Episode 12 - Keith Carlson - Leveraging Your Nursing Knowledge & Skill for Career Alignment & Job Satisfaction!

Thank you for joining me for another episode of the Nursing Strategies for Success podcast with this week's guest, Keith Carlson. Keith is an expert career coach, freelance writer, podcaster, motivational speaker, and award-winning nurse blogger. Might I also add that Keith has been a colleague and a friend of mine for several years now, as introduced through the National Nurses in Business Association. Keith's podcast, The Nurse Keith Show, offers invaluable information for nurses and healthcare professionals seeking career satisfaction, deeper knowledge, and he interviews high-level healthcare leaders and influencers. So let's welcome Keith to the show. Welcome to the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders educators, experts, and advocates to tackle some of our greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for this show. So sit back, relax, and get ready to learn that nurses can do anything. Okay, Keith, thank you so much for being on the Nursing Strategies for Success podcast. Why don't you just take a moment and introduce yourself for the listeners? Let them know a little bit about where you started in nursing and where you are today.

Ah, okay. Well, where do I begin? I was born in the house my father built. That's actually not true. I was born in the house my father bought. How's that?

Um, that worked. Great start.

Yeah. Well, I've been a nurse 25 years this year, so 1996, and I kind of got a later start. I became a nurse at 32 or so, right around then. And I did what many people would say, or many people did say, was professional suicide. I announced I wasn't going to take a job in acute care and everyone freaked out. And they said that it was basically professional suicide and it was really dumb. And I was like, well, hospital is not my happy place, and I kind of have a sense of what I want to do. And I always do things differently than other people anyway, um, for better or worse. So I went right into community health in a federally qualified community health center in a very poor neighborhood of a very struggling city in Massachusetts, and Holyoke, Mass. And then I went into home health and public health, and I've actually avoided the hospital for 25 years. I've been in it as a patient several times, but I haven't actually worked in one. So it was not professional suicide, and I've had a very interesting and varied career, and along the way became a nurse blogger. I was a very early adopter. I became a blogger in 2005, and that blog is now 16 years old, almost 17. Wow. Still going. Yeah, it's called Digital Doorway, and I had no idea what I was doing when I started, but it's just what it is. And then I got into podcasting and then speaking at conferences and then became what I call a holistic career coach for nurses about 10 years ago. And I'm a board-certified nurse coach. And so I do all these different things and a little consulting, and I work as a nurse on the side here and there. So my journey's been interesting, a little iconoclastic, a little different. And for me, it's been perfectly fine and fun. And it's, it's had, it's had its own life. My career has just been, it's been a little different and out of the box.

Well, that sounds very exciting. I'm sure a lot of the listeners here might have gone more of the traditional route or considering the traditional route going to bedside in an institution or organization like a hospital or long-term care. Facility. But you know what, what we do know, you and I both, because we've been working together and collaborating over the last few years now, we know that nursing has so much more than your traditional hospital or long-term care bedside role, right? There's so many different avenues of patient care and delivering healthcare, delivering our nursing knowledge and our expertise, which is made my career as a nurse super exciting as well. So this is, this is wonderful. So let's talk about what the, what the topic of this, you know, podcast is all about, you know, identifying some challenges that the nursing profession faces. We know there's plenty, we have plenty of challenges. And so, you know, what's one thing that you've identified across the spectrum of you being in the nursing profession? What's the one thing that you saw as a problem that you are now working towards helping to correct?

Well, it's a good question. One is this narrow definition of what a nurse is. I think it's a very, um, uh, limiting and potentially suffocating definition. And, you know, you, you help with NCLEX questions and that sort of thing, right? You help write questions and We've talked about the NCLEX before and you're an expert and the Future of Nursing Report that came out just recently, the 2020 to 2030, they're very specifically calling for more nurses in public health, community health, and home health.

Absolutely.

So doesn't that tell you something? Yeah. Everybody and their mother wants to become an ICU nurse or an ER nurse. Those are the really sexy things. And I totally get it. Critical care, adrenaline, ED, you know, not my thing. I'm not an adrenaline person.

Thank you.

Yeah, I, I like to do important things, but I don't need to run around, you know, saving lives and all of that to, to do that. And I know some people do that, and we need them to do that. If I get hit by a car, I want an awesome ER nurse in the ER to assess me and help patch me up.

