Ep.53 The Hidden Truth About Nursing Burnout | Nurse Jenn on COVID, Intuition & Saving the System

What should patients be thinking about whenever they're going to talk to their triage nurse so that they make sure they're taking the best care of themselves?

Yeah, great question. First and foremost, please have a list of your medications either on your phone or in a piece of paper in your wallet. A lot of people don't know what medications they're taking, and actually it can really prove to be a problem for us if we're kind of searching to figure out what's the root cause. So know your past medical history also. Any chronic medical conditions, if you're taking a pill for it, please mention that you're taking a pill for it. People, I ask, oh, do you have any high blood pressure? Oh, no, no, no. And then you get to the medication section, it says, oh, it says here that you're taking bisoprolol. And they're like, yeah, well, that's for my high blood pressure. I'm like, well, but you still have high blood pressure because you need to take the medication for it. So please be aware of what your past medical history is.

This is Uncommonly Remarkable. We have surprisingly casual discussions about the lives and notable accomplishments of community leaders, entrepreneurs, and everyday folks like you and me. Think of this podcast as an opportunity to learn something new and to pick up on an entrepreneurial tip or two through open conversation. I'm Artis Beatty. I'm a doctor of optometry and the chief medical officer for My Eye Doctor OD. Though we will inevitably touch on topics within my area of expertise, the opinions and conversations held here are separate from my work with My Eye Doctor. Jen, welcome to the show. I'm so excited to have you. Thank you so much for spending some time with us today.

So having me and putting up with my, my, my craziness.

It's going to be, it's great. You know, um, what I have learned as I've started to talk to people, and I'm so excited to be able to talk to people from now all around the world, is that you just never know what's going to happen with the schedule. And, you know, we plan these things well in advance and we've laid out this time and we know when we're going to talk. And then inevitably something changes, right? It's technology changes. Somebody loses a voice, which is not great if you're going to be talking to each other. Like, you just don't know. And so, um, I am, it's just super exciting that we were able to get the calendars to work out and we'll get to have a good talk today.

Oh my gosh. And there will not be children running into frame at a moment's notice because that happens.

That's fair. But full disclosure, um, I have a mini schnauzer. Her name is London and, uh, she is very, very attached and apparently mini schnauzers get that way. And, uh, she does not like for me to go into the closed door room without her. So she's here. Um, and she's being very quiet. She's napping. Uh, but you know, if the plastic bag moves a mile away and she hears it, she's going to wake up. We're going to hear London barking too. So.

And that's, and that's the beauty of it. That's just life, right? Like that's—

It is.

That's just it.

It very much is. So I have to say that as I've gotten to know more about you, I'm pretty— you've done some pretty cool stuff. I love your personality and the way you bring things to light. And so we have to start by really just talking about who you are and what you do today. And, you know, I have mad respect for you in being an emergency room nurse because my goodness, the things that you must have, you must encounter. So tell us a little bit about, tell us a little bit about Jen.

Oh my gosh. So I'm Jen Johnson. I'm an ER nurse of over 17 years, have worked in hospitals as big as trauma centers, stroke centers, pediatric emergencies. And then as small as hospitals where it's just me as the nurse in the department. So it's been the whole gamut of every size of hospital in like Northern and Southern Ontario. So it's been interesting that way. And then with COVID and burning out hard and hitting the wall, ended up writing a book about nursing intuition and how to trust your gut, which then kind of led me into business a bit. So selling the book, have made some journals, trying to get a nursing retention program together because in Canada, 30 to 60% of new grad nurses leave, choose to leave nursing within the first 2 years of their career, which is insanity.

Oh, wow.

After potentially putting in 4 years at university or 2 years at college. It's nuts. So have gotten into pitch competitions and nursing innovation spheres and am currently trying to kind of put together a pilot for this. So did I ever once think that I was going to do all of this? Absolutely not. But it's so funny what happens when you start saying yes to really random opportunities.

So tell me, so that's a really shocking statistic with, with so many people committing to a career, practicing in that career for a very short time, and then Changing. Is there, is there insight, like, as you've been kind of looking at this, is there a particular reason?

It's a multitude of reasons. Short staffing. And, you know, once you get your license, you very quickly are very protective of it, right? Because, you know, you've done the 4 years or the 2 to 4 years of school and you've put your heart and soul into this. And it can be as little as one shift, one hour in a shift where you've been put into a very unsafe position. Where you're having— excuse me— uh, to choose, um, you know, what you're focusing on. So all of a sudden you've got 4 to 6 really sick people that should be in ICU, but there's no spots. So they're, they're at your feet.

Yeah.

And you're trying to decide, who am I focusing on? Who's gonna— you know, I've got 6 med orders for all these people. Who do I do first? Who do I do last? And, and you're bouncing back and forth and You know, you can be put into some really awful positions and heaven forbid somebody actually dies. Not only are you carrying around that guilt for life, but then you're— the worry about, you know, did I do enough? Was I good enough? Am I learning fast enough? You know, all these kind of things. So, it's the— sometimes the situations that you're put into that all of a sudden you go, whoa, this is too risky. I can't be here. It's less risky for me to kind of maybe take a break from nursing, or maybe I change departments or go to night shift or whatever else.

Mm-hmm.

