SHIFT Talk – Ep012 Whitney Fear – Scrubbed Transcript
Whitney Fear (00:03): I think it’s about being generous to others as a way of being generous and respectful to ourselves. Like, when we extend ourselves to people, we are also extending that same treatment to ourselves as well. It feels good, right? Not extending yourself like that to somebody might be something you regret and feel bad about. I feel nurses are generous.
Nacole Riccaboni (00:28): It’s the season finale, guys. And I couldn’t think of a better guest to close us out than Whitney Fear. Whitney grew up on the Pine Ridge Reservation in South Dakota. Her childhood was shaped by alcoholism, uncertainty, trauma and poverty. Sadly, this is the reality for many indigenous people.
Whitney is resilient. She remains grounded in compassion and generosity, values that are the core to both her Native American culture and the nursing profession. Whitney took her early life experiences and used them to develop a trauma-informed and culturally sensitive approach to care. She truly listens to her patients and she honors whatever’s authentic to their experiences.
I was honored to hear her story. Actually, I was honored to hear all our guests’ stories throughout this season. They’re from diverse backgrounds and they shared a wide range of perspectives on health equity.
But there’s a common thread throughout all of them. Every guest has encouraged us to look beyond buzzwords and simply consider the ways we interact with people. Because when we take the time to ask questions, to consider the answers carefully, and treat others how they want to be treated, we are advancing equity. And as Whitney says, we do feel good.
I want to encourage you to keep thinking about all the ways you can break down your patients’ barriers to health. Know that whatever path you pursue, whether it’s taking more time with your patients, speaking out on social media, or even pivoting your entire practice, you are making a difference.
My name is Nacole Riccaboni. I’m a critical care nurse working in Florida, and your host for SHIFT Talk season two. SHIFT Talk is a podcast that brings nurses together to talk about the challenges we’re facing on and off the clock.
This season, we’re interviewing nurses who are working to ensure that all patients can have access to the resources and care that they need to be healthy. And that’s called health equity, by the way. We’re going beyond the clinical and looking at the social factors that impact health, from a person’s zip code, to their health, to even their job and even structural racism.
No health care provider knows more about nurses’ lives than nurses, right? We can really make an impact here, folks.
This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s change-makers. SHIFT is sponsored by the Robert Wood Johnson Foundation. Follow us on Instagram at @shiftnursing. And for more amazing stories and real talk about nursing, head over to shiftnursing.com.
One final note: This episode was recorded in July, so please keep that in mind as you listen to this great conversation. Now, let’s dig in.
Welcome, Whitney. Nice to meet you. Can you tell the listeners where you’re from, what kind of work you do, just generally, what makes you who you are?
Whitney (03:25): Thank you, Nacole. And it’s nice to meet you as well. I’m glad to be here. So I am originally from Pine Ridge Reservation in South Dakota. But I’ve lived in the Fargo-Moorhead metro area in North Dakota. Yes, there is a metro area in North Dakota, for about 16 years now. And I’m a psychiatric mental health nurse practitioner at a Federally Qualified Community Health Center here in Fargo-Moorhead.
Nacole (03:52): Do you live on the reservation, or you work on the reservation, or both?
Whitney (03:55): I do not live on the reservation. I live in an urban area. But the urban area that I live in is quite close in proximity to numerous reservations.
Nacole (04:06): Now, can you tell us, what was it like growing up on the reservation?
Whitney (04:09): Yeah. So honestly, growing up on the reservation is pretty rough. Daily life is a struggle. My family has a small cattle operation there in the Badlands. Like a lot of small operations agricultural wise, there’s a lot of uncertainty.
And sometimes there’s good years. And when I say good, I mean like you can repay your loans to the bank and not be in the red. And then there are some years when you’re taking out more loans after you sell your cattle, because the ones that you have, you’re not able to pay off all the way.
Whitney (04:47): There was a lot of times when my parents had to get jobs in town in addition to the work they did on our place. My brother and I started helping out as soon as we were old enough. And we were happy to do that. It’s pretty special to have your own little corner of the world like that.
And we knew that it was helpful, too, with our parents being so busy trying to keep things going. My dad’s side of the family has been in cattle for a few generations. So it’s a source of pride for us that we made a living this way for so long, especially in a place where, frankly, being able to do something like that is not easy for a myriad of reasons.
