Meet our Get to Know Nurse Elizabeth Voyles, Nurse Coordinator of Palliative Care at Children’s Hospital of Michigan. I ask Elizabeth about her career in pediatric nursing and also shared questions from current nursing students, as part of our first “Ask A Nurse” portion of the podcast.
MP3 Audio Podcast
Jamie Davis: Beth, welcome to Nursing Notes Live. It’s great to have you here with us today and I always ask the nurses that come on the show to share with us a little bit about why you wanted to become a nurse, why is it that you decided nursing was the career for you and maybe give us a little bit of insight into how your education progressed and your career progressed to bring you to where you are today.
Elizabeth Boyles: Well, I always enjoyed sciences when I was growing up and when you look at being a nurse. When I was growing up it was one of the professions that women could do and get into very easily and I really just thought it would be a good fit for me. I went to nursing school and it really was a good fit. I enjoyed it from the time I started. When I did my pediatric rotation, I fell in love with the kids. At the time, we did a team leading rotation that we had to do, which is sort of like your senior delving into experience. And so I chose to do mine at Children’s Hospital and I worked on an orthopedic-surgical floor for the kids and I loved it. That’s where I started my nursing career. Actually, interviewed and was hired on that floor and I’ve worked in pediatrics all of my career except for about two years when I was out of the area. But even at that time I did some home nursing care and then I ended up doing, working in the health department doing screening for children. So it’s still came back around to the backdoor to kids one way or another. People often ask me why I work with kids and I say that I just love them and I can’t imagine working with adults. So it’s been enjoyable in that sense.
Jamie: Yes, it’s interesting. A lot of people talk about – I hear nursing students say, “Oh, I want to work with kids” and it’s one of those fields that you either fall in love with it or you find out very quickly that it’s not for you. Do you agree with that?
Elizabeth: I think very much so and I think a lot of people start out in pediatrics too when they first graduate and they’re young and then when they start having family and they have kids of their own they find it even more challenging because you identify a lot with those children and your own children and you can see your own children going through this and I think the most difficult things for me in taking care of kids was when I would take care of someone who was the same age as my own child or whatever. And I remember one time taking care of this five-month old little girl who came into the hospital who they thought was previously healthy and she ended up having a cardiac arrest and a major cardiac problem and she died and I took care of her that night. And I had a five-month old daughter at home and I went home in the morning and she was in her chair and I grabbed her out of her chair and I hugged her and my husband was like, “What’s going on?” I said, “I just need to hug her. Leave me alone.” So it’s just those kinds of things and I think you need to work through those differences and realize that it’s challenging but it also makes us human and it makes us more caring when we’re actually caring for the patient and the family in some ways when you can identify with them.
Jamie: I see that you’re a palliative care nurse coordinator, can you explain a little bit about how your role in palliative care works with kids in Children’s Hospital?
Elizabeth: Sure. Our palliative care team started about in 2007 and I had worked most of my nursing career in the pediatric intensive care unit and working in the ICU you see lots of things. I see a lot of kids get better but you also see a lot of kids really dying a very long and suffering type thing. And during that time, I just really started to focus on what we were doing and why we were doing things and were we really giving families options and whether they’re really understanding the pros and cons and the benefits and the risks for all the things that we were doing. And so I got involved with end-of-life care and started really researching it and learning all about it and going to all kinds of educational seminars about it. I was asking our hospital about a palliative care program and, in the meantime, we had a physician that was going to palliative care. So they hired the physician and then I was asking, “Well, what about a nurse?” And so I really pursued a nursing position to support this doctor and to just begin to work with the children here. And as far as my job here, I see patients. I help coordinate the care of over – we’ve been involved with about over 500 families. Actively, we have about 180 families that we follow on a day-to-day basis. Some of those families were very involved with. Some of the families we meet when their child is first diagnosed with some type of chronic or genetic illness and we follow them for years. Some we meet when treatment is no longer available to them and they’re talking about end-of-life care. So we help them work through their end-of-life and help them make memories and decision-making and make sure that they know what to expect so that they’re not afraid of what’s coming up. So I’m very lucky in a sense that I work with families and children, some of them for just hours or days and some for years. So you develop a relationship with them and it’s all about trying to develop the trust and make sure that their goals of care are being met no matter what those goals are.
Jamie: With children, you really are dealing with a larger package when you have an entire family, and that includes siblings as well. Really, the nurses who perform that day-to-day care become almost members of the family. Do you find that this makes it easier or harder when you’re dealing with these end-of-life decisions?
