Nichole McCaffrey

00:02 My name is Nicole McCaffrey. I'm 45 years old, and today is May 23, 2024. And I am talking with my colleague and dear friend Oliver.

00:13 Hello, my name is Oliver Pelayo I'm 51 years old. Today's date is May 23, 2024. We're here recording in Portland, Oregon. Nicole, I remember when I started in Doernbecher in OHSU about, I think it's eleven years ago you also started, so I thought. But I was introduced to you as somebody who's returning to PICU. Tell me about that.

00:41 Yes. My first job was in the pediatric hematology oncology unit at Doernbecher. I worked there for a couple of years and then moved on to the PICU. I was always interested in working with the sicker patients. Like, I really enjoyed bone marrow transplant patients and high acuity. And it seemed like when they were getting ready to go to pick you, I was always curious what happened next. And then there was a, I did that for several years, and then there was just a period in my life when I needed to step away for a little less stressful work. And I worked in the outpatient world. I had a little bit of time. I worked with some pediatric specialist at Kaiser, and then there was a job available in that outpatient oncology clinic at Doernbecher, and I found myself there for about a year. I was going through a divorce at that time, so there was, you know, just a lot of change with my girls. I have three daughters, and I think the stress of the PICU was just a lot in that time. I have found, like, you know, work affects our life, and then our life affects our work. And I only had, I think that was the first time in my life I didn't even really feel like I had what I needed to even provide for my daughters, like, to be there for all their needs. So I had this step boy from the PICU for a while, but I found myself back fairly quickly, and, you know, I really enjoyed the challenge of critical care nursing and just being able to support family members through that experience.

02:48 Well, it sounds like it was a tough time during the time when you left the PICU, and just like you said, you also had experienced a divorce. And what brought you back to PICU during that time?

03:01 Like I said, I was, I really missed critical care. I missed, yeah, it's funny I reflect on that. I think I would find myself reminiscing about, like, a really, you know, a really sick trauma patient or something that had been in the unit for a few days, and they got stable enough that, you know, me and some of my coworkers got really good, solid bath and got those patients really clean up and braided their hair and smelling nicer in the room and a little bit more normalcy, which is a huge transition for families to help them see the light at the end of the tunnel in this really horrible time. It surprised me. I think that that was the stuff that I missed. But in reflection, I think I just. I really enjoy artwork. I think it's an honor to be there with people in these times.

04:03 Yeah, I missed it. Yeah. There are experiences at work that really make an impression on us. Mine was when I was working in home health, pediatric home health, and I became part of that family. I worked. I can't remember how long I worked with this teenager. And the family ends up buying a recliner chair for me in the room with this child. And I was like, don't do this because I'm here for their child, but they're catering to me. They're making me breakfast. Yeah. It just left an impression about how even though they're very vulnerable and their life is so complicated, they still have so something to give. What is your fond memory of, without mentioning a patient name, but what's a fond memory of patient experience you had?

05:02 I just have. I mean, I just have so many. I really enjoy that period of time when patients who have been so critical, and we did, we really didn't know if they were going to be okay when they start to turn the corner and we're really advancing their care. I think of one girl in particular that had been on ECMO and then was really unstable on the ventilator. We started getting her up, you know, mobilizing her when she was still on the ventilator. I think that, you know, this early mobility has been something that shifted through the course of my career. When I started in the picci, we didn't really get patients on the bent up and out of bed much, but this girl loved Justin Bieber, and the respiratory therapist used to come outside, you know, come with Justin Bieber music. And so we would get her up and have dance parties in the room a lot. And sometimes we even. Sometimes that even occur to at rounds, you know, once the rest of the team knew that the patient was getting joy in those little things, there was music during rounds and stuff, those little glimmers and a hard time music.

06:25 We love our music at work. Yeah. Especially if that make our patient dance. So you are. You have been at bedside, but you also took different roles now working as a charge nurse. How are you liking that?

06:43 Actually, really, overall, I really enjoy the role. I like being a leader in the unit. I enjoy sharing what I have learned over the course of my career. I really believe also that the charge nurse has the ability to set the tone on the unit. And like we've already alluded to a couple times, we do challenging work, and I definitely would not still be doing this work if it wasn't for the people that I deal with. I've met some of my greatest friends in outdoor network, and so I think as a charge nurse, you have a position to influence the culture in a positive way. So that piece, I think, outweighs, for me, the stresses of it, definitely. You know, there's an added layer of, obviously, responsibility, and sometimes it's hard not to internalize the stress of that because we want to be able to balance the resources that we have, the number of nurses, you know, the skill set in order to that our unit as a whole can support all the needs of the patients. And it's hard sometimes not to feel like I. We don't always have the resources to do it to our absolute best. So learning how to not let that get to me has been its own challenge, I guess.

