As a child, we all dream of what we want to be when we grow up, but life has a way of guiding you to where you need to be. Episode 42 of the Hope4Med podcast features NP Yvette Ash, a board-certified nurse practitioner with over 15 years of experience in the medical field. NP Ash walks us through her journey into her nursing career, from following her dreams of travel nursing to transitioning into a nurse practitioner. She shares her experience with burnout while working in busy New York emergency rooms and how dedicating time for herself helped her overcome burnout. It’s easy to get caught in the day-to-day and forget to take care of ourselves. We discuss the importance of being intentional with your “me” time and finding the activities that feed your soul and help you recharge.

Connect with our guest:
Website: https://caarehealth.com/

Transcript:
[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:02] Hi everyone, welcome back to the Hope4Med podcast. I am your host, Dr. JB, and today’s featured guest is nurse practitioner Yvette Ash, she is board-certified in family medicine with over 15 years of experience in the medical field. Welcome to the show, NP Ash!

[00:00:22] NP Ash: Thank you Dr. JB! And thank you so much for asking me to be one of your guests. As a boar-certified nurse practitioner, I literally have worked in almost every facet of the medical field. I started as a nurse technician, which is equivalent to say like a medical assistant or a CNA, and from there to nurse and then to nurse practitioner. I know the ins and outs of the hospitals and the urgent cares, but nursing is by far my passion and I absolutely love it. So thank you so much for having me.

[00:00:57] Dr. JB: Let’s start from the beginning, why did you decide to pursue a career in nursing in the first place?

[00:01:04] NP Ash: So to be completely honest, I did not decide to pursue a career in nursing. I pursued a career in medicine, I wanted to be a pediatrician, I always loved kids. So from a little child, I wanted to be a pediatrician because I played with kids, the babies loved me, and I was like, this is what I’m born to do. And then I got to college and some of the courses you have to take in order to pursue medicine, such as like bio-diversity and things like that, it was like, why do I need this? And I then started to reconsider my life choices. Oh, I want to have a family. I don’t want to be on call, all these different things and myths that kind of come– not all complete myths, but when you don’t really have a clear understanding, you talk yourself out of a certain path. And so that’s what happened to me as far as medical school.

[00:01:58] And so I said, you know what? I’m going to do the next best thing, I’m going to be a pediatric nurse practitioner. So I then transferred into, considering the route of nursing and a lot of my background, I’m a very active person, and so also what did not fit my lifestyle at the time was I played basketball. I played division one basketball, and nursing school nor like full medical career would allow me to do and pursue those things at the time. And while I was actually in college, I did get a degree initially in health services administration because that allowed me to continue to play basketball, which actually paid the bills at the time because I was on scholarship. So that’s like where it started.

[00:02:40] And then how I transitioned. So, once I did transition into nursing it was after I had graduated from my undergraduate with health services administration and then I did an accelerated nursing program that was offered at my school. And, and so with that, I got into nursing school. It was a quicker route, and I found that after my first rotation on the pediatric floor, like as much as I did love the kids, I didn’t necessarily love working with their parents. And so I was like, yeah, this is not giving me all the feels that I was hoping for, so at that point I said, okay either way, I’m in nursing school, I’m going to just continue on. And where I actually thought I would never want to work with adults as I continued in my studies, on my practicum, which is the last semester or like your last course of nursing school, I had a, my rotation was on a surgery trauma floor, only adult, and then I absolutely loved it, which then led me to the emergency room

[00:03:44] Dr. JB: It’s so funny how you said that although you liked working with peds, parents? That’s a different story.

[00:03:51] NP Ash: Yes. It, you don’t think about it at the time, the kids are, are the easy part in pediatrics. It’s dealing with the parents that becomes a harder issue. You don’t have that when you’re dealing with adult patients, even if the parents are there, at the end of the day, it’s the patient that is your responsibility and that’s where your that’s where, your focus lies.

[00:04:17] Dr. JB: But with kids, that’s a whole different story because they can’t make decisions and so you need to convince the parents.

[00:04:23] NP Ash: Correct. And that can be, it’s a challenge.

