EP 20: Do Nurses Eat Their Young?

In this Hope4Med podcast episode, we have an in-depth conversation with RN Michelle Lemmons, who shares her experiences as an OR nurse and clinical educator. We explore the truths behind the commonly heard phrase “nurses eat their young” and how we can change the culture for the next generation of healthcare professionals.

[00:00:00] Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Well, welcome to Hope4Med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4med, med.

[00:00:38] Hi, everyone, welcome back to the Hope4Med podcast with me, Dr. JB. This week’s featured guest is Michelle Lemmons. She is a nurse who is currently working as an operating room clinical educator. Michelle has over 10 years of healthcare experience, including admissions, OR, acute care, post-acute care, transitional care, and long-term care. She is passionate about nursing, healthcare, and individuals using their strengths to support teams and realize their full potential. Welcome, Michelle.

[00:01:14] RN Lemmons: Oh, thank you. What a nice introduction, I’m excited to talk with you.

[00:01:18] Dr. JB: Yeah, me too! So tell me, you have a very extensive background in working in the operating room.

[00:01:26] RN Lemmons: Yeah. You know, I, I did the Peri-op 101 program when I was just a few years into my nursing career and it was just kind of a, a unique environment and opportunity to get to be a part of. So it’s a really cool, it’s a really cool space. I think everybody tells you when you go to nursing school like all the things you can do, it’s endless, and so it’s just another one of those channels.

[00:01:51] Dr. JB: Yeah. And from your bio, it looks like you’ve had a lot of different experiences in the nursing world.

[00:01:59] RN Lemmons: Yeah. A lot of times before I had kids I was doing kind of two jobs at once, mostly just a two part-times if I wanted to, because I really enjoy, I really love nursing. So it wasn’t, it wasn’t so that I could spend all my time, of course, I didn’t feel like I was overdoing it, but just getting to see all those different spaces that people experience healthcare.

[00:02:23] Dr. JB: So, what made you decide to become a nurse?

[00:02:28] RN Lemmons: Yeah, I wanted to be a nurse since I was, I think I was seven actually at the time. And I had, I had gone into the hospital– maybe TMI, right, too much information– I had an extra ureter, so I actually went in for a surgical procedure and then was being cared for in the hospital. And all of that, of course at seven, you don’t really understand, but in addition to that, my parents had gotten divorced and it was kind of one of the first times that my stepdad and dad were around each other, and it got pretty heated in my hospital room between them arguing. And this nurse– I will forever wish that I had gotten her name or something, I mean she changed my, she absolutely changed my life really– she walked in and said, “you two cut it out,” you know, in a very stern voice, and then she’d walked over to me and she’s like, “Hey, how you doing?” She just didn’t– it wasn’t a moment of pity, it was just this very controlled, I don’t know, encouraging person to, to see her power and her authority, I guess, to be able to come into that just a very interesting, heated place, very vulnerable, intimate place and she just walked in with confidence and professionalism. I will never forget it. And I said, man, I want to be like that, that is, that is now my, my goal.

[00:03:56] Dr. JB: Wow. You know, as healthcare professionals, we think, oh, people would want to emulate us because we’re great at putting IVs in, or great at coming up with this broad differential, but that was just, that wasn’t necessarily a, per se, what word am I thinking of– technical skill. Yeah, technical skill. It was people skills.

[00:04:17] RN Lemmons: Yeah, absolutely. Yep. It was empathy. I mean, she read the room. It was just, it was incredible. It was just emotional intelligence, right? And maturity probably.

[00:04:28] Dr. JB: And so you became a nurse.

[00:04:30] RN Lemmons: So I became a nurse. It was just such a journey, a cool journey. I think that if anybody out there feels like, “man, I can’t do it” or “I’m not smart enough” or I’m not whatever, you can ignore that. And just find that, find an encouraging partner and mentor and somebody to walk through it with it. You can totally do it, cause I struggled with some of those thoughts as well.

[00:04:51] Dr. JB: In your bio, one of the things I really, really loved was “help people realize their full potential.”

[00:04:57] RN Lemmons: Hmm. Yeah. And I really love that too.

[00:05:01] Dr. JB: And part of realizing your full potential is battling these internal negative thoughts that say, “you can’t do this, you’re not good enough,” et cetera, et cetera.

[00:05:11] RN Lemmons: Yeah. Yeah, absolutely. And it’s the same with, I think it’s the same with our patients, right? Somebody gets diagnosed with like a new, with new hypertension say, and that’s a life change for them. They have to change their diet, they have to change their habits, their environment sometimes, and so it’s like we kind of, we start with the list of nos or we start with the list of barriers, and if we can be an advocate for one another to just slowly and steadily break down and say like, “yep, this can be a change, you do have the power to do this, we can make this happen, here’s a couple of resources.” I just think that there’s nothing more worthwhile maybe in, maybe even in our lives than helping each other overcome barriers to whatever.

[00:05:58] Dr. JB: Because time and again, you are more powerful than you realize,

[00:06:04] RN Lemmons: Right, absolutely. And there’s usually always something you can do, even when it feels kind of hopeless.