08:30 Well, charge nursing has a unique challenge, is you do still work at the bedside and do charge nursing. So now you've got to double challenges. What keeps you going?

08:42 The patients, for sure. Like, I love. I really love being a nurse. Like we talked about, you know, getting patients clean and things like that, even that, I just. I really enjoyed that, that human connection, being able to stand in the gap with people. So I think when I find myself getting overwhelmed with some of the stresses of our job or my frustrations of the day, I can pretty easily snap myself out of that by just going in my patient room and shutting the door and doing my best to give my best to them because I can always fill 12 hours.

09:37 Well, nursing profession is always giving, which, to a point, sometimes we empty our cup. How do you fill your cup at home?

09:49 Sometimes I. Sometimes takes me a day to recover. So I learned to give myself permission to need downtime and not be moving. And sometimes it's okay if stuff's still a mess or my yard's not perfect and everything's not exactly how I want it to be. But I also. I really enjoy being home. I like gardening, cleaning my yard up. You know, there's. I've been in my house now eight years, and it's fun to watch that's one thing I like about yard work. You can put some. I can put a half an hour into it, and I can see the fruits of that. But then, you know, the peonies that I planted five years ago are finally, like, they're just exploding on my hill right now. And it helps me kind of reminisce and count time and I guess maybe my blessings. I guess I just enjoy being at home. And then, of course, being present with my family is huge for me. I just. I love my daughters so much, and in this season of my life, I spend a lot of my time with them, so that fills my cup.

11:20 You mentioned about your daughters earlier. Tell me more about your three girls.

11:25 Yeah, I've got three just amazing daughters. My oldest, Grace, she's about. She's 22 years old. She lives here in Portland with her boyfriend. She's studying to be a high school teacher. Wants to. Ideally, she would teach high school theater. She's very creative and so just talented, but also just really loving. Incredible human. I'm so proud of her. She's in a really good space, too. It's kind of taken her a while. She knew in high school she wanted to be on this exact journey. You know, high school theater is what she said she wanted to teach. She kind of took a little slowed down on school for a little while and worked in coffee shops and retail. Wasn't quite sure exactly that she wanted to finish school. And now she's back at it and really focused. I think sometimes you need little push in life to continue your education, which is ironic, actually, when I think about it, because it was 100%. The moment that I held Grace when she was born was the turning point in my life. That pushed me to be a nurse, actually. Sorry. Yeah, I get emotional when I say it. I had made that connection, but school always came really easy for me, and I was working on, working on prerequisites, but I didn't have the drive, you know, to follow through. And I knew the minute. The minute that I saw her, I needed to get. Needed to put. Put the effort in and finish, and that changed my life. Sorry, I don't mean to. It's amazing when you really. When you love somebody deeply, talking about it can get kind of emotional. Yeah. I'm really proud of her. I. And grateful, you know, like that decision to become a nurse. I say, aside from becoming a mother, the best decision I've made in my life. I love this work, and I have the ability to continue to change what nursing looks like for me. And then in the spirit of being teared up, I guess it's a good segue to talk about Ava, who's my next daughter. Also, like, wonderful, creative, talented. She does competitive dance. It's just been fun to watch her grow and how dedicated she is and all the things that she has that she's learned that this translates into her life. She's just, like I said, hard working, dedicated, regimented, a lot of grit. When you spend time in a really competitive place and work really, really hard at it, it's easy to get bogged down. Bye. Comparing yourself to other people, I guess you know that. And so this is a lesson that I think we all learn in different ways in our life. Like, you can always invest, you know, your time, talent, energy, experience, and you're still probably going to be a whole room full of people that still are. Can outshine you in different ways. So how do you. How do you remember to compare your. Yourself to make your. What am I trying to say? To make your value about yourself, about you, not compare yourself to everyone else select. So she's graduating from. She's graduating from high school in just a couple weeks on June 13, and she's going to be a nurse. And she talks about, I want to be a pediatric nurse. He talks about, I envision myself working there in the Picci with you, which is just amazing to me. Yeah, I'm really proud of her. Verena. We're going to. We're driving out to Linfield today to have another college visit out there, and I think she's just, you know, I think this week she's going to make a final decision about where she's going, and it's a brief transition point in our lives. I'm really excited for her. It's going to be interesting to see if we, like, trans for lives, like, intersect again and we end up working side by side.