And a lot of family members struggled with alcoholism. My mom’s parents were alcoholics from the time I was young until I was almost in junior high. My mom could be scary and violent herself. But she had also grown up in a pretty unstable household.
My dad was a pretty calm, smooth presence. And I know me and my brother always knew we were very lucky for that, because some people on the reservation, some kids, don’t have that at least one stable parent. There’s a lot of grief and death there. And sometimes it feels like it’s just constant, ongoing.
There’s some good parts too, though. Of course, the kinship, like dozens of aunties and uncles and grandmas and grandpas, and just lots of different people around me. And raised on a lot of compassion and being understanding of where people are at being probably what they have the capacity for, basically, and that it’s not a personal thing.
Nacole (06:32): Now, how many people are a part of the Lakota tribe?
Whitney (06:35): Well, that’s actually tough to discern. It’s a little bit of a controversial issue about tribal enrollment, because some people feel it’s colonialism to enroll your child in the tribe because there’s a requirement that you provide blood quantum, which is essentially, the best way to put it is that you have to provide a pedigree like you would a horse or a dog that you’re trying to register in like the American Kennel Club.
So when I enrolled my kids in the tribe, I had to make a pedigree for each of them denoting their descendants. And some people have kids with someone who’s a member of the other tribe. So it’s like, which one do you enroll them in? Because you can’t be enrolled in more than one in the U.S.
So there’s a big problem with the census reporting being inaccurate too, because people will have more than what should be in their household living with them, because they can’t stand to think of their sister being homeless with her kids, so they invite her to live with them.
And there’s a fear, and this isn’t just with indigenous people, as it’d be among people who live in poverty in general, with reporting an accurate household size out of concern that it would come back on you, like, “Hey, you’re in this housing program, and you’re only supposed to be you and your two kids. Why is your sister there?” Now you’re getting evicted because you violated the terms of this housing arrangement.
So I know that there’s been estimates in upwards of 60,000 on my reservation when there’s really only been counted 25 to 30. And that really shapes our funding and all that comes from Congress, too, which is unfortunate.
Nacole (08:21): Now, can you explain a little bit about the Lakota culture to us? I hate to say that I don’t know, but I honestly don’t know.
Whitney (08:29): I would love to. Actually, I think that’s really an important part of things, because I think we get very generalized as being kind of like lumped together. And we do, where there’s some very big differences in one culture to the next.
So traditional Lakota society was matriarchal. Women owned the property and made the decisions about the household, including whether she wanted to continue to be married to somebody or not. A divorce was as simple as putting your husband’s stuff out in front of the teepee and saying, “We’re through.”
And there’s a huge emphasis on treating women and children and elders and members of the LGBTQ or two-spirit community with a high level of respect. Women being seen as the most wakan, or holy, people among the Lakota because of our ability to bear children, to bring life, for that being believed to be a gift that was given to women for their ability to be compassionate enough to risk their own safety to bring another person here.
So huge emphasis on respect for women and protecting women and children. We believe children have so much knowledge and wisdom because they just came from the spirit world. And compassion, generosity being two very high priority things.
The worth of a person’s life being based on what they gave away and what they did for others during their life, which helps a person reach what we would call the status of being an elder at that point, of having that wisdom, thinking about the collective and having that awareness that all humans can be selfish and that we can get arrogant and that we have to keep ourselves in check.
Nacole (10:26): I wish everyone lived like that. Maybe the world would be a much better place. Now, if we can just circle back, do you feel like what you experienced and how you grew up is a representation of the indigenous experience in general?
Whitney (10:38): Yeah. I do think it was. Again, also being aware that there were people who definitely had less fortunate circumstances than my family did. I don’t think anybody down there probably even doesn’t meet the criteria for being below the federal poverty line.
However, if you have the ability to put food on the table, get your kids clothes every month, that was the circumstances we were in. And were my parents cutting it close sometimes? I’m sure they were. But I had friends that were in a lot more dire circumstances, and things at home were pretty dangerous for them. I was definitely aware of that.
But I would say yes, the overall experience is that, again, this is an environment that is full of a lot of bad memories and bad things happening. And for that reason, I think that, overall, the experience is about the same.
Nacole (11:37): Now, you said that you did leave the reservation. Can you talk about when you left it and what made that possible?
