When nurses speak up: The hidden cost of patient advocacy

0:00Welcome to the untold, take it deep breath, take the higher road, it's what they always say, as if they know the way, they won't take it from me. Don't ever doubt yourself as wiping just a drain, you made your own so kick and scream, the people who will lock with and never end it for us, you never have the chance to watch your waiting for it. This is called my friend because this is what. It's time and this is what. For generations, nursing has been regarded as one of the most trusted professions in America. People place their lives in our hands, often literally, believing that nurses will always do what's right, no matter the cost.

1:07But what happens when doing the right thing comes with a price? What happens when the greatest threat to patient safety isn't a lack of knowledge or skill, but a culture that quietly teaches people not to ask questions? Healthcare doesn't usually fail because of one catastrophic event, more often it is the accumulation of tiny compromises, small shortcuts. Little moments when someone notices that something doesn't seem right, but convinces themselves, someone else must know better. Over time, those compromises become normalized. We've seen this play out in operating rooms and emergency departments, ICUs and during some of the darkest chapters in modern healthcare. We've seen nurses have experienced that unsettling feeling, that internal conflict between what policy says, what leadership expects, and what your conscience tells you. Today, my guest and I will be talking about those moments. You're listening to the nurses report on America Out Loud talk radio. I'm your host, Nurse Kimberly Overton.

2:08Before we get started today, I do want to encourage our listeners if you have questions or comments, or perhaps you want to share your own experiences with what you're seeing on the front lines of healthcare. You can now submit those to us directly by emailing us at nurses at americaout Loud.News. We would love to hear from you. We encourage all of you to engage in the battle and find your voice in this fight, but until you are able to do that, we will continue to be that voice for you. My guest today is Larkin Mercer, the pen name of a registered nurse with nearly two decades of experience in healthcare. Throughout her career, she served as both a frontline operating room nurse and a healthcare leader in a rural community. Experiences that have given her a unique perspective on patient advocacy, professional integrity, and the realities of today's healthcare system. Larkin is the author of While You Were Under, an OR nurses tale of advocacy. A powerful memoir that explores what happens when advocating for patients collides with workplace culture and institutional pressures.

3:09Rather than focusing on blame, her book invites readers to reflect on advocacy, accountability, and the human side of healthcare. It's a message that has resonated not only with nurses and other healthcare professionals, but with readers from all walks of life. When she's not writing or advocating, Larkin is a wife, the mother of two teenagers, a cattle rancher, farmer, avid barrel racer, and an outdoor enthusiast. She remains passionate about fostering conversations around patient safety, leadership, and creating a healthcare culture where people have the courage to speak up when it matters most. Larkin, welcome. Thank you so much for being here. Thank you for having me, Kimberly. Absolutely. I'm excited to hear. I was telling you a little bit before. I don't know if I'm more excited about hearing about the book or the bowel racing. Yeah, I am a barrel racing junkie for sure that adrenaline rush is incredible. Oh, I can't imagine I was reading your bio and I was like, this woman is just literally living my dream.

4:12I actually just got back yesterday from barrel racing. I've been kind of taking a hiatus a little bit. I had a couple of knee surgeries and rehab from that. So I got to get my fix over the weekend. I'll have to send me some videos or something. I'm just gonna have to I will live vicariously through you because these old bones ain't gonna be barrel racing anytime soon. Oh, there's some there's some old ladies out there that still can kick some butt. So goodness. I'll let you I'll let you to that. Yeah. But let's let's start with your journey. You know, you I want to know about the nurse behind the pen name. Like what first drew you into nursing and eventually into the operating room? It was kind of an unconventional nursing had never really crossed my mind. You know, some people are just completely like driven from a young age. I had a best friend growing up. Her mom was a nurse and she's like, that's what I'm going to do. And teaching was something that was definitely in my wheelhouse. I was really interested in that. I was interested in veterinary medicine and another one of my best friends is like, why don't you combine that and become a nurse. There's such a need for it. And you would be great at it.

5:24So in college like I was entered into college to do my prerex for teaching and I completely switched gears and did nursing and didn't look back. It was probably one of the best decisions. I enjoyed it thoroughly. And the nursing school was incredible experience. There were some things like we discussed just beforehand that we wish we've been told and taught. But no, I, yeah, I didn't look back. I became a CNA during nursing school and worked at the facility that I ended up working with for, you know, those two decades. And worked my way through nursing school working for them and then transitioned into nursing as soon as I graduated. Obviously, and you know, my book tells it's kind of an open book. And actually, what took place as far as the getting into OR nursing into the other was that something you were always drawn to or because for me, I was like, absolutely not like I can't work in an OR because I cannot work with the surgeons.