But the bullying in nursing, unfortunately, is still a horrific issue. There's also not a ton of support for new grad nurses. I mean, if you're coming out of school, so you've spent 4 years in university, you potentially have gotten a fairly decent amount of clinical experience where you're on the floor, you're doing the things, But nursing school doesn't have the time to teach you a lot of what you need to actually be successful on shift.

Mm-hmm.

You know, they don't have time to teach you emotional resilience. They don't teach you how to talk to people to, to talk them down if they're having a crisis. They don't teach you how to grieve your patient after you've lost them, how to process things. There's a lot of skills that you don't get to learn. They tell you, oh, it's going to be an on-the-job training. So your on-the-job training sometimes is 4 to 6 weeks and that is it. And you may be going into a specialty area which, like emerg, um, we suggest or we, we hope that maybe you've gotten 2 years at med-surg to really get used to people, get used to talking to them, get used to the routines and used to the medications that you're giving on a regular basis, kind of get some confidence up before you then come into emerg, which is a completely different beast. Yeah, it's different. Um, med-surg, you can kind of plot out your day. You can— okay, I'm coming on shift, I'm gonna get report, I'm gonna see my patients, and while I'm seeing my patients, I'm gonna do an assessment, I'm gonna do vitals, I'm gonna do their meds, and then I'm gonna chart, and then I'm gonna go to the next. And vitals, meds, chart, assess, on to the next. And, and you can do that, and then noon, you know, noon or midnight rolls around. Okay, usually that's another med pass. Okay, let's do my med pass, document, chart. another set of vitals. 4 o'clock, 1600, or 4 AM, 1600 rolls around, you're like, okay, meds, you know, there might be meds, um, assess and vitals and document. And it's just that kind of process where every time you're seeing somebody, you're more than likely doing meds, an assessment, and a set of vitals, and on to the next. Whereas emerg, people are in and out so fast sometimes that it's just, hi, uh, do you have any pain? Did you get anything at triage? No? Okay, I gotta go see the next. It's fast.

Yeah.

And there's a lot of things that, you know, med-surg, potentially your patients have been there already for a week or a month or sometimes 6 months if there's, uh, if they're more of a failure to cope and can't go home safely and we're waiting to find them a place in long-term care or a retirement home. Um, so there's not a lot of flux in, in that person's like, um, stability level. Whereas emerg, somebody can come in looking fine and 45 minutes later suddenly be having a seizure or stop breathing or something else. Like, you can't assume that somebody is well just because they look well at that moment.

And, you know, I think that, uh, that point is, is something that, uh, is probably flows through a lot of medical professional training. In that you end up with a lot of the things that you need clinically in the classroom, and then, then you do some out-of-classroom things, but you don't get prepared emotionally for what happens when you're dealing with real patients day in, day out.

Yeah.

And you don't really get prepared for what it's like from a busyness perspective. You know, I think about even my clinical training and, and, and, and you go, you, you're in an environment that's fairly controlled. And you, you know, you're seeing patients, but you always have a safety net, and you've always got a backup for you. And so you don't really realize what it's going to be like when you're calling the shots, or there are 100 people who are needing help, and you're trying to make decisions on what's going to happen next. And it can be very intimidating.

Yeah.

So I really applaud thinking differently about what it looks like for someone coming out of school to really onboard and really get into the career so that they can ramp appropriately. We work on that all the time so that they can be successful later and not feel overwhelmed before they actually get their feet wet, right? So that's amazing.

Exactly. Trying, right? You know, even if I make, I make a 1% difference, you know, out of 20,000 nurses that come in yearly, you know, what, 200? 2,000? 200. Just 200 nurses that could potentially be sticking around for another year, which, you know, patient safety increases. They get the time to then, you know, think about it, get more exposure, potentially get more support, kind of figure it out.

That's right.

And that kind of thing.

And you're reducing the shortage, which then helps people not be overwhelmed, which then helps reduce the shortage. And so, like, it spitballs, right? Like, it really does get better from there.

Yeah, it's, you know, if you can stop the spiral and go and start going in the other direction, that's, that's the hope.

So tell me, tell me a little bit about, um, the, your experiences during COVID You mentioned that earlier. Um, you know, I, we're 2025. We're, we're on the tail end, right? Like we've been dealing with this now for 5 years. People, Um, are used to the fact that there's this coronavirus out there, but it was not like that in the beginning. Right. And your time in emergency medicine had to be unheard of because we were all in the beginning trying to figure this thing out.

Yeah.

And the normal emergencies didn't stop just because we had this new thing. And so you had the 2 things kind of layered on top. Talk about that experience a little bit, because I think it was, it was wild, right?

It was insane. Um, I look back now and again, you say things now and people are like, oh, that's not a big deal. And you're like, no, no, no. Like, you don't understand. You know, when everything shut down, all of a sudden, you know, my kids are home. They were 4 and 5 and a half at the time when everything shut down. My husband is in infection control, uh, so he was also mandatory or, um, He was also essential. Um, so he's also still continuing to go to work, but no daycare. So all of a sudden, you know, you're— as a mom, you're going, uh, I want to keep working, but I have the kids. And so trying to manage the two of them, it was chaotic. Um, but, you know, we went from seeing— at least in my emergency department, we would see like 50 to 60 to 70 people in 24 hours, roughly. That's kind of our, our our gig, we went down in 24 hours to seeing 10 to 12 people in 24 hours.

Wow.

