1 00:00:00,240 --> 00:00:02,720 Welcome to the Becker's Healthcare Podcast. I'm Chris 2 00:00:02,720 --> 00:00:04,519 Sosa, the copy chief here at Becker's, and 3 00:00:04,519 --> 00:00:06,419 I'm thrilled to be joined by Denise Harmon, 4 00:00:06,559 --> 00:00:09,759 director of medical surgical pediatrics at Olympic Medical 5 00:00:09,759 --> 00:00:10,820 Center in Washington. 6 00:00:11,119 --> 00:00:13,059 Denise, thank you for joining us today. 7 00:00:13,464 --> 00:00:14,205 You're welcome. 8 00:00:14,985 --> 00:00:16,745 Denise, for those in the audience who are 9 00:00:16,745 --> 00:00:18,345 maybe not familiar with you and the work 10 00:00:18,345 --> 00:00:20,425 you've done, would you mind introducing yourself and 11 00:00:20,425 --> 00:00:22,125 telling us a bit about your background? 12 00:00:22,824 --> 00:00:23,304 Sure. 13 00:00:23,704 --> 00:00:25,464 As you mentioned, I am the director of 14 00:00:25,464 --> 00:00:28,739 the medical surgical pediatrics department here at Olympic 15 00:00:28,739 --> 00:00:29,480 Medical Center. 16 00:00:30,100 --> 00:00:32,440 We are a small rural community hospital 17 00:00:33,219 --> 00:00:33,719 serving 18 00:00:34,100 --> 00:00:37,719 the very, very far Northwest of Washington state. 19 00:00:38,739 --> 00:00:40,439 My background is mostly 20 00:00:41,299 --> 00:00:42,119 med surg. 21 00:00:42,515 --> 00:00:44,594 I have had this position. It'll be three 22 00:00:44,594 --> 00:00:46,755 years in April 0. Before that, I worked 23 00:00:46,755 --> 00:00:48,695 as a bedside nurse in this department. 24 00:00:48,995 --> 00:00:51,094 I've done a variety of things, some pediatric 25 00:00:51,155 --> 00:00:51,895 home health, 26 00:00:52,274 --> 00:00:54,215 long term care, some clinic work. 27 00:00:54,675 --> 00:00:55,909 But I 28 00:00:56,369 --> 00:00:59,089 love the the med surg department, so I 29 00:00:59,089 --> 00:00:59,909 like the 30 00:01:00,289 --> 00:01:03,109 the pace and the exposure to different things. 31 00:01:03,649 --> 00:01:05,170 Our house, as I mentioned, our hospital is 32 00:01:05,170 --> 00:01:06,069 a rural hospital. 33 00:01:06,609 --> 00:01:09,430 My department happens to be the largest 1, 34 00:01:09,704 --> 00:01:11,784 for what it's worth. It it has 40 35 00:01:11,784 --> 00:01:13,704 beds, so that gives you an idea of 36 00:01:13,704 --> 00:01:15,484 of what our hospital looks like 37 00:01:16,504 --> 00:01:17,405 as a whole. 38 00:01:18,825 --> 00:01:21,304 Yeah. I think that kinda covers my background. 39 00:01:21,304 --> 00:01:22,284 It's pretty straightforward. 40 00:01:23,439 --> 00:01:25,920 Well, terrific, Denise. If you wouldn't mind for 41 00:01:25,920 --> 00:01:27,519 our audience, could you lay out some of 42 00:01:27,519 --> 00:01:30,799 the top priorities today from the the angle, 43 00:01:30,799 --> 00:01:32,739 the example that that you push forward? 44 00:01:33,439 --> 00:01:35,119 Your background, that is, is from a rural 45 00:01:35,119 --> 00:01:36,099 community hospital. 46 00:01:36,895 --> 00:01:38,674 So our our top priorities 47 00:01:39,215 --> 00:01:41,795 are making sure that our hospital 48 00:01:42,255 --> 00:01:44,495 stays up to date with the with the 49 00:01:44,495 --> 00:01:45,795 latest and greatest, 50 00:01:46,174 --> 00:01:48,689 being that we are kind of remote ish. 51 00:01:49,490 --> 00:01:51,250 It it does take a little bit of 52 00:01:51,250 --> 00:01:53,829 time for kind of the newer stuff to 53 00:01:54,209 --> 00:01:54,950 to hit 54 00:01:55,490 --> 00:01:56,630 our our hospital. 55 00:01:57,730 --> 00:02:00,150 1 of the unique things about our department 56 00:02:00,209 --> 00:02:03,454 in particular, it we do have pediatric patients, 57 00:02:03,454 --> 00:02:06,255 but we, also take care of adults. So 58 00:02:06,255 --> 00:02:07,635 it's kind of a combination 59 00:02:08,974 --> 00:02:10,835 adult medical surgical pediatrics. 