6:29Oh, for me, they're their own breed. They are. They definitely are. Things happen behind that red line and those closed doors that, yeah, can be pretty brutal. And the OR was the one place in nursing school that I did struggle with. And it wasn't because of the surgeons. It was because I felt like we were doing harm to the patients, those incisions, even with IV starts I struggled, which is sad to admit they would make me losey. I just I didn't like inflicting pain on people. And, you know, even though we can discuss it with them and tell them what's happening and they, you know, give us their consent to do that to them. But even a simple nisco made me really queasy. So I knew the OR was not where I needed to be initially and, you know, hand me all the traumas and the ER and I took those and ran with them like it's like we can fix this. Yeah, but yeah, the OR was not where I intended to go initially because I knew I just couldn't stomach it and then personality wise as well. I was one of those nurses that I struggled to speak up and, you know, it was pretty me again. Let's just, you know, keep my head down, do my job, you know, and learn my skills and hone my skills.

7:42So that again was not the place for me and yeah, I mean, so people can jump right into it. Yeah, well, I commend you because they said I couldn't do the OR and I'm kind of the opposite and I have a mouth that sometimes doesn't show you can't keep it closed and I would be fired like day one because I would tell the surgeon way to go and what for. And I have done it as an ICU nurse, I have done it. So I think the ICU is the perfect setting for me because we just don't care in the ICU. We will tell you whatever. Yeah, but you know, your book is titled while you are under and that's a really powerful title because patients literally place complete trust in their surgical team while they're unconscious. Yes. What, what does that title represent to you? The things that happen while you're under and again, that like you said, they put their complete trust, their entire life and they're so vulnerable in those moments on the table and what happens and that we are fighting for you, you know, like I was voicing my concerns while those patients were under.

8:51This can't happen or anticipating things that we're going to potentially go wrong while they were under and you know, being able to speak up and that we are there for them as nurses, but that they also need to advocate for themselves too and to speak up before they go under. You know, and don't always take everything at face value or that, you know, ask for those second opinions if you're uncomfortable and to trust that gut instinct that we all we all have it. We just sometimes don't listen to it. Yeah. And I know we've all seen, you know, especially with the the advent of social media, we've seen things that were shared like really in a probi I've seen I'm sure you've seen these videos, like of patients that were. There was one particular patient I believe was having a colonoscopy and the cell phone inadvertently captured what was happening and it was just a trotious. I mean, the behavior was absolutely atrocious and something like that is so damaging and but I'm sure that you've seen this in your, you know, your time, just like inappropriate conversations or remarks maybe about a patient.

9:54And you know, that as nurses like I know I've seen it and I've spoken up about it, you know, because it really is they are trusting us with some of their most vulnerable moments. Yeah. And you know, we've also all been that patient, right? At some point or another and they have to get it in the back of your mind like, oh my God, is this what happens when I'm under or right. But it's so important I feel like for us as nurses to not allow that type of behavior to be considered acceptable. I get the dark humor and all of that and you know, being necessary, but these are human beings like these are people. Yeah, I was at a conference so like to tie right into that at a conference and the speaker asked us to all take out our cell phones and said now, you know, on your lock screen, you have an image of a person, right. Everybody is somebody's picture person. Yeah. So and those patients on our tables because it was a surgical nurse conference. Every patient on our table is somebody's picture person. So treat them as if they were yours.

10:57Oh, it's like a hole. It was that stuck with me and I and to you know, take that back home and tell my staff that like that is somebody's picture person. And how would you want your picture person to be treated on this table and to stand up for them and to advocate for them in again, their most vulnerable time with us. And those conversations do happen in just in the media recently too, they were talking about, you know, the cameras in the OR. And you know, the controversy around that. I think that you would squalto a lot of the bad behaviors if there was camera footage of what goes on in there. Oh, of course, it's a liability for, you know, they they just considered a liability and that's frightening in and of itself. It's like, don't you know what you're doing? That you know, why are you so afraid? Right. You know, whether it's like an inadvertent, you know, accident or I know I, you know, we're all human and things happen. We don't get that. I get that. But you know, maybe we would be a little bit more, I don't know, cautious. If we knew we were, you know, being being watched.

12:02Yep. Yep. I think that things do happen in the OR behind those doors and those, you know, that red line that shouldn't happen because it is just that team and that culture back there, that hierarchal with the surgeons and that they know best. Yeah. And you know, in my book too, you know, that line that we've all heard, you're just a nurse. Oh, yes. And you know, surprising in those almost two decades at that facility, that was the one time that I'd ever heard that. And I was like, oh no, no, no, no. Let's talk about what being just a nurse means. Yeah, exactly. You know, I think one of the concepts that you've written about is what you call the normalization of risk. Yeah. Yeah. Can you explain to the listeners, what does that mean? Because you know, how something that begins is just a small deviation gradually becomes accepted as normal. I'd love to hear what your explanation is. And then I definitely, I think we could talk about this for a few minutes about what I've witnessed and what we've really tried this nurses.

13:03Absolutely. I wrote an opinion article for nurse dog org and on this and kind of put it in layman's terms of everybody experiences this normalization of risk in the black and white speed signs, the speed limit. And you know, that 55 will today, I'm in a hurry. I have to, you know, I'm, you run through your entire checklist of things that have to be done throughout your day. And you cross over that 55 to 57 and nothing bad happens, right? So, okay, 57 wasn't so bad. And then next week, my schedule's even busier and I inch up to 59. You know, I'm breaking the law, but nobody got hurt. Okay. So maybe next time at 62, you know, and that's the normalization of risk that we all experience and then we become complacent with that. It's okay. Because again, nothing bad happened and nobody got hurt and I didn't get caught. So then you take that into the nursing side of things of, you know, my book, I talked about.