[00:06:11] Dr. JB: So, walk me through, so you finished with nursing school, and what was the first experience that you had as a nurse?

[00:06:18] RN Lemmons: Yeah, so I had been a nursing assistant for about seven years prior to nursing and I was working in a hospital-based transitional care. So it’s a little bit different than a community TCU, this was patients who had had a liver transplant or a heart transplant, but weren’t sick enough for acute care, didn’t qualify, but weren’t ready to go to a community facility or home. So we had this really unique position which was great, and I started there and then I went into surgery and I did their Peri-op 101 program and I worked on the CV thoracic general team at an educational hospital, an academic hospital. So we did, I did that for a while, and then after my son was born, my first child, doing overnight call and weekend 72-hour call just wasn’t working, so I stayed casual for a long period but I worked a little bit in admissions and then did a little acute care at another hospital close by after my daughter was born. So I’ve always loved education, which is what I’m doing now. You know, I think it’s kind of built into us as healthcare professionals, it’s a big part of our jobs and probably our identities to be helping other people understand. So, when I saw this role, I was, I was just immediately interested in, it’s just such a cool way to kinda help from the outside in for understanding and, and information.

[00:07:52] Dr. JB: So currently, what is your role?

[00:07:55] RN Lemmons: Yeah, so I am, I’m the operating room clinical educator and it, it truly is an educator position. So I work for a medical device company called Key Surgical and we have many items for the operating room and sterile processing and endoscopy. And in that role, I can speak at conferences, I speak at symposiums, do in-services and virtual in-services. I also write competencies, so tons of webinars and we have a podcast, so all of that is just like through and through education in addition to training the sales team on the operating room and competencies as well as products and what they do and how they’re used. So I do like a big breadth of things which is very, very exciting for me. It’s kind of that realizing your full potential. It’s constantly pushing you to do something, something new, do it better, figure out better, how people learn, and the best way is to provide information. So it’s really, it’s a super fun, interesting role to be in.

[00:09:01] Dr. JB: So, if we go back to the operating room, how stressful is that environment?

[00:09:08] RN Lemmons: Yeah, I’m laughing, of course not laughing “ha ha funny,” but it’s very, it is actually very stressful. There’s quite a bit of research, which I’d love to talk about too, but it is stressful. It’s, it’s pretty unique as I said before, I hate to keep saying the same word, but in the environment you have, I think, the most vulnerable patient who is on the table, sedated to one degree or another, multiple people, you have the CRNA and anesthesia, the anesthesiologist if they’re in there, surgeons, residents, surgical techs, everybody kind of forming a different role, strong personalities. The OR is known for a very, very strong personalities, and rightfully so, the things that we deal with in healthcare are very serious. You have the life of another person immediately in your hands, the stress, you have your own personal stuff, like we talked about with insecurities, and then that manifests in a multitude of ways. So I know we, talking about burnout or how we’ve talked about this a little, it really, it really shines clear in the operating room. It can be, it can be really easy to get there without the right things or people in place.

[00:10:28] Dr. JB: What’s funny is oftentimes when people picture the operating room, it’s a very sterile but controlled setting, right? And so when, when that’s described, it’s not described as this really stressful, high pressure situation, it’s everything’s under control. We have complete control over the physiology of the patient, everybody’s calm, and you’re saying that’s actually not what’s actually happening in the operation.

[00:11:00] RN Lemmons: I think it’s happening, but there’s a lot of things underneath that are also happening is what I should say. I always say that operating room staff are the absolute masters of the worst-case scenario. So masters, immediately when you hear your who you’re working with and what procedure you’re doing, you immediately go through, okay, worst case scenario, what do I need to be prepared and then how do prepare for that? So in that way, it is very controlled, but then when you look at that on a personal level, there are three things that typically people describe when they talk about burnout, right? And the first one is the most emotional exhaustion. Then there’s depersonalization is like another identifying factor, but then there’s also that sense of a low sense of personal accomplishment. So those are the three points that people discuss with burnout and, and in a high-stress environment with multiple personalities and people who are incredibly gifted thinking of the worst-case scenario, that can take a toll on a person. I think a lot of times it’s like it is sterile and it is controlled, but it’s human beings. So it’s not, it’s not a machine, there’s so many more levels and layers that, that go into a human than just… It’s great, it’s checklists, it can be very linear, it’s consistent, it’s sterile and it’s controlled, but then underneath that, you’re dealing with people which is wonderful. There’s no other way to go about it, but it’s also, you got to really be sensitive to it.

[00:12:38] Dr. JB: Hmm. No, that’s true. It does take a special person to be in the operating room. I remember when I was training, the one word of advice I got that I share with everyone is if when you’re in the operating room and you can imagine yourself anywhere else besides the operating room, don’t go into surgery.

[00:13:04] RN Lemmons: Yeah, exactly. Exactly. It’s interesting because I think it’s the same in nursing. It’s very polarizing, if you, if you work in the operating room or train or just shadow, it’s like, you either love it or you’re like, “get me out, I don’t know what is going on.” Yeah. It’s so interesting, yeah.