17:18 Yeah, that's an exciting future to look forward to. So I'm just impressed how Eva decided to become a nurse despite hearing all the stresses that you had at work, your experiences, but at the same time, that's the one that brought her to that idea of becoming a nurse.

17:39 Well, in ways, I'm really grateful that she's witnessed some, the ups and downs of my career and that she, like, is continuing to choose it because we need nurses and we need people to do stressful nursing roles, like working in PICu. But she witnessed me really get overwhelmed with work. And then, honestly, what I would describe as the true depths of burnouth, you know, I wasn't sure that I was gonna. I took extended period of time off. I wasn't sure if I was gonna come back to the PICU. I even found myself questioning if I wanted to be a nurse, which is wild to me because I love it so much. And I think she saw me actively working through that and finding ways to prioritize my own mental health and. And my own family. And I did a lot of. A lot of thinking and a lot of soul searching, and I landed back at, like, this is the pick you is the work that I want to do, and I don't want to leave this unit. And so I working really hard at identifying when I start to get overwhelmed or I feel like I'm not taking care of myself well enough, and it's part of my work to figure out how to take care of myself.

19:13 You know, a lot of people had mentioned about burnout, especially during the pandemic. How does that. What was your experience like? How did that look like? What did you do?

19:30 Are you asking me, like, how did I find myself in that place, or.

19:33 How did I work through the both?

19:36 I think the beginning of the COVID pandemic, we weren't that busy in the PICU. In fact, it was kind of quiet, low census. In fact, I remember some of my colleagues was one that had volunteered to help in whatever way you could on the adult side. I chose not to do that because I just really didn't. None of us knew in that time what Covid was really going to be. So, you know, in ways, we were all. It was such a weird time. Just remember, it was such a weird time. But then it was the RSV pandemic that really got us in the pickup. And I think that was. That was what really affected me, especially being a charge nurse in that time. It was. We just had way more patients than there was capacity to care for. We were asking other hospitals to hold on to patients that would have always been transferred to PICU or from or at least back to Doernbecher for a higher level of care. They were managing much sicker patients on the floor. And then there was even periods of time that we had cohorted patients, you know, multiple patients in one room, and definitely assignments that we would never have made before. But the other option was that patients were gonna, like, kids could die from RSV because they didn't have access to a piCU bed. And that was enough to keep me going through that time. So we just had to have this collective mindset that we didn't have enough resources, but we were gonna allocate them in the best way we could to take care of all the patients. In Oregon as a whole, it was really hard. That was a lot of. It was a lot of responsibility. And, of course, then we have co workers, too. As a church nurse, I always want to support the people that are at the bedside. I take a lot of pride in that, and it also feels like I have a lot of shared responsibility for doing best for all the kids that are on the unit. But the nurses that I worked with were frustrated and overwhelmed with their assignments, and I didn't have a better option. It was really hard, and I think that, yeah, it was really hard.

22:18 And that burnout, how did that manifest to you physically, psychologically? What did you notice?

22:26 I noticed that I was much more irritated. Like, people would set me off. I would be annoyed by things people said people did. Even people's presence sometimes around me, which was not me, and especially when I noticed myself not having as much empathy for patients families. And that's just not me. Like, empathy is at the core of who I am almost to a fault. You know, it's. That's really hard for me to turn off. And when I couldn't find that for people, that was pretty telling. That was pretty telling. And then I just had a really hard time, I think, processing and dealing with those, like, really acute, stressful things that we see happen. I think we had three or four, like, within, it was probably a two to three day period that we had more patients than those number of shifts that died in really tragic ways in our picu, and I was in charge those three days in a row. You just don't really. If you don't have an opportunity to really come down from all that adrenaline and process that and get it out of your body, I was just really kind of frozen. You know, the. Just the trauma that we had witnessed, I just didn't have the ability to get through it in an effective way. Way.

24:10 And you mentioned that you took an extended period of time off from work. What else did you do to get your back in center?