14:08And then I got to the surgeon asking us to cut corners with instrument processing because it was an emergency case and we needed to get it done. And, you know, they were sterilized at another facility. Let's bring them through into our OR, you know, the transport person said, you know, they were handled appropriately. Let's just get them into our OR. Industry standards on our policy state. No, they have to be processed again. We have to do the intake and it's going to delay things. It's not life or death for that patient right now. It's not life or death if they get an infection. So not being willing to cut that corner, you know, but had I not been there, that corner probably would have been cut because of that pressure from that surgeon and that he knew best, you know, and they he was an attrusted role. So we experienced that and also unsafe staffing ratios, right. So so and so called in sick today. Can you just take that one extra patient just today. Well, that's not safe, but okay, just today, but then you did it yesterday. So now can you do it today too?

15:11You know, and we just slowly get accustomed to it and break policy. That's that's my definition of it of how we can kind of those simple normalizations. And when you speak out, especially in an OR, a surgeon will throw you right the hell out of his operating room. I know that that's not happening. They will throw you right out. So I think you're going to question them and you're out. You're out. So that's always something. And I'll give you a little bit of my kind of example. When I think about this type of normalization of risk, I can remember back in nursing school when I was doing my clinical. I'm a brand new. I'm not even a registered nurse. I'm in school. I'm doing my clinicals. And the whole purpose of me being there and shadowing these nurses is to learn hopefully the right way of doing things. But instead of that, really what I was getting was was the the cliff's notes version. Okay. Well, this is how policy says to do it. But let me show you how we really do it here. So a good example is insulin insulin when you administer in a hospital setting.

16:19And I'm sure it's different in every hospital probably as their own policy. But the one that I worked at had a policy where you had to sign off to our ends had to sign off and look at the dosage and make sure it was correct. And you had a like a pin number that you would have that nurse would have to come in and they would have to put their pin number into the chart saying that they. They saw the the correct the dosage is correct and everything is good. But what was happening was nurses were just sharing their pin number so that you could enter, you know, you just enter it without having that second set of eyes on it. And I just I can remember just is a student nurse thinking, Oh, wow, that doesn't seem safe. Like this policy is in place for a reason. Obviously, I mean, and we all know how easily. You know, insulin can can kill somebody if you give them the wrong dose of it. So I remember thinking really on, Oh, that doesn't and I and I remember saying something to the nurse. And she kind of got a really nasty with me. She was like, Well, this is how it's done. And she was like, and you better, you know, learn how to adapt to this. I mean, because as you know, I mean, nursing isn't just a nasty toxic.

17:27And I'm just like over here going, I don't think that that's right. You know, and I think that this is safe and and they don't like that they don't like when you start questioning. And I am part of me understands because we are always can we are continually tasked with more to do and less resources. We really don't have the time to go and double check this and double check that. So I understand the the pressure of of doing that and just, Hey, yeah, I trust you. You're a good nurse. You you take my number. But they were they were giving me their numbers as a nursing student. I absolutely should have been being watched right? Yeah. I was like, Oh, God, this is this is frightening to me. But have you seen things similar to that? Absolutely, absolutely. And I mean, we just have that incident, you know, I mean, not just, but that incident where the nurse that work around with the omnisell right? Yeah. That hit the news and, you know, gave the wrong medication because it was a work around and they're they always create those work arounds and, you know, in the essence of time.

18:33And the do more with less always always. It definitely is that I will say the system. I feel like it's it's designed to to do this. And but we can and we can blame the system. The nurse is always the scapegoat. Absolutely. Like we are always the scapegoat. But we have to we also have to take some accountability and, you know, the changes are going to happen unless we stand up and we speak out. And so, you know, otherwise we are just becoming a part of the problem and and we can't allow that to happen. We just can't. No. And to, you know, lead into like, you know, silence culture is such a big thing. And that fear of retaliation, not just from your administrators, but from your fellow nurses, you know, those co workers. If you call somebody out on something, you know, are you going to be blacklisted if it's a supervisor like, Hey, you know, this wasn't I saw this. You know, I just want to say, you know, I just want to say, you know, I'm really excited to be here and to be on right.

19:33You know, you talk to him about it. Are you going to get a bad schedule the next time the schedule comes out? Are you going to get a bad patient assignment from somebody because of that. But that silence culture, definitely they encourage us to not speak up. And then the first to float will be all the things. And you get on the radar of the charge nurse and the charge nurse doesn't like you. Well, just forget it. And so most people, and I think we saw that. There was a huge thing during COVID. That's why people were keeping their mouth shut. You know, because they were just kind of you go along to get along. And that's really, really unfortunate that that is the culture of nursing. And speaking of COVID, I think that's where a lot of that normalization of risk, like I feel like it went rampant like a wildfire that corners did have to be cut. And we had to do different work arounds. And then it just became like that's we got away with it then let's get away with it now like thinking about the things that we did for our or work around, you know, into.

