Episode 1: Burnout Yall

The speaker discusses the issue of nurse burnout and how nurse-to-patient ratios contribute to it. Only four states have legislation regulating ratios, while five others have pending legislation. The lack of regulation leads to overwhelmed nurses and poor patient satisfaction. The speaker believes that taking care of nurses will help address the nursing shortage. Different ratios are discussed for ICU, step-down units, and med-surg units. The speaker shares personal experiences and frustrations with the current system. They argue that proper staffing improves patient outcomes and overall satisfaction. The speaker also mentions specific states with existing or pending legislation. They express frustration with the controversy surrounding the issue and question why it hasn't been fixed nationwide. The speaker ends by sharing their personal experience with overwhelming workloads and the impact on their mental health. Hey guys, and welcome back to She's Wearing a Doctor's Stethoscope. Today, let's talk about ratios, and specifically, how they contribute to burnout. Now, our good old trusty Google refers to nurse burnout as the state of mental, physical, and emotional exhaustion caused by sustained work-related stressors, such as long hours, the pressure of quick decision-making, and the strain of caring for patients who may have poor outcomes. When I refer to nurse-to-patient ratios, that just basically means how many patients a nurse is responsible for during their shift. It is my belief that perhaps many people who are not nurses do not realize how few states actually have existing legislation that regulate nurse-to-patient ratios. So, it's four. Four of our 50 United States have existing legislation for nurse-to-patient ratios, and five others have pending legislation. So that's nine. That's a total of nine states out of 50 that have decided that they're going to attempt to fix the problem that is nurse-to-patient ratios. And it's just my humble opinion that this is a big contributing factor to nurse burnout. You know, nurses are not the only ones affected by this. You know, CNAs are way overworked, and patient satisfaction is greatly affected. A happy nurse equals a happy patient. That's just my opinion, but I've worked in a lot of hospitals on many different units, critical care and med-surg. And before I was a nurse, I was a CNA, and I worked in nursing homes. And that is not trauma that I really want to revisit. Let's just say that I left each shift feeling as if the care I was providing was completely inadequate because there just was not enough time in a 12-hour shift to get the things done that I needed to do when I have 34 residents under my care. And that's what this is about, to bring it to your attention that this is a problem that needs to be fixed. Dare I say, since COVID, many, many, many, many things have changed, and it seems the rules have shifted slightly because it seems that the powers that be realized that nurses can do a lot. They can do a lot of different jobs, and they don't have to get paid to do it. We can pay one person to do it all and still take care of the patient. The patients are getting sicker and sicker, and we have more and more patients and more and more tasks to do, to where our jobs begin to feel very impossible. I have felt so defeated in many of my shifts. After many of my shifts, I have left crying sometimes because of the stress. You hold it in all day, and you're trying to get the things done that you need to get done, and it just feels impossible. It is overwhelmingly impossible. I'm not saying this is everyone's experience, but this has been my experience, and I have spoken to many other nurses who do feel the same way. I have also frustratingly spoken to nurses who would disagree with me, and I don't like you. I'm just kidding. I'm just kidding. Let's talk about patients. I mentioned that there are four states that have existing legislation, and those states are Oregon, New York, Massachusetts, and California. The five states with pending legislation are New Jersey, Pennsylvania, Georgia, Maine, and Illinois. Did you all know that this is a controversial topic? Can somebody tell me why it is this controversial? Why is this a problem that I'm having to discuss? Why aren't we fixing this issue across all of the 50 states of the United States of America and across the world for that matter? I know we're trying to solve the nursing shortage problem, but this seems to be the answer. Does it not? This seems to be the answer. More people will want to be nurses if you take care of your nurses. I was reading an article by Ayla Roberts. She's an RN, MSN. She wrote this article in the Nurse Journal, and it's titled, Nurse to Patient Ratios. These states have these controversial policies in place, and the specific quote that I would like to quote says, The push for staffing loss is certainly controversial, particularly among hospital and health system executives. Hmm. But supporters say it will help address the nation's ongoing serious nursing shortage. In fact, research indicates that proper nurse staffing improves patient outcomes and results in greater overall satisfaction for both patients and staff. Imagine that. Let's all just take a moment here and close our eyes Just imagine we're in another world where nurses are providing care to patients, and they have all the resources they need, and they have all the materials they need, and all the equipment, and all the PPE. And let's just imagine that they're only caring for the number of patients. That is a lot of them. By existing legislation that says the nurse doesn't have to care for more than five patients on a med-surg floor, the nurse doesn't have to care for more than three to four patients on the step-down