Nikki Greenaway: Continuing education is key. If you think that you know everything, then you’re a dangerous nurse. You’re a dangerous nurse…
Nacole Riccaboni: Yes. Yeah.
Nikki: If you think you know everything, like, “Oh, I got this. I got this.”
Nikki: If you don’t come to work with some type of anxiety…
Nikki:…then you’re a dangerous nurse.
Nacole INTRO: That’s my friend Nurse Nikki. Nikki always tells it like it is, and that’s what I love about her. We hit it off right away. Nikki is a nurse practitioner in New Orleans and she’s also the strongest advocate for maternal justice that I’ve ever met. She’s amazing.
In this episode, Nikki shares her early experiences in nursing, and why she believes that we all have to keep educating ourselves, especially during COVID times.
My name is Nacole Riccaboni. I’m a critical care nurse working in Florida and your host for SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT is sponsored by the Robert Wood Johnson Foundation.
Follow us on Instagram at @shiftnursing and for more awesome stories and real talk about nursing, head over to our website at shiftnursing.com.
One final note: This episode was recorded in mid-July, and things with COVID might have changed between now and then. Let’s dig in…
Nacole: Well, Nikki, we’re just going to get right into the questions, my love, because I know you’re probably a busy bee. Talk to me about your start as a pediatric ICU nurse.
Nikki: Let’s see. So, I graduated from nursing school at Loyola in Chicago, and up there, I worked with the – we call them PICU nurses up there. And it was really cool, you know, all this amazing equipment and technology and stuff.
And then when I moved to New Orleans and I was like, “I want to be a PICU nurse,” and they were like, “Okay. Well, we don’t usually let new grads, but we need you because we’re short because folks keep leaving.” I’m like, “Well, I wonder why folks keep leaving.”
When I got in there, it was like M*A*S*H* 2.0. I felt like we were making stuff. It was always something like, “Oh, do you have this? I used this in Chicago.” They’re like, “Oh, no. We don’t have that here. Here, let me show you how to make one.” I’m like, “I don’t think we should be doing that.”
Nacole: Oh yeah, that could be pretty sketchy. I get it. I get it.
Nikki: They’re like, “We’ve been doing this for years.” But one of the unique things about my experience is that I was trained or precepted by all men.
Nacole: Oh, really?
Nikki: I had four male preceptors. I never had a female preceptor. And if I did, it was because – just a one day thing.
But it was mainly Tommy and Justin and Dominic, and we were all – it’s so different, I feel like, when a female nurse and a male nurse – cause they were just sitting up there doing crossword puzzles. And they’re like, “Look, you got any questions, come get me. Don’t do nothing that you don’t feel comfortable doing.”
Nacole: Yeah, they’re pretty hands off, from my experience anyway. They’re very like, “Do your thing. Call me if you need me, but I don’t want to be all over you.”
Nikki: Right. But the emotions are removed. I felt like I got a lot of objective information, and it was just a different dynamic than what I got in nursing school and what a lot of my peers at the same level got.
And they’re like, “Oh, you got to do that?” I’m like, “Yeah. He was standing right there. He said – you know, and he was just sitting there with his arms folded and he’s like, ‘Oh, you’re doing it?'”
Well, and I just felt like it was just a different way of learning that I wasn’t exposed to before. And I’m appreciative of it.
Nikki: Yeah. So, it just kind of threw me right in and got me in there. But from that I felt like it kind of strengthened me because I was a charge nurse within that year of starting my nursing career, which is unheard of in our PICU.
Nacole: Uh-huh. So, they didn’t take new grads initially, or?
Nikki: Yeah, they didn’t take new grads initially. And they wanted – if you were a new grad, they wanted to make sure that you had, that you were a tech there ahead of time so you already knew the ropes.
Nacole: Oh, okay.
Nikkie: And I was coming in from Chicago fancy hospitals.
Nacole: Super fancy.
Nikki: Super fancy with brand new pumps, and I’m going over here using a tourniquet to make a pump.
Nacole: Wow. Big change.
Nikki: It was a big change. But it was awesome cause I just got to see everything. And when you look at the health disparities here in New Orleans, you really do see everything. So, I really appreciated that about my education and it’s something that I wouldn’t trade for anything.