20:38And we had our surgery area where we get changed to go into surgery as our decontam area for our hospital for the staff to go through like that is the most like you're supposed to be sterile. But now you're having it as a decontam that doesn't make any sense. No, it doesn't. But when it came from administration, that was what we had to do is, okay, well now what can we do safety measures to make sure that. You know, the OR is still a safe place. Yeah, and that was like that was one of the things that came up and one of the very first policies during COVID that really confused me and had me just kind of scratch and I had an asking questions was, you know, prior to COVID, we always don't adopt our PPE in the room. Infection control 101 right. Yeah, during COVID, they have us wearing the same mask right the same mask from our COVID patient rooms, don COVID patient rooms. We're just giving everybody COVID. Yep. And it's nice to me. No, and with the mask shortage to them, they're like, well, here's paper bags. Yeah, they gave us literally if you're listening to me, you have us brown paper bags and they told us that if we put our masks in these brown paper bags, they would somehow magically sanitize them for the next shift.

21:52And then we would start over all over again because we would they would ration the masks with, by the way, there was never a shortage. I found the stash down in the basement under blocking key. I mean, just Florida ceiling masks and everything you could possibly want. So they were hoarding them. They were hoarding. Yes, they were. We could go into a whole conspiracy theory thing on that. It was it was interesting them. It really was the supply chain change December. I'm just going to share this one little tidbits. It was interesting December of 2019. There was a mass shortage of end of recall of surgical gowns. I thought, well, that's weird. Why are they getting recalled and then COVID hit. There we go. That's interesting. But timing of that is interesting. And I really contend as an ICU nurse that I started seeing what we would later realize was COVID back in as early as September of 2019. Those patients were presenting very differently.

22:53And let's not forget too that we weren't wearing PPE during that time. Other than, you know, regular gloves. And so we weren't masking and doing all of that stuff. And it still took me a year and a half to get COVID. So again. Yeah. So we were wearing the virus. It's probably not exactly the same thing as the virus. The virus. It's not the same thing as the virus. It's not the same thing as the virus. I guess you know, you know, we weren't wearing PPE all of that. And it still took me a year and a half to get. Despite all of those things that I wasn't vaccinated and all of that. But yeah. That's the silence culture. I had a conversation with a teacher. So this is it's not just isolated to health care either. that speaking up and she was union involved and she got retaliated against. So this isn't, I was thinking, OK, it's just hospital systems, but it's not. It's workplace issues. And for me, that's kind of where the book is taking a different avenue of starting different conversations

23:53for other people as well that aren't just tied to health care, which was kind of exciting. But yeah, that silence culture is something that I'm definitely passionate about. How can we encourage people to speak up? And be willing to receive it if somebody calls us out on cutting a corner as well. Yeah. And I think if your nursing has really changed, now you've been a nurse a while. I've been in health care for 30 years now. And I have seen the shift in the nursing culture. And really all you need to do, I'm one of those nurses that you spoke of earlier that has been called to this profession. Like since I was two years old, I knew I wanted to be a nurse. All I ever wanted to do. And so I feel very called and very passionate about nursing. Some people just do it for paycheck. I will say that. And honestly, all you need to do is go to the comment section of any of these nursing groups. I'm sure you've seen them on Facebook. You will see the problem laid bare right there.

24:55Yeah, comment section. It's absolutely. It's maddening to me. It's frightening to me. And it just really saddens me for this profession and for people. And who the hell is going to take care of us? What does that mean? What does that mean? I am frightened. I am truly frightened. So I thank God every day for new nurses who are kind of being taken under the wing of nurses who actually truly care and are compassionate. Because unfortunately, you know, like I said in my opening, you expect nurses to be there and to take care of you and be compassionate, but it isn't always the case. No, no. And I felt, you know, even though I wasn't called to it, it was such an amazing, it is such an amazing profession. And I felt so privileged to care for this community. And I think that's why I was so passionate about speaking up and the longer I was here. Because I wasn't born and raised in this community. I moved into it when I got married. And it was unlike any other and protecting them.

25:55I became Mama Bear in that OAR. Like I'm going to protect these patients as much as I can. And I, it's an amazing profession. And it is an honor to be able to care for people, you know, out there most vulnerable because nobody really likes going to the hospital. Oh, exactly. And I think many people don't realize how razor thin that that line is between life and death. Yeah. And the fact that we are as nurses, like that's such a profound responsibility that we are like literally standing guard at that line. And for us to be like, if I always say, I say this all the time, if we as nurses are not standing in the gap for these patients, who is going to stand for them? Who is that? Yeah, and for them. And that's something I take very, very seriously. I can tell you do as well. And I think we need more nurses out there that really understand that this is a profound responsibility that we have as nurses. And they really need to take that seriously. Yeah, I think that that's something that needs to be talked

26:56about more in nursing school. I get it that the books and all that, but to have those serious conversations with them about the importance of the work that they will be doing. Yeah. Even just like to the fact that some nurses are so afraid, we talked about this earlier, afraid to ask questions. And I mean, if patients knew, if they really knew the amount of times that we as nurses have had to step in and have saved them from an unsafe physician's order, they would be horrified. Yes, they would. Yes, they would. What happens when those nurses aren't here anymore, those nurses that aren't afraid to question a physician's order? People are going to die. Yep. People are going to die. I mean, like I said, I can't tell you how many times I've had to, and that's just me personally, right? And think about that and what, four million nurses or something in the country. I mean, how many of us have similar stories? But I think many people assume that unsafe care happens because someone is just careless, right?