Absolutely.

However, only 50 to 60% of nurses work in hospitals. So what do all the other people do? And let's talk about you know, advanced practice nurses as well. Let's lump them in there. So one issue for me is that the NCLEX is so narrow, and I think the Future of Nursing Report is actually pointing to the fact that we need to expand what nursing is and make, make public health and community health and home health and school-based nursing sexy and attractive to people. And school-based nursing is public health. I see it as a form of public health. So Not everybody can and should work in a hospital. And we need employers to realize that new nurses who have not gotten a year or two in med surg are viable candidates for jobs and they just need proper precepting and mentoring. Absolutely. So we have to kind of like break these walls down and it's a really hard one. And I've been hitting my head against this wall for a long time.

Yeah, yeah, you and I both. You've been in the game a lot longer than I have. However, the 11 years that I've been at it, I've been kind of stumped from the beginning. And like I've said many times before, a lot of the issues that we, that we see that plague nursing aren't nursing-specific a lot of the time. Sometimes it's just process-specific or organizational kind of things, or administrative or financial things that aren't necessarily necessarily directly related to the practice of nursing. Um, and so yeah, this has been kind of the big question: how do we transform the way that nurses are viewed, um, valued, and also, you know, educated and trained? All of these things need to shift because we do need more nurses in the community, because we need our patients and our community members to stay healthy in the community and not continuously feed the big money machine that we have right now, right? The acute care, the disease, the Big Pharma, those type— and all of these are needed, you know. By no means are nurses trying to say that these organizations don't, don't provide an excellent service, because they do. But that doesn't need to be the primary focus of healthcare or of nursing. We do need to be more into preventative and prevention and holistic well-being and things like that so we can have communities that thrive instead of just staying sick.

Good point. We need nurses to understand this. Even if they're taught some aspects of public health or community health in school, it's still It all comes down to acute care, and the NCLEX is what schools teach to. So if that's what the NCLEX is about, that's what they're gonna focus on.

Absolutely. Now, you know, there is a push for more community-based questions to come onto the NCLEX. And I do believe from, you know, what I've been following from the NCSBN and a lot of the talk about the Next Generation NCLEX that should be rolling out in 2023, They've been researching these higher-level critical thinking type questions for a while now, but they are expanding the test plan to include more of the— what some people would consider alternative career pathways for nurses, although it's really just a returning to the community where we started in the first place, you know, back in the day when nursing was just coming to be. They're starting to emphasize more of the public health type roles in nursing, because we know systemically that is the big shift, and it's going to have to be the big shift in order for our healthcare system to survive.

And we all have to value nurses who choose those roles.

Yes, right.

We, we can no longer say you're just a school nurse or you're just a community health nurse. And that may seem like a small kind of, uh, superficial thing, but the words we use are powerful. And those words and those concepts get created and passed down in the midst of nursing education and early parts of people's careers when they're told what they should do rather than what they really want to. And nurses really need to realize that this way in which we limit ourselves and each other doesn't serve anyone. And, but we need, we need the system to change in a very large way because if employers aren't going to hire people who don't have a year of med-surg, then we're, we're in a tough spot. And there's not enough jobs out there for everyone, I think, to, to get those positions that they need to start out potentially. Um, so I think there's, there's lots of challenges that we need to overcome, and the Future of Nursing report isn't going to resolve everything, but I think it's a good guide for the direction that we need to head. And they, they too talk about, they talk about racism, they talk about George Floyd, they talk about the NCLEX, they talk about COVID-19. So they're, it's pretty timely, I would say.