Nacole: Was your experience always positive or you felt like you had a lot of bumps and kind of hurdles to get over?
Nikki: There were some bumps. There were a few bumps, and I think it wasn’t necessarily anything like blatant bumps. But it was, you know, like you see the dynamics of the nurses that have been there a long time and the student nurses and I’m like, “No, y’all. I’m a real nurse now.” And they were like, “Ah, no. You’re still a student. You’re a student.”
Nacole: Oh, so they could never see you as their equal kind of situation?
Nikki: Right, right.
Nacole: Oh, gotcha. You were always a student, forever a student.
Nikki: I was a student nurse and they were like – and then they kind of pat you on the head and I’m like, “I’m a grown ass woman. Stop that.”
Nacole: Yeah. I experienced that too. It was like – I mean, I was a student when I trained here, but I’ve been here for three years and you’re still trying to mom me a little bit.
And I don’t know if that’s something that you’ve experienced, but at first I was grateful. But then the dynamic never changed, and I was like, “I don’t understand why you can’t see me for more than kind of like your underling.”
Nikki: Right, right. It was like that for a while until I was just – it was – we had a code, and after that code, you know, I went in and I was helping another underling myself cause it was her patient. You know, talking her through it.
And – because I’ve been teaching CPR. I’ve been a CPR instructor for 15 years even before then, so I knew how to run a code.
Nacole: Oh, really?
Nikki: You know, it was in me and I was, you know, running it and they were like, “Oh, snap. She may know what she’s talking about.”
So, after that it was kind of like, “Oh, okay, well, you know, come help me with my patient and let me show you something.” So, it was then the elder nurses were kind of like, “Okay, I kind of -”
Nacole: We trust you now?
Nacole: Oh, you finally got the clearance from the higher ups.
Nikkie: Even the residents trusted me.
Nacole: That’s funny. Now you mentioned a story about you being written up before.
Nacole: So, what happened there?
Nikki: So, I was pulled to the cardiac ICU, which is no one’s favorite place to go at our hospital.
Nikki: I love the babies. I semi-love the nurses. It’s the cardiothoracic surgeons.
Nacole: Yes, girl. Don’t even get me started. I worked with CT surgery for, oh god, six months. And the level of emotions? Oh my gosh.
Nikki: Oh my gosh.
Nacole: I cried every day. I cried every day.
Nikki: Every time I pulled.
Nacole: Every day.
Nikki: Every time I pulled, I was like, “Okay, let me make my checklist. Let me look at my patient.” I felt like everything had to be the most perfect cursive.
Nacole: Perfect. Heightened level of perfection, level of stress. It’s a whole different ball game there for sure.
Nikki: Yes. We had two cardiothoracic surgeons, and this is how bad it was. One they called God and the other one was Baby Jesus.
Nikki: That is the level of insanity. One morning, Baby Jesus comes in and I’m like, “Oh my god.” He’s like, “No, remember? I’m Baby Jesus.” And I’m like, “Oh my gosh.”
Nacole: Yeah, these nicknames are not suggestions. They are where they want to be called.
Nikki: Oh my goodness. So, the nurses were kind of on that same level sometimes of, “Maybe we have Nefertiti over here,” or whatever. Some royal folks.
Nacole: Yeah. You know cardiac nurses. You know how they be.
Nikki: The head is always tilted up. I’m like, “Bring your chin down, bring your chin down.” So, yeah, I was seeing a patient. I had a baby who – our babies come back to the bedside with their chest open from cardiothoracic surgery, because if you close them too soon, then it would cause extreme swelling and it could pop.
Nacole: Oh, wow.
Nikki: And you want the incision to stay together. So, they would come back and then they would close them at the bedside after a day or so.
Nikki: So, I had a baby there, chest open, and a mom. The baby’s mom came by the bedside and said – you know, we were talking. I was just giving her the rundown. And she was like, “Okay, well, I’ll be right back. I’m going to go have a smoke.”
And she’s like five months pregnant. And so I’m looking. I was like, “I don’t know if we need to do that.” I said, “Are you sure you want to go for a smoke?” She said, “I know, I know. I’m trying to quit.”