60 00:02:11,694 --> 00:02:14,889 So that means that our our nursing staff 61 00:02:14,889 --> 00:02:17,229 has to be able to care for that 62 00:02:17,370 --> 00:02:18,509 very, very diverse 63 00:02:18,810 --> 00:02:19,310 population. 64 00:02:20,009 --> 00:02:22,650 So our our main priorities are making sure 65 00:02:22,650 --> 00:02:24,889 their education is up to date, making sure 66 00:02:24,889 --> 00:02:25,629 that they 67 00:02:27,004 --> 00:02:29,084 know what is going on in the world 68 00:02:29,084 --> 00:02:29,824 of peds, 69 00:02:30,764 --> 00:02:32,764 as the majority of our patients are not 70 00:02:32,764 --> 00:02:33,264 peds. 71 00:02:33,724 --> 00:02:34,224 So 72 00:02:34,525 --> 00:02:35,485 that is 73 00:02:36,125 --> 00:02:38,685 I am in constant contact with our local 74 00:02:38,685 --> 00:02:41,389 pediatric clinic who has a relationship with some, 75 00:02:41,709 --> 00:02:43,810 pediatric hospitals in the Seattle area. 76 00:02:44,430 --> 00:02:46,349 They do a really good job of making 77 00:02:46,349 --> 00:02:48,430 sure that we are, you know, updated on 78 00:02:48,430 --> 00:02:49,729 any changes in processes 79 00:02:50,030 --> 00:02:51,949 or, hey, you know, now we're treating this 80 00:02:51,949 --> 00:02:54,675 condition differently. This is what we're doing now. 81 00:02:55,235 --> 00:02:55,735 And 82 00:02:56,115 --> 00:02:58,275 our main priority is making sure that our 83 00:02:58,275 --> 00:03:01,555 nursing staff is familiar with those changes and 84 00:03:01,555 --> 00:03:02,055 comfortable 85 00:03:02,754 --> 00:03:04,935 with those changes so that they can provide 86 00:03:05,074 --> 00:03:07,254 the care that our patients need. 87 00:03:08,330 --> 00:03:09,849 Thank you for laying all that out for 88 00:03:09,849 --> 00:03:10,430 our audience, 89 00:03:10,729 --> 00:03:12,430 Denise. Speaking of changes, 90 00:03:12,810 --> 00:03:14,810 looking at the next eighteen months or so, 91 00:03:14,810 --> 00:03:16,969 how do you anticipate your role is gonna 92 00:03:16,969 --> 00:03:18,509 change and the role of your team? 93 00:03:19,449 --> 00:03:19,930 So, 94 00:03:20,250 --> 00:03:20,750 I 95 00:03:21,324 --> 00:03:23,324 am not sure how my role is going 96 00:03:23,324 --> 00:03:24,764 to change. I know that we, 97 00:03:25,644 --> 00:03:26,144 are 98 00:03:26,924 --> 00:03:28,704 coming out of the post COVID, 99 00:03:29,324 --> 00:03:31,564 slump, as I like to call it. We 100 00:03:31,564 --> 00:03:33,185 had a huge amount of turnover. 101 00:03:33,939 --> 00:03:36,020 You know, our organization as a whole is 102 00:03:36,020 --> 00:03:38,659 kind of bouncing back from from that where 103 00:03:38,659 --> 00:03:41,219 we were just kind of rolling minute by 104 00:03:41,219 --> 00:03:43,219 minute, figuring things out. Now we've got time 105 00:03:43,219 --> 00:03:44,280 to breathe and we're 106 00:03:44,740 --> 00:03:45,719 we're refocusing. 107 00:03:46,819 --> 00:03:48,039 So my role is 108 00:03:48,555 --> 00:03:50,955 will remain the same. But I know that 109 00:03:50,955 --> 00:03:52,875 it's going to shift into a different direction 110 00:03:52,875 --> 00:03:54,014 with different responsibilities 111 00:03:54,474 --> 00:03:55,935 as as things arise. 