Nikki Greenaway: Well, since this was the year of the nurse.
Nacole Riccaboni: I know, right?
Nikki: It’s funny how we’re challenged this year. This is a test we never knew was coming.
Nacole: For sure. This is the pop quiz of all pop quizzes.
Nikki: I know. I was like – I’m telling all the new nurses, ‘You don’t have to take your NCLEX cause this is the real deal.’
Nacole: Yeah. You gonna learn today for sure.
Nikki: You gonna learn today.
Nacole INTRO: So, in our first episode with Nurse Nikki she and I talked about all the nursing drama, all the crying in the bathroom, all the write-ups, all the things that drove us crazy. Her and I really got into it. It was a great episode.
Now in Part 2, we’re going to zero in and focus on Nurse Nikki’s true passion which is maternal health. And you can’t talk about maternal health without talking about racial disparities, because black women, which I am, we are way way way more likely to die from pregnancy related complications than white women. And that is completely insane to me, but that’s not even factoring in COVID at all. Like we said, you’re gonna learn today. So buckle up and let’s get started.
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: So, talk to me about your practice. I know that you care for mothers, but as far as the challenges and inequalities go, what do you usually see in that department?
Nikki: So, I have a private practice that I actually started right out of NP school. And I had one little job right out of the NP school and the lady, the admin, at the front desk – she was like, “Nah, nurse Nikki. You ready.” I was like, “No, ma’am. I’ve only been an NP for six months.” She’s like, “Nope, you ready. Go on and make that little side gig you’re doing, your real thing.” And I was like, “Ah!”
Nacole: See? Good. Aw, that’s awesome. She saw it in you.
Nikki: Yep, she saw it. She saw it. But I went from there and I just kind of delved into what I knew. But one thing I noticed about my practice is I didn’t get my first black patient until four years ago, and I’ve been practicing almost 10 years.
Nikki: Yeah. It was just – I was like, “Do people not understand what I’m doing?” And then you really have to deal from a cultural perspective of what does family mean to a pregnant person? And when coming back into the home space, how does the family react to that? What are the cultural and familial dynamics that happen in different cultures?
And it was strong in the African American community. You know, your elders come in, they tell you the information and stuff like that. And I just – I mean, it’s hard to compete with grandma sometimes.
Nacole: Oh for sure. It is. I didn’t even think about that. It is.
Nikki: It’s hard to compete with that. Also, you know, these services are not – we’re not, at the time, covered by insurance.
So, you know, someone coming in and doing prenatal education in the home, someone doing postpartum home visits in the home – if you’re on Medicaid, you know, they have the global Medicaid OB package where you go to the same provider, they deliver your baby and then in six weeks, that’s the person you see.
So, in that whole time, you have to see that same provider. You can’t break that. So, it was very hard for me to see Medicaid patients because Medicaid patients couldn’t pay for the services, and I wasn’t set up in a way where I could receive grant funding.
So I was, you know, limited to – a lot of my patients were upper class white women. And while that’s fine, you know, I love helping, but I really wanted to dive into helping folks that were most at risk.
And we know that African American women have a higher maternal mortality rate than white women. And the fact that I couldn’t infiltrate that was really bothersome to me. I wanted to help women that look like me. I want to help. Women that look like me are the ones most at risk.
So, I started reaching out to organizations like Healthy Start, which is a perinatal home visitation program, and WIC and reaching out to them and proposing, “Hey, I’m an NP. You know, I do lactation support. How can I help you better serve women?”
And they were like, “Oh, we have this huge deficit over here. Let’s set up a clinic.” So, I had a latch clinic. I did prenatal visits with them. We had a little clinic. And so it was really cool to be able to help folks that needed it most.
But also I started helping on the policy side in that I got involved in the pregnancy-associated Maternal Mortality Review Board. So, we look at all the cases of maternal deaths within the first year of giving birth and then be able to affect policies and just really, there, look at the health disparities that are happening.
And that made me find even more ways that I can help marginalized individuals and really tap into, “Why are black women receiving this – why are they having these outcomes, and what can we do to change it?”
So, my business has kind of pivoted in the point of just being an activist and really going out, speaking out and trying to use my position as a nurse practitioner and a IBCLC – which I am the only black nurse practitioner IBCLC in my entire state – using that to kind of get the message out and get policies changed and get providers held accountable for their biased behaviors.
Nacole: For sure. Cause even like I said, I had my son about three months ago and my postpartum experience still ongoing has been one just – I felt like I wasn’t heard.