floor, and a nurse on the ICU should not have more than two patients. Doesn't that just sound like heaven? Just to me, I can hear the music playing. The heavenly, heavenly music playing and the angels singing. But, back to reality. So, for the hospitals that do not exist in states with these legislation, regulations, whatever, they supposedly utilize reporting systems and or nurse-led staffing committees. Oh, how's that working for you? It ain't working for me. So, I can tell you, I live in Kentucky, and I've worked in Indiana, and I've worked in Nebraska, and pretty much I have felt overwhelmed in all of those states. I can imagine in other states that you're feeling pretty overwhelmed also. So, let's just talk about, for those that do not know, what ideal ratios look like in the hospital. If you work on the ICU, it is typical that you would have two to three patients. Three is pushing it. Okay, you have to keep in mind that on the ICU, these patients are thicker. They often have drips that require very close monitoring of their hemodynamics and their vital signs. And a lot of times they have equipment or devices that are in use keeping them alive. You know, like a ventilator or like CRRT, you know, like dialysis that's helping their kidneys, helping to filter out those toxins that are killing them. And sometimes they have devices like, I don't know, a balloon pump or an impella, things like that, that are really helping the blood pressure and helping the heart pump the way that it should. And so they require a lot of work. And a nurse really should not be having more than two of those patients at a time. And a lot of times those devices, there should only be one nurse to one patient. So then on the step-down unit, now step-down is a level down from ICU for those of you who don't know. And these patients are not thick enough to be on ICU, but still a little too thick to be on the med-surg and they can go either way. But really, you know, it's a scary floor to work on because you don't know if your patient's going to or if they're going to go home. Step-down three patients is good. Four patients is pushing it because they're really pushing the limits of step-down units to stay in time, especially after COVID. And they're really caring for some pretty sick patients on these units and the drips that they get. And I even worked on the step-down unit that allowed arterial lines, which for those of you who don't know, that is an invasive device that goes into an artery and monitors blood pressure. I feel like they shouldn't have more than three. Most places try to keep it at four. And then for med-surg units, it kind of varies. And I can speak for Kentucky, they like to keep it at six. Indiana, seven. And in Indiana on night shifts, you're probably going to have eight, which is unreal. When I walked in, my last contract, and I saw that assignment board, and it had eight patients assigned to one nurse. My flabbers were gasted, y'all. My flabbers were so gasted. And I was like, where am I? What the hell's that? What is this? Why am I here? How are we here? It's too hard. This should not happen. I hope y'all agree with me on this, because I just really think that what it comes down to is that dollar-dollar bill, y'all. Now, y'all, let's discuss my final week of bedside nursing. Because it is that final week that really let me know I could not do another day in bedside. It has not been that long ago, as recent as March, in fact. That week broke me. Let's take it from the top. All right, so let's go through my day. This last week, I had three shifts. My schedule was 6.30 a.m. to 6.30 p.m. And every morning, I would wake up, get ready for work, and at 5.30 in the morning, I would get a text that told me where to go. Because keep in mind, I'm a traveler. I'm on contract. This facility that I'm working for has three facilities, and I could go to any of them. And so they would send me a message every morning saying, go to this hospital, this unit, blah, blah, blah, blah. So that's what I did. And on this last week, I was on a neuromed surg unit. Neuro is my least favorite. I would like to just throw that out there. You know, you get to the hospital, you go in and arrive to your unit, and you look for your assignment, and you pick up your phone. So you go in. This facility had a big white board in their conference room, and that's where you got your patient assignment for the day. So looking at the assignment, I could see that several people had six patients and a few had five. I started the day with five, ended the day with six. Now, in a perfect world, I would prefer to get my meds passed between 7 and 9 to 9.30 a.m. While I am passing my medications, I'm also assessing my patients, getting their vitals. I assess them and get their vitals to determine if they're safe for all of the medications that I'm giving them. And if everything's okay, then they get their medicines, and, you know, I move on to the next patient. And then, you know, you have medications scheduled periodically throughout your shift. Ideally, after I get my morning meds passed, I would like to be able to sit down and do my charting, chart all of the assessments I just did, chart all of the vitals I just did, and anything else I did while I was in the room, if they used the bathroom or anything like that, you know. Ideally, you want to chart as you go. It sounds great on paper. It does not always work in real life. But for the most accurate information, that's really what you should be doing. Now, let's talk about the patients that I had on this particular week. In an ideal world, your patients are going to be close together, and your charge nurse will have considered the patient she's giving you, considered their acuity, and determined that they're safe to all be on one