[00:04:32] Dr. JB: No, I completely understand ’cause I also wanted to do pediatrics. When I started my training in medical school, everything was peds, everything for like ever since I was a kid, I said peds until I did my pediatric rotation. And then similarly, similar to you, I changed my mind.

[00:04:52] NP Ash: So I often tell, I try to tell my students and all the nurses in that I come in contact with early on, listen, don’t paint yourself in a corner, just go in with an open mind because in the end you really don’t know what’s gonna strike your fancy. You think it’s going to be this and in the end, it’s not what you thought it was going to be.

[00:05:14] Dr. JB: And it’s so common, it’s so common. And really just giving yourself that flexibility to change, it’s perfect.

[00:05:22] NP Ash: Yeah, cause oftentimes we’ll, because we said no, but this is what I’ve always said, and then we have this fear of No, I can’t change my mind because this is what I’ve always said I was going to do, it doesn’t matter.

[00:05:37] Dr. JB: Exactly. So then you found yourself in the emergency department?

[00:05:41] NP Ash: Yes.

[00:05:43] Dr. JB: And how was that experience?

[00:05:45] NP Ash: Oh, so I loved the, I say, not loved, I still love the emergency department. How it went for me, so in nursing school, right after your first semester of nursing, you can actually get a job in the, in a clinical area and so I did that. I went though to say nurse administration, where I would do the hospital admission, so I spent a lot of time in the ER, collecting information for the admitted patients so the nurses on the floor wouldn’t have to do it. And so, that’s where I started. It helped learn, helped me to learn different disease processes while I was in school, helped me to correlate the medications that went with them, and so I was just a really good starting point. And then I didn’t have to work a lot, they understood I was in school, maybe 4 to 16 hours a week max is what I was actually doing, but it gave me a foot in the door so people could see my face and learn my name.

[00:06:39] So when it came time for graduation, I actually started to pick up shifts in the ER because they would see me down there a lot. One of them– they gave me an opportunity to be there as a nurse tech while I was still in school, so I would pick up shifts here and there, and like I said, I only did it very few hours and it was just a means of saying, “you know me, I can do this.” And so, and that worked out in my favor because when I graduated, I got accepted into the emergency department nurse internship program, where a lot of like nursing instructors or teachers will say, don’t go into the emergency department or the high acuity areas straight out of nursing school, make sure you go to med-surg and learn your time management and all of these things, which that is also a myth, I do not prescribe to that because I was one of them. And then after being in the ER for a while, you have to unlearn all of those med-surg bad habits. So I say if you’re interested in it, push forward. So in any case, I, it worked out in my favor, I got accepted into the nursing internship program and it was because they had knew me, and I got in, I loved it.

[00:07:49] I’m a third shifter, I love night shift. I like the ability to– it’s just, it’s a different lifestyle all around working that third shift. So I worked 7 P to 7 A starting out in training, however, when I got off of training in the emergency department, which was about three months training, there was no room for me to go on night, so I did transition to day shift. Which is just, like I say, it’s just for different people. Fortunately, I can go day or night so I did fabulous on the day shift, but I’ve always been a night person and so that was where I would prefer to be. So after a year, I did transition back to nights at the emergency room I started in. And I think that’s going to be the difference wherever you start your career, it matters where you start. Fortunately, for me, my emergency department was very busy. We did not have residents, so all of the skills that I learned I had to take with me, but I had to do everything. There was an electronic medical record, however, we still had to take phone orders. So I had to learn to take, first of all, I had to learn how to communicate well with the doctors, I had to call them for orders, I had– because there was no one else that, there was no intermediary, so it was nurse, doctor. And in the ER, nurses and doctors have a very different relationship of working relationships, so that was easy and it really helped me to grow.

[00:09:09] Also in this ER, it was all ages. So we saw from birth to, you know, from cradle to grave, we got to see everything. And that was also great for me because a lot of ERs these days you find are separate. You have your pediatric ER and you have your adult ER, so if you start in adult only ER, but then you have the transition to one that sees kids you’re completely lost.