I said, “I know quitting is hard.” I said, “But maybe I can help you with some resources of getting you some help and cutting down.” So, I talked about starting the first cigarette later every day, and I said protecting, you know, her sick baby here and then for the baby that she’s growing and all those things. She said, “Okay, okay. Thank you, nurse Nikki.”
And then she left and the charge nurse comes over and she’s like, “Um, what were you doing?” I said, “I was just talking to that mom.” And she’s like, “Yeah, I heard.” She’s like, “You can’t tell her stuff like that.”
I was like, “Well, why not?” Like, morally, as a person, I can tell her stuff like that. I truly believe she did not know that she was causing harm.
Nikki: And she’s like, “No, no, you can’t do that. I’m gonna have to write you up for that because that is not -” I was like, “But I just don’t understand the linkage between writing me up and giving helpful information.”
Nacole: Educating. Interesting.
Nikki: Right. That’s what we do as nurses and as humans. So yeah, I was – after that, from that day forward, I said, “I am getting out of this hospital and I’m getting out of tertiary care.”
I felt like, you know, it was secondary or tertiary care. I want to do preventative care. I felt like that mom – had she had somebody on the other end, like at her appointments or in the community, in her space educating her family, like, “You should stop smoking.” You know, things like that.
Nacole: Yeah. She might not have even known that.
Nikki: Right. So, that brought me to outpatient care.
Nacole: Now, do you feel that nurse managers or house administrators are out of touch with what everyday nurses are dealing with in general?
Nikki: Especially if they don’t take patients. Especially if they don’t take patients or they’re not helping with patient care is what I saw, like if you’re in the office or, you know, what we call the ivory tower or things like that where you’re not actually down there.
Let’s say we have tons of patients coming in. I’ve known nurse managers to come in – like we had patients in the hallway in the PICU and we’re like, “Okay.” And she’s like, “Let me go get some scrubs.” And she starts, “I’ma chart on this patient.”
I’m like, “See, that’s what we need right there,” as opposed to someone saying, you know, “Call me if you need something.” You know, sitting in their office, eating lunch while none of us have eaten lunch yet.
Nacole: For sure. Yeah. I mean, you have to be in the trenches with me. I mean, I don’t – I can call you and that manager aspect is great, but when we need you, we need your help. And that’s how you show leadership is action. Not just by emails and office work.
Nikki: Right. I can’t stop and email you my question while I’m in the midst of a code.
Nacole: Seriously. And I also don’t have time to find you either. I’m not going to be looking for you. I have 900 things going on.
Nikki: I’m not paging you.
Nacole: No, me neither.
Nikki: I’m not doing that.
Nacole: I agree that that bedside experience is crucial and that patient interaction is crucial because sometimes managers make recommendations that just will not physically work within a hospital system.
And they love adding on all these different tasks for nurses. “You know what’d be great? Let’s add 15 more things for nurses to do.” It’s like, “What?”
Nikki: Right. “If you could fill out this form right here in addition to your other form.” And I was like, “Yeah, that’s not gonna work for me.”
Nacole: It’s not gonna work. And you think they would ask – if they had to physically do what they recommended, they would realize that it’s not feasible. So yeah, I think that bedside experience is crucial.
Nikki: Very true. And I think I see it on the other end also as, you know, administration. For example, I’m on a committee of community providers that are helping hospitals provide better postpartum care.
Nacole: Oh, nice.
Nikki: So, as they leave the hospital, we’re going to bridge that gap in their postpartum education that they’re giving. And so when I was telling her, I was like, “Well, here’s the checklist of these that you need to go over. And this is for the nurses that are doing the discharge.”
And they’re like, “We just can’t do that.” And I’m like, “Well, I don’t understand why you can’t do that.” And they’re like, “Well, we have all these other things to do.” And I’m like, “But this is really important. You really have to do this.”
Nacole: Super important.
Nikki: And so I kind of – I see a smidgen of what they’re feeling is like, “I need them to implement this. Why can’t they do it?”
Nacole: Yeah, that’s true.
Nikki: Cause I haven’t been in a hospital in that long, but I also know that there are other things. Let’s look at all the things that you have to do and see – prioritize what’s the best for the patient care, not necessarily for the nurse’s convenience.
