it. Well, what's wrong with you? You know, why didn't you get your prescription? Why didn't you take this heart medic, this new state of the art heart medication? Because they couldn't afford it, you know, and do we think about how can we tailor this to the individual and what's within the reality of their life, that lived experience of the person? We're just so quick to follow that cookbook protocol medicine. Well, evidence based medicine says here you go, before we can treat your back pain, before we can get an mri, you have to get X rays, then you have to go to physical therapy, then we have to try an injection, up to three injections. And if that doesn't work, then we can get an MRI and oh, you have a ruptured disc and you need a surgery. But we make them go through this whole freaking process us before, you know, we can. And we have to do that legally for insurance to pay for it or the person receives a huge bill. So we're practicing insurance and we're not practicing medicine, the art of medicine. So we don't allow people to maximize healing processes within their lived experience with the goal of well being. It's just like, here's what I say, I'm the provider, you have to do this. And they're like, yeah, right, that's not going to work. As they're walking out the door, they're throwing that prescription in the trash or they're throwing that diet. You know, you're telling somebody, well, you're a diabetic, you need to follow all these rules of dieting. But maybe you're on food stamps and you're feeding a whole family and can you change the whole family's diet for you? No. So the reality is that person's blood sugar is going to stay elevated because maybe they can only afford the foods that are cheaper that will feed the entire family. That's the part that I feel like we're moving away from. And the touching. The touching.

52:25 Like you've talked about that a lot, that you were not touching as much.

52:29 Yeah. In the olden days, even before I became a nurse practitioner, if we didn't give a person a back rub, if we didn't change their sheets, if we didn't do an assessment every single time we saw that patient, then you would fail your class. You would be in your evaluation. You would be evaluated as not doing your job. Nowadays I see RNs walking in, they have their computer, they're like, here's your pill. How are you feeling? Oh, you're feeling great. And they walk out of the room. They never touch their patient. They might at the very least stick a stethoscope on their chest if they have a heart, if they've had a heart attack or if they have copd, they might listen to the lungs. They don't check the abdomen, they don't check the feet. They touch people and think about this. We're exchanging energy all the time. When you. There's a place called the Heart Math Institute in San Francisco, and they talk about how EKGs, we're putting out electrical impulses all the time that are interacting with the environment. And you're picking it up, and I'm picking it up from you, even though we're not conscious of it. We're looking at body language, non verbals. And so when I reach out and touch you, we're sharing energy. So when you touch somebody, you're exchanging either your tension or your calmness. I have a dog that has stress anxiety with the lightning, and I have to put a thunder jacket on him, and then I'll just lay on his chest with him and I'll just start slowing his breathing down. Do we do that with people? No, we're like, here's a pill. Take this, it'll calm your breathing down.

54:13 And you mentioned about a computer. Yeah, lots of times.

54:16 So a lot of times what I see when I'm walking into different clinics is here's the computer on the desk. Now, we never had computers before. And here's the patient sitting next to the desk, and the provider is sitting there asking all the questions, not looking at the patient and giving eye contact, not leaning forward into it, not touching their hand. And they're typing in the computer everything they're saying. And then they turn around and they might stick their stethoscope on their chest. They never get them on the exam table anymore unless they say their ears hurting or they have to look in their throat. And then they say, okay, here's a prescription, go pick it up at the pharmacy. And they never touch their patient, they never look at their patient, they never interact and exchange that energy with them. It's just so cold. It's so transactional. It's not relational at all.

55:14 If you could have three wishes for nursing, what would it be for the nursing profession?

55:18 Well, my first wish is that it's that they. That people that go into nursing have to Understand it's not 8 to 5, Monday through Friday. And a lot of times nurses that have extended family, like husbands and children, they don't understand that. And I think it has to be. Everybody has to recognize that this is not a profession like a secretary. Okay. Things happen. And it's not 8 to 5. I think for someone to want to be a nurse, they have to have a passion about the work. It's not a business. If that's the way. If you want it to be an 8 to 5 and you're not passionate about the people you're interacting with, then you belong in it or something. And not. And not in a clinic taking care of people. And I think the other thing that I really like about nursing, it's so diverse. Look at all the things I've been able to do in my career, all these different experiences that have really helped me to grow as a person. So that's what I wish somebody would have told me before. So what do you.