[00:13:26] Dr. JB: And so how long did you work of operating rooms?

[00:13:28] RN Lemmons: Yeah, so I, it’s hard, I have a little bit of a brain fog because I had two children at that time, but I think all in all–

[00:13:36] Dr. JB: You’re forgiven

[00:13:38] RN Lemmons: Oh, thank you, my goodness. From the Peri-op 101 to, to being casual for a long period, probably like four years or four and a half just in doing all of it. So I really enjoyed it. It’s absolutely incredible to see what can happen to the human body and then to see a team that works really well together, be able to literally give somebody life again or fix, and it’s awesome. It’s absolutely awesome.

[00:14:10] Yeah. I think that some of the, I think we talk about a lot, it’s really well-known and I think that’s good and we should keep talking about it forever about medical, people in medical school even, physicians in medical school, and afterwards, a lot of times we talk about in general, physicians and their suicide rates. It’s, it’s out of control, I think it’s like a thousand a year, is that correct?

[00:14:35] Dr. JB: For physician suicide? No, the numbers a little less, still stark, but it’s between 300 and 400. A medical school size.

[00:14:45] RN Lemmons: Man. And that’s crazy high. So the same as in nursing, they, they’re showing the same increased suicide rates compared to the general population, a lot associated with burnout and depression, and it’s, it’s really not any different in the operating room. There was just a couple of studies, one was from 2017, it actually was from China, it’s all very similar all over, and they found that 70% of operating room nurses, they did a self-administered questionnaire of over 500 operating room nurses, just were in a state of absolute stress, of job stress, that had negative effects on their, of course, emotional exhaustion and depersonalization and their patient care and their patient rates, their complications. So I thought that was just so, so interesting. There was another one in, actually for surgery, surgical specialties from 2011 to 2014, the rates of burnout increased from 42% to 52%, so that was even higher than what they found to be in general in all specialties, which was 51%. So it is a very high-stress environment, so that can quickly go.

[00:16:08] Dr. JB: What are your thoughts about what is contributing to these numbers? Is it the time constraints or?

[00:16:15] RN Lemmons: Yeah, I mean, I think yes and yes. There’s been quite a bit of research, especially for physicians, that talk about electronic health records and just the increased amount of time and, and different things like that that leads to it. But if I had to boil it down to, I don’t know four, I guess the first is a lot of times it’s staffing. I think that’s pretty broad everywhere you go. It’s not enough people and the people that are there are required to do more in less time, with less materials, and to do it at a high level without mistake. In addition to that, we have, I think another one broadly is education. A lot of times we’re kind of thrown into a situation that yes, I went to nursing school, yes I’m equipped to do an assessment, but I, I’m not always equipped to fully understand the ramifications of something, or I’m not fully prepared, not educated for that moment or for that space. I had one, I had one situation where I was working in an acute care and I got floated over to the ED with no training in their department at all for a young infant who came in and I couldn’t even find their saline syringes. You know, if you don’t know your department there’s, that can quickly as a human being, and you don’t even have to be a mother, but just as my own personal, as a human being and a mother and a nurse and somebody who feels very prepared in an emergency situation, the feeling that I can’t do what I need to do because I’m not equipped? Oh man, that eats me. It eats me alive. And then you go home and you can’t, you can’t leave those things at the door. They come with you, they become a part of your story. So the other thing I think that kind of adds to some of this is leadership and transparency and kind of big, big systems, when one person, this physician who just wrote an article about burnout in surgery and the American College of Surgeons just said, feeling like a cog in a way. Just very replaceable, which lends quickly to that depersonalization and low sense of personal accomplishment, because I don’t know anyone, I don’t know any nurse, any physician, any nursing assistant, any surgical tech, anyone that goes into healthcare that isn’t like, “man, I want to make a difference in somebody’s life.” So if you take that away and you feel like a cog in a wheel, it’s defeating, it’s discouraging.

[00:18:54] Dr. JB: And so do you feel like this is something that’s new or is a new development?

[00:19:01] RN Lemmons: I think it’s, I think it’s one of those things that’s kind of, I have to say, I think it’s getting a little bit worse because I think we’re, we’re kind of losing in, in at least some of the bigger systems maybe, and that’s my own personal thing, is we’re losing a little bit of that role delineation. So who can do what and who do I go to to figure that out? And that can be really challenging when you’re working. And the other thing I think is that we’re really seeing research and talking about it, even though it’s something we’ve known about for a long time, it’s almost like a permission to say like, “oh man, yes, me, add me to that list, I am burned out, I can’t keep carrying this.” “I just thought that maybe I was weak or I just thought that maybe everybody else had this figured out already and I’m catching up,” but now we’re just seeing more and more research that that’s just not true.

[00:20:01] Dr. JB: Yeah, I agree with you completely. This has been an ongoing issue for a very, very long time, but it’s been so taboo to talk about it.