Yeah. So, I mean, we definitely need to start at the ground up, right? So, so, I mean, that kind of leads us into identifying one of the biggest issues that we're having right now, um, with all of the challenges that healthcare in general plus nursing is facing, and that's keeping nurses in the profession. And so, you know, we have to reframe the way that we are educating our nurses. We have to reframe the way that nurses are being valued by, you know, the community as a whole, not just, you know, healthcare institutions, but also society, what the general average person thinks what nurses are or what they do or how they can contribute. We need to change the way we're compensated. We can't continue to allow private institutions to dictate our salaries where almost all other healthcare professionals have some form of seat at the table to negotiate their salaries, whether it's by billing insurance or having some kind of, um, you know, supporting organization that negotiates on their behalf, like unions, um, things that just aren't very uniform in nursing. And nursing seems to be the last one out when it comes to having a seat at the table for, you know, that salary bump that we all need, not only to survive in our society where things are getting more expensive, our salaries aren't keeping up. You know, I started nursing 11 years ago. Nurses brand new coming out of school are getting paid the exact same thing I was getting paid back then around $25 to $27 an hour. Registered nurses, it doesn't matter if you have an ADN, BSN, it doesn't matter. This is what they're starting at. And now with many years of, you know, education experience, I'm still being offered positions where I'm creating entire programs for institutions in the low $40s per hour. So, you know, there's a big problem here with how nurses are being compensated. Um, and it, I think a lot of it has to do with the fact that we're relying on private organizations to dictate our salaries rather than nursing-led organizations. So yeah. So how do we, how do we keep, how do we keep our nurses, Keith? What are we doing? Or what are you doing maybe to help address some of these issues?

Well, one is, is offering a wider array of things that nurses can do out of school and Nurses do come to me who don't want to go into the hospital, and I tell them my story, and I tell them that there is a certain liability— and I'm putting quote marks around that— um, not doing that 1 to 2 years of med-surg. And it does take a certain amount of temerity and courage to do that kind of different route. So that's one thing. And then we, we need the schools and everything to be geared towards, like I said earlier, making people aware of the other opportunities there are. And then we need employers to be open to that. Otherwise, we all know that the culture within healthcare is a big issue. You and I both are friends with Renee Thompson, Dr. Renee Thompson and her Healthy Workforce Institute. And her life's mission is eradicating bullying from the profession, which when you tell the average civilian about it, they can't believe there's bullying in nursing. It's like, what do you mean nurses bully each other? Institutions really need to get on board with this. And I don't know if the Future of Nursing Report talks about culture, workplace culture.

I think I saw the word incivility in there.

Yeah, I think it might be in there. I haven't read the whole thing. It's really long.

It is long.

Yeah, hundreds of pages. But that needs to be addressed by institutions individually and then organizations on the bigger systemic level. And it just can't be tolerated. And a lot of people leave the profession after a few years, oftentimes because of how they've been treated. Absolutely. And that's a sad, sad statement, isn't it?

Yeah.

Especially about the profession that's the lifeblood and connective tissue of, and the mitochondria of healthcare. I mean, that's just not okay. We also need to make sure that nurses earn proper compensation, like you just illustrated and elucidated about your own experience. And we need to make sure that when they get out of school, they're compensated, they're not bullied and not treated poorly, they're treated very well, and they're— they're— it's communicated to them how valued they are and how grateful we all are that they've entered the profession. And we also need to make sure that— or we have to cajole facilities and organizations into offering more precepting, mentoring actually, and orientation that actually brings them into the fold. And I speak with and I coach a lot of new nurses who are applying to nurse residencies in various specialties right out of school. These are so competitive, there are so few spots relative to the number of people graduating that not everybody can get in. It's just not possible. And back in the day, before you and I were probably, well, maybe after we were born, but when we were little, nurses were trained by hospitals. That's where the nursing schools were. And a lot of older nurses lament that schools, the schooling of nursing moved out of the hospitals to community colleges first, I think, to a large extent. Right. And they lost that access to like really intensive clinical training. I personally feel that Every brand new nurse going into acute care should go directly into a residency.

Mm-hmm.

Every single one. No one should be left out if they want to be in a residency. It shouldn't be this like precious thing that a few select people get to experience.

Yeah. And from my experience working as a nurse educator in the hospital setting, not all facilities have residency programs even established.

They don't.