Even when I was in the hospital asking for certain things, they would kind of listen, but they were just going through their task list, checking the baby, checking me, leaving. If it wasn’t something that they had to do right then, it was like, “You can deal with that pain. I’ll kind of come back at you later. Or if you’re itchy, I’ll come back at you later.”
And since I gave birth during the whole COVID pandemic, my husband wasn’t there. So, it wasn’t like I had somebody to take the baby when my abdomen hurt or when I was throwing up from the pain medicine, he could hold the baby. It was, “I’m throwing up. I’m holding a baby. My abdomen hurts. You know, you told me to walk around. I’m wearing this mask.”
It was just very overwhelming. So, I was crying a lot and I didn’t – people saw me crying and nobody asked me what was going on.
If I didn’t deliberately say that I was in crisis, nobody even checked up on me, versus my coworker who had a baby the same week as me – they were checking up on her, talking to her. They had her do a phone call and do a postpartum survey.
I didn’t get a survey. I didn’t get any postpartum paperwork. Now that could be due to the COVID pandemic craziness. But when we talk even now as coworkers, our experiences were completely different. And I’m a medical professional.
Nikki: And then some people are like, “I wonder why. Oh, that’s so sad. I wonder, maybe this, maybe that. Oh no, but maybe.” It is what it is. You know, we call it what it is.
Nacole: Yeah. Even when I go to the hospital, even when I go to my regular primary, if I don’t literally tell him I need this medicine, “Oh, we can get refills later,” or “Everything’s fine.” Or I think my blood pressure’s high, unless I say, “Can you do this?” he will not do it.
I have to be very deliberate and advocate for myself at least two or three prompts to get anything remotely done.
Nacole: He’s a nice guy, but clearly there is some sort of bias there that you either don’t believe me when I tell you the first time or you don’t care or both.
Nikki: Right. And that’s one of the things that – I love talking to my clients prenatally. And regardless of socioeconomic status, I love talking to them. I was like, “Hey, this is – you are a consumer. You are buying services.”
Nacole: Yeah. You forget that sometimes.
Nikki: This is the only time where we don’t question what providers say, and I want you to question me too. If I tell you something off the wall, say, “Nurse Nikki, you know what? That don’t even sound right.”
Why don’t – even when someone has a cancer diagnosis, they’re like, “I want a second opinion.” But when someone says, “Oh, you’re gonna – we’re going to stick a needle in your belly for amniocentesis,” they’re like, “Well, I mean, the doctor said -” Ma’am, ma’am. Let’s ask some questions. Why do we need to do something so risky?
And even I had a similar experience with my second child where I’ve had thyroid disorder since – for the past almost 20 years. And so now with this pregnancy, she’s like – and I’m 41 weeks and four days. I go in. I get, you know, my check and all this. It was a midwife.
And she’s like, “Oh, we need to keep you.” I was like, “I don’t understand. For what?” I said, “I just worked for 15 hours. I got four red velvet cupcakes in the car. You don’t need to keep me.” She’s like, “No, no. You know, you’re high risk because of your thyroid.” I’m like, “Are you serious right now? I’m not.” And she’s like, “Well, we have to do a nonstress test.”
So, I go over here, do these tests. She’s like, “Oh, you just had a – the baby’s having a decel.” I’m like, “It was one decel. I’ve been here for four hours. The baby’s hungry cause I need to eat.” And I am about to lose my shit.
Nikki: “We have to admit you. We have to admit you and induce right away.” I was like, “Really? I just don’t think this is necessary.” And I was so not argumentative, but going back and forth.
And my mother, who was a different generation, she’s kind of like, “Nikki, why are you arguing with this lady? You just need to do what you’re supposed to do.” I said, “Because, hell, cause we do the same thing. That’s why.”
Nacole: We do the same thing, and I know enough information to know that what you’re doing is not really making – it’s not connecting all the dots.
Nikki: This is not working for me right now.
Nacole: Yeah. Yeah.
Nikki: So, you have to – I want to empower people, not to – I don’t want to speak for you.
I want to give you the information so you know what you know, and you’re like, “That just doesn’t feel right,” and go with your gut and ask questions and know when something just doesn’t sound right or have the courage to leave when it just feels like an abusive situation. Your relationship with your provider should not be abusive or feel like a hierarchy.
Nacole: It shouldn’t be. My husband had a cardiologist who I went – my husband had a heart attack when he was 28. He was a mess. So, we had the CABG surgery, a four way CABG, and needed cardiac rehab.