[00:20:11] RN Lemmons: Exactly. But I think it’s that same conversation like we’re talking about in the operating room, like from the outside, it looks controlled and it looks sterile and it looks– which it is still– it’s just human beings and you have to, you can’t neglect adding that piece in there. You know, you never want a patient, I never, as a patient, want to walk in the room and feel it gets chaotic or out of control at all, because then I’m scared and I don’t have trust. So I think there’s a way that we can have these conversations and still establish, and still have established trust and control, but add in some of that transparency that can lend actually to deeper trust.

[00:20:54] Dr. JB: I think it’s so easy for people to somehow dehumanize healthcare professionals and make it seem like they’re superhuman when, in fact, we’re not.

[00:21:08] RN Lemmons: My absolute least favorite thing for healthcare right now is the conversation of, of heroes. I, you know, they are absolutely incredible, I’m in awe of the things that people can do, right? And, and all of that, but it, I think it’s really dangerous because it does lend to, when you think of a superhero, Superman, you can shoot him and he doesn’t, nothing happens, but that is not, that is not real life. These are real human beings who are dealing with all of these real things too. So I think that can be a really dangerous dialogue and almost encourage people to stuff what they’re going through because they’re, they want to be considered a hero and be– I, I think it can just be dangerous in certain ways.

[00:22:02] Dr. JB: It makes you less likely to be vulnerable.

[00:22:04] RN Lemmons: Yeah. Yep. And to be seen as a human who makes mistakes and who is dealing with there life too, it puts, it puts the pedestal pretty high and that’s a fault, it’s a big fault.

[00:22:18] Dr. JB: And then adding stress to already stressful situation.

[00:22:25] RN Lemmons: Yeah, absolutely. Absolutely. My grandma actually she’s 94 and just had a fall and she’s okay, but she had a, she had a big laceration and subdural hematoma and she’s fortunately just doing really great, but making calls to her for her doctors and nurses and my mom’s staying there and taking care of some of that is just, it’s it’s quick to see when you haven’t been doing it it’s easy to feel overwhelmed by some of that. So it kind of, it is the same for the healthcare professional. It’s a lot of things to juggle and a lot of things to keep straight and you’re gonna make mistakes or notice something after the fact. It’s like being able to bring the patient, the family, the healthcare providers all together is I think the original vision that can just be so effective, having that open communication for all parties.

[00:23:29] Dr. JB: Yeah. And then, with the whole hero title, heroes don’t make mistakes, they, they come and they save the day all the time. Right? And, and what happens if you can’t save the day?

[00:23:43] RN Lemmons: Exactly. Or what if you miss something.

[00:23:44] Dr. JB: What does it mean, and what does it mean to save the day?

[00:23:47] RN Lemmons: Yeah. Yeah. It’s really interesting. And, and sad. It’s a tough one. We have a, there was a lot, there was the first, the first webinar I ever did at Key Surgical, which I love, I really love working for this company for many reasons. It was started by three nurses who kind of got frustrated wanting the things that they wanted when they wanted it and couldn’t get it, so they started their own company, which I think is incredible, that’s a great story. And now we’re part of a larger, part of we’re part of Steris. So Steris actually bought Key Surgical, but the first webinar I ever did for Key Surgical, which they just completely encouraged me on, was called “Nurses Eat Their Young Because They’re Starving,” which I still kind of like, oh, that was, I just went for it.

[00:24:37] Dr. JB: Yeah, you did. There’s no beating around the bush.

[00:24:41] RN Lemmons: I know, but I, you know, I think it just goes hand in hand with that hero mentality. I think it can be confusing for somebody who’s not working in the field to hear, “man, there’s a lot of bullying in nursing” or “nurses eat their young” and they’re like, “what does that mean?” And then in health care, you’re like, yeah, I totally get it. I’ve seen it, makes sense. But what I really wanted to draw attention to is there’s a reason why, there’s a reason why some of these things are happening and it’s this burnout crash.

[00:25:12] Oh, you know, absolutely strapped for educational resources, equipment, resources, staffing, and then they say, “hey, train this new person who doesn’t know, who is, who’s brand new or who is coming in from a new facility,” and you, you have to, it’s very challenging in that space. And we don’t have that time and other things to do that really well, which is very challenging because you want to, there’s nothing more that you want than, than wanting to show someone and encourage someone and talk to them about that emotional intelligence piece, but when there’s no time, it just becomes a hindrance. And you’re like, why don’t you know this already? That becomes the dialogue. Not for everyone, there are incredible people, but it has to become a big, a big point of conversation in the nursing world actually about when they incur, when they surveyed about 200 nurses in one of these surveys, 72% reported that in the last month they had been bullied in the workplace by like a lateral professional, which I thought, man, that is very high.

[00:26:26] Dr. JB: So when you say bullying, what do you mean by that? Do you have any examples?