All of a sudden the waiting room's empty, the department's empty, the people who are admitted on the floor are very quickly going home if they can, and we're fully staffed. So I think we were only 4 RNs and 1 registered practical nurse, so, um, or an LVN. Who was like 11 to 11. And we just sat there and you're, you're, you're all geared up. You're, you're kind of sitting there going like, okay, what do we do now? Like, you know, you're sitting there and you're watching Wuhan fall. You're watching London fall. You're watching New York City fall. And we're only, you know, a couple hours from New York City. We're only maybe an hour from the border. And you're going, whoa, okay, when— so when is this going to hit us? We understand that this is going to hit us. So you're kind of, you're talking to your co-workers and you're all kind of on edge and you're just sitting there on edge waiting for something to happen. And the policies would change morning to noon to night when normally policies do not change at all ever.

That's right.

So you'd, you'd In the morning, you'd be working a day shift in the morning. Okay, it's this, it's— this is how it's spread, this is how we're gonna put on— this is the mask that you use. By 2 o'clock that afternoon, no, no, no, um, now it's spread like this, this is the mask you wear, you have to wear, um, gloves, or you have to totally gown up. Like, okay, that's how that is. Then 7 PM would roll around and no, no, no, we're going back to the first way. And it just was this constant flux. where you had no idea what was going on. And to be fair, nobody did. So—

Yeah.

We were all just kind of fumbling the whole time. And so all you could think about was like, okay, heaven forbid somebody actually comes in here who fails like our very quick screening. And even the screening, the symptoms would change morning to noon to night. Oh, this day it's fever, short of breath, runny nose. And loss of taste. Oh no, no, no, by noon it's, uh, no, now it's, um, have to have red eyes or, um, you know, coughing up blood or, or this. And then again would change. And so you're like, I have no idea what to even screen for to, to be able to prevent myself from being in contact with this. And so again, you're just sitting and you're just waiting and, you know, nobody's in contact with anybody else. You can't really— there's nobody who's an expert that you can lean on to be like, hey, I just need a little bit of support. Nobody's in the hospital. There is no auxiliary staff available at all. Your manager's not there. Everything's through a phone call. Um, and then all of the gratefulness happened. And—

Yeah.

Up here, people were banging pots and pans at 7 AM and 7 PM. Everybody was getting out, so you could hear it from the hospital. Uh, and that went on for months. months and months and months, which again was like, whoa, what is going on? The response by the public was almost a little bit more alarming than anything else, only because I like to describe working a merge as being in an abusive relationship with the public. I expect almost that the public is going to kick and scream and spit and cuss me out and swing at me.

Mm-hmm.

You know, I'm, I'm expecting that. What I am not expecting is thank you. Oh my God, you're a hero. We couldn't do this without you. We're praying for you. All these things. And then all of these, you know, the food was nonstop. You know, you stopped packing food to come to work because there was just a constant stream of food. There was constant stream of gifts. And, and, you know, I'm getting goosebumps just thinking about it because. we'd never seen anything like that. And you're going, okay, like, that's really, really nice, but I am so uncomfortable because I, I don't know if this makes this better or makes this worse.

Right.

And people started to offer their services. So we had psychiatrists and psychologists who had banded together to say, hey, we're willing to give unlimited therapy for all frontline responders. Here's our number. And I'm like, I'm getting on that bandwagon. I probably racked up at least $6,000 worth of, like, free therapy because I'm like, I don't know what to do with this. And, and then the lawyers, bless them, um, they came forward and they're like, we'd love to do all the first-line responders' wills for free. And you're going, okay, I, I know now that they just wanted to offer their services and make sure everybody was taken care of and, and everything was— that's what they could offer. Um, at the time, all I heard was, we are not expecting you to live.

Yeah.

So I'm going, okay, if I wasn't freaked out enough before, now the lawyers are volunteering to do stuff for free and the lawyers don't do anything for free. So you're, you're kind of in the spot to go like, oh, this could be really bad.

Well, and I mean, I think people— it's an interesting thing though, because from day to day, and we were talking about this a little bit before we actually started the conversation, you know, you spend a lot of time working with the public, working with people, and you're close to them and you got to touch people. You've got, you know, you've got to assess them, you got to help them, and you're constantly being exposed to something. Right.

Yeah.

And it felt like during COVID for the very first time, the public started to understand what we as healthcare providers new all the time, right? Like, we're constantly in contact with something because we're constantly in contact with people. And for the first time, the public thought, these poor, these poor healthcare providers, they are trying to make sure we all get to stay healthy, but who's looking out for them? Right. And it was a very different feeling than what you normally get because people were really, they thought about you and your family, right? Because they didn't want you to take stuff home to your family, which it was a big deal.

Yes. Oh my gosh, it just— you're like, oh, somebody's thinking. And again, for the public generally in an emergency setting, nobody thinks about anybody else but themselves. It's, it's really unfortunate. You know, you're in pain, you can't get outside of yourself to think about others. And this was the first time that you saw the public going like, oh, I'll make sure to keep 6 feet away, I don't want to expose you. Let me wear a mask, let me wash my hands, let me, you know, I— people would come in, I think I might have COVID, and they would stand 10 feet away from the triage desk and be like, I really just don't want to expose you, I don't want to— they were so respectful in the beginning.

Wow.