24:20 Well, a lot of that was actually one of the precursors to that time off was the conversation I had with my, um. Okay, well, I think in the period of time that I was off, I tried really hard to just focus on being present with my family. You know, my youngest daughter, Molly, had talked to me prior to me finally deciding to take time off. We had a really, really meaningful conversation, and she talked to me about being present and how she had noticed when I don't work as much that I have more ability to be that. And so it's one of just most powerful things I've ever had anybody say to me. I think because it was coming from my youngest daughter that I love so much and being present is exactly what I want to be as a single parent, though. I only have so much that I can give. And I really needed to. I just really needed to slow down and step away and leave room and space to process and deal with the stress of the work that we do and just how it had affected me as a person. I think I was surprised. I thought that. I thought initially that I would take a week or two off, was actually my primary care doctor. I had gone there and said, like, I'm so anxious, I'm not sleeping well. And she said, you need to take time off work. Like it would. It would not be right for me as your primary care doctor to let you keep working. You need to take care of yourself. And I think having someone else say that in such a black and white way, you know, and it was my own primary care doctor that I'd known for 15 years. She knows the work that I do. I think that gave me permission to be honest with myself about that I wasn't coping with it well and that maybe I was burned out. And that was hard. I think it was just really hard for me to admit to myself that I was in that place because I take such pride in being a nurse. And I know I love the work, but that doesn't mean you can't exist in a place of being burned out. And then as I was off and away from it, I think that was. That's when I started to realize how it was probably really long overdue. Wasn't probably long overdue. It was a long overdue in ways. I wish I had identified it earlier. But, yeah, a lot of the. So, of course, I spent a lot of time talking to a counselor. I went through our Eap and asked to talk to someone that had some experience working with people from the medical field. And I just approached those appointments in, I'm going to focus this on work. And there was plenty of stuff to talk through and work out and fill those appointments. So that was really. That was really helpful. And then that just being present with my girls and learning to say it still more was really healthy for me. And then there just came a point when I knew it was time to come back.

28:33 Hey, thanks for sharing that story and showing vulnerability a lot of people talk about a burnout, but they cannot articulate it. But, you know, you were able to identify that and work through that problem. So, yes, we haven't talked about Molly.

28:53 Yeah. Molly's my youngest daughter. She's a sophomore in high school, and she's just. She's just a joy. It's gonna be such a. I think it's gonna be a different experience in the fall because it's probably just gonna be the two of us at home. And I'm really, really looking forward to being present with just the two of us, see how different our life is. She loves animals. She wants to be a veterinarian. She's really involved with FFA and four h, and she's a leader. She likes to take on leadership roles in both of those organizations. And yesterday, we're just like, yeah, she got inducted into national honor society. She really, like, community minded person. She wants to, like. She wants to help. She's a huge helper. Yeah. My girls are just. Just the greatest blessing. I'm so proud of them. They're all so different.

29:56 You have a very strong girls in your life. Yes. They already know their future. They know where to go. They know what to do. It's impressive. So what is your fond memories of your girls?

30:16 Of my girls?

30:17 Yes.

30:19 Just watching them be together, you know, be their, like, authentic selves. And you know that so much of your personality develops at home. You know, they're also different. I remember they used to spend a lot of time outside on their tricycles and bikes, and we lived on this, like, flag lot, so they felt pretty protected from traffic and spent just a lot of time out there in their little swimsuits and rain boots, making potions. You know, they always like to, like, pull the flowers off of the bushes and the sticks and stuff, and I just. They would have me sometimes come out and take a look at it, and it's actually been really fun. Now, I've uncovered a lot of videos and stuff that they had taken when they were younger. Going through videos for Ava's graduation party the last couple of months. I've seen a lot of.

31:18 You showed me a baby picture, too, right? Or a child photo. That's so fun.

31:22 With her stethoscope. Oh, yeah. I keep making everyone, everybody on the unit has seen at least a couple of pictures of my girls when they were little the last couple weeks, because we've just gone through a lot of old memories. Yeah. I think my fondest memories earlier, just, like, being together, like family, being that safe space where we get to just be ourselves and not worry about maybe what people are thinking or, you know, how you're looking or comparing to other people just being together.

32:01 You know, it just dawned on me that you were saying that Ava is wanting to be a nurse, maybe just because of watching you as her mother. I'm just curious, is there something someone you have seen watched or somebody influenced you in becoming a nurse?

32:25 Oh, yeah. I mean, I grew up saying, I want to be a pediatrician. Like, my whole life. I was always interested in the medical field. But when I was in my late teens, early twenties, I was really kind of lost a little bit. Like we. I alluded to that talking about when Grace was born, and it really. The nurse who took care of me when I was in labor with Grace was amazing. And I don't think I really had thought that much about what nurses do because I hadn't really interacted with them much. I hadn't been in a hospital. I didn't know. And like I said, when Grace was born, I was like, I've got to figure out how to. I got to grow up and figure out how to provide a life for this girl and my family. And I realized that. What? That the nurse was the one that was with me through all those hours during labor. And, you know, of course the physician was there delivering the baby, but it was the nurse that was there with me. And I was like, I think that's actually what I want to do. And, like, within a year from that was, I was applying to nursing school.