And I went with him to his cardiologist, and it was this very weird dynamic. He would yell at him and say, “You need to lose weight, and you’re not listening to me.” And I said, “Sir, you know, he’s very fragile right now. He’s depressed from the surgery. There’s a lot going on. He’s trying to lose weight.”
And it was like, “Hold on, we’re paying for this?” At some point it just clicks in your head. I’m not gonna let you talk to me that way, and you’re not educating us. You’re just screaming at us.
Something clicked and I was like, “We’re not seeing him anymore,” and we saw another provider who was the complete opposite. Very warm individual, educated us on everything. But I think people forget that they can pick and choose their providers.
Nikki: Yes, yes. All day. You can. And I think some people get bullied into thinking that they can’t. And you know, it was a young lady and she has developmental delays, so we always had somebody go with her to advocate, to help her at her visits.
And one time she – cause she has a seizure disorder. So, folks that have epilepsy, they sometimes get – textures bother them. So, she was taking that glucola and she said, “I’ve had that before. Please don’t make me take it again.” And they’re like, “Well, if you don’t take it, I’m not going to be your provider anymore.”
Nacole: Oh, they love saying that. They love saying that. “I can’t see you if you don’t follow my program.” Yes.
Nikki: I’m like, “How dare you? C’mon, there are other options. There are other options than that nasty glucola. Why are you telling that lady that?”
Nikki: So, I don’t like those scare tactics. And I’m like, “You know what? Well, we’re not going to be here anymore. Let’s find you someone else that is not going to be harmful like that.”
Nacole: And there’s so many other providers that have so many other options. You might have a provider that loves one medication and they want to prescribe that medication cause it works for them for so many years.
And that’s great, but your body doesn’t respond or react appropriately to that medication. If your provider isn’t willing to work with you and change things up, you should advocate for yourself.
Nikki: Absolutely. I tell my patients all the time. I said, “The provider – me, the provider – I am the expert on the body. You are the expert on your body.”
Nacole: That’s so true.
Nikki: “So, that’s why we have to work together in partnership to find a happy medium, because I have to respect where you’re coming from because I haven’t been in your body. I don’t know what you’re going through. I can only go by what you tell me. And I can tell you how that sounds and all of my training of the body – what I can do to help that.”
That’s how we have to work together.
Nacole: You do. Because even – I work in an ICU. I’m seeing you right now for a short period of time, but I don’t know your history. I don’t know what works for you, how you feel about stuff, what your kind of religious preferences are in terms of where we are, you know, at this point in time.
Talk to me. Let me know, because I know nothing about you other than what’s happening from this point forward.
Nikki: Right. We have to establish that trust, otherwise they leave out information.
Nacole: For sure.
Nikki: Like, “Oh yeah, I’ve been eating a grapefruit every day.” “Well, ma’am, that will totally affect this medication that I’m giving you.”
Nacole: It will, and you’d be surprised how many providers don’t talk to patients. They’ll prescribe you medicine all day, but to have a conversation with you, that requires a certain level of, I guess, socializing they’re not really ready for or trained for. So yeah, for sure.
Nikki: Right. Right.
Nacole: So, tell me how you feel that COVID has exacerbated these kinds of challenges, inequalities.
Nikki: Oh man. The disparity. I don’t think – I mean, we knew. Working in healthcare, we knew about health disparities. And I don’t think folks living in the community, kind of in their own bubbles or socialized bubbles per se, knew about the disparities.
But then when COVID hit, we truly see the disparities when we look at the numbers and how it’s affected African American communities. And it’s blatant that, “Oh wait, they didn’t have as many resources as everyone else.”
Nacole: I know. Yeah. Yeah.
Nikki: Oh my gosh. Baby, it’s been a food desert forever. That’s what happens when you’re in a food desert and a medical desert and a technology desert. You know, when you’re living in virtual poverty, those types of things, those terms come up.
And they’re, “Virtual poverty? Technology poverty?” I’m like, “Yeah, there’s poverty to the point where you don’t even have technological devices to do those things.” Telehealth is a privilege. That’s a privilege.
Nacole: Amen to that. That’s so true. That’s so true.
Nikki: So, trying to do telehealth with the homeless when you have to think about all the other barriers that happened before COVID – transportation, getting into your appointments, those types of things, having your medication, going to Walgreens. It’s not the same for a homeless person as it is for somebody that has a car or a home or something like that.
So, when we put it in perspective of a pandemic where we’re supposed to stay inside, first of all, where is this homeless person supposed to go? Now we have to think about an address. You know, all those types of things.
Nacole: Yes. For sure.