They were so respectful and so caring and thankful and grateful, and it really, it was almost more unsettling because you knew it was that bad because the public had never done that before. And so you're like, oh, this is, this is really big because now the public's changing and the public's viewpoints and opinions and behaviors are changing. Whoa, okay, this is, this is, this is Bad News Bears.

So now that we're, uh, we're 5 years later and You look back, what did you learn during that period that has now kind of colored the way you think about things now?

Yeah, I think probably the biggest lesson is putting me first. You know, there's an undertone of, um, you're not a good nurse unless you put everybody else ahead of yourself. You're not a good nurse if you don't pick up that extra shift for your friends. You know, they used to call us, and again, depending on the healthcare system, scheduling would call you and be like, oh, they're too short today. Like, they're gonna be really— they're gonna be run off their feet. Like, can't you come in? And you'd give them an excuse or you'd say no. Oh, are you sure? Like, they would guilt you so hard into coming in. And it was just this undertone that you were expected to, like, work yourself to death in order to appease the corporation.

Mm-hmm.

And so with COVID it was like everybody showed up for their shifts. Nobody called in sick. Um, you, you didn't pick up overtime because really there actually wasn't any overtime to be had because everybody just showed up for what they were supposed to do. The only time you really called out, um, was if you were having COVID symptoms and you weren't sure and you needed to get tested and that kind of thing. But really the, what we kept talking about as, um, as an ER was we're saving up our sick days in case we need to get intubated. We're saving our sick days in case we're, we're having, we're, we're really sick. We have to be intubated. We're on the vent for, for days or weeks or months. You know, we're saving our sick time because we don't know what's gonna happen.

Well, and, and you would've had such a different perspective than the typical person, right? Because You know, it's one thing to hear on the news or even know somebody. It's something different to have a hospital that is filled with people who are suffering from COVID in a worse way. And so you are able to visualize and understand at a level that someone who's not inside the healthcare system would not be able to understand. And so that is wild to think about. You guys were Thinking, let me think in advance, I'm going to save up just in case, right? Because that wouldn't be a thought that most people would have.

No, no. But again, you saw— I think the worst one was probably New York just because they were so close. You know, it wasn't like they were, uh, oh, they're, they're an ocean away, it's fine, like, we're okay. But once it hit New York and you saw the images of like the refrigerator trucks for the bodies outside of the outside of the, um, hospitals when, when World Health— or was it World Health? I think it was World Health who, um, said like, oh, wearing a garbage bag is fine as PPE. Pardon me? A garbage bag?

Mm-hmm.

That's what we're wearing. We're gonna reuse masks. We're gonna put them in Tupperware containers and hope to God we have the right mask and the the mask is falling apart and we can't get a new one. What?

Like, yeah. It was, I mean, it was, it was bizarrely crazy, right?

Yes. It was out of an apocalyptic movie for sure.

Well, you know, one of the things that, that you've, that you talk about is, uh, the use of intuition and thinking about like getting through those times, like, how are you kind of guiding yourself using your intuition? Because you had patients who were coming in who obviously were COVID ill, but you had patients that were coming in that had other illnesses, and you had to triage and guide and kind of decide who was going to get what.

Yeah.

And, you know, I think that comes— the intuition piece comes both from experience in what you do, but it also has to have a piece that comes from being able to probe and get the right questions and right responses from people to kind of clue you in onto what to do next.

For sure. And really, triage is the probably the easiest place to kind of really use your intuition and hone it. And truly, I mean, we've all got intuition. It, it just is something that we've all got in our back pockets. It's just a matter of are you listening to it and doing anything about it, or are you just like, Oh, I don't care that I shouldn't be walking down that alley. Like, I've got to get home. My time is more important. I'm going to go down that back alley, you know, and then something happens.

Yeah.

You're like, oh, I should have listened to myself. But with triage, it's always been, you know, you, if you're doing triage appropriately, you've got 5 minutes to figure out if somebody is, you know, we use CTAS, which is like EIS with you guys. And so you've got 5 levels. So 1 is dead or just about to die. 2 is really critical, you need to be seen within about 15 minutes by a physician. 3 is, yeah, you've got some factors that put you a little bit more at risk, you know, you probably could have gone to an urgent care, but you should probably be seen within about 30 minutes. 4 is really pushing, something that could have gone to a family doctor, but we'll see, we hopefully should see you within an hour. Uh, and then a 5 is this problem's been going on for months. Um, I, I need— that's very much a family physician problem, um, not an emergency. So when someone's coming in, you've got 5 minutes to kind of take their story. You get their vitals, you get what medications they've been on, what they're taking, what their past medical history is, because sometimes that kind of colors how we're looking at things. And then you decide 1 to 5. How quickly do I need to get this patient in and seen by a physician? And especially with our wait times up in Canada, like we're pushing 4 to 6 hours roughly to be seen by a physician, even if you're a CTAS 2 or CTAS 3, you know, you're waiting.

Wow.

You're waiting, you're waiting, you're waiting. Um, not to say that we can't do interventions before then, you know, we can do a little bit of blood work, we can probably give you some Tylenol, Advil, Gravol, just to kind of get you feeling a little bit better, But it is still going to be a while before you get to see anybody. And triage, if anybody— you see the stories of people dying in waiting rooms and you're just like, guess who that bounces back on? That bounces back on the triage nurse.

Mm-hmm.