Or if they do have one, it's not really a residency program. And, you know, I've worked with people who go and audit residency programs and, and do that kind of ongoing consulting with these institutions to make sure that if they're claiming they have a residency program, that it is actually up to par. Um, but, you know, I've worked in institutions where they claim they have a residency program and all new graduates do go through the program. It's a mandatory requirement for their onboarding. It usually is spanned over 6 months or a year depending on the institution. But, you know, from an insider's perspective, I can tell you it's still bare minimum. It doesn't really meet the needs of the, you know, evolving healthcare setting, and it often misses a lot of the essential skills. And I have to give a shout out to Dr. Dr. Keaton, um, who works at NYU, because she helped me transform the way that I speak about soft skills and, and relabel them as essential skills. And they often miss those essential skills, um, because the educators are strapped. They're already overwhelmed. They don't have the capacity to be with the residents the way that they should. And then oftentimes even their preceptorship programs, how they train their trainers, often falls short because of the fact that they're just so task-oriented and so overwhelmed with patient care and the tasks of patient care that they don't have the appropriate support that they need to have these robust kind of programs. So, you know, some places are better than others. We know this is true, but this is a systemic problem. And so Yes, everyone should have a residency program. And I'm, I'm glad that you offer that, you know, coaching and mentoring for these individuals who are transitioning into care, because institutions need people like you and I to help buffer some of that, you know, to bring these people in. And if institutions could see the value in, you know, investing in our services to kind of fill these gaps for these new graduates, they would definitely get a return on their investment because they'll have a much more prepared, you know, nurse who has someone that they can rely on when their educators and their preceptors have their attention focused on patient care, because that's often the case, right?

Yeah, wouldn't they? So everyone would benefit, but we all know that, you know, the for-profit healthcare system— and I'm not a healthcare economist by any stretch, but the for-profit healthcare system is part of the issue here because it's for profit, right? So a residency costs money. It costs a lot of money.

And it's a— in their eyes and the individuals who balance the budget, right, it's not very much of a good investment on their end. They don't see the return investment. Um, again, nurses don't bill insurance. We don't bring in a ton of money as far as when I go to work, do my work, I'm bringing in thousands and thousands of dollars. However, it does always translate to money, the nursing care that's being provided, because without nurses, the care is not being done. Without nurses, patient injuries would go through the roof. Without nurses, you know, you wouldn't arrive to the outcomes that you need to meet in order to even stay in business, right? So really, the economists or the financial guys in the healthcare They're for-profit, and you're right, it's generally the problem. But I personally don't understand where the problem comes from, because to me, it's clear as day that nurses actually bring in all the profits, because without us, you would make none.

That's true. And I do believe the Future of Nursing Report, to go back to that once again, it does mention changing the payment system. And it's been said for quite some time by certain people in that economics world of healthcare, that nursing tasks and nursing care should actually be a billable, um, uh, it should be a billable thing. It should not be something that's just wrapped into the room cost, because that actually, you know, if you think about it, devalues what we do because it's not given a monetary value. And also it does it, it sends a certain message, it sends a signal, and that's not a very helpful one. I mean, I mean, environmental services, it's very important, don't get me wrong. That's wrapped into the room charge, right? Um, picking up the trash, cleaning the rooms, disinfecting. Nursing is lumped in there too, and we're providing hands-on care to real-life people. Not that we're any better than the environmental services people, but we're clinicians, licensed clinicians. And that care should be billable. Don't ask me the deeper economics of it because I can't explain it.

Right. But to piggyback on that a little bit, you know, it goes into, again, how we place value on things in our society in general. Right. There's a lot of things that we, we pour a ton of money into that is truly, at the end of the day, not important. Right. It does not impact anyone's life beyond entertainment. Right. We pump in so much money into entertainment. But going back to say the differences between environmental services and nursing, or nursing and dietary services, right? Yes, we are no better than them on a human level, right? We are all valuable, we are all necessary, we all play our part. But the big difference, just like doctors or physical therapists would argue, is that they are providing a specialized service to meet the individualized needs of the patients, residents, or clients. Right? And nurses do the exact same thing. We change our care based on what the patient needs. We change our care based on patient preferences. We change our care based on the status of the patient. So if they're crashing and they're showing signs that they are not doing well, we immediately stop everything we're doing and change things around to get the patient stable. So we are providing a highly specialized highly critical thinking focused service that again, without us, the patients would die because the doctors, there's not enough doctors to go around to be there at all moments in that patient's status. So again, yes, we need to, we need to be out of room and board. And from a business person's perspective, profits and all, I understand. If I have a very expensive thing to pay for, I'm going to do everything I can to save money to be able to afford that. And nurses do eat up a large profit of these healthcare institutions. It doesn't mean they're not making money, by no means. So anyone who thinks that poor hospitals— don't even go there. They're still doing well because if they wouldn't, be doing well, they would shut down, right? Business is not going to be in the red for too long before they shut down, especially one with such high, you know, stakes. So, you know, yes, we need to change the model system, but there's more than enough evidence to show that nurses should be compensated differently than the way that we are. And I think that's a— and I agree with you, that's a big reason why we have a lot of the issues we have in the institutional settings, you know. Now offering these different roles for nurses back into the community, or even in business like both you and I are in, that opens up so many more opportunities for nurses to really hone their skills, utilize their expertise to make the impact that aligns with them better for career satisfaction. And so that's exactly what you do. You help people figure out how to find that satisfying career utilizing what they already have. So, um, can you elaborate a little bit about, you know, what services you offer and how you get people to that place?