56:27 What do you know about nursing now that you wish that somebody had told you before your career? Yeah. What do you know now?

56:34 Well, those, I think, were the three things that I think people should know now. Yeah, the wishes. I wish there was flexibility in nurse. In work schedules for nurses like three 12s or four tens or the ability to adjust based on their family needs. I think we'd have a lot more people interested in the career instead of pulling away post Covid. I think maintaining those skills of touch and healing, that relational piece and professionalism through their. I am interviewing a lot of applicants for our programs and I've done this for over like four years now. And only rarely does somebody tell me that they're involved in their professional nursing organization. So they're not even expanding nursing as a profession. They're just locked into what they do. Go do their job and leave. They're not passionate about what they're doing. They're not looking at bigger pictures and thinking about how can I improve the health of this city, this state, this nation, you know, what is my role in all of this? They don't see the bigger piece. So I think that's really important. What are my three wishes? For me, I wish I would have gotten more involved in wilderness medicine. I love wilderness medicine. I would have liked to been part of the outdoor adventures where you go out into the back country for a month and take groups and teach them about the beauty of nature. That's just my passion and traveling. I just had this job offer which was really amazing, and I want to hear more about it. For $197,000 a year to go obviously to the borders and deal with the undocumented. And I'm like, wow, that's so tempting. Not so much because, you know, I feel bad for those undocumented and the kids and the families locked together. It has to be family practice now. I just said, you know, what does this involve? Is this 60 hours a week. Do you provide housing? You know what your. That's a chunk of money that they're offering. Does it cover malpractice? Am I part of the federal government?

58:45 Where is this, Laurie?

58:46 New Mexico, Arizona and New Mexico. Arizona, not California. Texas. Texas. Yeah. I'm not sure I would want to go to Texas right now because I see people getting, you know, they have those balls with the barbed wire on the Rio Grande. I'm not sure, you know, I would hate to have to treat someone that's been tangled up in that barbed wire. That would be really bad. So. Yeah. And the other thing I wish I could have done if I was younger I wanted to do that is maybe work for who international or do international health care or maybe work for an embassy. I love cultures. I love different. I like at risk populations. So I like to explore those other areas of nursing. But, you know, now I'm like, retired. I'm kind of too old to do those things. So did.

59:40 Did we. Did you feel that you were able to answer the question about what do you know about nursing now that you wish that someone had told you?

59:48 Yeah. Before it was the. Not 8 to 5, not 8 to 5, Monday through Friday. You need to be passionate about your work. If you think you're going into this like a business and not be involved, then the diversity, the diverse diversity of the profession, that just because you don't like it in one area, you can go do something else. You can teach, you can be in a clinic, you can be in a hospital, you can be specialized in a specialty clinic. I mean, there's so much you can do.

01:00:17 You wish someone had kind of told you about that.

01:00:19 Yeah, yeah. Instead of that one year where I thought I ruined my life. I hated hospital nursing.

01:00:27 How would you describe the practice of nursing and what makes nursing different you've touched on?

01:00:31 Well, I think that's that relational piece, that interaction with the patient, the whole person, the exchange of energy that, that caring that goes beyond.

01:00:42 Okay, tell us about a time when you advocated for a patient or advocated for an ethical value and what happened?

01:00:48 I love this story. I love this story.

01:00:51 So you tell us.

01:00:52 I was in Nevada and there was a lady that lived in, in actually Ely, Nevada, my favorite place, like Ely, Minnesota. And she was exposed to, and I didn't know this, but she developed high grade bladder cancer and she came to the urology clinic and she didn't have any insurance. She was working as a waitress. They didn't have the Obamacare there. So she had nothing. And it was pretty serious. And something hit me in my mind, I don't know if I read an article about it or I, it was at a conference, but the federal government, she was exposed to above ground testing as a child, nuclear testing in Nevada. And she was one of the downwinders. And so I was able to look and there was actually a whole settlement and a downwinders program where all of her medical care for the bladder cancer, which was one of the criteria listed, would be covered and approved through a U.S. congress compensation plan made by the federal government. So she was able to get the insurance and to get treated and to get cured. Actually she was cured the last I heard. So that was like. That was when I advocated for the patient and I felt successful and it was wonderful.