You know, did I triage that person appropriately? Did something change and they didn't come and tell me? Or did they leave out a piece of information that was really critical, but they thought it was very minor? And so looking at somebody, you know, you get a very quick sense of, okay, I think you look well, let me get the story, let me see what's happening. Oh, okay, you're kind of saying some things that make me a little bit more worried. Your vitals, you know, they may be okay or they may be starting to shift. You're like, oh, okay, that really is not great. Um, but sometimes there are people who cross your path and they sit in the chair, they look well, the vitals are okay, the story's not really concerning, but you go, you— there's something wrong. I don't know what it is. I don't know what is happening. Maybe I'm missing a big piece of information that they're too embarrassed to tell me at triage, but oh my gosh, you need to come in now. So typically those people, um, you know, you bring them in and you hook them all up and you get to the doc and you say, hey, here's the story. I don't know what's going—

Mm-hmm.

On, but I need you to see them. I just need you to see them. I don't know why I need you to see them, but I need you to see them. And so the doc, if they're good, usually stop and say, okay, give me 2 minutes to finish up whatever I'm doing. I'll be right there. And you're like, perfect, thank you. And then I go back, I do the blood work, I get the IV, I hook them up to the monitor, get a better eye. And then you're going like, I'm waiting to like do something. And usually it's a CT scan. That then reveals, oh, their aorta, which is the big main vein that goes from pretty well top to bottom of you, it can rip and leak. And that's something that can be very, very insidious and present as very vague complaints. And, you know, the patient can be okay at the beginning and then very suddenly turn. And So you're always watching out for those ones where it's like, I just, I don't like the look of you. And it's not, it has nothing to do with you personally. Just there's something about the undertone of your skin or you're super pale or you're head to toe sweaty and it's not really all that warm outside. Like, there's something, your body's compensating and the vitals don't reflect it just yet, but something's gonna change real fast. Yeah.

Well, I mean, and when you think about, when you think about an aortic dissection or just, or an appendix that is going wrong, right? Like there are things that may at the initial presentation not seem to be as severe as they will be minutes or hours later, right?

Yep.

And so the, There's got to be some level of trust between the physician and you so that they understand that you're just not going to bring any and everything to say it's an emergency type deal for them. But there's also got to be some communication, right? So that you guys can get on the same page around it.

Yeah. And again, it's, it takes time to A, build up the confidence to even talk about, I feel like something's wrong, because again, you say that to any regular person, they're like, you feel like something's wrong? Like, that's the least quantifiable scientific thing in the history of life. However, with science advancing daily, there's actually so much information, not just on intuition, but specifically intuition in nursing, and how it's developed, and who's using it more often, and trusting it more often than not, and who's right more often than not. And so when I go to my physicians, depends on who I'm talking to. So again, because I've been doing this 17 years and I've been in the same spot for at least 6 or 7 now, I know my docs. And so I— will I taper how I'm talking to which doc? For sure. Will I completely change my script if it's— if I'm talking to a doctor I haven't worked with yet? Absolutely. If there's any one way to get a physician to Stop, um, and listen to you. It's, um, hey, I've got this patient I just triaged. I don't know what's going wrong, um, but I'm just— I'm advocating that you need to see them right now. You throw the word advocating in there, holy crap, people stop because we do not use that word very often. We use that word as a legal word. Um, so once you say that word and it triggers the, oh my gosh, this could be a legal thing down the road, Sure enough, people are very quick to come and see your patient. Not to say that I haven't said to other physicians, hey, like, I think something's up, like, I need you to come and see the patient, and I've been pushed off before. And had that with my— one of my first patients who died and thought something was going wrong. I pushed the doc, I called, I called, I called, I called, I called. By the time they finally came in to see the patient, they were already starting to crash. Within 5 hours of me coming onto shift, they were already— we were doing CPR, uh, and by 6 hours into my shift, they were done. They were dead. They were gone. Um, Oh my goodness. And I got so much pushback from that physician, and I was so new that I thought it was a me issue. I thought, what did I miss? What did I— I didn't push hard enough. I didn't— like, I was calling that doc every hour on the hour, if not every half an hour to 45 minutes. And I just kept getting pushback and pushback and pushback. So, it took me a long time to come to terms with that wasn't me. And it wasn't until I left that job 5 years later that that physician kind of took me aside and said, you know, I know that you're moving on. We're really sorry to lose you. Don't let anybody tell you that you don't know what you're doing, and walked off with no context whatsoever. I knew exactly what she was talking about.

Yeah. Yeah. So, you know, there's the flip side of this too, right? Because there's the patient who comes in and needs to be able to adequately describe what's happening to them so that they are able to get triaged the right way.

Yep.

What should patients be thinking about whenever they're going to talk to their triage nurse so that they make sure they're taking the best care of themselves?

Yeah, great question. First and foremost, please have a list of your medications either on your phone or in a piece of paper in your wallet. A lot of people don't know what medications they're taking, and actually it can really prove to be a problem for us if we're kind of searching to figure out what's the root cause. So know your past medical history also, any chronic medical conditions. I don't— if you're taking a pill for it, please mention that you're taking a pill for it. People, I ask, oh, do you have any high blood pressure? Oh no, no, no. And then you get to the medication section, it says, oh, it says here that you're taking bisoprolol. And they're like, oh yeah, well, that's for my high blood pressure. I'm like, well, but you still have high blood pressure because you need to take the medication for it. So please be aware of what your past medical history is. If you can keep your answers Short and concise. It helps us because we are typing at the exact same time that you're talking. So if you talk very quickly and in a great amount of detail, it's hard for me to kind of figure out what I'm filtering out to, to write down. Um, and try to keep it within the last, like, week to 2 weeks to last month. Um, I understand that Mrs. Smith loves to come in and she's a little bit lonely and she wants to tell you everything that's happened since 1965.

