Our Spotlight series highlights a new nurse from the SHIFT audience each month. We ask the same set of questions each time, but of course, we get all kinds of answers. The individual stories and surprise twists in these conversations make us laugh, cry, and feel proud. Over time, we hope to discover both what makes each of you unique and understand what ties all nurses together.
Renee L. grew up and went to nursing school in the Philippines. With strong interests in innovation and tech, after graduation she moved to the U.S. in 2011 to pursue both passions. She was ready to begin her nursing career right away. But she wasn’t able to actually be at the bedside until over five years later due to the complexities of transferring an international nursing license to the U.S. During that time, she worked a number of jobs, from retail to caregiver to administrative assistant to informatics technician supporting an EPIC implementation in a hospital—all during a period when she was also studying for the NCLEX and trying to figure out what exactly she needed to do to get licensed in California.
Never one to give up, today Renee is not only practicing in California, but she holds a master of science in nursing, with a post-graduate certification in health care informatics. She is also a certified operating room (OR) registered nurse and is currently pursuing her certification as a nurse informaticist. With love for both the fields of informatics and surgery, she has found a hospital in Los Angeles that allows her to combine the two specialties. And when she’s not “on the job,” she’s giving talks about her experiences to inspire other nurses and mentoring peers who are early in their careers and interested in hearing about non-traditional paths.
Renee’s story is all about perseverance and the wide array of options available to nurses today—within nursing. We are so excited to share her story and her perspective.
Why did you decide to go into nursing?
I always knew that I wanted to do something to help people. In fifth grade, we had a substitute science teacher who came and taught us biology. She was a former lab tech, and we were learning about blood typing. It was really hands-on. I got so excited about science from that, and the human body just fascinated me, and so that’s the path I started heading down early. Then when I got older, I actually thought I wanted to be a doctor. In high school I started thinking about the steps toward meeting that goal and how to pick a pre-med track. A lot of people said to get my bachelor’s in biology, that it would really set me up for medicine. But I felt like there was something missing there, because you can study biology all that you want, but that doesn’t really give you a feel for being a doctor. I felt like the closest thing to this career path was to be a nurse, because you’re in there with the patient, probably even more hands on than doctors. So that’s the story—originally nursing was actually supposed to be my pre-med. But at a certain point, I just fell in love with it, especially when we got to the point in nursing school where we started learning about the different specialties. I was just so blown away learning about the different ways I could grow. I could even go beyond clinical if I wanted—become a nurse attorney or a professor. I felt like there were so many different ways I could pivot and grow with this career. And I have.
Tell us about a time when it was really hard to be a nurse or a time that made you question being a nurse.
That makes me think of one of the first times I was dealing with organ procurement, which is part of being an OR nurse. I have only ever worked at trauma centers, and I did night shift for a while, which is often when organ procurements happen. I remember having a conversation with someone from the ICU, and they asked me, “Do you feel anything when you do this?” That was followed by the statement “You guys appear cold. It’s very emotional when we do these and it seems like it doesn’t make a dent with you sometimes.” That made me question myself. I wondered, “Am I even cut out for this?”
I had to pause, because in those moments I don’t really think about what everyone else sees. My response was, “Well, when I do them, I feel like I have to keep it together. I think to myself—how would the family feel if they saw the surgical team falling apart? How would they feel if they turned over their loved ones to us and we were a ball of emotion? In the OR we are literally the last ones there to declare the time of death. I need to show that I am together enough to see their loved one through to the end.”
Organ procurements can happen either after cardiac death or brain death. Protocols are different for both. After cardiac death is a bit more intense because we have to be there and wait a full hour before we can begin. Within that hour, you’re literally just watching the patient die. The family may be present, waiting and watching with you. The OR is cold, and there’s only so much you can do. Sometimes you can’t do anything. Death is hard, but watching a person die can be harder. I try to take comfort in the fact that other lives will be saved by organ donation. But sometimes it just doesn’t feel any better.
Who inspires you?
Oh! I have been so blessed! It’s actually my first boss who I think of when you ask that. When I started working in informatics rolling out EPIC for a health system in California, my very first manager there, even before I was a nurse, later turned into my nurse preceptor and then into my mentor. She’s done so many things, she’s achieved so much, and honestly, I look up to her. We’re coming up on about eight years now of knowing each other—and she’s been my mentor essentially all that time, even when I didn’t work at the same organization as her. She is the one who encouraged me to pursue other avenues in nursing that are not necessarily at the bedside. She’s the reason I learned that if I wasn’t at the bedside, that didn’t make me any less of a nurse. She has been so supportive, so amazing—I really have no words. I look up to her so much, and I hope to one day be that for someone, to inspire them the way she inspires me. I do some talks, and sometimes people will refer other nurses to me if they are thinking about nursing informatics or the OR, and I always tell them that they should go for what they want to do. Just because your career path doesn’t look normal by someone else’s standards doesn’t mean it’s not normal for you.
Describe your SHIFT BFF. Why are they your best friend on the job?
I actually just started a new job, and last night [before the interview] was my first time going out and bonding with some of my new coworkers! I like people who are kind of goofy. At work I’m honestly kind of a goofball, but I’m also still a big nerd. I’m the “new kid” right now and I’m trying not to attract too much attention, but I guess I’ve said some things that make them think I’m funny [laughs].
At my old job, I definitely had a work wife. I still call my work wife that even though I’m at a new job. She actually used to be an OR scrub tech and now she’s a nurse—similar path as me—so I’ve been mentoring her and helping her through the transition. I really gravitate toward people who are sure of what they want in life—that have plans that they are working toward. People who are bettering themselves, people who are in nursing for the right reasons.