01:02:13 That's wonderful.

01:02:14 Yeah.

01:02:16 You know that expression of nursing eat their young. Did you ever have that experience of being shunned or sign lined or gossiped about about a nursing profession?

01:02:23 Only with those jail nurses, when they did their strikeout, you showed them. I was like, they are not going to get me. I was young then. I was kind of dumb.

01:02:35 That was amazing. You did though.

01:02:36 Oh my God, I was so exhausted.

01:02:39 It's amazing again, how many were in that jail system? How many?

01:02:44 So there was 900 male inmates and then there was the Honor Farm which is probably another 2 or 300 and that housed women also. But the sad part about the jail nurses was after they realized that I wasn't going away and that we had to all work together and that I was actually pretty fair and advocated for them, about three years later they did actually privatize. And so all these county nurses, hardcore jail nurses, were given the option of floating back to the county hospital. But the Only the only positions they had open for them were nicu, pediatric, intensive care. You got these jail nurses taking care of these hardcore adult inmates with infectious diseases, addiction, and they're putting them in a nicu and they had to go through a training class. All of them were able to do it. They were so stressed out. And I was able to help them transition. And that made me feel good that I had won their loyalty, that they trusted me enough to help them transition to this totally, very different. Yeah, inappropriate, actually, transition. Or they could stay with the new contractor, the private contractor, but none of them stayed. The only person that didn't fit was this one man jail nurse who had done it for like 20 or 30 years. He was like 6 foot 4, almost 300 pounds, and he just couldn't adapt to the NICU. So they finally moved him to radiology. Like, whoa.

01:04:20 Oh, my.

01:04:21 I'll never forget that.

01:04:22 I just. That transition is. Seems so different.

01:04:25 It was. It was so hard for them, I'm sure, and it was really not appropriate.

01:04:30 You supported them. I want to talk a little bit about St. Kate's and we talk about that. St. Kate's was founded by the Sisters of St. Joseph's of Carondelet on the value of loving the dear neighbor without distinction. And have you been able to live this value through your profession of nursing?

01:04:45 Yes. And I want to talk about the Sisters of Corona Lay, because I'm not Catholic, but the reason I love St. Kate's is because of the Sisters of Karondele. And. And there's a quote from them that I'm going to read. The Sisters of St. Joseph are called to love the dear neighbor without distinction, not to deny differences. The sisters acknowledge that everyone has human dignity, a human worth, and celebrate that diversity. They serve others in the United States, Japan, Peru, in a manner that respects their individuality and diversity. They foster the common good through parish service, adult education, spiritual direction, retreat work and direct service of the poor and social justice activities. And they find their strength from being in a community which allows them to share their resources and skills. They advocate for systemic social justice. They don't impose their values. They accept people for who they are. And that is one of the missions of St. Kate. And because of that, I really like. I like to be part of that kind of system and that kind of belief. So, yeah.

01:05:53 Do you feel that you can embody or use your education skills in that kind of a situation? Do you feel like.

01:06:02 I feel like I've done it all 40 years and right now I'm volunteering at a little nonprofit grassroots.

01:06:09 Tell us a little bit about that.

01:06:10 Clinic called the Wisdom Wellness Clinic. And it serves low income Native American and Hispanic elders. And we just go in and do screening and try and triage or offset any kind of crisis. We try and keep them in their lived environment and make it successful for them so that we can avoid the emergency room or going to a TC or in assisted living. We try and help them to survive in that environment. And believe me, it's difficult because there's people that are on dialysis there. I mean these are private apartments. This is not a skilled nursing facility or a senior center. It's just low income housing. So there's very sick people there. And trying to help them to adapt and to be able to survive is very challenging at times, especially when they have some mild dementia going on. They're forgetting their meds, they have all those social determinants. They can't get transportation to go pick their meds up. So we created, at least for the Native Americans, a system of doing a med sync every 28 days where we have a volunteer pick up the medicines for. We register them in a Native American pharmacy. They pick up the meds, we deliver them, we disperse them to the to. I think we now have 14 or 15 residents part of that system in less than a year. Started with one or two.

01:07:39 How long have you been doing this?

01:07:40 I've been doing it since 2019.

01:07:42 And you bring students there as well?