Whitney (11:43): Yeah. So I left the fall after graduating high school. And I had almost not graduated high school. I almost dropped out. And honestly, if it wasn’t against the law of the reservation to do that and you have to be 18 to drop out on my reservation, then I probably would have.
I had like a 0.5 GPA going into my third year of high school. I didn’t go to class. I skipped work. I just didn’t do it when I was there. I wasn’t really invested. I was very angry and sad about a lot of things. And I just didn’t have the focus.
And the guidance counselor at my high school saw a lot of that, for sure. He asked me one time, why, if I was so smart — because he said, “I know you are because you’ve taken standardized tests, and you perform very well. Why do you do such stupid stuff?” and I didn’t have a good answer for him.
And he wanted to know, “What do you do when you’re not at school?” And I’m like, “I’m not doing anything. I’m smoking a lot of Marlboro Lights and watching terrible daytime TV.” And he said, “It just would be a shame if after all the things that your ancestors went through and your people went through, that you just wasted your potential by doing nothing with it.”
And I worked with getting me back on track. I really wanted to graduate on time. He wasn’t sure it was possible. But my auntie, who non-Lakota, was actually a third cousin, we came up with an idea for me to do some high school credits through our tribal college in addition to my high school class.
Then she had told me, “If you get an education, no one can ever take that from you. They have to give you a seat at the table if you show up dressed nice, acting respectful, and have a degree in your hand. If you want to set things right, then you have to learn their rules and beat them at their own game.”
I really felt like she put some good, positive pressure on me to do something with that. And I did. And it made me really happy to be able to repay her for that by graduating on time. And I was, at the time, still drinking a lot of alcohol frequently. And I continued to do that. But I didn’t want to do that anymore.
But it felt like to be successful at all in getting an education and not really descending into super heavy alcoholism, I needed to get away from there, that environment. And so I did. That’s what made me make that decision. And I don’t know how, with my record and my GPA, I got into a college in North Dakota. And I moved here. My parents were really supportive. My dad especially.
Nacole (14:37): Now, in terms of the reservation, what educational options are available?
Whitney (14:41): So there is a tribal college on the reservation. And I believe it’s a very high quality education. There are some issues with the national accreditation of some of the programs, which is, I don’t necessarily think, always reflective of the quality of education as much as it is the ability to recruit instructors, right, of a certain education level and background and experience and such.
Tell me how many professors of nursing or education or social work are going to be like, “Yes, I want to move to the middle of nowhere on the Pine Ridge Reservation and teach at a tribal college.”
Nacole (15:19): Can you explain how you went from making your decision to leave the reservation out of high school and then going to the nursing track?
Whitney (15:26): Yeah, so I started college up here. And I wasn’t really a hundred percent sure what I wanted to do as I was taking generals. And I’d been thinking a lot about a career in the health care field for a while, but I didn’t think I would be considered for admission because of my high school GPA, not to mention the lack of preparatory classes. Which, even if I would have been on point with my high school career, high school education is a struggle too, right?
The teachers are so overwhelmed trying to just keep kids in school, keep them from dropping out, that they don’t necessarily have the capacity to offer those upper level classes like that. So that was another thing too. Just looking into it, I had thought — just overwhelmed by all these prerequisite things.
And I was working, though, at an inpatient psych hospital while doing my general classes. And I really felt like I wanted to do what the nurses were doing there. There were some that encouraged me to apply more a tech school route for nursing.
And they had been like, “Hey, you know what? I suck at math too. But if you can do cross ratios, you’re good. That’s about the extent of math in nursing. And you don’t have to pass calculus or whatever to get in.”
So I did that. I got into an LPN program. I had to work while I was going to nursing school, always, all the way through. And that really kind of sucked. I would work over 12 hour overnights and then go to class the next day.
But I also got really great experience too, though, that really reinforced, “Keep going with this path, because it really is for sure what you want to do. And it’s going to be good.”
Nacole (17:19): Now, as a person that failed college algebra three times, I feel your pain on all that. I was like, “I’m never going to pass this class. I’m never going to be a nurse.” And it’s just like, you just keep going. You keep trying and doing the best you can.
So I’m glad to hear that your journey got you where you needed to go. Whitney, can we talk about the connection that you made between nursing and your ancestral culture?
Whitney (17:41): Sure. So I’d mentioned earlier, compassion, generosity are two huge traditional Lakota values. And compassion, calling us to look for empathy in times when you might feel angry or frustrated, disappointment, resentful towards the person or situation.