[00:09:34] Dr. JB: That’s right. And that’s the same with the docs too, after they graduate and they spend time just working in the adults and then they have to pick up a peds shift, it’s very uncomfortable.

[00:09:44] NP Ash: It is. And so I was so happy because when you get out of school, that learning curve literally is 180 degrees up and starting with the exposure, with that wide exposure to everything was amazing. And like I said, it was a very busy ER, so like we would have, we could have multiple codes going on at the same time, but there was, we’re going to save you, you know? Even the doctors, we got to get it on. So it was great.

[00:10:15] Dr. JB: How long did you work there?

[00:10:17] NP Ash: So I did, I was there for, I did right at a year and about nine months. I was supposed to give them two years, but I cut it short, saying I don’t think they would realize and I don’t think they’d come back after me for the money I shorted them from leaving early, but I had the travel bug and I was ready to get out of there.

[00:10:43] And so I left that, which I would tell you, my first job was so amazing, I actually I loved everyone I worked with, it was such an inviting environment, I really felt like I could have retired from that job. That’s how much I actually did like it. However, I’ve never been one for stagnation I’ll say, or comfort. I like to move around, so at about that year, nine months– the goal was always to travel as a nurse too, so it was like, all right, it’s time. And so myself and one of my sorority sisters who we went through nursing school together, we began traveling. So we left there and we went to California, and fortunately with the ER, there’s always opportunity. They always need ER nurses and so getting a travel assignment was not hard at all. And so we got a travel assignment in California and we worked in the ER there, we stayed there for about nine months and then we transitioned from there. I went to south Florida, which is where I was from originally, she went to Okeechobee, Florida, which is where she was from. So we stayed there for about three months while we worked on our next travel assignment, which was to New York and then we went to New York together where I then stayed for five years.

[00:12:06] Dr. JB: Wow. You got that New York city bug.

[00:12:09] NP Ash: I think– I’ll tell you what happened. That was not the plan. Me and my sorority sister, when we set out traveling, we had a list of all the places we were going to go to and we said, we’re not going to get stuck. We’re going to try all of these places cause at that time where we’re singles, we have no kids, so we loved California so we stayed there for nine months, which was, I was okay with that. Went back home for a little break, okay, and then we transitioned to New York, but then after our first assignment in New York, she wanted to go back home, but I was not going home. I didn’t also want to travel alone, so I stayed in New York longer. So she was only there actually for three months and then I stayed, built more of a, like a working relationship with the nurses there, and then oh, this is cool, since I don’t want to necessarily travel on my own, I guess I’ll stay here.

[00:12:59] And then part that was also different in New York is that New York is so progressive overall, and it’s always been a very progressive state, and so with the nurses that I worked with, a lot of them were already in, in school for another degree of some sort. Most were in school for nurse practitioner, some for just a master’s level, but they were all in school pursuing something else. And so then it was like– and the reimbursement was better than Florida, but I come to find there were better places in New York for reimbursement, however, it was much better than what I was familiar with. I said, I guess I’m going to jump on the bandwagon and go back to school, hence two years of school. And then I got my first NP position in New York, and then another three years. So five years total. That’s my New York stint.

[00:13:54] Dr. JB: Got it. And I’m sure that time went by in the blink of an eye. It didn’t feel like you were there for five years.

[00:14:01] NP Ash: Sometimes. New York is not an easy place to live, especially as a Floridian. It’s a big culture stock. I will tell you every year I was like, I can’t wait to get out of New York. You know, we had a freak snow storm in the month of October, and it’s like, how is it snowing in October? New York, I do I love New York for, I think New York is actually the best place to go and visit, have a summer home or a winter home or something like that, but it’s not a place to live permanently for me as a Florida girl.

[00:14:39] Dr. JB: So was it, is it just the cold weather that was like not doing it for you? Or was there more to it than that?