27:58But you argue that good nurses can be come part of unsafe systems. And I absolutely agree with that. And without even realizing it, how do you feel like that happens? I think it happens when you've spoken up and you weren't heard. And you speak up again, you're not heard. And maybe the tone shifts when you're talked to, you're not included in certain discussions. And you kind of become like, what's the point? Why am I speaking up if nothing's going to change? And, or if there's small retaliations or being the one that spoke up, my husband would tell me when I would be like, oh, I can't believe this happened. Not giving him a ton of details, but man, I, you know, this, you know, because of that, I got a bad call schedule for the next month or, you know, because I spoke up. It's like, why don't you just go in

28:58and keep your head down, your mouth shut and just do your job? Yeah. Because that's, you know, but it's more than a job. And those patients count on us for speaking up. But if you don't see that change, even those good nurses can then become again, what's the point? Yeah. And burnout is real. It is. It is a real phenomenon in nursing and it happens more than we would like to think. But I think that, you know, one of the biggest reasons that I started Remnant Healthcare was because I was tired, right? I was tired of begging for change. It's never coming. It's never coming. And I think it was so important for us to take our knowledge, our skills and our passion and to just walk away from this broken system and let's build up something else. Like let's build something that actually is truly patient focused and that is creating an environment where both nurses and patients are able to thrive. And that was my vision from Remnant Healthcare.

29:59And I'm so proud of what we've been able to build over these last God, I can't believe it's been over three years now. But we continue to thrive because this is just, it's so needed. And anybody who spent five minutes in the system can understand that. But you know, you can have all of the, you know, you can do the union stuff. And you can, I remember being very upset when they did the million nurse march. And I wouldn't participate in it because they wouldn't, they wouldn't discuss the vaccines. They wouldn't discuss bodily autonomy or anything that mattered. It was like the nurses were wanting to pick it only when it hit their wallet when it hit their paychecks. And I was like, oh, this is so cringe. But again, we're begging for change. It's never coming. So, but we, we've got to pivot to a break. But when we get back, we will get more into this incredible conversation, silence, culture and all things nursing when we get back with Bark and Mercer. America out loud talk radio plays on the IHR radio network. You can also listen on our media player from any web browser,

31:00anywhere in the world. We have the best in class apps available on Apple Android or Alexa 24, seven great talk radio. All of our shows go to podcasts the following day. You can hear them on apps such as Spotify, Stitcher Pandora, IHR podcast and many more. Be sure to subscribe and rate the show on Apple Podcasts for me. As we go to break, I want to share something I've been personally using and recommending to my clients with incredible results. It's the Trinity Pack from root brands, Clean Slate, Restore and Zero In. Clean Slate is all about cellular detox. Restore supports gut health and inflammation and Zero In helps balance energy, mood and mental clarity. I can tell you firsthand, I felt the difference, more energy, better focus and just an overall sense of balance. And I'm seeing the same thing with my clients, real noticeable improvements. If you're looking to support your body at a foundational level, this is a great place to start. You can check it out at my link, the root brands.com, forward slash Kimberly, your body will thank you. I'll catch you in the side of this break. Stay with us.

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34:06in the AI race? Now is our time, my fellow Americans, America out loud.News, Liberty and Justice for all. Welcome back to the Mercer's report on America Out Loud Talk Radio. I'm your host, Nurse Kimberly Overton. Wherever you're listening from today and whatever you're doing, I thank you for giving me the gift of your time. I want to take a moment to speak to my fellow nurses out there. If you are ready to step away from sick care, functional nurse academy may be exactly what you've been looking for. FNA is the most comprehensive, dual accredited, functional nursing program on the market and even includes business mentorship. As a graduate, I can speak from personal experience it. When I say that this program truly changed my career, I highly recommend the functional nurse academy to all of my colleagues who join our growing team at Remnant Healthcare. Click on the link in the show notes for more information

35:07or visit functionalnursacademy.com forward slash remnant. Also be sure to make AmericaOut Loud.News, your daily stop for all the latest news and don't forget to check out our online store at americatoutloud.shop where you can find all of the products that we represent on our network at a discounted rate. We almost do our part and share the stories, the articles, the podcast and videos so we can help secure America's feature. If you're just joining us, I've been talking with certified operating room nurse and author, Larkin Mercer. Let's jump right back in. Larkin, thank you again for being here. Oh, thank you for having me. Kimberly, this has been great. Yeah, it's been a great conversation so far. It's a much needed conversation. I don't think it's something that as nurses, we talk about enough. So thank you for having the courage to step out so many don't. Yeah. It was scary, scary step, but that first one, I'm glad I took it and it was forced upon me to take because it has changed the trajectory of things for sure.