And I don’t know, even these days, how many nursing students have even read “Notes on Nursing” by Florence Nightingale, but I have many times. And she mentioned so many times that it’s essential for nurses to maintain a compassionate approach.
There’s a spot where she talks about, basically, don’t take it personally when somebody is sick. They’re not super polite and nice to you because, hello, they’re sick in the hospital, and you’re taking care of them. So they might be a little grouchy. And you need to take that into consideration.
Generosity calls us to value experiences and other people over material possessions. But I also think it’s about being generous to others as a way of being generous and respectful to ourselves.
Like when we extend ourselves to people, we’re also extending that same treatment to ourselves as well. It feels good. Not extending yourself like that to somebody, that might be something you regret and feel bad about. But I feel nurses are generous.
Things like patient-centered care are very much thinking about, “How does somebody else want to be treated when they’re getting health care?” Being mindful of the whole person as unique individuals. It shows when we’re reporting high levels of satisfaction in our work.
And I think it also shows in those surveys. I don’t know if they did one last year, as the pandemic, but there’s a nationwide survey that, I think it’s 13 years in a row, we’ve been indicated to be the most trusted profession in the United States.
Nacole (19:35): Oh yes. Woo-hoo.
Whitney (19:37): Yeah. And that’s a big deal. It’s over fire fighters.
Nacole (19:41): For sure. I know. We’re pretty awesome.
Whitney (19:42): You know, that’s a big deal. And I think that’s a huge honor that people trust us so much. So Lakota people, we believe that if you live those values, that one day you’ll achieve, like I was talking about earlier, that status where you’re in harmony with other beings and very happy and fulfilled.
Nacole (19:59): Now, you work at a clinic. Can you tell us a little more about the clinic, the services and the patient population?
Whitney (20:06): So, where I work is a federally qualified community health center. And FQHC is the lingo that we use.
Nacole (20:13): Is that a government thing? Because I know governments love acronyms.
Whitney (20:16): Yes. Oh yes, it’s absolutely. It is under the BPC, the Bureau of Primary Care. It is under HHS, the Health and Human Services Administration. All the acronyms. And FQHCs are set up to be the safety net health care provider for the United States. And keeping in mind that these were set up many years before the Affordable Care Act.
So places like where I work, we’re a literal lifeline for a lot of people who didn’t have access to insurance or they were under-insured. And even though the Affordable Care Act opened up the potential for millions of Americans to access health insurance coverage, there’s still a lot of gaps that exist that leave people without preventative care, care for chronic health conditions.
And something that’s really unique about where I work is that we’re a Level 3 Patient-Centered Medical Home. Here’s another acronym, PCMH, which is a really distinguished designation, because it’s the highest level that can be awarded to organizations that demonstrate that their patients are able to get essentially all their care at the same place.
And we offer primary care, dental care, midwifery. We also do have once a month an OBGYN coming from a larger health care facility to take care of high risk pregnancies, 340B pharmacy, lab, dietician services, smoking cessation, assistance for obtaining screening services for mammograms and pap smears, colorectal cancer screening, sliding fee scale for people without insurance. But that can also be used as a secondary insurance for people with high deductible plans.
Nacole (21:55): Oh, that’s smart.
Whitney (21:56): Yeah. Help with enrolling people in Medicaid programs, access to legal services of North Dakota, the state’s only Health Care for the Homeless clinic, medical care for inmates at the Cass County Jail, Hep C treatment, MAT services for opioid use.
Nacole (22:13): It’s really comprehensive.
Whitney (22:16): It is. That’s how you get PCMH status.
Nacole (22:18): Wow.
Whitney (22:19): Medically and trained interpreters for multiple languages. And then my program, which is probably our newest program, this integrated behavioral health.
Nacole (22:28): Oh, okay. Now regarding the patients, is it just the patients, like they’re indigenous or there’s other populations that are there as well?
Whitney (22:37): Oh, it’s everybody. Anybody who is uninsured, under-insured, does have insurance and just prefers to make us their medical home. I’m a patient at the clinic that I work at. And so are my kids and my husband. People of all walks of life basically.
Nacole (22:54): Now, Whitney, does having federal funding and being a Federally Qualified Health Center, does that impact your approach or the providers within the organization?