[00:26:31] RN Lemmons: Yeah. You know, bullying can range from a lot of different things. Of course, like the classic, we all think of bullying, we think like somebody is calling you names or belittling you in public, which yes, absolutely, some of this bullying is. For example, one example I have from the operating room when I was new to the operating room is withholding information. So, if I come into a case to circulate and you’re scrubbing or you’re circulating through and training me, not telling me a key piece of information that I need to make the procedure go well, or to be safe for the patient or to get to know and develop a trust, trusting relationship with a surgeon or our CRNA. So it can be as, as which I think is a very common one unfortunately, withholding information, belittling, degrading someone in public, you know, all of those fall into that category of incivility or bullying.

[00:27:27] Dr. JB: And the withholding information, is that something that’s intentional just to make you look bad?

[00:27:31] RN Lemmons: Yes. The operating room is very interesting in, in a couple of ways, but people take a lot of pride. There’s a lot of pride in, I know this surgeon and what they like and how they want it and what time they want it and what, you know, all of the things, their exact preferences better than anyone. There is, there is sort of a very weird environment that’s created with that where it’s a moment of pride. So part of that withholding information is I want to continue to be on this pedestal of knowing this surgeon the best, better than anyone, they ask for me because I know exactly what they want every single time. So some of it is that in the operating room, we just kind of have a very unhealthy, an unhealthy relationship in that way. And, and other times I think it’s to, to do the latter, to kind of make you look stupid or make you look like you haven’t, like you’re not equipped or not, not relevant.

[00:28:37] Dr. JB: I find that sometimes in healthcare, people forget what it felt like to be a learner.

[00:28:44] RN Lemmons: Yeah.

[00:28:45] Dr. JB: And I remember– speaking about the operating room, cause I remember this very vivid when I was going through training– I think I was in medical school and I was in the operating room retracting. That’s the role of the medical students, only to retract. Can’t see anything.

[00:29:01] RN Lemmons: Mhmm, hold the retractor and don’t touch anything else,

[00:29:03] Dr. JB: Come toward the body and just retract. And I remember I got really degraded by the surgeon and I felt small. And I remember at the end of that experience, I left, of course I was imagining being anywhere else but the operating room, so clearly, I did not go into being, to surgery or becoming a surgeon, but I remember explicitly promising myself that I would never forget that I was once a learner. That I once had no idea what was going on.

[00:29:44] RN Lemmons: Yeah, that’s right, exactly, because you, because you’re going– the thing, the thing I think we forget or just neglect to accept maybe is that healthcare is continuous learning. I mean, we say that it sounds like, “oh, okay, you’re going to be continuing education, blah,” you know, we say it almost sounds cliche or like, “yeah, yeah, yeah, we get it.” But you can’t forget to say like, no, really there’s going to be every single patient, every single operating room, every single tech, surgeon, everyone is learning something new every single day, every day, because there’s no patient that’s exactly the same and there’s no situation exactly the same, and we’re human beings. And so, so we’re going to do things a little differently, so that’s the, that humbleness of I am going to be learning forever, and good because the moment that I stop– one of the other things I just say, I feel like if anybody hears me talk a lot, they’re like, okay, Michelle, but the only scary nurse in my opinion, is something I always said to people I was training as well, as I’ve said until I’m, ’til I’m blue in the face now, but the only scary nurse is a nurse that never asks any questions, because there is no way on earth that you know everything. I don’t, I don’t care what your title is.

[00:31:11] Dr. JB: Yeah. But the issue is that too often people are afraid of being berated, right? And so they don’t ask questions because they’re in their heads thinking “I should know this, shouldn’t I? Should I know this? Maybe, I don’t know, I’m just gonna pretend I do know,”

[00:31:30] RN Lemmons: yeah. Yeah, exactly. And, and I’ll tell you there’s nothing that’ll make you throw up when you get home like making an error for something you should’ve just asked and you knew, like, man, I should know this, maybe I know this, maybe I don’t, let me just ask because, like I said it, it might make you feel stupid in a moment, in the moment and that’s part of your story, I totally I get that. I feel that way. I still may, I still screw up and do that, we all do that, but at the same time now it becomes, if I make an error with my patient, with our, I always say our patient on the operating room table, that’s a part of their story too. Forever. And it could have just been, I guess, part of that heart in healthcare is that I’d rather have it just be a part of mine and have it be like so sucky and somebody made me feel stupid and small, which that’s about them, not me. I’d rather be the one to ask the question and if I’m stupid, teach me, just teach me because here I am and I am your teammate. I’m your advocate. I’m with you here in partnership to, we have the same goal and the same outcome. So yeah, it’s very, I get so, it’s really, it bothers me a lot when people belittle and degrade, because I’m like, man, we’re all just somewhere in the ebbs and flows of life. Next week somebody’s going to make you feel like that, so don’t turn it around and lash out at somebody else. Just be with that emotion. That’s, that’s really hard, but…

[00:33:07] Dr. JB: But then circling back to what you said in the beginning is being in healthcare is all about teaching. So it’s interesting how we run into this paradox, where it is about teaching and is about learning continuously, but then when you have somebody who doesn’t know, then a part of the culture of, of medicine is to make them feel bad. For physicians and physicians in training, it’s called pimping. We get pimped all the time. And you, and if you happen to get the answer right, it’s not, “oh, good job, you got the answer right,” no, they continue. They continue asking more and more questions until you get it wrong and then they’re like, “aha, see you don’t know anything.”