112 00:03:56,395 --> 00:03:58,814 As far as my my team goes, 113 00:03:59,675 --> 00:04:02,569 we had a large turnover of more experienced 114 00:04:02,569 --> 00:04:05,050 nurses, so our team is relatively young. We 115 00:04:05,050 --> 00:04:05,550 also 116 00:04:05,930 --> 00:04:08,270 are finally coming out of the, 117 00:04:09,210 --> 00:04:09,710 heavy 118 00:04:10,010 --> 00:04:10,510 traveler 119 00:04:11,210 --> 00:04:11,710 nurse, 120 00:04:12,250 --> 00:04:15,664 population. We had quite a few open positions, 121 00:04:16,285 --> 00:04:17,964 that we had filled with travelers and now 122 00:04:17,964 --> 00:04:18,785 we are getting 123 00:04:19,324 --> 00:04:22,064 nurses in. Some of those are fresh graduates, 124 00:04:22,125 --> 00:04:24,865 some of them are experienced nurses from other 125 00:04:25,245 --> 00:04:26,720 other areas. So 126 00:04:27,020 --> 00:04:29,339 as we build our team back up to 127 00:04:29,339 --> 00:04:30,480 permanent staff, 128 00:04:31,259 --> 00:04:33,339 there are a lot of changes that come 129 00:04:33,339 --> 00:04:35,339 with that. So we have to build a 130 00:04:35,339 --> 00:04:38,400 lot more familiarity with our pediatric population. 131 00:04:39,589 --> 00:04:42,495 How how we do things because they're they're, 132 00:04:42,634 --> 00:04:44,795 you know, during COVID, I think people just 133 00:04:44,795 --> 00:04:45,455 kind of 134 00:04:45,995 --> 00:04:47,435 did the best they could with what they 135 00:04:47,435 --> 00:04:49,835 had at the moment. And so there was 136 00:04:49,835 --> 00:04:50,975 a lot of, 137 00:04:51,835 --> 00:04:52,889 spur of the moment 138 00:04:53,370 --> 00:04:55,210 decisions like, hey, this is what we're going 139 00:04:55,210 --> 00:04:56,050 to do right now. 140 00:04:56,490 --> 00:04:58,350 Not a lot of time to really 141 00:04:59,370 --> 00:05:02,030 think through and develop a solid processes. 142 00:05:02,810 --> 00:05:04,670 So we are working on 143 00:05:05,050 --> 00:05:06,430 improving our pediatric 144 00:05:07,375 --> 00:05:08,675 orientation and education 145 00:05:09,935 --> 00:05:12,514 process for our nursing staff. So that is 146 00:05:12,894 --> 00:05:14,495 more clear, more in line of what the 147 00:05:14,495 --> 00:05:16,995 other facilities in our area are doing, where 148 00:05:17,375 --> 00:05:18,974 we know that if we end up having 149 00:05:18,974 --> 00:05:22,000 to transfer a pediatric patient out, that our 150 00:05:22,000 --> 00:05:24,240 care is gonna line up with what their 151 00:05:24,240 --> 00:05:26,000 next step in care will be at those 152 00:05:26,000 --> 00:05:27,220 higher acuity facilities. 153 00:05:28,319 --> 00:05:30,579 Making sure that our staff is comfortable 154 00:05:31,199 --> 00:05:33,600 caring for pediatric patients. You know, we have 155 00:05:33,600 --> 00:05:34,259 we have 156 00:05:34,675 --> 00:05:36,595 brand new nurses out of nursing school who 157 00:05:36,595 --> 00:05:39,395 are in their early twenties, no experience with 158 00:05:39,395 --> 00:05:39,895 children 159 00:05:40,275 --> 00:05:42,035 in any way, shape, or form. They tend 160 00:05:42,035 --> 00:05:43,955 to get that deer in the headlights look 161 00:05:43,955 --> 00:05:44,455 and 162 00:05:44,995 --> 00:05:47,155 panic when you say, hey, here's a kid. 163 00:05:47,155 --> 00:05:49,879 Let's, orient and train with them today. So, 164 00:05:50,199 --> 00:05:52,459 getting them more familiar with that population. 165 00:05:53,319 --> 00:05:55,079 We have been working really hard on building 166 00:05:55,079 --> 00:05:56,860 better relationships with our pediatricians. 