nurse's team and grouped together, you know, as a team of patients. Keep in mind, I said that's in an ideal world because seldom does that ever happen. Okay, so I had started the day with five patients, as I said. My patients were very spread out. I do not remember the room numbers, how they were laid out on this floor, or even how many rooms were on this floor. I want to say something like 36 or 38, maybe more. Shoot, I don't remember. Just to give you an idea, and this is a very large, very spread out unit, very nice facility, very nice unit, beautifully, beautifully, not decorated, but, I mean, it's a very nice facility. I had one patient in room, let's just say 17, because it's on like that end of the hall where those numbers are, the lower end numbers. And then I had another patient that was in like room 30, which was kind of close to the nurse's station where I was sitting, not far from where I was sitting and charting. Then I had two patients on the complete opposite end, like they were on the very end of the hospital. And then I had one across the hall, long of the short is that they were, or short of the long is that they were all spread out. I was doing a lot of walking on this particular day, okay. The patient that was completely the furthest away from me, completely the furthest away from all of my other patients, was an alcoholic patient. For my nurse friends, you are well aware of an alcoholic patient, like how they are. You know that they can be very unpredictable. You know that a lot of times they're disoriented, and this patient was all of the above. Disoriented, impulsive, frequently getting out of bed and setting off his bed alarm, and very high fall risk. So I'm having to run when his bed alarm is going off, because no one else is responding to this bed alarm. I'm the only one that can hear it, apparently. I know everyone else is busy, I don't mean that ugly, but if your bed alarm is going off, if you have a safety alarm that is dinging, everyone should respond who can hear it. Unless you're in an absolute emergent situation, or a situation that you cannot leave, you should be responding to that alarm. Welcome to my TED Talk. I'm having to run to get to this patient. Very impulsive, alcoholic patient, all of that. Sometimes he would be compliant with me, other times he would not. Sometimes I could get him to do what I needed him to do, and other times I could not. Typical alcohol withdrawal patient. Down the way, on the other end, I had one that was closest to the nurse's station. He fired every CNA, and told me he did not want any CNA in his room. The CNA should not be doing any of his care, that it should be a nurse doing it, because the nurse is who has the training to do all of this stuff. Despite education provided to the patient on multiple occasions, that yes, CNAs are in fact trained, well trained, to do the cares that they're doing for you, he still refused. Refused to have a patient care tech, which is what they're called in this facility. Would not, could not have a CNA in his room. So this means that this patient is now total care. And he's very call light happy, he was pressing his call light very frequently, and it would frequently be for nothing more than just to have a conversation with me about someone who really pissed him off. So I was in his room, frequently, for long periods of time. And I was having to do everything for him, from giving him a water, to the nursing task, you know, giving him medications and taking him to the bathroom, and helping him bathe, and changing his sheets, and everything like that. I mean, because he's total care, because he will not allow anyone else to do anything for him. Not that I cannot do those things as a nurse. Not that I shouldn't do those things as a nurse. I do not rely solely on my CNA to do these tasks. However, once you hear about the rest of my day, you'll understand where I'm coming from. I did not have time to be in his room for an hour every time I went in and provide all of his care for him. And he's a grumpy, grumpy man, anyway. On the end of the hosp, another patient that I had was a very big fella. Large and in charge. He was probably about 6'3", 6'4", every bit of 300 pounds, maybe more, probably more. I really can't remember, but probably more. Could not use his right side, his arm or his leg. He had very, very limited use of his upper arm, but his right leg, forget it. It's not doing anything. But he refused to accept that. Now, let me tell you, he's in his right mind. He knew what he was doing. Answered all questions appropriately. He just was bullheaded and would not listen when told to press the call light, because you cannot get up on your own. And so, here's another patient that I have that is impulsive and getting out of his chair whenever he damn well pleases on his own. And, as you will hear here in a few minutes, it is going to cause us a problem. A little ways down the hall from him, about another 50 million steps from the guy on the opposite end of the hospital, this patient, nice guy, but as the day progressed, became more and more irritable because he got tired of waiting on the doctors to put in discharge orders and couldn't understand why I couldn't get them to just give the discharge order or just let him go. And I said, you're free to go. You can leave AMA. That's totally fine. I'll bring you a paper. But you need to be aware that there is a risk that your insurance may not cover your hospital bill if you leave against medical advice. So he decided that he would stay, but he was just going to bitch about it the entire time. And he became, you know, very irritable, a little hateful from time to time. And I cannot make the doctors go any faster, and I cannot do anything without a doctor's order. So if I don't have a