Nacole: And, you know, sometimes out of all the things that I need to do, I know that these 14 are really important and these five are kind of important. So, sometimes tasks supersede, you know, based on level of importance.
But yeah, you definitely need that perspective because every hospital system, even every floor has a different culture, a different perspective, as far as performance goes. So, yeah, I completely agree with that.
Nikki: Yeah. Different dynamics.
Nacole: Yeah. So, talk to me about your postpartum experience. I know you were pregnant while you were in nurse practitioner school.
Nikki: Mhm. I was. I was pregnant. I graduated in May, I moved to a new house in June and I gave birth in July.
Nacole: You did everything at once? You did everything literally at once.
Nikki: I took my NP exam on my due date.
Nacole: No. Get out.
Nikki: Yep. I was like, “This baby’s not coming.”
Nacole: You’re like, “I’ll be fine.”
Nikki: So, I’m sitting there having contractions in the midst of my exam.
Nacole: Oh my god.
Nikki: And the proctor – she was like, “One more contraction, you leaving. I’m not dealing with you no more.”
Nacole: You’re a mess. I wouldn’t either.
Nikki: I didn’t have that baby ’til like two weeks later.
Nacole: Really, did you? Oh my gosh.
Nikki: I had it at 42 weeks. And so that happening – you know, coming home to this brand new house and nesting and preparing for the baby.
I had an amazing birth. And then after the birth of my baby, we brought him home and he started turning blue. And after that happened, that was a whole ordeal. Went to the hospital. He coded. I coded him.
Nacole: Oh gosh.
Nikki: It was a mess. Only to find out he has a urinary tract infection and he was septic. So, that whole ordeal happened.
And then after that, I come home. Now, mind you, graduated, new home, baby, baby went to the hospital. Now I’m home. Nobody’s here but me and the baby and I’m like, “Oh crap.”
Nacole: Oh gosh. Yeah.
Nikki: It just hit me hard. It just hit really, really hard. And I felt like there was nobody there to kinda understand what I was going through or to help me process all this stuff.
I felt like somebody should be coming to the house. Somebody like a nurse or somebody should have been checking on me, like somebody. And my family didn’t quite understand. They’re like, “Postpartum depression?” It’s not something that’s talked about I think specifically in the African American community.
Nacole: For sure. I agree.
Nikki: And it’s kind of like, “Well, you should just pray about it and I’ll check on you every day and we can pray together.” And I’m like, “That’s great, but God also made therapists, and I need one.”
Nacole: For sure, who I see on the regular. I need one in my life for sure. For sure.
Nikki: Self care is healthcare.
Nikki: So, that’s where my brother kind of challenged me to say, “I think for you, it’s just a matter of getting out and helping other moms. You see the deficit. How about you be the change that you want to see and kind of flip it?”
And I started slow, working my way – I was like, “Oh, I am a nurse practitioner. Oh, I can do that.” You know, just in a matter of just support, just friends reaching out, being that person like, “Hey.”
And not necessarily their provider, but just kind of a secondary ear to listen and to refer them to different places. So, that’s kind of where my whole nurse Nikki prenatal, postpartum support career started: from my own postpartum situation.
Nacole: That’s amazing because, you know, I just had my son three months ago with the whole COVID thing, and I feel very isolated. And like you said, there are people that are checking in on you and, you know, “We’re praying and we’re calling,” but I need medicine and I need attention.
There’s one thing to provide support, but there’s another thing to where you’re at a point where you feel like you need to talk to a professional. And that should be okay and their resource should be available to you. Because it’s not just you now. It’s this new kid, this new baby.
If you’re married, you know, you have marriage dynamics that are also changing and shifting. And if you have other kids, the other kids are acclimating to the baby. You don’t – I never really thought about my relationship dynamics and how that would stress me out even more, like separating the time between two kids and, you know, the marriage.
And it’s just like you said, you call your family. You talk to them. They’re great people. I love them to death, but, you know, you want to make sure the path you’re going down is a healthy one. And that’s kind of where those experts, those professionals, come in. So, yes. I love what you’re doing.