36:10Yeah, absolutely. It's had some really meaningful conversations with people about nursing and the system essentially. And earlier, we talked about burnout, but something that was kind of new to me during this process was the moral injury that we experience in the job and that we don't recognize it right away because we talk about burnout. The system talks about burnout, which puts the blame on the nurse, right? Yeah. We can't handle it. Yeah, that's what's right. And yeah, it was, you know, they talk about the burnout and you can look at nurses that just give and give and give to, you know, the system to the health, you know, picking up extra shifts, doing more stain late, taking on extra assignments that necessarily they shouldn't, but they do it for the name of a job, you know, in the sake of taking care of those patients because if I don't, who else will, and they do truly experience the burnout, but those small compromises that we take

37:11also cause that moral injury to us. And that was something that I didn't expect to experience in a profession that is trusted to care so much. Exactly. And we care for everybody, but we so often don't stop to think about caring for ourselves. We cannot pour from an empty cup. We've got to take care of ourselves if we are going to be there to care for others. We've got to care for ourselves. Boundaries are so important. So important. I can't advocate for that enough. I wrote a blog piece about a year ago. It was called like the sacred yes or something like that. But I talk about setting those boundaries because it's constant. Oh, can you just work one more shift? Can you just take one more patient? Can you just do just this one? And you think the patients need me? My coworkers are drowning, all of that. And we just do it over and over again. And so we have nothing left. And we can't continue on that road. I really want to talk about leadership for a moment

38:12because what do you feel like some are the unintended ways that healthcare leaders can discourage on this communication? Even when they genuinely believe they're fostering an open culture, what are some of the ways that these leaders, you feel like would discourage that communication? I think that by shutting it down and being dismissive in it or a night experience that you had said it earlier too, this is the way we've always done it. This is the way it is. And it's worked for us. And that's even if there's not a policy that supports it because that's just been the cultural norm for so long. I think that that, you know, your most senior people, you know, it's the hospital system you work for, has put those people in those positions of power that they must trust them, you know, immensely. So why shouldn't I trust that what they're saying, you know, is exactly what the industry wants us to be doing.

39:13The system wants us to be doing. And also I think that fear of retaliation again is very, very real and that can discourage people too of, you know, that side glance or, you know, I have to put in this time off request, is it going to get denied if I speak up in this case? But I still really think that biggest one this is the way we've always done it. Yeah. And I think, and I don't know, you know, COVID was really eye opening for me personally. And again, I've been in healthcare for 30 years, but I started asking questions that I had never really thought about before because I had always implicitly trusted things like vaccines. I always implicitly trusted that these people that were, you know, this is not something that's not my realm, right? I'm not in vaccine science or anything. So I just trust that these people are doing their due diligence, right? And I always kind of, it was really weird to me. And I started kind of questioning that because like with medications, for example, we always knew, you know, we knew everything about them.

40:14We knew the side effects and all of the things, but with vaccines for some reason, I don't know if this is true for you as well. But for me, we are, I just always implicitly trusted them. Yep. And I think that just goes to show the level of conditioning that has been placed on us. Because as you well know, the only education we receive on vaccines in nursing school is just safe, effective and necessary. Yes. Exactly. And you know, when here's the vaccine schedule, you can't just put it in your mind. Yep. And you follow it to a T. Exactly. So I think that's just one of those, another, just another example of how we can sometimes implicitly trust. Absolutely. And just again, this is the way that it's always done. This is so we don't question. Let's talk about psychological safety. Because that has become, it's become something of a buzz word, but many, many organizations struggle to actually create it. What does true psychological safety look like? In a hospital or an operating room? That they're like in the perfect world

41:17that even speaking up or asking those questions, you don't get those side glances, you don't get that side of like, oh, you're delaying this again. Why are you asking this question that it's a safe space, and that to feel that everybody in that room has the patient's best interest at heart, that it's not a money grab. It's not, I have a vacation coming up and I need to get all of these cases done beforehand, or I have a quota of surgeries that I need to get done to meet my bonus, kind of think that those happen, but that psychological safety that if I speak up, I'm going to be heard. And I'm that mutual respect in the operating room that there's no fear of retaliation as well. I keep saying retaliation because it is a very verbal thing. But in so many forms, so many forms, I felt it in the biggest form by losing my job for speaking up, but there wasn't that psychological safety in there.

42:19And taking out that hierarchal that, yes, they're a doctor, but I'm a nurse. And we have very different roles and we both are equally as important in that room. I think that that's to level the playing field for everybody and that nobody is above another person. I would tell the housekeepers in there that if they saw something to speak up as well, to create that safe workspace and that if they don't do their job, it doesn't matter how good I do mine, that if they don't do it, the patient could still get an infection no matter if I go through every check box. So if they need equipment to do their job better, let me know, but that doesn't always happen. No, health care is a team sport. Yeah, I completely agree with you. And I will just say this, my chain of command never ended with an MD. So no, I don't work under a physician.