01:07:44 Yeah, and I've been bringing a lot of St. Kate students. So I have my doctorate students working on their, their quality improvement projects, whether it's medication assistance, looking at the system, how can we improve the system? Or undergraduate nursing students just they're not licensed yet, teaching them how to do injections or addressing changes or we have what we now call the frail elderly program where the people that can come down to our little once a week clinic come down, but some people are too sick. So now we're going up and doing house calls, apartment visits, and that's how we keep people in their home. And I think we've lost that connection piece of what we had in the olden days. The practitioner that would do house calls. How do we keep these people in their home? How do we avoid going to. You know, I'm hearing that some of these total life care centers are between 8 to $10,000 a month. People can't afford that. And so how do we help people to at least stay healthy in their living environment? And we need that in between. And I Don't see that there. That's a piece missing in our society right now.

01:08:57 You've kind of come full circle with what you did with your dad when.

01:09:00 Yep.

01:09:00 When you're young. Right.

01:09:01 I think we need to go back to that, to teach, to help people. Okay.

01:09:06 I do have some questions that we'll try to touch on. Who or what has been a mentor to you in your nursing.

01:09:13 Well, first of all, my dad, I mean, he kind of just pulled me into it.

01:09:18 By the way, I wanted to.

01:09:19 Oh, Paul Menon.

01:09:21 Paul Menon, yeah.

01:09:22 Dr. Men. He was actually a doctor, moved to California. He was able to challenge a two hour exam and use the title md. There wasn't much difference in those days. And another person that really influenced me was Dr. Pamela Brink. She taught at UCLA and she was. She taught transcultural nursing. And she took me over, she took me to places in her descriptions of studies that she did, particularly in Africa. And actually I did my master's proposal on curling photography.

01:09:59 I'm not sure what I know what that is.

01:10:00 Most people don't do.

01:10:01 You know, can you just explain it?

01:10:03 So there was this. This curling photography is measuring the electrical energy that we give off that radiates out through our body. And you can take pictures of it. Okay, so you can do it with inanimate objects, but you can do it with humans. So when you take pictures of a finger or a leaf, there's actually energy fields around those bodies. And so that's what Kirlian photography does. So I tried in my infinite wisdom, rather than keeping it simple until I could graduate, was to take pictures of blood drops of people with cancer to see if I could see their energy and if it was different from people who didn't have cancer. Of course, I never got an answer. It was like way too big for me to do as a little master's degree student. That's fascinating, but Pam Brink, she got.

01:10:53 You, gave you that idea.

01:10:55 I think she published me in one of her re. She did a lot of research and so she had a book on research and she published my proposal in the appendix.

01:11:04 I just want to ask, where was she again? Which university?

01:11:06 UCLA.

01:11:07 UCLA.

01:11:07 And her name again was Dr. Pamela Brink. I'm not even sure. She's probably way retired by now.

01:11:14 No, it's just so nice to know we touched a little bit. Is tell me about your most memorable experience, your most memorable patient in your.

01:11:22 Career besides the lady with the bladder cancer. I caught the guy under the bridge.

01:11:27 Tell us a little bit about the.

01:11:31 Guy under the bridge. So this guy would come into the county clinic in Las Vegas, and he had terrible problems with kidney stones. I mean, he get kidney stones at least as large as my. A thumbnail, a half to 1 centimeter. And he would pass them on his own, and it was terribly painful. And he was homeless, and he didn't like to go and live in the homeless shelters because people would steal and there were lice and all of that. And he would come to get the pain medication, and, you know, we were very considered concerned about opiates. But when I. He'd bring in those stones, I was like, yeah, you need pain medicine. And he would even pass them while he was there at the visitor it. And I was like, okay. So I would refill his pain medication and opiate, and he would tell me stories, and he'd say, yeah, I live under the bridge, but I'm in a big lawsuit with one of the casinos because I had these winnings, but they're saying, no, I can't have these winnings. And, you know, and, you know, you hear all these stories, so you're just like, yeah, right, okay, sure. You just keep coming back, you know, let me take care of your health needs. Let me check your labs periodically. And he kept coming back. And he would tell me about, you know, this lawsuit and how it's going and how this elderly lady finally accepted him and let him move into her house and be his caretaker. But the elderly lady had nobody, and she was in her 90s, and she finally passed away, and she left him a house, her house. And so not only did he have a place to live now, but he also won his lawsuit and he became a millionaire. And then he tells me that his daughter is a judge on the East Coast. And it was like, oh, my God. And I said, so you can go to anyone. He goes, yep, but I'm going to keep coming back to you because I like you. I was like. That was like my. One of my favorite stories. So you can never judge somebody. Okay, that's a good point. And sometimes people are at their lowest point in their life, life, but that can change. And so it's always to be respectful and patient. I think that's one of the questions. What are the lessons that nursing has taught you? It's been patience, respect of other people, tolerance, justice. That social justice piece, empathy, having empathy.