Elizabeth: I think what I do is both a blessing and a curse at times. Because you do become attached to these families because you do develop that relationship and you get to know them. So when they die, you grieve along with the family. When you’re losing large numbers of people that you’ve gotten to know, it can be painful and it can tug at your heart. But I think it can also be rewarding and a blessing to know that you’ve been able to touch these lives and to help them in a time when they’re very much at struggle within themselves and grieving. I’ve often said that I really think it’s beautiful to help someone die as it is to help someone be born. To see the families know what to expect and to have the fear taken away and to have them be able to hold someone in their last moments and to tell them that they’ve loved them and that they’ll be missed and that they are loved or to help make sure that they create memories, tangible memories that they can hold on to. It’s really important. And I think it helps them in the long term in the grieving process, to be able to look back and see how things occurred.
Jamie: Let’s shift gears a little bit and talk about what you enjoy most about your job in pediatric nursing.
Elizabeth: I think it’s just how kids are so amazing. The things they say. I remember – many people might remember Art Linkletter show about the “Kids Say the Darndest Things.” They do say the darndest things. They do the darndest things and they’re resilient. They get sick fast but they get better fast too. Their job is to play and that’s what they’re interested in. They can be sick of can be and laying in there and have a high fever, feeling terrible. As soon as you get that fever gone, they’re ready to run around and play and laugh and talk with you and so I think just seeing them be kids is one of the things I really love. And again just talking – families can be a challenge. Families are one of your – parents are one of your hardest parts but they’re also one of your easiest parts to be in. So just talking with the families and when I worked in the ICU, I always used to like to ask the families to tell me what their child likes to do at home. What do they do normally or bring pictures and let me see them when they’re normal and healthy because I can also make home visits now. So I get to see the kids in their home environment which is totally different then the hospital. They’re so much more at ease and they’re much more talkative and they want to share things with you and so that’s one thing that I love about working with the kids.
Jamie: Why do you think nurses play such an important role in working with pediatric patients? Even if they’re not pediatric-specialized nurses, so many nurses in other areas and specialties come in contact with kids. What makes that role an important role?
Elizabeth: I think nurses are the core of the medical profession. Yes, doctors make diagnosis and treatment stuff but it’s the nurses that carry out that plan of care. It’s that nurses that have that one-on-one with the families. It’s the nurses that are at the bedside getting to know the patients, assessing them, seeing the changes, knowing when to push, when to pull away. Nurses have the relationships with the patients.
Jamie: If someone listening to this, we have a lot of nursing students that listen to the show and nurses in different stages in their careers may be looking for a change, what piece of advice would you offer to them to build some knowledge or develop certain skills that would help them if they decide to branch out and become a pediatric-specialized nurse?
Elizabeth: I think getting education is always important whether it’s by attending different conferences, attending nursing grand rounds that are held within your hospital, getting involved in committees, finding out how things work and doing this for your own personal and professional growth not because it’s going to get you another dollar, another 50 cents or whatever but I think involving yourself in organizations and finding out - like I’ve always been really involved in committee work. It makes you more rounded and it makes you understand the whole process of what’s going on within the hospital and healthcare itself. I think it’s important to know those different aspects and you can’t always just rely on - patient care is great satisfaction. But I think when you get involved and can see processes change and improvement made, that I think that’s a big plus.
Jamie: Nurses really, I think, are on the forefront of improving so many aspects of patient care right now, do you see nurses being involved with that in the pediatric realm as well?
Elizabeth: Yes. We have committees and we have nurses that go to conference and stuff and they bring back information, they bring back some pieces of equipment that’s been – they saw and saw how it worked and could promote better patient care in different ways. They bring it to the administration. So there’s committees that can do that and I think nurses are doing that. I think nurses are also politically involved in things in trying to make changes with different standards of care and making sure that patient care is appropriate and that it’s the right proper numbers and that the patients aren’t suffering. Safety is a very important thing in care right now and nurses are pushing for that. So I think nurses have a lot of impact in the hospital. They’re probably the largest number of section of employees of any hospital I would think. So they have a lot of impact on patient care and where things can be changed and made better.
Jamie: You’ve mentioned conferences twice. I’m a big proponent of people going to their specialty conferences in nursing or any field of healthcare. What has been the most rewarding thing or takeaway that you’ve received from conferences? Has it been going to the classes or has it been those hallway conversations, those networking situations that happen so often at conferences?