Tell us something about your specialty that other nurses may not know.
There’s so much that other nurses don’t know about both the specialties I’m in, because they are each really specific and sort of siloed off.
There are definitely misperceptions about what OR nurses do, even from other nurses who work in recovery! I’ve even been asked, “So what do you do, just sit there and chart? Do you run and get things for the surgeon?” And the answer is “No!” Positioning is our jam—with surgery you have to know how to position patients exactly the right way. We’re also checking on so many things in the room—it could be something really mundane but still important, like where the plugs are located in the room. It still matters so much. We think about logistics and steps and backup plans in a very precise, intricate order. It is also part of our responsibility to know everyone’s role in the OR—from the environmental/cleaning side of things to sterile processing to anesthesia and actual surgical concerns—not only in the intraoperative phase but throughout all phases of perioperative care.
And then when it comes to nursing informatics, immediately many people think of medical charting, but it’s so much beyond that. What I like to tell people is that yes, it does involve technology, but it’s really about how technology is used. It’s taking the patient data that’s collected and figuring out how we utilize it in a meaningful way. Nursing informatics also includes things as seemingly simple as ensuring that hospital systems can “talk” to each other.
I also am really passionate about contingency planning and creating downtime plans for the OR—that’s not something other nurses think about in the same way. Our policies are just so different from the rest of the hospital. With unplanned downtime, there’s no way to access the computer system. Or even if WiFi is off and servers are down. What that means in the OR is that you suddenly might not be able to see the scan you’re relying on to successfully navigate that surgery and keep the patient safe. It’s scary, so I have been really hands-on in that kind of planning.
What does community health mean to you? What do you want for your community in terms of health?
To me it’s empowering patients to take ownership for their health and encouraging them to advocate for themselves. In LA, we have a very big LGBTQ population; we have a diverse population in general. We have people with strong religious beliefs, strong cultural beliefs. And as nurses, we need to be mindful about that—what are the implications? An example is Jehovah’s Witnesses and their belief that it’s not right to receive blood. We have to be able to have a conversation about that. Even something as seemingly simple as what pronouns you use with people is important. Community health means really being with your community and encouraging them to be more proactive with their care, but at the same time, giving them that safe space to ask for help. Whether it’s a woman’s right to choose to terminate a pregnancy, or an issue with addiction. If you’re seeking care, that’s what I’m here for, period. Community health has nothing to do with me and everything to do with you. I’m here to facilitate.
What is your vision for the future of nursing?
A lot of things that have blossomed from nursing over the past couple of years, I didn’t even dream could happen. I remember coming across an article about nurses and “first assist” (where an OR nurse can assist a surgeon, just like a resident would)—I’m so excited for that personally, for nurses being able to perform independent procedures. I’m really excited about that from an OR perspective.
I see nursing informatics encouraging women to go into STEM careers. I actually do talks with little girls to try to get them interested in STEM, to get them interested in computers, medicine, biology, chemistry, math, statistics.
Overall, with how things are progressing, we’re really pushing and testing previous barriers. Nurse practitioners are getting more and privileges, there are more advanced practice roles being empowered (midwives, for example). Especially with this pandemic, it just speaks to how resilient we are as a profession. I feel very strongly about continuing to advocate for the profession.
When I think about what I’m doing today out here, I hope that it is paving the way for nurses in the Philippines. I am not surprised that so many Filipino nurses have come to the U.S. to help with COVID-19. And I’m really proud of that. I have gone back to my college there and spoken about being an OR nurse and working in nursing informatics. I want to open all nurses’ eyes to the amazing things that could be in their future.
How can nurses be better to each other?
I think there’s a lot of internal work and we need to just be kinder. I come from the generation where nurses eat their young, but now I’m seeing a change to more “let us help you grow” with this new generation. I think the eating our young thing is a trauma response. Nurses have their own burnout and then whatever is going on inside comes out and they take it out on other nurses when they’re unhappy. I had a previous encounter with someone who, in my opinion, appeared to stay in this rut. She was a seasoned nurse, full of knowledge and experience with decades on her belt. I sought her advice as a resource, and instead of helping me come to the correct practice or solution, she instead made a comment about my degree and how I should know the answer based on the fact I have a master’s degree. I felt that, in that instance, she was projecting her own dissatisfaction. So it’s like, OK, you’re unhappy about where you are with your life, and somehow that translates into you resenting me for something that I have no control over. Nurses like that, somehow instead of choosing to get out of a certain situation, they’re choosing to stay unhappy. They’re choosing not to do something about it—I do believe they’re choosing to wallow in unhappiness. I can say this because I’ve been there—if you’re unhappy, change it. It just makes you a kinder person. And shaming is not an effective way to get to the best solutions or practice.
Describe one of your best shifts ever.
This one is a hard one! I have so many wonderful experiences and currently as an OR nurse, I am in constant awe of what we do when we’re behind those closed doors and past that red line. But I would say the best recipe for an awesome shift is being with my coworkers that I work well with, doing a line-up of cases in my favorite service line with awesome surgeons and anesthesiologists. I think team dynamics are very prominent in the OR since we are literally stuck with each other for hours on end. It helps if there is some background music that we all enjoy!
This interview is the part of our new monthly series, SHIFT Talker Spotlight. If you’re interested in sharing your story, please reach out or email us at email@example.com.