43:20A lot of people have that false. Like again, my chain of command always ended with the C&L. So we work alongside of physicians. It's in my mind, it's parallel. I am not under a physician. I don't feel beneath a physician at all. We just have, it's different. We're working in a parallel system and it's kind of different roads, but we hopefully are working towards the best possible outcomes for our mutual patient, right? Absolutely, absolutely. But I feel that that's something that's not every nurse believes that, especially the baby nurses coming in, they're awestruck that the physician even talked to them. So why would you even question them? Oh, so it's kind of funny. I was like, oh, there'd be so much for that first phone call, they have to make sure a physician is there. Oh, my one of you stuff, I'm not getting the phone. Oh, no, I remember like the first few phone calls. I would write out the script of everything I was going to say

44:21and just a little bit of the night calls. Yeah, I think I was really fortunate that I did. I've been in healthcare for a long time, 30 years, but I became a nurse later in life. So I was already kind of experienced and have a lot of life under my belts, you know, I didn't become a nurse and so I went back to nurse school in my late, mid-s late 30s. And so I was not as kind of meek as maybe a younger nurse might have been. So I'm just over here, I'm like, you know, that they put their pants on the same way that you do one leg at a time. Like they are not gods and don't let them tell you otherwise. Yeah. But we talked a lot about moral injury. We talked about nurses feeling burned out. Do you actually think that they aren't grieving the loss of the profession that they thought they were entering? And because some people, I idealized nursing my whole life. And when I got there, it was a little different. Do you feel like we're kind of grieving the realization that this isn't exactly what we designed up for?

45:24Yeah. Absolutely, absolutely. And it's, you know, revered as one of the most trusted professions and has been for so long and to then see where, you know, to pull back that curtain, I think I referenced that, you know, like the Wizard of Oz, you pull back the curtain and see behind it. Like, oh, okay. And to see that we do eat our young at times, we eat our old. That's a new thing as well. Or maybe it's not a new thing. Maybe it's something that, you know, I hadn't experienced it until being a more seasoned nurse and like, oh, wow, we're not as nice to our more senior nurses as well that it's just, it can be a very nasty profession and it doesn't have to be. We're one of the most caring professions, but we're so mean to each other at times. I believe girl culture in nursing is real. It's definitely a thing. I think, you know, advocacy, it often sounds very noble

46:25until you actually have to do it. I know that I stood up for nurses, older nurses, younger nurses because I don't believe in that toxic culture and I really have to, I love we're building it remnant because we have such a beautiful culture of where we support one another and, you know, it's not so cutthroat. But can you tell us about the personal cost that can come with advocating for patients and speaking these types of uncomfortable truths? A lot of times it comes with a cost. Yeah, it can come with a very, very high cost. Like I said, it cost me my job. What I felt was the end of my career where it should have just been the middle of my career. But I'm still, I'm pivoting right now and figuring out where I need to be at and what does nursing look like for me. But it does come with, it can be a small cost like we discussed earlier, you know, and a bad patient assignment or what we view as a bad patient assignment or an unfair or unsafe or a bad schedule

47:26all the way to a promotion. And then even when you're in a leadership role and advocating, you know, then you stop being invited to certain meetings, you don't get included in emails. And that cost then, it doesn't only hurt you, it hurts your team and it ultimately hurts the patients as well. But it can then cost you your career. But you have to be willing to, you know, weigh it. Can I live with the decision that I made if I didn't speak up and what happens or something happens to that patient big or small and leaving with your integrity intact? Your memoir intentionally focuses on systems instead of blaming individuals. Why was that important to you as an author? For me, it wasn't about the system that I worked for. It was the entire system. And that I think that those bad behaviors that I experienced,

48:31it wasn't necessarily the individual's fault. It was a system that allowed them to behave like that and that they had gotten away with it. That was their normalization of, you know, if I talked to a nurse that way and was dismissive to her or him, I mean, and that they got away with it and they got what they wanted. So, you know, like Pavlov's dog, that was a conditioning of if I'm rude to this person, I get what I want and life goes on. So it wasn't that they were necessarily a bad person. It was that the system allowed it. And that was why the focus was away from the system that I worked for, but, you know, the system as a whole, entire healthcare system and that it wasn't just me that was experiencing it either. It was that so many other people have experienced it and that they didn't necessarily need to feel alone anymore because I felt so alone in my journey

49:31because I thought, you know, I'm the only one that's experienced that this is the only place that this would ever happen that no other place would allow this. But now the conversations I'm having with people, you know, that I had throughout my writing process made me realize that I wasn't alone. So it was much bigger than me. And that's why the focus needed to be taken off of any individual in that book. And that's why I, you know, changed names, changed genders, you know, and changed the focus. Yeah, I think that's important. I think, you know, I've observed to throw up my own career nurses sometimes and we've talked about this throughout the日l. It's really been the theme of the show that nurses sometimes will feel isolated when they're trying to do the right thing. How do you think that nurses can better support one another so that speaking up becomes the exception, I'm sorry, the expectation rather than the exception? I think it starts in nursing school. I think that you have an advocacy course that they, you know, teach this. Oh, me too.