Yeah, well, thanks, Damion. Um, first of all, the, the nursing process, as much as when we're done with school we don't want to hear about it anymore, but we always start with assessment. Right? We do everything we do, we start with assessment. If we're going to go grocery shopping, we assess what's in our fridge before we go, right? So you can apply the Nursing Process to your refrigerator. Yeah, um, you heard it here first. Um, so the first thing I like to do is an assessment. I have various forms people fill out. We have conversations. We, we really try to find what it is this person is all about, what makes them tick, what has not worked, what is working, what they think they want in the short term, the midterm, and maybe even the long term, and then devise a strategy for how to get there. And oftentimes people come to me with nuts and bolts questions like, I have an interview, or, and I need to prep, or I need to up my resume game, or LinkedIn, or I need to write cover letters and I don't know how. Um, so it could be something as simple and kind of like straightforward as that. Or people also come to me with existential questions like, "I don't feel like I can do this another day. It's killing me." And I'm like, "Okay, that's not a resume question." No, this is like existential questions. And I also like to dig as deep with people as they're willing to go without delving into the realms of psychotherapy. I know where to draw the line and say, "You need to see a therapist that piece. But we need to have deep conversations about what values inform our lives and the types of lives we want to live, which includes our work and the career path we want to forge for ourselves and the, the lives we want to create for our families, for instance, our loved ones. So I call it holistic career coaching because yes, I can help with a resume, yes, I can help with the COVID letter, But I really like to look at a person's life from a pretty global perspective if they're into it, and a lot of my clients are into it. So that's a lot of what I do. And, you know, a lot of people come because they just can't get hired or they can't get interviews, and we work on the stuff that matters and what a person needs to do in order to move the needle when they're out there in the— in a often challenging marketplace. And sometimes people come to me because they just don't know what they want anymore. And then that, that entails assessment and conversation and a strategy as well. So I love helping people with these sorts of things.

Yeah, so it sounds like, you know, kind of what I've done in my nursing career for myself is when I feel like things aren't moving in the direction I want them move in, or I'm feeling like my back's against the wall sometimes. I mean, it's so sad to say this, but I felt that was the first, like, 3 or 4 years of my nursing career. I felt like my back was against the wall the entire time, from graduating nursing school, passing the NCLEX, landing my first job, and then, you know, navigating the complexities of my first role, trying to be mindful of how I present problems and not just be, you know, a troublemaker, but offer solution, and I just wasn't getting anywhere. I was getting a lot of resistance, a lot of, you know, well, this is the way it's always been, or, oh, you're just a new nurse, or you don't know anything. And not once was I ever rewarded or, you know, even recognized for the 15 years of experience I had before I became a nurse, like the 15 years of adult working experience that I had in food and hospitality industry, opening multimillion-dollar restaurants up and down the Eastern, you know, shore board. And, you know, being someone who's created corporate-level curriculum for front of the house training, and not once were any of those skills acknowledged. And that goes back to what you said earlier about how we are treating our nurses when they come into the profession, once they get their licensure, and even when they're a student. I mean, I can't tell you how many times I was bullied or, or made to feel, you know, inadequate or intimidated by my instructors. People who look at me and say, half of y'all are gonna fail this, this clinical before we're done. Like, why would you be teaching in the first place? Like, what is your motive? Yeah, right. So, you know, I just, I had a lot of that early on in nursing, and there was a few times where I seriously considered, why am I doing this? Why am I even wasting my time? I feel like I've been put into a position where no one wants the work that I want to provide. No one wants the innovation or the collaboration or the change. They just want the status quo.

Yeah.