33:51 I'm curious, did you get her name?

33:53 Yeah.

33:54 What's her name?

33:56 Patsy.

33:57 Patsy. Thanks, Patsy, for influencing my friend here, Nicole. And now she's here sitting, thanking you, and also making a difference in nursing. I hate to take you back to work. We talk a lot about gratitude at work. What are you most grateful for? Doesn't have to be at work.

34:22 Oh, well, relationships, like, because it was family and friends, 100%. When you can just build authentic relationships with people that grow over time, you get to be your true self. And, you know, those relationships also. People are in a position to help you grow too, over time. Yeah, I'm definitely most grateful for the people in my life.

35:09 You talked a lot about your girls and how important they are. They're special people in your lives. What are your hopes for them?

35:20 That's a heavy question. I hope that they, as they pursue their career, how they spend their time, and who they choose to share their lives with. I have high hopes for that. They're just incredible people who, by their nature, desire to give and make the, you know, make the world a better place. I hope that they find partners in their life that value them, you know, that, like, feed into them in the way that I know they will for their partners, because that is their nature, you know, to give and take care of people. You know, I just hope for them that they have people that love and value them and respect them the way that they deserve, because I don't. I don't think it will be hard for them to find someone to share their life with, but that it will be someone who values them the way that I do because I. Of course, I'm biased, but I think they are amazing. And then as far as how they spend their time and their. Their work, I'm excited because I think all three of them have chosen career goals that are. I think they're all rewarding to have. Being able to have a purpose for your work, a why that you can come back to that, like, keeps you going. And it's more than a paycheck. That's one of the things I love so much about nursing. It's so rewarding for me. So I hope that they can identify the why for the work that they do, so that when times get tough, they have that to go to look back on. I just. I think they have all. All three of my girls have so much potential, and they could. They're at this transition point in their life. It's really exciting to watch. Although there's been a fair amount of tears on my end, because it's wild to me to realize that, how fast it's going. So I hope that they can learn from the lessons that I've learned in my life that can help propel them for their life to be just a little bit better than the incredible blessed life that I have had.

38:30 I guess we talked a lot about heavy conversation topics here. I'm going to bring you back to a little lighter.

38:40 Okay.

38:40 Again, referring to your girls. Uh, we talked about spirit animals at work one time. What are theirs and why?

38:49 Oh, this is fun. Grace's is definitely colorful. I guess they're something really theatrical. You know, like one of those tropical birds. It's like blue, but has the big plume on the top of their head. I'm picturing that. But then also, it can sing and mimic. Mimic you and stuff. Something like that. She's an amazing singer, but also just. She's like. I remember there's a. Oh, my gosh. What is the line in this song? There's a line in a song that Grace really loved in middle school. It talks about being a zebra in a pony show. She's 100%, unapologetically herself. And I love that. I love that about her, especially because it's just, you know, her uniqueness is. She's just. She's just great. Yeah. A tropical bird for grace. And then what would Ava be? Something a little bit more. More. I mean, she's really good at, like, building the. Her mind puts things together. Well, gosh, that's hard. I should have prepped for this question and then pause it for just a second. Let me think about this. Don't worry about it. I think Molly, my youngest one, would be some kind of dog for sure. I would say a golden retriever, because they're so easy going and easy to be around. I mean, I've. Molly's personality is. She really is very easy to be around. Yeah. So a dog. Okay. Going back to Ava, I think she's. Maybe it's a weird one, but I think about oyster when I think about her, because it's. You know, when you open it. When you open it up, there's that, like, beautiful pearl inside. And she's also, like. She's kind of. She can be pretty shy until she gets to know you. And then she's, like, the funniest, bubbliest, energetic person in the room. But she's kind of. She's kind of reserved. And sometimes she just has to, like, shut the shelf. She goes back to her room and, like, shuts the door and needs to be alone. And that was hard for me to get used to because I would think that means something's wrong, but that's just how she gets her energy back.

41:51 I see. What about you? What is your spirit animal?

41:58 Probably a bear. I know this is very cliche, but the mama bear thing is really easy for me to relate to.

42:08 I see. Hey, thanks so much for opening up and sharing your story, and I will see you back at work.

42:17 Looking forward to it.