[00:14:44] NP Ash: Oh, there’s way more to it than the weather. ‘Cause I don’t mind the cold weather, but honestly, a lot of it has to do with the people. The mentality is just so different. You– as a Floridian, you get there, you’re walking the street, “hi, how are you doing?” People are friendly. And it is none of that, you lose that. And then just a lot of the brashness, some people really like that, some people feel like, oh, they’re just keeping it real. Sometimes they’re just flat out rude for no reason. And it’s just like, yeah, no, you don’t have to be that way to be like, oh, I’m keeping it real or, but I mean now, don’t get me wrong, I met some great people in New York and some of my better friends are actually some of the nurses that I worked with there, but overall as a society. And it’s just like a lot of it feels like– it’s always a dog eat dog world, but I feel like it’s amplified in New York. And so that was also just harder to get used to. But the progressiveness, as far as how liberal they are, how open-minded they are, that is very different than where I came from as well.

[00:15:54] Dr. JB: Yeah. No, it’s funny because I trained in New York City for residency, and as a Floridian myself, I remember going up there and when you said, oh, from the south you’re, everybody is so nice, and I clearly remember when I got to New York and I was in the Heights walking around, trying to make eye contact and say, “hello, good morning,” they walk by and they just ignore you, and getting cursed out on my shifts.

[00:16:24] NP Ash: Yes, you lose that really quickly, right? You lost that real quick.

[00:16:29] Dr. JB: Yeah. Yeah, no, I stopped that so to the point where, when I went back down south and people were approaching me trying to say hi, I was like, what do you want?

[00:16:40] NP Ash: Do you need something? Did I do something to you? I’m sorry, you’re looking at me, what’s up?

[00:16:48] Dr. JB: I’m not used to this friendliness. What are you talking about? “Hello. Good morning.” Okay. Good morning. But…

[00:16:54] NP Ash: And the other part of that, the other part of New York, actually in the hospital system, I won’t say everywhere in New York, but in the hospital systems that I worked in and I worked in more than one, a lot of it becomes a whole sense of entitlement overall. There’s a lot of sense of entitlement in New York, from the citizens, from the non-citizens, to the immigrants that, and that was pretty taxing as well. I don’t feel that I necessarily, some of the other hospital systems I worked in prior to New York, and I probably say I worked in about a good other like 10 other hospitals prior to coming to New York, I didn’t feel like that heightened sense of demand, of “I demand you do this for me,” or “you have to!” Listen, I would tell my patients, like I love nursing and I love my patients, and I say, you know what? A lot of patients, they may or may not, they either love me or they hate me. I don’t really have that in-between of nursing. And I tell them, I will give you everything that you need but I may not give you everything that you want. And there, it was a lot of demand for things that were not necessary, and that a lot that really pulls on you, like becomes mentally, emotionally, physically draining in the healthcare.

[00:18:11] Dr. JB: When we talk about being emotionally, physically, mentally drained, highlights aspects of burnout. So did you experience burnout yourself?

[00:18:20] NP Ash: Yes, I would say I definitely did. I feel like I’ve had, I had a lot of coping mechanisms that I employed where I might not have actively known in the moment that I was going through burnout and using these coping mechanisms or methods of like self-care, but when I finally graduated out of NP school and I could leave the bedside of nursing, like step away for a bit, it was like, I can’t wait!

[00:18:55] And it was like, most people they, people ask me why do you really want to be a nurse practitioner? And it, because in New York the pay scale is not that large of a gap between say a nurse and a nurse practitioner. So people, and sometimes nurse practitioners will take a pay cut when they transition from their nursing– New York nursing job to a nurse practitioner job. And so they couldn’t really understand, some people couldn’t understand why I would go back to school and it became, I’m tired of breaking my back, like I want to be able to have my back for when I do have kids so I could run around with them. And it was just so physically– and like I said, it could have been so emotionally, depending on the day just– and I don’t wanna change poop anymore. That was the other big thing, like poop was my big nursing thing and I was tired of changing diapers because forget about having help sometimes.

[00:19:48] Dr. JB: Oh man.

[00:19:53] NP Ash: So I have, so we talked a little bit about the burnout, but one of the biggest things, what I didn’t really go into deeply enough is oftentimes in nursing school, we always, we talk about what we need to do as nurses or say– and I can only speak from a nurse perspective, so I’m going to give you my take on it– and in nursing school, it’s how do you take care of the patient? How do you do this and how do you do this? But always for the patients, they never do actually talk to the nursing student about how to take care of yourself while taking care of all these other people. And that comes into how do you then prevent potential burnout or things of that sort? And that will be self-care, right? But self-care is such a generic word that is thrown out everywhere these days but no one really explains or helps you to understand what exactly is self-care.