Whitney (23:04): It impacts both for sure. I think that if you’re coming to work there, as a provider nurse, as a professional, you have this awareness and understanding that this is a place that is intended to be the safety net health care provider.
And that there’s going to be a lot of people who’ve had adverse childhood experiences, who are living in poverty, who are otherwise not having access to a lot of different services that other people have access to.
I think that the professionals that we attract to work there want to work there for that reason because they feel like it’s somewhere that’s going to really challenge them. And that’s the populations that they really are wanting to serve.
And I would say there’s quite a few people who work there that that’s their background. They grew up that way. And I know I feel that connection to the place for that reason.
You know, “Where do I go to see a doctor? I’m pretty sure I have a UTI and I don’t have insurance. There’s no Indian health services here. So what do I do? Because I’m calling clinics and they’re telling me I have to have some down payment of a couple hundred bucks to see a doctor there, and I don’t have that. And where am I supposed to get the medication from?”
Those worries and concerns. I really think that a lot of it is attractive for that reason. And people want to do that kind of work. And that’s what they’re interested in. And they know that it’s going to be very fulfilling as well. That’s something that keeps professionals there. We don’t really have much of a turnover where I work. The people that I started working there with when I first came there as a nurse 7 years ago are many of the same people I still work with now.
Nacole (25:00): I think I usually only work with people maybe 2 to 3 years and they’re gone. So that’s nice.
Whitney (25:05): Yeah. It’s really great to have that. And it is almost like a family. We’re a small enough organization that we have gotten to know each other very well. And we celebrate things together. We really had a year as everybody out there did. Generally we all felt comfortable enough with each other to share in that too. Like, “Hey, this is hard and this really sucks.”
Nacole (25:32): Seriously. For sure. It’s been a crazy year.
Whitney (25:35): Yes, for sure.
Nacole (25:36): Now, your patient population might also have the homeless demographic in there as well. What barriers do you face when you’re managing the care of someone who is homeless? Or what do you observe the difficulties being?
Whitney (25:48): I had been the nurse in our Health Care for the Homeless grantee clinic. I did nursing case management in that job. And probably the first big barrier that I think is really significant is just major mistrust of providers. And that comes from a lot of sources for people who are experiencing homelessness.
There’s not a whole lot of trust in anyone in general. A lot of them have had some really terrible experiences. Institutionalization just ended in the late eighties, so there’s some people who are highly institutionalized prior to that.
So as a behavioral health provider, that’s something I try to be really mindful of is that there are people who were in state facilities for decades, or maybe several years at a time. A lot of people who have been incarcerated too. And that makes it really hard for them to adjust to life outside of a penitentiary. It’s a whole different environment.
Another big challenge is there’s very few providers that are willing to utilize harm reduction as an approach with not just substance use, but mental illness, chronic health care. And we really are, not just at the Health Care for the Homeless part of our clinic but just overall, very open-minded to using that approach.
Because it is more about, “What are my patient’s goals, not my goals that I want to have for them?” I don’t like to use the term crazy ever, but I will reinforce for people, sometimes like other providers, it’s not against the law to be crazy. It’s not against the law to be mentally ill.
If somebody is not distressed by their symptoms, they don’t want to take medications for whatever reason. And trust me, I know my husband’s seen commercials for some of the antipsychotics on TV, and he is like, “How do you get people to take this stuff?”
Nacole (27:47): Have you seen the side effects? Oh my gosh.
Whitney (27:48): When you read the side effects. He’s like, “Can that really happen, a life threatening fever?”
Nacole (27:54): Baldness. Skin falling off. Fingernails falling off. Like what? Going bald? What is happening right now?
Whitney (28:01): Yeah. I mean, It’s a tough sell. And I get it. I definitely do. But just, are they safe? Are they going to hurt somebody or themselves? No, they’re not. Then if that’s what they want to do, then that’s what they can do.
And I do tell people that I see as patients that I’m not there to be the boss of their health care. If we were going on a road trip, they would be the driver. I have some maps, and they can tell me where they want to go, and we can find what route they would like to take. And I can give them some advice on how to get there based on that map, but ultimately they’re the decision maker.
Nacole (28:42): Now, can you explain this harm reduction approach? Give me an example of it, because that’s something I’ve never heard of before.
Whitney (28:47): Harm reduction works on the principle of how do you — instead of trying to come from an approach like abstinence, say for example, with substance use. How do you instead approach it from like, “Okay, you’re not ready to not drink alcohol anymore. So what are some things that you would like to see improve that don’t involve necessarily quitting drinking altogether?”