[00:33:53] RN Lemmons: Yeah, they want you to fail. Yeah.

[00:33:57] Dr. JB: And the thing about that is, so they tear you down to make you feel dumb. Cause all, all these super smart people who did well on their examinations, “I’m going to show you, you don’t know nothing.” We don’t know anything, you know, like it’s, it’s a fact, we don’t know anything when we’re, especially when we’re learning, right? But then you go ahead and you tear us down, but then when do we get built back up?

[00:34:19] RN Lemmons: Yeah. Yeah. Good question. Good question. We, we talk about this a lot for nursing school. In nursing school, it’s like, “hey, you don’t give anything, you do not give a Tylenol at all without checking with someone, confirming three times,” doing the, of course the five medication checks. But in addition to that, you’re checking and checking and checking and checking, and then the day that you graduate and pass the boards, they’re like, “here you go, you can give chemo.” You’re like what? I couldn’t even give Tylenol last week. We’re not, you know, that, that slow lead into independence doesn’t exist in healthcare. They’re like, you’re dumb, you’re dumb, you’re dumb, you’re dumb, ok, you’re a nurse. I don’t trust myself then either I’m terrified of everything. The other thing is when, when you’ve been in healthcare a while, the thing I always think of is people want to help you get tough skin. They’re like, you’re going to need tough skin to be in this field, so I’m going to help you by degrading you and belittling you because you got to suck it up and deal with it. But the reality is we don’t develop tough skin by berating each other, we develop tough skin and strength actually by encouraging, uplifting, reminding, talking with one another through a situation by, by being open. There’s nothing about bullying or slighting or any of that, that is actually going to build another person up. It doesn’t work. It can be isolation. You can become independent in your isolation, but that’s scary too.

[00:36:01] Dr. JB: Survival of the fittest.

[00:36:03] RN Lemmons: Exactly, yeah. That’s so, it’s so interesting that the whole “nurses eat their young” thing, I get gasps by people who’ve never heard that before and they’re like, “that’s gross,” but it’s in the wild sometimes animals do eat their young for survival of the fittest, to weed out the weak, but it’s like that is not what we’re doing here, we’re building the next generation and we’re building the teammates that we are going to rely on in emergency. And we’re building the surgeon who’s going to take over the case for us when, when something happens or take over the second part of the case for us. We’re building our colleagues. We’re not weeding out the weak, that will happen, I mean people will come into it and think “this is not for me,” but it shouldn’t be because they’re being degraded and bullied and made to feel stupid.

[00:37:02] Dr. JB: I think that’s just how medicine has been for so long and people feel like, “oh, that’s just how things are, those are the rings of fire I had to jump through to get to where I am, so you have to jump through them too.” Not realizing, or not even not realizing, just forgetting, time makes you forget how miserable it was. Time makes you forget how miserable the experience was.

[00:37:24] RN Lemmons: Oh my gosh, you’re like, I was so tired. How did I, how did I do that? The other thing I think that adds is like, it’s not like these people who bully and are, are bad people, it’s, it’s a huge environment thing as well, and in healthcare systems, you have various severely ill patients, exposure to infectious disease, that’s very stressful, we’ve seen that a ton. Security risks, which is also like a big, hot topic this year. There’s really, you can call security, but kind of minimal protections against those things when you’re in the immediate environment. Some exclusion from decision-making skills, like for example, that, you know, electronic medical records and how things are done, it’s like, so you have to do this today. So now you have your own human home, personal stressors, plus all the stressors of the system and security and do more with less, and then you have your colleagues, which just seems like the easiest thing to, to weed out, to get something off of your plate.

[00:38:34] Dr. JB: It’s like the one thing you have control over is how you treat somebody else.

[00:38:40] RN Lemmons: Yeah, exactly. Just something that you can make actionable. Right? Some of those other things, you can’t do anything about. So it’s never that, that I think anybody’s like just innately a bad person. There’s a lot of things, people are people.

[00:38:56] Dr. JB: But when you eat your young, then you have less young. There’s no relief. So who’s gonna come replace you when your shift is done?

[00:39:05] RN Lemmons: Exactly. Or they won’t ask you questions or they won’t think that you’ll tell them all the information. So that’s really stressful.

[00:39:16] Dr. JB: So how do we stop eating our young?

[00:39:18] RN Lemmons: Yeah, that’s a good question too. I keep saying that, these are good questions. I think we stop eating our young by, I always start with a pause. Pause, and just have that breath that says, like, why? Is it this person, you know, is it this– I always, I don’t know, it’s easiest to start with, I guess, taking it, what is actually, what is it in this moment that is so overwhelming to me that I feel like I am depersonalized from my work, I am emotionally exhausted? And then kind of examining some of that, just taking a second to examine some of that. I think a lot, a lot, a lot of what we need to do right now in healthcare is, is create better boundaries for ourselves, for our professions. From physicians, nurses, surgeons, everyone, to keep saying like, “Hey, this is not right.” To have that collective, “this is not right, I can’t do more with less, and if they’re going to ask me to do that, I cannot, you know, I respectfully decline.” Because while it will seem like we can’t, we can’t say no to taking another patient today or to doing another procedure today, I think we have to start getting together and saying, “no, we, we can’t do this this way or it will crumble.” So kind of that initial self-advocacy to examination advocacy.