Nikki: And then we have to think about the phone. Maybe it’s a government phone. Maybe it’s a phone that works. Do they have the ability to do a telehealth visit? Can they download Zoom or, you know, Google Meet or something like that? Do they have the capacity on their phone?
Nacole: Yes. Yes. For sure.
Nikki: There’s just so many different elements. And when we think about those, the disparities just kind of do-do-do. But also, let’s go to the hospital.
Maternal health. Well, we already knew that there was a health disparity between black women and white women, but now we’re pushing folks out in less than 48 hours. So, what’d you think about to happen now with our breastfeeding rates and other things?
Nacole: Yeah. That’s very true.
Nikki: We were looking at these things. We’re kind of like, “Okay, we are going to see a huge rise,” but one of the biggest things that we’re seeing now in our report is domestic violence, intimate partner violence, and how that has increased during our pandemic because now folks are required to stay home with their abuser.
Nacole: Oh, yeah. That’s true.
Nikki: And so we’re seeing more calls, we’re having more situations where families are feeling unsafe, and it’s one of those things where the whole protocol should have been changed ahead of time before COVID anyway.
Especially in Louisiana, the question’s like, “Do you feel safe?” What kind of question is it that? That is not asking, getting to the grit of domestic violence.
Nacole: The meat. Yeah. It’s so vague too.
Nikki: “Do you feel safe?” And you have to put it in context. Elaborate. Do they feel safe in their home? Do they feel safe when they walk outside of their home, in their community, you know? Is there anyone in your life that you don’t feel safe with? You know, things like that.
Nikki: And in New Orleans, our human trafficking numbers have gone up, and New Orleans was already a hub for human trafficking. So, we noticed that our numbers have started going up and the folks on the frontline or human trafficking folks think it’s the police and it’s not.
It’s healthcare providers, because we have a lot of situations where folks are trying to tell us something, but we’re rushing through things so quickly that we’re not catching those highlights.
And that has happened even more so now because of COVID. Folks aren’t even going to the hospital now. So, now they lost that whole line of defense. So, I feel like a lot of things are going to come out of this.
It’s going to be some public health – a lot of – there’ll be classes coming from this whole pandemic of what happens, the public health crisis that happens during a pandemic and the disparities that result. So, it’s an interesting time.
Nacole: Well, do you feel like your community appreciates what you and other nurses in your community are doing during COVID or?
Nikki: I do. I do. At first, I felt lost. You know, I’m like, “Oh, I can’t.” Because I’m a home visitor, and now you’re telling me to go on the other end of the spectrum to virtual and telehealth?
And I, just for my own mind and the way my personality works and the way I interact with my patients, I just couldn’t wrap my head around it. And I said, “I’m useless.” And that’s just kind of what I just said to myself.
Nacole: Aw, no.
Nikki: “You’re just useless, Nikki. You need to go back to the hospital. You need to. That’s where the action is. That’s where they need you.” I was like, “But if they’re, you know, chucking them out so quickly out of the hospital, who’s going to take care of them in the community?” And I was like, “Oh, it’s you, Nikki.”
So, I do think that they appreciate it. You know, folks have told me that and it’s great to get those accolades, but for me, I need to know that I’m helping my patients find the best care, get the best care that they need.
Because a lot of times, you know, their doctors now are even less available to them as far as, you know, prenatally or postpartum. So, they text me.
They’re like, “Nurse Nikki. Oh, this stuff is coming out,” or, “My contractions are this close together. What do I do? Do I call the ambulance?” I’m like, “Do you want to have your baby at home?” “No.” “Okay. So, now we need to. This is when we call an ambulance and we go to the hospital.”
So, it’s being that on call person. They’ve been calling it “Nurse Nikki on call.”
Nacole: Oh, I love it. That’s awesome.
Nikki: To be that on-call person to contact, you know, just like, “Can I text you?” Like today, I’m pretty sure she just left the doctor with these test results, but I guess her doctor was just rolling today.
And she’s like, “What does a glucose of 155 mean while you’re pregnant?” I was like, “Well, that is kind of high.” So, we talked through it and she’s like, “Okay, thank you.” And I guess, you know, just being available has been awesome, but also you don’t want to burn yourself out.
Nacole: That’s so true.
Nikki: And I hit that mark about maybe five weeks into this being at home where I just collapsed, literally. And I’m like, “What is happening?” Because you’re homeschooling, you know, you’re parenting, you’re wifing and then you’re working. And I was working from 9:00 PM to 2:00 AM in the morning and then trying to sleep and then get up and do it all over again.