Nikki: I tell all of my patients, “Expert attention.” They’re like, “Oh, I could just call my friend.” You need a therapist. Your friend is not your therapist, nor should your therapist be your friend.
Nacole: For sure. I mean, friends are nice, but you need to make sure you’re going down a path of wellness.
Nikki: They have baggage too.
Nacole: Oh, all types of baggage, sinister backgrounds. It’s just like, “You need a professional to sift through your stuff in the appropriate manner and to make sure that you come out the end better than when you started.”
Nikki: Better than before and not with more baggage, like you have more suitcases and it’s your friend’s baggage.
Nacole: I know. Yeah. You’re trying to fix your problems and your friends’ problems. They’re all mushed together and the dynamics are off. No, you need a professional. For sure.
Nikki: That ain’t nothing but a support group.
Nacole: Exactly. And I mean, that support group is great, but that does not replace an expert or a professional in that department.
Nikki: Oh, no. Not at all.
Nacole: So, talk to me about your experiences, about having to prove yourself to older veteran nurses.
Nikki: That has been one of the things that at the beginning weighed very heavy on me. That was like my second round of depression. So, I have been a nurse for maybe three years, three or four years.
And I was like, “I want to go back to school.” Cause my goal had always been, since I flipped the script my senior year in college, that I was going to become a nurse practitioner. And then I was like, “Well, why not get started now?”
You know, I was working in outpatient and adolescent medicine, which I love. And I said, “Well, why don’t I start?” Cause the schedule was cool. And, you know, I asked some veteran nurses who were – they were NPs, and I said, “Hey, can you write my recommendation?”
And they were like, “Oh, uh-uh. We not ready for that yet.” I was like, “We? I. I am. You already have yours.”
Nacole: What do you mean you’re not ready? What do you mean? Oh. Oh, I know what they mean. Oh, I get it. You’re not – oh, they don’t think you’re ready.
Nikki: Yeah. They’re like, “We’re not ready for that.” And I was like, “No, me. I’m ready.”
Nacole: Oh, wow. It’s like that? Okay.
Nikki: I just didn’t understand. I didn’t understand. And so I was like, “No, no, I am.” They’re like, “No, you’re young. You should be a nurse for at least 10 years before you think about that.” I was like, “Ten years? Ma’am, are you serious?”
Nacole: That’s insane.
Nikki: No. I can’t. I’m not fooling with that. And I feel like everyone has a different pace, you know? There are some nurses, man, some damn good nurses that have been nurses for 30 years and they know everything.
And there are some really good nurses that have been bedside nurses for three or four years. And I feel like they got that little piece of information and they added it to their toolbox and they move on.
Nacole: For sure. Yeah. And they grow and move on.
Nikki: Exactly. And I feel like those nurses that do that kind of, you know, go to a job, stay a couple of years, things like that and move on to a different specialty as something – they’re frowned upon as being inconsistent and hopping around.
Nacole: Yeah, that’s true. Yes.
Nikki: And I’m like, “But no, those are tools. They’re getting tools to help them.”
Nacole: In their toolkit of life. For sure.
Nikki: In their toolkit of light. I can’t tell you all the experiences up ahead. If I didn’t have the adolescent medicine experience and sexual health experience that I had, then I don’t think I would be where I am right now in my NP career of doing, you know, sexual health and reproductive health stuff with my clients.
But the nurses there didn’t respect that at all. And they just really didn’t want to do my – it was kind of hard finding a recommendation, too. I had to sit down with a physician.
Nacole: That’s insane. Well, it’s not really insane because I had the same issue. They’re like, “You’ve only been here for three years.” And I’m like, “Okay, so what does that mean?” “Well, you should probably give it a couple more years. Become more seasoned.”
I said, “Okay. So, that’s a no? I’m confused about this conversation. Are you telling me that I can’t apply, or that – what’s happening right now?” It threw me off so much.
Nikki: Right. You almost have to ask permission. It’s almost like a permission thing, like submit an application to them. “Oh, application denied. Try again later.”
Nacole: And then they’re looking at you like, “How dare you?” And you’re confused about, “How dare I what? I’m confused about your stance right now. I don’t know what’s going on. I’m so disoriented right now.”