[00:40:49] Dr. JB: Yeah. that’s definitely challenging. Challenging to say “no” period, but then, because as healthcare professionals, what, what are we doing this for? We’re doing it for the patient. And so it’s even a million times harder to say no to a patient.

[00:41:06] RN Lemmons: Yeah. Yep. Absolutely. I do not, I don’t feel like it’s like a small thing, but at the same way, sometimes when we say yes to a patient, we actually ended up hurting them more. Then you have a burned out nurse who is emotionally exhausted and misses something, and now you have an error that– you know what I mean? It’s kind of six in one and a half a dozen in the other, it’s like, you can’t continue with the burnout, you’ll have nothing left. And it’s really hard to stand up and say no to that as well, to the patient, but it’s opportunity cost, right? It’s like you’re saying no to one thing so that you can say yes to something else. So I think that’s just, of course, there’s no perfect answer and that’s a very, like maybe a blanket statement of like, “just start saying, no,” that’s not what I’m saying. But kind of getting together, we need dialogue. We need communication. We need a couple people who are willing to talk together and say, here are the things in our unit or in our department or whatever that are absolutely I feel ill-equipped. So let’s say they changed the medical record, they changed it and something else has to be, and it added three hours to your day because now you have to figure this out. You know, it can be as simple as saying, I need training on this. I need time to sit down and learn this better because it’s sucking my life away from my patients and adding three hours and I’m missing my family and now I’m spending time here and it’s extra time in the case cause I can’t find it. Here’s where my patients are put in the cross hairs of, of my lack of equipment or knowledge. So being able to have a couple people that get together and say, let’s look at this, let’s distill it down and say, what is going on here? What do I really need right now first? Do I need a staff? Do I need training? Do I need– you know, “what do I need?” And then really advocating for that. Like starting, just with one thing, there’s always one thing in every department, I don’t believe that there’s anywhere in the world that you can work where there’s not one thing drives everybody nuts. So if you can make that an actionable step, it’s encouraging once it builds up, it builds up your satisfaction in your work, your personal accomplishment. So kind of doing some of those things is really, can be really powerful to bring meaning back into your work.

[00:43:41] Dr. JB: Well, on two folds, I think in the realm of leadership, those are the low hanging fruit that leaders can tackle for their employees really, to say, “I hear you, I hear your complaints, this is something we can do to intervene, to make your life better, to allow you to hopefully leave here on time, to spend time with your family, understand the importance of work-life balance,” et cetera. But then on the hand of the employee, it’s about them being vulnerable and saying, “I do not know this or I’m not very efficient with this, I need help.” And asking for help is one of those things that’s very difficult for healthcare professionals, because we’re so used to being the helpers.

[00:44:30] RN Lemmons: Yeah, which I’m, I just think, I always am like, man, that’s so hard because you can’t be a helper without help. I don’t, I don’t want to ever believe I can just go do something alone, but I think that is how the dialogue goes. And the other thing that I don’t, that I don’t ever want to get confused is because a lot of times when you’ll say, well, I’m staying late because this process is inefficient and then leadership– I’m just going to say leadership in general– says you have to leave on time. I don’t care if it’s done, how it’s done, you just have to leave on time as the solution, but that’s not a solution. That’s not a long-term solution, so that it can get kind of swept. Along with that I think, I think that as we look into people that are in leadership roles or director roles, just getting more training. That they, they need more training on team development, listening and, and all of that, because I think a lot of times– which is great as an opportunity in healthcare, that me, I’m a nurse, I have great experience, I’m CNR certified, and then I get moved up to a manager position, which is awesome– but now I need some training on how to be a manager, otherwise I can’t. It’s not– it’s a developed skill, you can definitely develop the skill, but I need some training and I need some help, and I want to advocate for that instead of just moving into the role and doing how I see fit. So I think we need to establish some of those as well, just training for people in those positions.

[00:46:09] Dr. JB: Yeah. Just like we have continuing medical education, continuing education and feedback and feedback loops for leadership.

[00:46:17] RN Lemmons: Yes, exactly, exactly. That’s right.

[00:46:21] Dr. JB: So that the employees feel like they’re always heard, because that’s also really important in terms of really gaining the backing of your employees. If they don’t feel heard or they don’t feel listened to. That’s very detrimental.

[00:46:34] RN Lemmons: Exactly, I agree with that. And it’s, I always love, I love, love, love that we work in teams, in groups of people because one person is like a strong verbal advocate and the other person is like very organized detail-oriented, makes Excel spreadsheets for fun, and you get those two together and you can really make moves and make waves in some of these spaces. So I just think that as we, we need each other’s help, we’re all meant to be like a big symphony and each has a different instrument, so working together to, to achieve those things is, is vital.