I was like, “Something has to give. You’re always on.” I didn’t know when to turn it off. So, that has been interesting. But when I pulled back, I realized that I’m helpful and I can only be as helpful as I am healthy. So, I have to be healthy in order to be helpful.
Nacole: That is so true. And yeah, this whole COVID thing has everybody kind of turned upside down. So, you definitely have to make sure that you’re dealing with things healthily, even as a provider, that you’re not stretching yourself too thin.
Nikki: Right. Absolutely.
Nacole: So, what does the future of nursing look like to you?
Nikki: Well, since this was the year of the nurse.
Nacole: I know, right?
Nikki: It’s funny how we’re challenged this year. This is a test we never knew was coming.
Nacole: For sure. This is the pop quiz of all pop quizzes.
Nikki: I know. I was like – I’m telling all the new nurses, “You don’t have to take your NCLEX cause this is the real deal.”
Nacole: Yeah. You gonna learn today for sure.
Nikki: You gonna learn today. But I think the future of nursing is going to be – it’s going to be more respected, but we’re also going to have to – this will bring us together. I’m hoping that it’ll bring us together.
Nacole: Me too.
Nikki: And just also kind of clear the clutter. I feel like nursing has a lot of clutter and it’s kind of foggy and we’re one of those healthcare professions where you can become a nurse a variety of different ways.
And because of that, and because there are so many different types of nurses and levels of nursing, I feel like it confuses some of our peers and providers, which is why, you know, nurse practitioners can’t be independent in all 50 states. Because there is some confusion.
They’re like, “Well, you go to medical school and, you know, you do your residency.” And they understand that. It’s very clear and simple, to be honest, but ours is kinda different in that, “Oh, she was grandfathered in. Oh, this has happened. This has happened.”
And I think it will allow for conversation to kind of clear out and streamline nursing a little bit, not to the point where we lose our ability to move different specialties, but just in the matter of the process of it.
Because I feel like a lot of parameters, barriers were actually put in place to prevent some nurses from rising, others from not, depending on your state. And I was like, “Come on now, we shouldn’t have had all these different states having all the different rules in the first place.”
Nacole: There’s so many different rules. That’s so true. That is so true.
Nikki: Especially with the nurses coming from New York – I mean, you know, nurses from Louisiana going to New York and things like that, there was so much red tape that people had to relax a little bit in order for the nurses to even go up there to help, you know? With all the executive orders.
Nacole: Yeah. Florida even released some sort of – yeah, the executive order from Florida was as long as you have a license, you can come on down. Everything changed. Yeah.
Nikki: Right. And I was like, “Why was this put in place in the first place? Why can’t we move about the country the way that we need to?”
Nacole: Yeah. We’re all registered nurses. We all did the same test relatively. Yeah. For sure.
Nikki: The NCLEX hasn’t changed. Pearson VUE is not changing that test based on state.
Nacole: It does not change, but each state has you run through a specific series of hoops to get to where you need to. And yeah, it was confusing for the first couple of weeks.
Nikki: Right. So, maybe we can get some collective thought around just licensure. And you know, just – we’ve been through the trenches. Folks that never thought they would go through the trenches or have a trench. You know, it’s been quiet. They’re at this quiet little hospital.
And then boom, you get hit with COVID and you gotta come together. Either you a part of this team or you not. This is not a single nurse operation. We have to work together. So, I’m hoping that’s what the future of nursing is, is just, you know, partnership, teamwork and just a common thought. We have one voice and, you know, we’ll all rise together.
Nacole: Oh, I love it. That’s perfect. Well said. I like that.
Nikki: Thank you.
Nacole: Nikki, thank you so much for doing this interview. It was great. I learned so much about your community and how to better my community. Cause I only do inpatient, so it’s great to hear what everyone is doing outpatient and what the community needs are.
Nikki: Thank you. Thank you for having me. And don’t say you only do inpatient. Inpatient is awesome. We can’t do outpatient without the education that inpatient nurses do, so.
Nacole: Every time I see a patient leave, I’m always like, “Please take care of yourself,” because I only see them when they’re sick.
Nacole: So, it’s like, you know, “Please make sure you see your doctor. Please make sure you do this. And if not, call the social worker.” And you just hope everything goes well. But it’s good to see the other viewpoint and perspective of that. Someone picking up those reins. That’s amazing. I love it.
Nikki: That is our task, to connect to that. So, I hope we can do this.
Nacole: That’s amazing. That’s perfect. Thank you for sharing your story. I had a great time.
Nikki: Thank you. I did too.
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!