[00:20:47] And self-care is going to be, it’s going to be individual to the person and it’s going to be finding that thing or things that help to elevate you. For some, it could be taking a bubble bath. For others, it could be maybe having a glass of wine where then that glass of wine is completely destructive for other person. For some, it may be just taking a walk, being in nature, listening to some calming music or dance music or whatever the case. It is really going to be individual to you, but you do have to find those things that can help ground you and help give you space to breathe and get back centered.

[00:21:31] And it’s really funny, I was talking to one of my coworkers and we were talking about it. I was like, yeah, when my patients come in, I always, some patients if they come in really stressed and things like that, I’ll, I have a sheet of coping mechanisms that I’ll provide to the patients and she says, “oh that’s great, but do you ever actually provide that say to your nursing students or anyone else?” I said, you know what? I never have. And it was just like, how eye opening is that for me, who knows what we go through as nursing and as I bring my expertise to nursing students, I have never thought to say my nursing students could benefit from having this list of coping mechanisms as they began their careers, because depending on how they work or their schedules, inevitably you can, you will start to feel the weight of the career choice you’ve chosen. And so that is going to be very important, and I really think that we need to pay more attention and provide more services to healthcare professionals to help them perhaps prepare for it before it gets to that point.

[00:22:45] And I really think that your podcast and your presence is helping to bring more information and knowledge to individuals about how they can help themselves and know –and showing them that they’re not alone, there are so many things, it could go on forever.

[00:23:01] But I will also say, one of the biggest things I will say that I also, after doing, looking into some research, like I said, I probably wouldn’t have thought or felt I was truly burned out, but one of the things I realized that maybe why I never felt as burnt out as I was, looking through articles and things, they were saying how to prevent burnout and things of that sort is when I was in New York– and New York was probably one of the hard, not one was the absolute hardest, harshest working environment that I ever had to work in as a nurse. And let me just paint the picture really quick, is when I started there as a traveler, before going as a traveler, the agency, my recruiter was like, are you sure? Are you sure? Like she did not want to send us to New York because she had actually had nurses back out of their assignments because of the conditions that they had to work in. We were like, Nope, we are going to New York, so we went and when we got there, we understood why she questioned us so much of, are you sure you want to go and do this? Because when we got to New York as travelers, we, it was not uncommon to have a 19-patient load, a 21-patient load, and this is in an emergency room. And it’s not, like you say, oh, I’m just a traveler so that’s why they’re giving me all of these patients, because everybody had that amount of patient load, so we weren’t being singled out. It is what it is. And we, I worked in a very busy ER, it was not uncommon to have 180 patients in our emergency room at any given moment. It was just really that busy. So among the 19 to 20 patients, you could have an ICU patient, a neuro ICU patient, a surgery ICU patient, and then amongst you have all these other patients in between that may be a toe stub or an alcohol withdrawal, then it just went on and on.

[00:25:03] And so it really taught me time management, but one of the biggest thing is that I had an amazing group of nurses that I worked with. They were smart. They were, it was a pleasure to work with them. They, we would help each other out. So that working environment where it was really stressful, we all came together to help with, help each other through this shift. And sometimes you don’t get that depending on where you start out of nursing or, or at any, at the hospital system you’re just working within, it’s not always that collegial. But I think that’s maybe why I did not necessarily feel the burnout as bad as it could have been because I had help. We would have a terrible shift, we would go have breakfast together. When we got off, out at 7:00 AM, we’d go have breakfast, maybe we finish at noon, because we just sit around and enjoy the day we– and I miss that, but like I said, I still keep in touch with a lot of my coworkers from New York. And so, it was a beautiful thing, but so that would be one of the really big things that would help, those strong coworker relationships.

[00:26:15] Dr. JB: When during your career, did you realize the importance of incorporating self care?