01:13:56 It's beautiful. What phrase is given by older nurses inspired you? Is there anything that someone said, well.

01:14:03 I'm kind of flaky by nature. And so one of the things I always hear Is you need to organize yourself, get all your equipment out so you save steps, blah, blah, blah. And I always. That sticks in my head every time now. Okay, get your tray set up. Get everything on that tray so you don't have to stop. And then, oh, where's my gloves? Oh, where's this? You know? Yeah, just be more organized.

01:14:23 What sustains you in being a nurse?

01:14:26 I think the narrative stories of the people I serve, hearing their stories, that passion of people like, and this isn't even just with patients, the DMP students, you know, I. I'm amazed when I hear their stories. Like, the last three of my students were all people that came to this country, sought education, got their rn, worked, and came to graduate school. And when they were graduating, they told their stories of being in refugee camps. I was just like, wow, I didn't know that about you. You know, look at how far they've come. It always chokes me up when I hear that and I think about it. You know, look at what they went through.

01:15:10 They're inspirational.

01:15:11 Yeah, yeah. You know, I was in a ref. A refugee camp, a Tibetan student, my Liberian students. It's amazing. And they have ptsd. And I don't think we recognize that as faculty or instructors. What they've gone through to get where they're at compared to other students and then learning another language, you know, they're.

01:15:31 Facing a lot of different challenges.

01:15:32 Right. And we don't even get that. And I don't. That's one of the things with St. Kate's I don't think that St. Kate's really honors that to help these students with these other challenges. And I think that's so important.

01:15:46 And you think we should.

01:15:47 Should, obviously, yes.

01:15:49 We need to.

01:15:49 Well, if you follow the Sisters of Kalay, yes. We should be thinking about how to support these students and help elevate them and instead of setting them up to fail.

01:16:02 So that's something you think saint kids should work on is.

01:16:05 Yes. Kind of that social justice piece in.

01:16:08 This kind of day and age, because.

01:16:09 Right.

01:16:10 We are seeing so many students from so many different countries and.

01:16:13 Exactly. Exactly.

01:16:16 How has being a nurse changed your life?

01:16:19 Well, I think I'm more person centered. I'm less judgmental of people. I'm more person centered. I'm more appreciative of people with different cultures and beliefs. And I don't. And I really, really don't ever want to impose my values. You know, I always respect my values. I want to respect your values. And they may be very different than Me. And let me tell you, that was really hard. That's a hard one for me. When we went through Covid and the to mask or not to mask and getting the vaccine or not getting the vaccine, it was really hard to say I don't agree with those people and everyone needs that vaccine. And don't they respect the other people they're exposing them to and to step back and say they have the right to their opinion? Just be respectful of me. If you don't want to wear a mask, then don't go out in public settings. It was really hard to have that acceptance piece in those situations.

01:17:13 What challenges does the profession of nursing face at this time? We talked a little bit about that.

01:17:18 Well, I think it's kind of like our whole society balancing the art versus the business of medicine. And at what point do you find that balance? You know, I. And, and actually not just the art, but the business, but also the it part of it, the computer part. There's three different pieces and they're all very different. And we're not looking at how to merge it together for the best interest of the patient because there's so much information. It's depersonalized, personalized. We're minimizing patient care to maximize the volume of patients seeing to practice, insurance and revenue. And how long will our society tolerate standardized medicine? The evidence based practice versus the whole person.

01:18:08 You know, that's interesting that you're talking about evidence based practice as almost a dichotomy with, you know, the compassionate, whole looking patient. That's an interesting how important it is.