And from my assessment, status quo is not nearly what I expected it to be. And I wasn't going to settle for less. So I kept pivoting. I kept saying, well, this isn't working, so let me go try the next best thing. And so early in my career, a good 3 years in, that's when I decided for me, I felt it would be easier to maybe work for agencies and not necessarily work for an organization.

Right.

And that provided me a lot of freedom. It provided me a lot of autonomy in my nursing role. It allowed me to travel the country and see how things are done in different areas so I can continue to live my mission and try to improve the process and, and learn how I can continue to be a better nurse and serve the community in a better way. And I just learned that the, the issues in nursing are really fundamentally the same across all spectrums of healthcare. And again, what I said earlier, it's not often nursing specific. It's often systems, operations, communication, the way we treat each other, all of these essential skills, and the way we're compensated, you know, all of these things that have nothing to do with nursing practice per se, right? Um, so yeah, we have a lot of room for improvement, and I wish I had a a holistic career coach like you early on, because I really did go through some dark times where I was just— you guys almost lost me. Let's just say that you almost lost me. I was almost out the door, back into the restaurant industry where I knew I would thrive, because I love, you know, everything about customer service and food, and I'm an excellent chef, and I could have really done something there. But I was just really hold to helping people in a much more meaningful way other than entertainment. Again, food and hospitality is kind of— falls under entertainment still. We spend so much money on entertainment, but again, when you wake up the next day, that meal last night truly, you know, impact your life in a way that's going to be, you know, you know, this radical change. Sometimes, sometimes we have meals that are like that. Um, or just for the sheer, you know, nutrition. Right. But yeah, people don't go to restaurants for sustenance. They go to restaurants for pleasure. They do. Um, so yeah, so nursing for me just felt a lot more meaningful spiritually even than just, you know, taking care of people's needs on an entertainment level. Right. So I stuck it out and I'm so glad I did because I've been able to do some pretty awesome things. And meet awesome people like you.

Aw, thank you. Shucks. Yeah.

So, okay, Keith. So, you know, as we wrap up this episode, you know, um, all of your contact information, I will make sure it's in the show notes of this episode, but why don't you just briefly let people know how they can reach out to you if they're looking for a holistic career coach or someone that they can collaborate with?

Sure. Um, well, thanks for your kind words and, um, NurseKeith.com is really the best place. There's links to my blog, there's links to my social media and my podcast. And if a listener is a real podcast person, they can find The Nurse Keith Show. There's over 350 episodes. And so it won't take very long to get through them all.

Just a few days.

A few weeks. Yeah. Um, so that's on every app you can imagine. Spotify, Stitcher, Intune, Apple, et cetera. It's The Nurse Keith Show. And those are the best places to find me. I hang out on Instagram, I hang out a lot on LinkedIn, and some Twitter and Facebook. LinkedIn is sort of one of my happy places and Instagram too. So that's where people can connect with me professionally, especially over on LinkedIn. So I highly recommend it, and I love hearing from people. So they can reach out and there's always a 30-minute complimentary consult if someone wants to bend my ear and talk to me. And then They're not obligated to work with me, but we might be able to move the needle a little for them in 30 minutes. So they're more than, more than welcome to contact me.

Awesome. And I just have to say, for anyone who is considering if, you know, Keith is someone that they should connect with, even if it's for that 30-minute consultation, you should do it. You definitely want Keith in your professional network. 'Cause just his blogs alone will give you so much value. So I highly recommend also, you know, subscribe to Digital Doorway, get those blogs, listen to his podcast, connect with him. And if you would like to work with him, you won't be sorry. So thank you so much, Keith, for being on the Nursing Strategies for Success podcast. As always, I enjoy our conversation, and I can't wait till the next time we get to hang out.

Thanks for having me, Damion, and my blessings to everybody. And I hope everyone stays safe and healthy this winter and continues living the lives that they, they're truly meant to live.

Awesome. Thank you so much, and we will be in touch soon. Take care. And that concludes episode 12 of the Nursing Strategies for Success podcast with this week's guest, Keith Carlson. We hope that all of the strategies we've covered in today's episode will help motivate, inspire, and empower you to lead the charge. As always, if you have any questions about anything we covered in today's episode, you can visit thenursespeak.com/contact and get in touch with me. I would love to have a conversation with you. All of the ways to connect with Keith will be in the show notes of this episode. And until next time, take care, be well, and remember that nurses can do anything.