[00:26:23] NP Ash: I don’t know if I ever really, if I necessarily took stock and said, okay, I need to start doing it. And I probably would say if I did, it would have been more, it would be more recently and it would have been after I actually had a child, as when I was single or even if I were in a relationship, it did not demand as much of my time or energy. But when I became a mother, that’s when everything shifts. And then it just becomes a really high stress, just like overwhelming at points and that’s I would say when I started to realize, okay, wait a minute, taking care of baby, taking care of daddy, but wait, taking care of patients, but where am I? And that’s when you realize, okay, I need to dedicate time here. I need to dedicate time over here.

[00:27:12] Dr. JB: But it also has to be very intentional because if you’re not intentional about it, it’s not going to happen.

[00:27:22] NP Ash: Very true. Cause it’s so easy to fall back into those habits of just moving and following, going with time, you know, time is going to pass with or without you, everything ends. And so you do have to intentionally seek moments, seek time. I now have a journal that I’ve been using, it’s called the Finishers Journal, and it’s really nice because it helps you to compartmentalize and help you better define like tasks that have to be done versus tasks that you want to get done. And so with that, it also helps you to be more intentional with habits, daily habits, nightly habits, and things of that sort. And at one point I actually had one hour of free time, like just me time, one hour is all I had for the day, one hour! And I will tell you, that was hard. That was really hard for me to actually– always, and I didn’t always check that box, but you’ll have to, we have to find the time. It’s important.

[00:28:24] Dr. JB: You have to carve the time out, because that’s all part of being intentional. You have to intentionally carve out that me-time and then fill in everything else around that carving.

[00:28:39] NP Ash: Correct. Yeah, you really do. And it’s not easy.

[00:28:45] Dr. JB: No, it’s not.

[00:28:47] NP Ash: But necessary.

[00:28:47] Dr. JB: And it’s not something–, it’s not something that we’re used to doing. So that’s also part of why it’s not easy because when you’ve been going so long without prioritizing yourself and now you’re supposed to change things around and start figuring out how to do that, it’s definitely a learned skill, but with the more you do it, the easier it becomes.

[00:29:12] NP Ash: Yeah. And part of that becomes a fact that when you work in healthcare, most of us go into healthcare with these grand ideas of like literally changing the world and making everybody feel better and all of that good stuff, so we have that nurturing spirit. It’s not something that only came because I’m a nurse or you’re a doctor or you’re a paramedic, it’s in you. And so it’s not just when you’re at work, you’re busy taking care of people, it’s then when you’re also out in the world in plain clothes and taking care of people and you’re just, most of us are also very more giving in general. And that becomes a task.

[00:29:56] Dr. JB: Yeah. Since we’re so used to taking care of people and giving, what would that look like if we took care of ourselves, what does that look like?

[00:30:07] NP Ash: What does that look like? One, it looks like boundaries and then making sure people respect your boundaries. And that becomes a large charge because that you’ll feel, not only will you feel, everyone around you will feel ,when you say, listen, don’t call me after 9:00 PM, that’s my me time. They’re like, “wait, what?” Or when they call and then you don’t answer the phone, “I was calling you.” I told you that’s my time. And yeah, that, it becomes– and you ‘ll, like I said, you’ll feel it and everyone else around you will feel the difference of when you do start to really take care of yourself, but they will in time, once you are more recharged, they will then also reap the benefits.

[00:30:50] Dr. JB: Exactly. And so will you reap the benefits, so it’s a win-win situation.

[00:30:56] NP Ash: It is, yes, it won’t start out as a win-win.

[00:31:00] Dr. JB: No, not at all.

[00:31:02] NP Ash: It’ll feel like a win-lose for the other person, however, and even for yourself because it’s not easy for us to then carve out that time. It’s not easy for us to say, Hey, I’m not available. To be easily accessible at all times. But you get better with time, like you said.