The nurse practitioner who works in our Homeless Health Clinic does an awesome job when people have alcoholic gastritis. Like, “I want to quit having heartburn so much.” “What do you drink, usually?” “Typically, I drink hard alcohol or whatever, or beer.” “Well, what are some things that seem to make that worse?” And they tell her. You know, “Maybe drink less of those then.”
Nacole (29:31): Okay. Okay. It’s not about completely stopping. It’s just about reduction?
Whitney (29:35): Yeah. Here’s some ways that you can maybe — and I’m going to put you on like a PPI or something to try to reduce the acid in your stomach so you can sleep at night and you’re not waking up from heartburn.
I don’t necessarily have to demand that you quit drinking in order to treat stuff. That’s more productive, because if people aren’t ready and they’re not in the space to do one thing or another that’s the recommended guidelines — those recommended guidelines, those are written very generally.
And if you look at every single one of them, I would almost put money down that every single one of them has a disclaimer that says this should be used as a guide and not like, this is something you should apply to every single person who comes into your office.
Nacole (30:18): Gotcha. Now, I also heard you mention that you might have a virtual medical detox program that you guys started. Can you share a little more about that?
Whitney (30:27): At the beginning of the pandemic, things really accelerated quickly here, as it did, I think, a lot of places in the United States. So like early March 2020 is when we really saw the first real big surge of COVID-19. And at that time, there were so many unknowns. We didn’t really have very many tests either.
I thought about all the people that I had done nurse case management for when I worked in the homeless health part of our clinic. And I thought, “Oh man, if any of them,” — I was thinking of just a list of people that if they got put into quarantine, their alcohol withdrawal is so dangerous they’d have seizures.
Nacole (31:09): Oh, I didn’t think about that.
Whitney (31:10): I’m like, “Oh my gosh.” Something that was on the priority list for all health care providers: try to keep your patients out of the ER. We got to keep the ERs and ICUs for a COVID patient. So anything you can do to keep people out of the ER is ideal.
I was talking with a colleague, “What’s going to go down with quarantining and stuff, individuals who are presumed positive or whatever?” And they had said, “Well, the state’s arranging this alternative care site for people who don’t have housing. They won’t be mandated to stay there.” And I don’t think any place in the US did any mandatory quarantining. “However, we really need to try to get them to stay there.” I’m like, “Yeah, I totally agree.”
Because this, I mean, also was thinking of a huge list of people in my head that COVID-19 would be fatal if they got it. And when you’re sleeping outside in March in North Dakota, what COVID-19 would do to your body if that’s your state of health in general.
We were texting that weekend and I’m like, we always talked about that I would be willing to do some medical detox. I guess I should provide a quick side note. There’s not a single medical detox program or facility in the entire state of North Dakota. So there was no option for this other than the ER.
And of course, if you’re wanting to quarantine somebody, it’s not ideal that they go to a detox facility anyway, because that’s usually communal. And the people I was thinking in my head, “They can’t get Gatorade and a bologna sandwich. They need lorazepam.”
Nacole (32:46): They need meds.Gotcha.
Whitney (32:48): Yeah. And so we always talked about that when I was done with school, we would get something off the ground for offering medical detox. I think we have to do it. And they agreed. The shelter that I partnered with on that, the Gladys Ray Shelter in Fargo, is actually operated by the city. And I worked super close with them when I was a nurse. And that’s who we coordinated that through.
So we had the nurse from homeless health services and their shelter advocates, or harm reduction advocates, helping lineup telehealth visits for me to do with patients, get consent, assess their withdrawal and then prescribe treatment. And then the staff was going to the pharmacy and picking up the medication. And the patients are self administering that, but we were also having the medication be stored by the staff in order to avoid a situation where if somebody did.
And I would tell patients that, “You cannot take your Librium with you if you leave. Because if you drink while you’re taking that, and the Gabapentin or whatever else I also prescribed, you will die. So you can’t take it with you. It’s for use while you’re at that alternative care site”
I told them some of the other things they could take with them if needed. So we got that up and going on the fly. And it worked very well. All the people that I saw for that purpose were retained in quarantine and they did not leave quarantine for the recommended period that they were asked to be there. So I think it really helped. None of them visited the emergency room for detox related stuff.