discharge order, I can't make it appear, and I can't just let you go. And I'm sorry, but in a hospital, we have to prioritize patients. Doctors have an entire hospital full of people that they have to see. They have multiple patients on their service across the entire facility, and they have to see the sicker ones first. I mean, that's just the way that it should be. You have to prioritize the higher acuity patients over the patients that are safe and good and ready to discharge. So you're ready to discharge, you're really kind of not a priority to that doctor because anything emergent, anything urgent, anything that requires immediate attention, the doctor is going to take care of first. And a discharge is not urgent or immediate. You know what I mean. Whatever. A little further down the way, I had a little bitty lady. Opposite of the other one, she had no use of her left side. She was basically a total assist. I'm sorry. I'm stressed just talking about this assignment. I'm stressed talking about this week and this particular day. It stresses me out to relive it. This lady was a very nice lady, very pleasant. Her entire family were pleasant. I have no complaints with any of them. They were all very nice to me. However, she was a frequent urinator and needed to go to the bathroom, when I say about every hour, it was really about every hour. Every hour to hour and a half, she pressed her call light to go to the bathroom and also was wanting pain meds in between. So I really was in her room about every hour, maybe more frequently than that even. Yes, we have CNAs that should be helping me get her on the bedside commode, but I spent the entire shift just about doing it alone and lifting her and putting her on the bedside commode by myself. She's a small lady, but I'm 5'1", and I don't care how small a patient is. After a full 12 hours of picking someone up who is dead weight, it takes a toll. It takes a toll, and it's not that, you know, I've always said, no, forget it, I'm not doing it by myself and blah, blah, blah. But she can't sit there and wait. She can't sit there and hold it. I don't want her to sit there and have to peen on herself because I cannot find a CNA to help me. And that's not to say that the CNAs are not available or that they just don't want to help. It's saying that they're too busy, and I cannot find one because they are busy. They're doing other things. I can't find one, and the nurses, same thing. They're all in their rooms. They're all taking care of their patients. They're all just as busy as I am. They're all just as stressed as I am. So it's just much easier to do it on my own, and that's what I did for 48 hours straight, 48 hours. I lifted this patient back and forth to the bedside commode. I started my day with those five patients. By the end of the shift, I ended up with the sixth patient. I can't even remember what that patient was here for or there for. It wasn't a difficult patient, but it's just the process of getting a new patient and having to assess them, look at their skin, find another nurse who can look at their skin with me and put in the admission and get all of the new orders rolling and going for that patient. You know, if they have antibiotics due, because a lot of times when they come up from the ER, they're going to get an initial dose of some kind of antibiotic and possibly some fluids, and, you know, you've got to get that initial set of vitals, and you've got to get their weight, and you've got to just verify all of the new orders, and it's a lot. Make sure that you're releasing orders that were put in earlier by the physician that could not be released in the ER, but now that they're on the floor, you release them and you do them. So I ended up with that sixth patient. Between me trying to pass meds, trying to get my assessments in, trying to get all my vitals done, trying to respond to the bed alarm to my alcoholic patient who is getting out of bed every 30 minutes or so, trying to respond to my call light from the lady who needs to pee every hour to every hour and a half, and answering the call light to my gentleman who just wants to talk and be pissed off at everybody. Oh, and also he was wanting Tylenol every time it was due on the dot. Like he could not be late with it or he would fire you. He would be pissed. So you took in that Tylenol on the dot every time, and he could have it every four hours. So I'm responding to his call light and taking care of his needs because there is no CNA. He's fired them all. And then my other patient, who is so ready to go home and just really pissed at the world because that is not happening. During all of this, at around I'd say maybe 2 o'clock, I have not charted a single assessment. I have not sat down. I have not taken a drink of water. I have not eaten. I have barely seen any of my coworkers. And I am on the verge of tears because I'm just so stressed and overstimulated. 2 o'clock, chair alarm goes off. It's my big-ass guy, and he's on his ass on the floor. Because he's been periodically getting up throughout the day, trying to get up on his own, even though his fucking right leg does not work. Okay. Okay. I'm sorry. So sorry. I'm sure my irritation, no, I know my irritation was showing on my face. He was not injured. I would like to just say that. He did not get injured. But for those of you who do not know, when a patient falls in the hospital, it is a whole process. And there is a lot of paperwork that has to go into it. You fill out all of it, and you do all of your charting that you have to do, and then you have to do a debriefing, and you have to make sure your patient's fucking safe. You have to make sure that they're not injured, and you do all the scans and all of that jazz. So we did all of that. But while he's sitting on