50:32Me too. Let's make it happen. Yes, I have actually reached out to some nursing schools and was like, here's the book. I have the study guy that goes with it and the discussion guide that can happen, these are real life case studies that you can use. But I think an advocacy course because we talk about it, like, oh, you're an advocate. And like you said, it sounds great, but how do you do it? And how do you stand up for somebody else to it? If they say, hey, I saw this happen, you know, will you go with me as a witness to it? You know, if they witnessed it with you, will you go with me and, oh, no, you know, how do you encourage nurses to, we can do this? Yes, it's wrong. That shouldn't have happened and to stand together united. Yeah, absolutely. I, yeah, that one, I think it does start in nursing school for sure. And I think then there's a movement right now that's not tied to just healthcare,

51:32but to end workplace abuse. And because it is another podcast that I went and she's like, Kayla, you're not okay. All right, Larkin. She goes, your book, like your experience was an abusive work environment. And it was. So to end workplace abuse is a movement right now to get into legislature to make laws, to protect people that can speak up. But again, you have to have people that are willing to enforce those laws. Yeah, exactly. But I think again, nursing school is the biggest thing and that you, the system has to encourage people to be willing to speak up because it is patient safety at the end of the day. We really need to catch these, these nurses, these baby nurses, really young and really early in their careers because as we mentioned earlier, the culture has definitely shifted. And you know, there aren't going to be any good nurses left unless the ones that are left, you know,

52:35takes on the newer generation of nurses. I personally want to open up my own nursing school that is on my bucket list as well. I have a ton of stuff on my bucket list. I'm going to live long enough to get any of this stuff done. But that's why I love meeting other incredible nurses that like, let's collaborate, let's get something together with. Even if it's not a nursing school, but if it's a program that we present to these nursing, you know, I'll partner with you on that. Let's do that. And anybody will tell you that that follows me, that I believe very highly in collaboration, I don't believe in competition, I believe in the best, and get stuff done. Yeah. And you know, somebody had mentioned too that if we were to talk about advocacy and the importance of speaking up that we would, and how important and what happens when you do speak up, things that you might experience in the workplace, they said, you're going to scare nurses away. You're going to scare those nursing students and they won't want to be nurses. So, but I would rather go in with the blinders off.

53:36And the rose tinted glasses tossed out the window to know what I was getting into because it was an eye opener and I think that that's why it took so long for me to find my voice in it as well. Yeah, we have to be better preparing these nurses for what they're going to face because we all know nursing school is nothing like what actually happens in their world nursing. That's why I like to, I think my real world experience because I had been in healthcare for so long, really, kind of like as I was studying for the NCLEX, I was like, oh, but you know, because you have that real world experience and then you have the picture perfect NCLEX world, which is just not the same, right? No, not the whole thing. But yeah, I think it's really, really important that we get these nurses and we get them young and we teach them how to be better advocates, not just for their patients, but for each other. We need to be empowering each other as nurses to stand up and ultimately at the end of the day. Like I said, we can create an environment where all of us can thrive.

54:38I really can't believe we're at the end of our time together because those buy so quickly. It does. I will definitely have it back because I can think there's so many more things we could talk about goodness. Yes. But really quickly before we end today, if you want to tell people where they can find your book and of course we'll include all of that in the show notes as well. Fantastic. Yes, it is available on Amazon and Barnes and Noble. You can just look either under my pen name, Larkin Mercer or just by the title of While You Were Under in Oarners' Tale of Advocacy. I'm on Facebook, Instagram, Instagram is a little sketch. My teenage daughter's helping me with that. And I do have a website that I'm still kind of playing around with as well. But that's where you can find me. Absolutely. Well, we'll make sure we include all of those links in the show notes that will accompany this episode once it goes to podcast. Again, Larkin Mercer, thank you so much for joining me. I really, really enjoyed this conversation.

55:39And I will definitely, we'll be having some awful in conversation. I guess we'll have to say. That sounds great. And really thank you so much. You're welcome. And that is all the time that we have for today, friends. But remember, we are here on the air five days a week, Monday through Friday at 10 a.m. Eastern with a different nurse host daily. Please be sure to tune in and listen to myself and these courageous nurses. As we walk you through all of these hot topics, we will empower you with information and education. We will advocate and we will stand in the gap for you because we are nurses. And this is what we do. I'm your host, yours Kimberly Overton. And you can find me here every Wednesday morning at 10 a.m. Eastern. Until next time, be safe, be well, and God bless. Remember, we are in a war for truth. We are putting out a bounty on the real misinformation and exposing the pervades of propaganda. No topic is often limits as we shine our lights and expose the darkness. It's time in this six world.

56:39It's time in this six world. Oh, oh, oh, oh. Oh, oh, oh, oh. Oh, oh, oh, oh, oh, oh. Oh, oh, oh, oh, oh. Oh, oh, oh, oh.