Nikki: Right. Right. And I was like, “Oh, I’m sorry. I didn’t ask for your permission. I just asked you to write a recommendation,” but that went on.
Nacole: I’ve already paid for the application already, so I’m not really sure where we’re going here. But if you say no, that’s fine. I’ll just find somebody else.” So, you found a physician to do your letter?
Nikki: Yeah. And I felt, kind of, you know – I felt a type of way about asking a physician for it, to write a recommendation for NP school.
Nacole: Me too. I do too. “Hey, I know you don’t know me. Cool, doc. Cool.” I barely knew his name. I saw him like three times in a year and he was like, “Oh, that’s fine.” He didn’t even care.
But all the nurse practitioners were like, “You’re not ready. It’s not the time. I feel like you’re going too fast. You need to slow down.” I was like, “What? What’s happening? Why aren’t you supporting me?”
It made me feel like, “Am I not okay to do this? Am I going to fail? Do they know something that I don’t know?”
Nikki: But yeah, to talk about the seasoning, I was like, “What type of seasoning do I need, exactly? What concoction of skills did you think that I need?”
Nacole: Yeah. What am I missing? What is this magic potion? Yeah.
Nikki: “Is something gonna happen in MP school? Am I going to fail?” And then when I get to NP school, hell, there’s so many people that are in bridge programs that didn’t have any floor experience or any, you know, nursing job experience.
Nacole: Any hospital experience. Yeah.
And they’re going through there and they’re like, “What is that?” And I’m like, “I don’t want to be the problem, so I’m just going to help you.” Because I feel like, you know, that’s what we’re supposed to do. How are we going to get there? Together.
Nacole: Yeah. We’re supposed to uplift people and they determine if they’re ready for something or not. But I would never tell someone they’re not ready for something.
Nikki: Right. Uplifting their power.
Nacole: How do you determine the readiness for someone to grow and develop? That’s impossible to do.
Nikki: Right. Exactly. We wouldn’t tell our kids – they’re like, “Mommy, I want to go to the potty today,” and you’re like, “Oh, you’re not ready.”
Nacole: “You’re not quite – that’s too advanced for your skill level currently. No.”
Nikki: “You can’t do that. I’m going to keep putting these diapers on you.”
Nacole: Yeah. “We’re going to revisit that topic in maybe two years when you’re more seasoned.”
Nikki: Right. We would never do that.
Nacole: And they also assume that experience equals performance, which it doesn’t.
Nacole: I try to tell nurses all the time, “Okay so you’ve been a nurse here for five years. That doesn’t mean that everything that you’re doing is accurate and safe and per evidence-based research. That just means that you’ve been doing something for a long time. That doesn’t equate to a knowledge base.”
Nikki: Right. Right. Continuing education is key. If you think that you know everything, then you’re a dangerous ass nurse.
Nacole: For sure.
Nikki: You’re a dangerous nurse if you think you know everything, like, “Oh, I got this. I got this.”
Nacole: Yes. Yeah.
Nikki: If you don’t come to work with some type of anxiety, then you’re a dangerous nurse.
Nacole: Yes. I am constantly humbled. I am constantly humbled. Every shift, I am humbled by either a family member who tells me about myself or a nurse that tells me something I didn’t know.
Or if a pharmacist or an attending – I learn something every day. That’s why, when people come into a setting where they think they know everything, it’s terrifying because there’s so much that you don’t know, that you can’t know.
Nikki: Right. You have to be checked. You have to have the ability to be checked.
Nacole: For sure.
Nikki: If you can’t be checked, then we have a problem.
Nacole: It’s going to be a very short career for you. I’ll tell you that much.
Nikki: And a long shift.
Nacole: Yes. With your counterparts. For sure.
Nikki: For sure.
Nacole OUTRO: Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, a new community for nurses ready to make a change. SHIFT Talk is sponsored by the Robert Wood Johnson Foundation.
To learn more about our guest and hear more nurses talk about the important issues we’re all facing right now, visit our website shiftnursing.com. And please subscribe, rate and review SHIFT Talk wherever you get your audio content from.
Until next time, stay safe and keep being awesome!