Elizabeth: Conferences present a ton of opportunities for people. They present that opportunity to, one, increase your knowledge by attending the different classes that are available. The networking opportunities are amazing. To find out that your hospital is doing things that other hospitals aren’t doing. Or that another hospital is doing something that you’re not doing, that you can bring back to your hospital. It’s a place to find mentors. I’ve been involved with the Society of Pediatric Nurses for quite a while. I served on their national board of directors. I was at a planning committee for one of their conferences, the planning chair for one of their conferences. It gives you an opportunity to just really learn so much more than just what you do in the classes. I found a mentor there who encouraged me to publish a paper and helped me do that. I wouldn’t have done that without ever attending this conference. It will never enter my mind to think about doing that or that I could do that. So I think you can gain so much from being involved in national nursing groups and attending conferences. It’s a wonderful plus. It’s been a great asset in my life.
Jamie: We get questions in from student nurses particularly about what experienced nurses have to share about their careers. One of the questions is, what is it that you know now that you wish you had known when you first started in nursing?
Elizabeth: Oh, gosh, there’s so much I know now. I probably would have pursued my further education sooner in my career. I was very focused as a clinical bedside nurse for years and I was very focused on doing that. I worked part-time, fulltime, adjusting my working career to my family. And I think it would have been a plus to further my education sooner in my career. But I also think that it’s important to get real experience at the bedside and not just go for your advancement without knowing what it’s really like at the bedside and caring for people at that time.
Jamie: I think that’s some good advice there because you really do need some of that real-life clinical background and not just what you got in your clinical rotations in nursing school but really what it’s like to operate independently as a nurse.
Elizabeth: Yes. And you don’t know until you’re out there. You need to develop that critical thinking and you need to be able to set priorities and handle more than one patient at a time. I think there’s a good basis for – if you like pediatric starting in the medical-surgical background in pediatrics and adult medical-surgical before just going into the critical care. So I’m a critical care nurse. Through and through, I’ve 30 years of critical care experience but I think that your basics need to be fulfilled and then move on to what your choice is.
Jamie: What about work-life balance? So we got a question here that asks what advice a new nurse might need to maintain and set up that work-life balance?
Elizabeth: I’ve always been pretty good at work-life balance. People have told me that too. I typically always try to make sure I plan some time away every three or four months from work just to make sure that I can keep myself fresh. I think that’s one of the things that nursing offers that a lot of other careers don’t offer and it’s still to this day is available to people. The flexibility of changing your hours and work in different shifts when your kids are at different stage or your family is at different stage or you have different needs for parents. You might need to take care of your parents at some point in time. And I think it’s important to realize that work is here but there’s other people that can do your work when you’re not here. None of us are disposable and none of us are indispensable and it’s great to help out work overtime some but don’t drain yourself. I think that you have to get away. Because if you’re not in touch with what’s happening to yourself and you’re not able to recognize when you’re burnt out, your care is poor.
Jamie: We’re so focused on caregiving as nurses that I’ve often heard it said we don’t take such good care of ourselves.
Elizabeth: Very true. And when we don’t, we’re really not doing great job of caring for somebody else if you’re not caring for yourself. When I lecture with this particular topic, when I’m lecturing on palliative care and end-of-life, people will often say, “Well, how do you do what you do?” And I just say, “Well, you have to do what you can do and recognize that it’s not your death, it’s not your family and you’re there to help them through it and you do as much as you can and then you have to let go and really know that you’ve done as much as you can as well as you can.” And some people are going to handle their grief situation very well and others are going to have a very difficult time and you just have to help them find the resources to help with that afterwards because we can’t be everything to everyone.
Jamie: Final question that came in was, and you’ve mentioned that working and mentoring, so I’m interested to hear your response to this, but what is the best piece of nursing advice you’ve ever received from someone else?
Elizabeth: I think it’s to make sure that you care for the person and treat them as if they were family. And if you care for your patients, as if you would want your family cared for, then you will be feeling like you did the best.
Make sure you check out the entire March, 2014 issue of Nursing Notes, where we look at the pediatric nursing specialty. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our panel of pediatric nurse practitioners including Anne Pettinger, a board Certified Pediatric Nurse Practitioner at Pediatrics Northwest in Washington state and Anne Derouin, also a Certified Pediatric Nurse Practitioner and a faculty member at Duke University School of Nursing. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.