Mm-hmm.

But I have 5 minutes, I have 4 more patients to triage after you, and I don't want to be rude, but at the same time, like, what— why today? Why now? Why not last night? You know, why— I'm gonna be asking why a lot.

Yeah.

And it's not to try and put you down or wise you up that you should have done something else. It's just I'm trying to figure out where we are in your treatment. So you've been vomiting for 48 hours. Now you're not peeing as much. Now your mouth is very dry. Your tongue is like thick. Your vitals will also help me to kind of understand the degree of dehydration potentially that now is going on. Okay, your heart rate's really elevated. Oh, but now you've got a fever. Please, oh please buy a thermometer. Please have a thermometer in your home. Please do not let it be a temporal, so that you put either on your forehead or the side of your head. Please let it be an oral thermometer because again, if you're having, if you're having fevers at home and you say, well, I don't know, I don't have a thermometer, then it kind of leaves me in the dark where I'm going, okay, well, let's work around this. Well, have you been having fevers or like chills, like hot, cold, hot, cold? Have you been doing that? Oh, well, yeah. Okay. So to me that sounds like a fever. So I'm going to mark you as having a fever. So now you're isolated because I think that you've been having fevers at home.

That's crazy. You know, you make, you make so many good points. One of them that I think it bears repeating though, is that having, taking a medication does not eliminate the chronic root cause. Um, and it is one of those things that I can guarantee you any healthcare professional listening to this or watching this is shaking their head, right? Because it happens all the time because the medications aren't curative. Right? Like they are not curing this thing. And we need to know that that thing exists so that we can treat you the right way. But the other thing though, I think is the, is you have to have a measure of empathy because patients are coming to you in not their best state. Right. And so, and I'm sure you understand that.

Yeah.

But Even when people are not in their best state, there is a delivery that people can use to have this conversation to get them along the process that is much better than some, than some of the other ways they can deliver their issues. Right. And so like, can you talk a little bit about that? Because I, I can only imagine if people are in pain, people are, um, they're, they're, something's wrong and they think it's life or death. They're not always the sweetest individuals. And I'm sure you understand that. But how do you work with that in your environment? And what should people as a patient be thinking about?

Yeah, so ER nurses get the bad rap for being cold and disinterested and checked off. Like, we're not falling into, not playing into, but like, We understand that you're stressed, you've Googled it, Google's telling you that you're dying. You know, they—

Oh, Google.

People come in, they think that this is the end of their life, and they're freaked right out. And so if you look at your triage nurse, look at them, and you're telling your story, is the triage nurse suddenly kind of moving around a little bit more, moving at a bit of a faster pace? Is your triage nurse calm, cool, collected, talking maybe a little monotone, maybe purposefully a little bit slower than normal? Do they seem relaxed, or do they seem like all of a sudden they're sitting up straight and they're really paying attention? That kind of— you can use that to gauge their reaction, right? Like, if your triage nurse That's a great point. Is looking bored and disinterested, I'm sorry to say, things are probably okay. Not to say that that's across the board. People are very different. Sometimes people have a very good poker face. And even if you are really, really sick, we're not gonna start like running. We don't run. If we're running, somebody is dead, like 100%. We don't run. But if all of a sudden, um, we're doing things and, and we're not even finished— if we're not even finishing the triage and we're bringing you straight in, that's, that's a sign to be concerned. Um, in Canada, I like to say if, um, you're actually very lucky if you have the ability to wait. You know, if I'm triaging you—

That's a good way to think of it.

And I've, I've done all the things and I'm like, okay, well, you can just go wait along the back wall there, And they go, what? And I'm like, yeah, okay, it's, it's just along the back wall. Please take that as I'm not as concerned. If I am not directly rushing you in, that is a great, great sign that you are probably not nearly as sick as you may think you are. Not, not to say that we aren't wrong sometimes, but—

Yeah.

You know, it's 17 years and, and thousands of people that I've triaged probably, I know what sick, not sick, really sick looks like. So on first glance, if I'm not stopping the triage and being like, actually, if you don't see me immediately talking to my charge nurse to try and find you a bed, that's a good sign.

Yeah.

Like, you can, you have the luxury of waiting. And so take that as a sign that, okay, maybe it's not as As bad as you think you are, then that's a good thing. And then talking to parents, you know, parents and kids, it's a very interesting relationship that they, you know, the parent comes in worried, they're carrying the kid, they're trying to tell you the story and burble out the story and you're like, okay, like, and again, that's when I go into very slow mode, which if you know me, I don't do slow. So then it's very purposeful. Hi, how are you today? How are things? Do you have your health card? Okay, well, let's just, you know, so the parent sees me being exceedingly calm, so they kind of calm down. And then the kid, because they see mom or dad or both calm down, they calm down again.

They calm down too. Yeah.