Nacole (34:29): That’s a great program. Now, throughout the interview, you’ve mentioned how poverty and health equity has impacted your patients in your community. How can nurses who don’t struggle with those things develop cultural sensitivity in their care approach?
Whitney (34:44): I think really taking a look at adverse childhood experiences and the data on that. I think that is so profound when people look at that. I hope that we continue to, as a profession, implement that as required information for education, because that is a landmark study.
We don’t usually get a conclusion from a first run at things. And this was a positive correlation, dose mediated response between things that happen that are bad in our lives and the development of chronic health issues. And not just mental health issues — heart disease, diabetes, cancer, all these things. So I think when people see that data, it becomes like, “Wow, this is not something that people can just decide to pull themselves together and get past it.”
Nacole (35:37): I agree. “Just get it together. Just get it together.”
Whitney (35:42): Yeah. And I think too, a lot of information on — I would really implore nurses to look into trauma-informed care. And not only what that can do for your patients, but what that can do for you, because nurses and health care providers who utilize trauma-informed care have substantially lower rates of burnout and moral, ethical distress.
Because from a mental health standpoint, I’ll tell you, what that does is it takes the accountability for your patient’s actions off you and puts them back on the patient. This is what they’re capable of doing. These are their goals based on what they have said they can do. I am not responsible for any of that.
Nacole (36:22): I like that.
Whitney (36:23): What they do is what they do. And I’m just here to appreciate them.
Nacole (36:26): I’ve got to write that down. Okay.
Whitney (36:30): Yeah. It really provides a lot of capacity for that compassion. But also treating yourself well, too.
Nacole (36:39): That’s definitely something you struggle with. You want your patients to do the right thing, but sometimes they’re not quite there yet, and they’re not quite ready. And you can’t stress yourself out trying to make someone do something that they’re not quite ready for.
Whitney (36:51): Yeah. One hundred percent. And why do that to yourself? Certainly, I will tell you, in the history of never, has that approach worked.
Nacole (36:59): In the history of never.
Whitney (37:01): In the history of never. I mean, I’ve gotten frustrated like that. I remember even when I was in LPN school, I had transferred from work at that psych hospital to working as a CNA in the intensive care, progressive care.
And there was somebody who had, oh my gosh, this patient had had a massive heart attack, like a widow maker. They barely survived. They had a quadruple bypass. And they had a slew of goals set for them. Because this was also 14 years ago or whatever. I think we’ve come a lot further with patient-centered care since then.
But this person, one of the things was recommended: eat less red meat, eat more fish. Well, I was on progressive care this shift, and this patient’s spouse brought them in McDonald’s. And I thought, “Oh my God, you got to be kidding me. You just had a heart attack and you’re having McDonald’s.”
Nacole (37:52): Like, what are you doing? What are we doing here?
Whitney (37:56): But you know what, though, Nacole? They had a fish sandwich and they didn’t have the fries. And now thinking back to that, I’m like, that’s what they had the capacity for, and they were trying. They really were.
I remember they were super concerned about how many days they were going to be in the hospital, and what the bill was going to be and all that. I don’t think that before I went into nursing, I would have known the difference, cholesterol wise, between a breaded fish filet on a bun and a piece of Atlantic salmon.
Nacole (38:23): Yeah, me too. Yeah. That’s true.
Whitney (38:25): I mean, maybe this person thought like, “Hey, I’m following doctor’s orders. I’m going to change things for the better.”
Nacole (38:32): With the knowledge that they have right now.
Whitney (38:34): Yeah. And maybe that was a celebration, like, “I didn’t die.”
Nacole (38:37): Yeah. They need something. And they just had a catastrophic life event. “Can I get a sandwich? And can you leave me alone?”
Whitney (38:48): Yeah.
Nacole (38:49): You got to respect it. Whitney, thank you so much for sharing your stories about your community, your patients, your clinic and everything in between. I learned so much.
Whitney (38:58): You’re welcome. I was happy to be here today. And thank you so much for having me.
Nacole (39:08): Thanks for listening to SHIFT Talk. This podcast is brought to you by SHIFT, an entertaining nursing community for today and tomorrow’s change-makers. SHIFT is sponsored by the Robert Wood Johnson Foundation. The views expressed in this podcast are of the guests and hosts only, and do not necessarily reflect the views of the Robert Wood Johnson Foundation.
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