[00:31:23] So when it came time for me to get to step away, I was so excited. I could not wait to find an inpatient, to get out of the ER. And so I did. And when I did, I put in my two weeks notice, I was out of there. And I will tell you, I went back into the ER, nine months later. And so I had my NP job, my full time NP job, and I had my per diem ER nursing job because I missed it, but I needed that time to like recharge and step away. And… and when I came back, I was definitely a better nurse. And even if I feel like, some people don’t understand like nurse practitioner roles, but every role is different in healthcare. And when you finally transition to a new role, you can then better understand your role and the role you play and the other person’s role in the grand scheme of healthcare. And–

[00:32:26] Dr. JB: What do you mean by– could you elaborate on that a little bit, what do you mean by that example?

[00:32:29] NP Ash: So like when I was a, when I was a nurse tech– so this is where it all started for me and I realized it because I lived it and I went through it– so as a nurse tech, I would go through, I see the patients and be like, oh, can you do that to me? Or can you do that for me? Yes, let me let your nurse know. And so then, I became the nurse and as I’m going to my rooms, I’m doing my thing, then, oh this, that, and this and other, and I’m like, oh, okay, let me let your doctor know. So then I’m moving on, I’m moving on, and then I became, I became the nurse practitioner and it’s oh, I need such and such, and it’s oh, okay, I guess that buck stops here. And it’s okay, give me a minute.

[00:33:09] Now with that in mind, I remember as a nurse in the emergency department, and New York is my first hospital where we actually had residents, so that’s where I first encountered residents, and this was probably, so this would have been about my three years, or four years into nursing and I never had residents prior. So the system was different in that there’s a lot of duties actually they take away from the nurses because there’s residents and they would like for them to also get some experience in procedures and different techniques that are actually nursing duty. So in the case when it would, I would be in the ER and I’d be with a resident and I’m like, Hey doc, the patient’s having a headache. And the residents would be like, “oh, okay.” Can you just order the Tylenol for me? Tylenol, ibuprofen, it doesn’t matter, can you just give me something? They have a headache, and it was like, “wait, I need to check liver function. I need to make sure the kidneys are okay,” and as a nurse, I didn’t understand this. Okay.

[00:34:10] So then I became the nurse practitioner and it was like, the nurses would come to me and “oh, doc the blood pressure’s high” or “doc, patient has a headache,” and I’m like, but wait, are they on anything? Let me check this. Let me check that. And so then I really, I better understood the resident and I had more compassion for them when I did return to the emergency department because I did not have that prior to. And a lot of it is because our training is very different. As a, when the residents are there, they don’t necessarily have the experience at the bedside. They definitely don’t get as much experience at the bedside as a more seasoned nurse as I was at the time, and so sometimes, I couldn’t correlate like what they’re going through, how their processes went. And then when I became the nurse practitioner, I fully grasped what, how you had, how your mentality has a change in how you approach the medicine. And so where nursing is very physically draining, nurse practitioner and, you know, above, it’s so mentally draining from trying to make sure that you are following orders or evidence-based medicine and doing things in accordance to help protect yourself and protect your patients. And so that’s what I mean when I say the role transitions are so different. You think you know it because oh, I’m a nurse, but you don’t know anything until you then become the nurse practitioner.

[00:35:43] Dr. JB: But I thought that was very interesting how you’re like, okay, I’m an NP peace out, here’s my two weeks, and then a mere months later, you’re like, ah, let’s pick up some extra shifts.

[00:35:55] NP Ash: Yeah, nursing’s my calling. I love ER nursing, I absolutely do. And yeah, after about nine months, I was like, cause I felt like the transition for me from nurse practitioner into– from nursing into nurse practitioner– so I became a hospitalist, which was my first job, which I did, I loved being a hospitalist. So I got to see from an ER nurse standpoint, I know exactly what we did as a nurse, and then as a hospitalist, I admitted the patients from the ER. So then I see all those kinds of bad habits I used to do as a nurse too, I also see that how they affected the patients when they got up stairs, some bad habits, some not so bad. ” Hey, give this patient a bolus at 125,” and you’re like, yeah, okay, the bolus is going, and next thing, it’s not eight hours, nine hours later, it’s like four hours later and you’re like, the bolus is done. And then the patient’s on the floor and they got crackles in the bottom and it’s well, didn’t they know? They weren’t paying attention, things like that. And so I love seeing full circle how the patient transitions from ER to the floor. And then I would see them maybe either through, I’d worked for observation unit so I would either see them to full on admission or discharge out of the hospital.