Once parents Once parents see the kid calm down, they calm down again. So it's this little seesaw that we ride to finally get to a point where I can talk to you appropriately. I can get full sentences from you. You can sit there and start to put words to what's been happening. And again, people ask me all the time at triage, well, what's going to happen? And I And again, you can't say much, but you learn to say, do I look worried?

Yeah.

And they look at me and they go, no. Like, so if I'm not worried, I think you're okay to wait. And they go, okay, okay, okay. And like, you can see the anxiety sweat off them.

It's absolutely amazing, right? Because I have done that. I've done the exact, the exact same thing, like the literally the same, the same words, um, with, with people, with patients. And it's like, if I'm not worried, then you don't have to be worried. And, um, and it's, yeah. And, and, um, and it's a great way because then people can actually hear what it is that you're trying to tell them versus being panicked about what they think it might be. Right.

Yeah. And it's not to say that the ones with sick kids then aren't also overreacting. I honestly, I just had a mom and dad come in with a little 2-month-old and they're telling me that babe's had a fever. So fever under 3 months, that's a big deal in the emerg. So I'm going, okay.

Mm-hmm.

And I'm hoping that they don't have a number for me. I'm hoping that they Don't have a thermometer at home. Sure enough, these are really great, amazing first-time parents. They have a thermometer, they check the temperature, they did everything right, and they're still telling me that he's got a fever. And I'm like, okay, all right. So then I'm like, okay, well, now I have to weigh him, and I do have to get a rectal temperature because he's so young. And if you're telling me he's had a fever and you've got a number for me, I want to be Super, super careful as to like making sure that I get a very accurate number. And so we go to weigh him, he's on the scale, he's adorable, you know. And so I take the temperature and sure enough, it's, it's fever on my end too with, with a rectal temperature. And I'm like, crap. So I'm like, okay. So I get them all, I'm like, all right, so if you just wanna— Mom, you know, we'll kind of dress him up a little bit and, and you can come with me, but Dad, if you want to finish up the registration, that'd be great. Because again, brand new baby. Probably doesn't have registration, probably doesn't have all the information they need, and that could come in very handy if it hits the wall. So I'm like, Dad, you just go and finish up registration, you know, make sure you get your phone numbers and sign up for My Health and, and all this kind of stuff. And Mom, I'm just gonna— we're just gonna walk back to, you know, I don't say recess, but we're walking back to recess. And so, you know, okay, well, let's put the babe on the monitor. And sure enough, babe's heart rate's up and respirate's up because they've got a fever. So I'm—

Fever.

I'm not concerned about that as much as the babe's having a fever at 2 months. That's what I'm worried about. And then I'm looking at babe's legs and they're kind of mottled, so they get this kind of lacy pattern, which again, sometimes it happens just because they're cold, but sometimes it can be a really bad sign that they're centrally, um, they're shunting. So they're pulling all their blood into the middle to get all the core organs. So immediately I'm to my doc, I'm like, I've got a 2-month-old with a fee— with a true fever. You know, I, I know that we're probably— the kid's probably going to need a lumbar puncture and we're going to have to do blood cultures. We're going to have to do IV, probably IV antibiotics, all these— like, I can see what's coming down the pipes and I'm like, you need to go now, please. And sure enough, my doc, yep, not a problem, off and, um, got seen within moments of coming in, which again does not happen in healthcare unless things are really wrong. So—

Yeah.

You know, ended up, they went, um, to our, um, they ended up going to our pediatrics hospital, which is a good hour down the way. And sure enough, I heard back from my doc, uh, the night, the next night or the night after, he goes, oh, there was E. coli in the urine. And I'm like, okay, okay. That was a good catch. I'm like, I'm going to take that win that I caught that. And he goes, absolutely take the win. Like, okay, we're done. Good.

Yeah.

Fantastic. So it happens that sometimes people come in very, very calm because they don't actually know the severity. So it does take a lot of maneuvering to kind of figure out, are you overreacting? Are you underreacting? Are you just reacting?

And so tell me then about what sparked the book, because these are all pieces of it, right? So it's Um, it's all the things that happened during COVID where you started to see things differently, understanding that intuition is important, thinking about how patients interact, um, with nurses and the healthcare system. And then comes the book. So tell, tell us a little bit about that.

Yeah. So August or July, actually, I think of 2020, my exhaustion was hitting the bricks. Um, you know, Canada didn't kind of come back to normal nearly as quickly as Uh, the US did. So we had just started to open up, I think, the bubbles at that point. So like you can have a couple of people in your bubble. Um, but my kids, um, they were still home. They— there still wasn't any, um, daycares open. So I was up all night for shift, for my night shift, and then I'd be up all day with my kids, and then I'd go back into night shift and be up all night, and then I'd go back. Like, I was— so out of my mind that I probably shouldn't have been nursing. Like truly, I shouldn't have been. But again, you're like, I'm a tough nurse, they need me, I'm just gonna push through like an idiot. So you— I kept pushing through and July 2020 rolls around and it comes to the point of like, if I— what happens if I got sick? Because now it was starting to come into Canada.

Right.

And I'm like, oh my God, what if I get sick? What if I die? How do you tell the kids that mom chose to go to work this whole time? And so I thought, okay, I'll write down my good stories for my kids. And so I wrote down my good stories. And because I was so mentally and physically and spiritually exhausted, there was no more reserve to keep the bad down.

Wow.