01:18:19 Yeah, it's cookbook to me. I think it's important to minimize abuse or excessive use, like not ordering a whole panel on every single patient that walks in the door. But on the other hand, not everybody fits into those patterns and you have to be able to, to look at the person and not have them not get paid because you made decisions that they needed a test that wasn't approved by evidence based practice.

01:18:49 We've talked a little bit about this, but is there anything you want to add to this? If you could change one aspect about the nursing profession, what would it?

01:18:56 What's the depersonalization? I see that trend towards lack of touching patients, lack of listening, even just to do foot care. On a diabetic, we have a lady that comes to Wisdom Wellness and she does foot care and she soaks the foot for 45 minutes and then she cuts the toenails and she massages the feet and documents any problems and. Or if you get a Massage. Think about how you feel after you get a massage. The art of touching, the art that's so healing just to feel another person so lovely.

01:19:30 If you could give a message to others about what nursing has meant to you, what would you say?

01:19:35 I'd say it's a lived experience. You know, you can't, you can't sum it up. You can't really, we can talk about it, but you can. It's sitting there with that person and that lived experience and that interaction that it's really hard to share with other people. It's that moment, exchange that is so valuable to me. What you learn from other people, whether they're homeless, on the streets, whether they're like living in a mansion, those little things that you share between each other, that can be life changing for both of you when you think about it.

01:20:13 What values have you chosen to live by and what experiences clarify this for you?

01:20:20 All of those experiences I talked about and what I choose to live by is compassion. And sometimes it's hard to have, but to have it. Community, you know, community is so important to me. Competency, you know, being a competent person when you're interacting and, and treating other people. Humor. Oh, boy, you have to have humor. One time I was, when I was still working in the hospital inpatient ortho ward doing primary care, I had this little psychotic patient. I had to give her an oil retention enema. That was one of the highlights of why I wanted to quit. And the seam was faulty and it ripped and it's. Instead of going in her, it splashed back on me and I had oil all over me for the whole day. I was like, oh, my God, I hate this. I think learning and curiosity. I think to stay in this profession, you have to learn. And even when you retire, you're still learning about healthcare and it's changing, it's always changing. And that the work is meaningful. For me, if it's not meaningful, I don't want to do it. Primary care wasn't very meaningful people, but at risk people. You love that, I love that. Yeah.

01:21:44 It seems to me that so much of what you're talking about is like community and your love of being out in the community.

01:21:50 Yeah.

01:21:50 And helping people where they are, not having them come to a hospital.

01:21:54 Right.

01:21:54 Rather kind of help empowering them where.

01:21:56 They'Re understanding their lived experience, looking at their life where they're at and how can we make this better for them? Not for me. Not saying, here's your prescription. Okay. Like, I got 20 patients in today and I Saved all this money for the insurance company that I don't want to be that person. So. Yep.

01:22:18 What is the most fun that you've had being a nurse?

01:22:21 The nurse honor guard. The Florence Nightingale tribute. So when nurses pass away, this group of retired nurses in Minnesota, and I think it's nationwide created what they call the nurse honor guard. And you wear your white nursing cap and the white uniform with the white stockings and you have a cape like the 1940s and probably early 1950s and you have a little lantern with a candle and we go to the memorial or to the funeral service and they do this Florence Nightingale tribute to that person and then they give the family members, they light the candle and they blow it out and give it to the family members to honor the nurse. Because really I don't think people understand. It's hard work and it's a lifestyle. It's a lifetime of work that these women have given to the profession and they need to be honored. Just like the military honor guard or the police honor guard guard. I think nurses should have the same thing, an honor guard when they pass away to be recognized for giving their life to this profession.

01:23:33 I would last would like to ask you. This is, this is a recording that's for, you know, impulse for forever. We'll have this in perpetuity. Right. And so what would you like to say? That if there's something that, like a message that you'd like to share about being a nurse. What would you like to share? What would you like to say?

01:23:50 I just think that for me it's been a wonderful profession and I've had wonderful experiences in my life. I think my family probably suffered a little bit because I was passionate and dedicated. But I also think they grew to be self supporting young men. And I wouldn't change it for anything.

01:24:14 You've really loved it.

01:24:16 Yeah, this is who I am.