the floor, we realized, you know, it was me and two CNAs who responded to his chair alarm. We can't get his ass up because he's just too big. So we're going to have to have some more hands and probably a lift to get him up. So we press, we wear these little badges that have a button on them. When we press it, it's a staff assist button, and it alarms, not like for a code blue or rapid response or anything like that. It just alarms your particular unit that you need more people in this room to help you. Help me! So we press it, people come, and we get the lift, and we get him back in bed. I had a medication to give him, so I give him his medication. And like I said, I'm just not a happy camper, not just because he fell, but just because of my entire day up to this point. And how bad it's been and how I've accomplished no charting. And I've just been tasking all day and responding to call lights and toileting people. And that's not, like, I can't even make it sound as bad as it was. Like, I cannot even stress to you how bad it was. So he, you know, obviously sees the frustration on my face, and he's like, well, you don't have to be so pissed. And I said, well, I'm really trying not to be, but I have told you and asked you and reiterated so many times to you that you need to press your call light, that you cannot get up on your own. I know you did these things before, but you are not independent at this time. Will you regain that function? I hope for your sake you do, that as of right now, you're not at the functioning level. Your mobility is nothing what it was prior to your admission to this facility. And what I need for you to understand is that you're under my care. And I take pride in my work, and I work hard to keep my patients safe. And it is very important to me that my patients feel safe under my care. And the fact that you have now fallen while under my care, it feels like a failure to me. And although you're not injured, I still care very deeply that this happened to you. And it really has upset me. And I just wish that you would press your call light because you are, and I told him this, I was like, you're completely aware. You're completely competent. You understand what's going on around you. You know what I'm saying. I don't understand why you won't press your call light. I don't understand why you fell on the floor when all you had to do was call for help. So I gave him his medicine. I exit the room after turning on his bed alarm because I fully believed he would still do it again even after that conversation. In the meantime, I'm answering all my other call lights that are going off. I'm taking so-and-so to the bathroom. Taking so-and-so a Tylenol or a water. Responding to the bed alarm on the other end because the patient's not getting out of bed. Checking to see if I have discharge orders yet for my other patient. Passing any meds that are due. Answering my phone because my phone is going off like crazy. You know, there's a lot of other things going on just besides what I'm telling you about right now. You've also got labs that are due and some patients have central lines and you've got to draw them for a lab because labs cannot pull from the central lines. So if they have labs due, you've got to stay on top of that and make sure that you're drawing them on time. Especially if they're time-sensitive labs like a troponin or something like that. You've got to make sure you're getting it. Ideally, you need to be at a computer to know that you have this due. I've not even been at a computer all day except for passing my medications. I've barely looked at my orders to see what labs I do have due. If a lab does come and try to draw out of a patient who doesn't have a line and they're not able to stick them, then you've got to go try. You've got to try to stick this patient and get these labs or you've got to call somebody who can. On top of, you know, people's IVs are beeping, their fluids are running out, their IVs go bad. So you just have to consider all of this stuff that happens while you're doing all this other stuff. It's just a bunch of multitasking. In the meantime, after I've given him his pill and after he's fallen on the floor, I'm out here responding to other lights and still haven't set down the chart. And his call light actually goes off. And me and the CNA respond to this call light. We both show up and he's got to go to the bathroom. But he is refusing to use a bedpan and urinal. And demanding to walk to the toilet, which he cannot do. And I simply told him, you cannot walk to the toilet. We are not walking to the toilet. I don't have, I can't carry you to the toilet. We're not doing that. You're going to use a bedpan and you're going to use a urinal. That's your choice. That's your only option. You're just a fucking bitch. Get the fuck out of my room. Gladly. When you can no longer hold your bladder, please give me another call. And I step out of the room. I would say maybe about another 30 minutes to an hour his call light goes off again and he's got to go to the bathroom. At this time, I call the CNA and have her come in. And I actually told her to bring another CNA because he's a big guy and we're going to have to roll him over. And he can't use the right side, so we've got to roll him. And he's still mad that he's got to use a bedpan, but he can't hold it anymore. So he's got no toys, he's got to use a bedpan. And he's still calling me a bitch, mind you. Telling me that I'm just a hateful bitch and, you know, I can't even remember everything he was saying. Finally, I told him, I said, you know what? I am a bitch. And you have met your match here. And it is absolutely just so fun and probably the most exciting thing. The one thing I love about my job the most is being, you know, called a bitch