And I then all of the trauma that had come up over what, 13, 14 years at that point, started writing it all down, all the bad stories, all the patient losses, all of the things that live in me That I'd never dealt with. And so it came out and I was like, okay, well, there are some stories. I'm like, I don't know if I want my kids to know those ones. But I was listening to— so Llewellyn, who's a publisher in the US, that's a metaphysical publisher, they were having online book fairs. And so the author would come on, they'd talk for 30 minutes about their book. And the one book that I ended up finally catching was Intuition at Work. And it was just this lightning bulb moment of like intuition at work. I use my intuition all the time at work. And it was just like, that's it. That's 100% it. Like, holy cow. So I went back and went through my own stories and I'm like, every single time I used intuition and the outcome was different for every single one. You know, did I actually say anything? Did I not? Was I believed? Was I not? And then did we change treatment or didn't we? And going through it, I'm like, oh my gosh, oh my gosh, oh my gosh, this is it, this is, this is it. And like, I know intuition exists, I know that we talk about it at 3 AM, but we don't talk about it in school, we don't teach it, we don't do all these things with it. So I thought, okay, well, you know, now August— now it's August of 2020, and the misinformation and disinformation is really starting to pick up. And I'm like, I think I'd actually be putting my license at risk if I published this book without science behind it. Like, I think I'd really be taking a chance. So I went on a deep dive and I'm like, oh, let there be like 1 or 2 papers, please let them— let there be 1 or 2 papers. There was like 25 to 40 papers alone within the last 5 years, you know, peer-reviewed, evidence-based, reflective studies, like all these things. And I'm like, oh my God, there's the science. The science is there. The science is— why aren't we talking about this if the science is there? So I'm like, okay, that's it. That's where we're going with this. So the rest of the book was written really, really quickly. Kind of fell back into school mode and I'm writing a paper and here's my references.

Amazing. Yeah.

And so put it all together and I was like, okay, this is— I'm like, I may be getting— I may get raked over the coals for this just because it does seem very woo-woo, but the science is in there, my personal stories are in there, you know, it's anecdotal, but then there's evidence and all this kind of stuff. So I'm like, you know what, I'm going to put it out there because we need to start talking about it. Because what if this is one of those skills that really, again, for new grad nurses, that we're not teaching and we really need to be teaching? So put it out just in December of 2024. And since then have gone to a couple of conferences. I actually get to teach with Nurse Blake this summer, which—

Nice.

If you're into nursing, he's kind of like our, he's kind of like one of our big, our head honchos of like the TikTok social fame.

Oh, that's amazing.

So I, I'm still flabbergasted that, that I got there. But again, saying yes to random opportunities, going like, okay, let me apply to be a speaker, like apply to be a teacher. They're not going to pick me. And then all of a sudden it's like, there's the interview. Okay, well, I'm not going to make it past the interview process. And then all of a sudden you're getting this email. And like, I screamed when I got the email. My poor kids were like, Mom, are you okay? What's going on? Oh my God. Oh my God, I gotta talk to your father. I gotta like— so I ran upstairs and told my husband, and it's just like, holy cow, this is happening. Like, that's amazing. Okay. All right, here we go.

Well, if people want to pick up the book or learn more about you, where should they go?

Yeah, so the book is on Barnes Noble, and Indigo and Amazon. If you search up Jennifer A. Johnson, RN, it should come up a little bit easier, but the name of the book is Nursing Intuition: How to Trust Your Gut, Save Your Sandy, and Survive Your Career. I've got some journals on Amazon also that you can look into that are great for gifts for new student nurses. Please, please support your new student nurses if they're in the family. You can find me at www.nursejenn.ca. TikTok and Instagram are ernurse.jenn. And I'm actually probably most active on LinkedIn, Jennifer Johnson, BScN RN. And for anybody listening who's a nurse, I'm sorry, but there's just too many Jennifer Johnsons. I had to do the BScN RN.

I am going to make sure To put those links all in the episode description. Um, so if people are listening while they're driving or they're doing other things, they'll be able to click and be able to find you. Um, but I have to say, this has been amazing and thank you so much for spending time with us and sharing this. I mean, I think there's so much to learn and I love the fact that we were able to give people practical things that they can think about to take better care of themselves. Um, and, um, and hopefully they understand a little bit more about what nursing goes through trying to make sure we all stay healthy.

Yeah. Thank you so much for having me. This has been an absolute pleasure.

It's been great. And, uh, I can't wait to actually, uh, check out more of your writing. I've, I've checked out a bit and I've, I've looked at the blog. And so, uh, that's why I felt like I knew you. And I was like, oh, that's good to see you again. Because I had actually—

You're like, hi, how's it going?

Yeah. Yeah. You know, We've been besties. Um, but no, I look forward to following you and, uh, and hopefully we'll get to chat again sometime soon.

Would be more than happy to come back on.

That'd be great. If you've made it this far, then I have to thank you for your time. I hope you've learned something new and enjoyed listening to the discussion as much as I enjoyed having it. I'd love to hear from you about the show because we're working really hard to bring you great content, and the feedback really helps us get better. If you like what you've heard or watched, for those of you who are streaming out on YouTube, then take a split second to give us a thumbs up or a like. It really helps other people like you find the show too. And no one likes to miss out on the good stuff, so go ahead and subscribe and hit the notification bell so you don't have to wonder when or if there's a new episode. And until next time, stay remarkable.