[00:37:09] And so yeah, but even to, I will say I was still working in the ER as a nurse up until 20–, 2018?, 20–, 2018, 2019. I, I would still pick up shifts in the emergency department and then it just became a little… reconciling the pay scale, because then I moved to Georgia and I was working in Georgia at the time, reconciling the pay difference between a nurse and a nurse practitioner in Georgia is major. And it was like, as much as I love this ER, I can’t reconcile coming here when I can make like $30, $40 more at my NP job if I pick up a shift or something. So that’s when I finally had to stop.

[00:37:59] Dr. JB: And that’s completely understandable. Now when you’re saying 30 or $40 more, you saying–

[00:38:02] NP Ash: Per hour, yeah.

[00:38:06] Dr. JB: That adds up.

[00:38:07] NP Ash: Absolutely. And that’s why I was like, yeah, I love this, but yeah, I can’t do this. And then again, I did, working as the nurse, working as the nurse at the bedside, the nurses do most of the work. The doctors are there, but the nurses are so highly involved with the patients and It’s work. I love it, but it’s work, it is not easy.

[00:38:33] Dr. JB: Yeah. Because doctors don’t deal with poop, it’s usually, oh, let me see who I can get to help you with that.

[00:38:41] NP Ash: Exactly. And yeah. Yeah, that can be the challenging.

[00:38:45] Dr. JB: Except for if we have to like disimpact, then we’re the ones that are doing that mostly, but, that’s

[00:38:48] NP Ash: Let me get your doctor in here, come on doc!

[00:38:53] Dr. JB: So now what are you doing?

[00:38:55] NP Ash: So now I still pick up shifts. I am self-employed, the lovely 1099, I will, I’ll pick up shifts periodically at an internal med clinic and then I will also, I’m working on my own business full-time, that’s really what I do. And with that it’s, the business is Caare Health, Caare Health Enterprise, and here, what we do is we use we provide American Heart Association certifications. So that would be your BLS, your PALS, ACLS, we also do medical assistant training courses, we do, I do DOT physicals for truck drivers or anyone who, you know, those other like Class C drivers and things like that, and then we do a comprehensive health and wellness assessments. So we provide a variety of services for individuals. And, and yeah, so that’s where I spend most of my time these days.

[00:39:55] Dr. JB: Okay. And this is out of Georgia?

[00:39:59] NP Ash: Currently out of Georgia.

[00:40:00] Dr. JB: So, If anybody wants to find out more about your organization, how could they find that out? Or how do they–

[00:40:06] NP Ash: Yeah, so we have, we have a website and that’s going to be CAARE Health, care with two A’s, C A A R E health, H E A L T H dot com and we’re CAARE Health on Instagram, on LinkedIn. Yeah. And that Instagram has where we currently post most material now, but coming soon, will be more YouTube and things of that sort.

[00:40:31] Dr. JB: Excellent. And in closing, do you have any last minute words of wisdom for my listener?

[00:40:38] NP Ash: That when you start to feel like you’re losing yourself because you’re in this day-to-day routine rat race of just doing tasks, but you’re not doing anything to feed your soul. And feed your soul is whatever that means to you. Whether it’s you have your religious beliefs, you have exercise, you have meditation, you just have journaling. There’s so many options of whatever it takes to feed your soul and only you will know what really recharges you individually, but sometimes it’s even hard because you don’t even know. You’re so busy caring for other people that you don’t take the time to realize what it is that I need. And I’m actually one of those people. It’s like when you think about, you have to really search yourself to find “what is it that I really enjoy?” Or what was it as a child that I remember doing that just brought me so much joy, and sometimes I think I know and other times I still don’t think I know. And it’s just a journey that you have to go on with yourself to find that, I won’t even say balance because finding a balance is so difficult, but at least finding ways to help nurture yourself in the midst of trying to nurture everybody else.

[00:41:55] 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.