[00:47:15] Dr. JB: And along those lines, every single instrument is important.

[00:47:19] RN Lemmons: Yes, absolutely.

[00:47:22] Right? Cause also as a part of healthcare, there is that, “oh, I’m more important than you.”

[00:47:28] But reality is if, if one of those people wasn’t there, it couldn’t happen, or it couldn’t happen as well. Or everybody sees– this is a terrible analogy– but everybody sees, you can have 10 people watch a car crash and they all will explain something a little bit different, but that’s the beauty of our teams. And I, I really firmly believe and restate every day that every single person, every single person is a leader. You don’t have to wait for somebody with that title to generate the idea or to generate the steps. You are, you are a leader too.

[00:48:03] Dr. JB: But it’s, it’s on the environment that the person finds themselves working in to really provide that space for them to step into their leadership abilities.

[00:48:16] RN Lemmons: Yeah. When I was going to college, they had a student senate that was making a bunch of decisions for all the students on campus and one day I just saw a sign when I was walking into school and my class was canceled that they were having a student senate meeting that day. And I was like, oh, interesting, let me go. Let me just go check this out and see what student senate does, they make these decisions for all of student body. And when I went to the door, they said “you can’t come to this meeting because you’re not a member of student senate.” And I’m like, man, that’s interesting. You’re making decisions for everybody. So I just did all the things that I could do to become a member of student senate and then got really involved. So I also think like, yes, it’s on the leadership and the culture to open the door for you, but also go open the door. It’s, there’s usually a back door. We can find it. I will help. You can find it. There’s usually a back door together that we can get to, to say, to get in there and say, “Hey, this isn’t right” or “this isn’t working” or whatever. This person Susan over in this department has great ideas for this, and you should listen to her. That’s why we need each other to advocate for one another.

[00:49:36] Dr. JB: And if you’re burnt out, it’s hard for you to be able to, you’re so depersonalized that you’re not going to step into that leadership role.

[00:49:46] RN Lemmons: You’re going to just silently suffer.

[00:49:50] Dr. JB: Yeah.

[00:49:51] RN Lemmons: Which sucks. It absolutely does. It’s really unfortunate.

[00:49:56] Dr. JB: But that’s why we’re having these conversations.

[00:50:00] RN Lemmons: That’s right.

[00:50:01] Dr. JB: Trying to get it to as many ears as possible, really just showing how detrimental burnout is for you and your patients.

[00:50:10] RN Lemmons: Yeah. Yep. That’s right.

[00:50:14] Dr. JB: And, and how the culture of medicine needs to be changed so that allows space for vulnerability and for learning and growth and development.

[00:50:26] RN Lemmons: Yep. One of the other hot button words that I kind of go on a soapbox about is resilience and that dialogue of developing resilience in your nurses or developing resilience, which can sound like you are not resilient right now and you need to get stronger and stuff. It can, the message can get twisted really quickly. And one of those, this psychologist, which I just thought her article was great. She said we really need to ditch the R word, you know, she made it sound like a swear word, which I agree. Ditch it, ditch it, ditch it, the way that it is now where it suggests that individuals should be able to avoid or recover from burnout all on their own, they should be able to figure it out, develop resilience, dig yourself out of your own hole. It’s a fallacy. That is absolutely a fallacy. So resilience is actually defined as the capability of a strained body to recover its shape and size after deformation that’s caused by compressive stress. And what I think we need to really start saying is you already are resilient, you already have been resilient, and we need to come around these people and say, You’re not little. You’re not less. You’re not weak. This is really hard, and let’s start talking together about developing solutions through transparency and vulnerability and encouragement right through the team. The team is always the answer.

[00:52:00] Dr. JB: And in healthcare, we all work as a team.

[00:52:02] RN Lemmons: Yeah. Yes, absolutely.

[00:52:07] Dr. JB: So I love that. I’m not going to get on my soap box about resiliency, I was already there. So, do you have any last minute words of wisdom or encouragement that you would like to leave with my listeners?

[00:52:29] RN Lemmons: Yeah, good, let’s see. Let me think of my favorite ones. I just think, I would first just like to say, you’re not alone. You’re not, you’re not alone. You’re not weak. You’re not less capable. It’s okay to feel what you’re feeling and going through. Find people to talk to, don’t feel like you have to do it all by yourself, and you were created, truly, I think a lot of us are really just designed to love others and to encourage, and technical skill and wisdom, you have these great, incredible skills, but they need boundaries and they need encouragement. So, take your pause and do the things that you need to do to get back to where you started, where you felt like I’m so excited to be here doing this. What was giving you that? And as you come out of that, as you come out of those feelings and spaces, get in a leadership role, encourage other people to do the same and let’s change the whole thing. Let’s change it all so that we can be our best for our patients. Not just on paper, but as a whole person.

[00:53:51] Dr. JB: Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some. Each one, teach one. I’m done.


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