when I'm about to wipe someone's ass. Am I proud of myself? Nope. I immediately wished I didn't say it, but my insides were boiling and I had to step out of the room because I was so mad at him. He just kept calling me a bitch. And it would be, like, if he was confused, I could accept it a little better, easier. But he wasn't. He was completely oriented and with it. And I just had a really bad day. And I just, you know, I was really just pushed to the edge. I was just walking a very thin line at this point. And it was that very moment when I realized, I'm done. I'm done. I cannot do this for not even one more day. I cannot do this. And it's not his fault. It's not any of these patients' fault because they deserve the best care. They deserve the best nurse. They deserve empathy. They deserve someone to be nice to them, to respect them, to preserve their dignity, to preserve their autonomy. And I felt that I was unable to do any of that in the state I was in. And this is not even the worst week or the worst day that I've had as a nurse. I've definitely had worse than this. So that just goes to show you, that just proves that I just got to a point to where there was no coming back. And there is no going back for me. I can't do it anymore. And it really frustrates me because I worked so hard to get here. I worked so hard to get my nursing license, put myself through all of that stress. I've worked so hard to protect my nursing license. I worked so hard to gain skills. I worked so hard to learn the things I needed to learn in critical care and gain those skills. And I'm at a point now where I recognize that I cannot work as a bedside nurse. My mental health will not allow me to do it. I can honestly tell you that my family and my friends and people that are close to me have no idea. No idea the mental state that I was in. I really cannot go back. I can't. I would love to. I would love to be able to work with, you know, vented patients and those high acuity patients. That has been my passion. But I can't. So I made the move. This was all in March. The week of March 11th. I knew I was done. And I made the move to case management. And that is now what I'm doing. I'm a discharge planner. And it has been such a weight off of my shoulders. I do miss critical care. And I'm afraid that I'm going to miss it to a point where I'm tempted to return at some point. But like I've mentioned, I just don't think that I should. I don't think it's a good idea for me. But I'm thoroughly enjoying this new job. Like maybe I'm just in the honeymoon phase. I don't know. But I'm absolutely enjoying it. Not that it's not stressful. It's a different kind of stress. And it's completely starting all over. You know, I'm learning a new skill. I'm learning something completely different than what I've been doing. I really do like it. And I get to talk to the patient still. And I'm not so frazzled that I'm being rude or that I'm being inconsiderate. I'm being inconsiderate of their illness and their feelings. And I feel like I can do them justice in this job. I feel that I can help them. Whereas it got to a point in bedside nursing where I felt like I was just barely getting by. Barely making it through a shift. Barely accomplishing the things that needed to be accomplished to provide safe patient care. It just did not feel safe for me on so many levels. And for so many reasons, it just did not feel safe to me anymore. I really hope that there are other people out there who can understand where I'm coming from. Not that I hope you can relate. Because I hope that there aren't that many people feeling this level of burnout. I guess I've only been a nurse for eight years. I've been a nurse for eight years. I did not know that this would be this bad. I did not know that burnout existed at this level. And this is not the only contract that has contributed to these feelings. To my mental health. It's not the only job. And traveling is not the only reason that I have reached this level of burnout. There are a lot of things that have contributed to these feelings and to me making this change in my career. So yeah, moving forward with this podcast, I really hope to have a good time. Not every one of these episodes is going to be a therapy session for me. But my point of this episode was just to kind of help you understand why I'm at where I'm at. And the importance of change in nursing. The importance of safety in nursing. And how all of that really does affect our outlook on the field. And how we feel going in every day to our job. And how we treat people. It affects our lives in many ways. You know, going forward. I do want to have fun. And I hope that you guys come back and keep listening. Because I'm really excited for this podcast. I'm really excited to tell my stories. And I have a lot of friends who have a lot of great stories. And we have had some crazy times in bedside nursing. And I'm looking forward to the future. I'm in a great place right now. I'm absolutely loving my job. I'm absolutely loving everything right now. And things are going great. And that's something to be said for nursing. You know, if you're not happy what you're doing, there are a million other options. There are so many options in nursing. And if you're at a place in bedside, I mean, shoot. Just try something else. You can always go back. My whole feeling behind it and the reason that I got where I was is because I was pushed to a place where I felt that I was not safe. And I could not provide safe care. And it just took its toll on me after a while. I don't feel like it should be that. I don't feel that that is how it should be. Things could be so much better. And they should be so much better. Anyway, if you agree with me, please make sure you come back. And let's continue this. Come back.