167 00:05:57,959 --> 00:05:59,259 We have a great team 168 00:05:59,560 --> 00:06:01,419 of pediatricians here that are 169 00:06:02,035 --> 00:06:04,455 very good at making sure that 170 00:06:04,835 --> 00:06:07,495 our staff knows what the plan is, 171 00:06:07,955 --> 00:06:10,615 knows that they're a resource at any time 172 00:06:10,754 --> 00:06:12,214 they can reach out. So 173 00:06:12,675 --> 00:06:14,995 over the next eighteen months, we're gonna focus 174 00:06:14,995 --> 00:06:17,740 on that education and building up those stronger 175 00:06:17,800 --> 00:06:21,020 relationships and getting those policies and processes solidified 176 00:06:21,080 --> 00:06:23,800 so that our staff is comfortable, and we 177 00:06:23,800 --> 00:06:25,720 know that we are providing the best possible 178 00:06:25,720 --> 00:06:27,900 care to our patients while they're here. 179 00:06:28,840 --> 00:06:31,160 Chase, I'm glad you mentioned, the younger nurses 180 00:06:31,160 --> 00:06:33,245 and the amount of turnover you had. Certainly, 181 00:06:33,644 --> 00:06:36,044 your organization is not the only 1. But 182 00:06:36,044 --> 00:06:37,665 I'm curious as to 183 00:06:38,204 --> 00:06:40,544 what you find are the most important resources 184 00:06:40,685 --> 00:06:43,644 when you have a younger crop of, nurses 185 00:06:43,644 --> 00:06:45,264 and other staff coming in. 186 00:06:46,080 --> 00:06:48,660 So our our most important resources 187 00:06:49,120 --> 00:06:49,620 are 188 00:06:50,240 --> 00:06:52,100 our more experienced staff. 189 00:06:52,480 --> 00:06:55,279 They they do a great job while we 190 00:06:55,279 --> 00:06:56,899 have less than we had before. 191 00:06:57,199 --> 00:06:59,939 They do a great job of kind of 192 00:07:00,464 --> 00:07:03,185 calming that panic down. You know, you're you're 193 00:07:03,185 --> 00:07:05,105 a new nurse. You feel like you don't 194 00:07:05,105 --> 00:07:06,805 know anything. Everything is, 195 00:07:07,425 --> 00:07:09,205 you know, appears to be 196 00:07:09,584 --> 00:07:11,925 a huge deal when in fact it isn't. 197 00:07:12,319 --> 00:07:15,060 So we utilize a lot from our experienced 198 00:07:15,199 --> 00:07:18,319 nurses. They're they're great, kind of keeping people 199 00:07:18,319 --> 00:07:20,180 in check and helping people out. 200 00:07:20,800 --> 00:07:24,099 We have our education department has actually, 201 00:07:24,475 --> 00:07:26,975 in the past few years, started a residency 202 00:07:27,194 --> 00:07:28,654 program and it has 203 00:07:29,035 --> 00:07:31,355 progressed over the years. It's it's a year 204 00:07:31,355 --> 00:07:34,394 long program for them. The residents, they meet 205 00:07:34,394 --> 00:07:35,694 weekly with their cohort. 206 00:07:36,154 --> 00:07:37,915 They get to bounce ideas off of each 207 00:07:37,915 --> 00:07:39,979 other. They get to work together with all 208 00:07:39,979 --> 00:07:41,979 of the residents in the different departments to 209 00:07:41,979 --> 00:07:43,439 kind of give each other 210 00:07:44,060 --> 00:07:46,060 a bigger view of the of the hospital 211 00:07:46,060 --> 00:07:48,300 as a whole and what everyone's different roles 212 00:07:48,300 --> 00:07:51,120 look like. So there's that good 213 00:07:51,964 --> 00:07:52,464 interdepartmental 214 00:07:53,485 --> 00:07:53,644 communication. 215 00:07:55,084 --> 00:07:57,004 Whereas, you know, we're not kind of siloed 216 00:07:57,004 --> 00:07:58,925 out together. You know, med surg does their 217 00:07:58,925 --> 00:07:59,425 thing. 218 00:07:59,884 --> 00:08:02,285 The ED does their thing. ICU tele does 219 00:08:02,285 --> 00:08:03,985 their thing. So we have really 220 00:08:04,889 --> 00:08:08,169 worked to build those relationships between departments so 221 00:08:08,169 --> 00:08:11,129 that we all get a better idea of 222 00:08:11,129 --> 00:08:13,370 what's going on. So, you know, people are 223 00:08:13,370 --> 00:08:14,569 a little bit more, 224 00:08:20,964 --> 00:08:22,564 you know, we're we're giving each other a 225 00:08:22,564 --> 00:08:25,365 lot more grace. And those those things, the, 226 00:08:26,245 --> 00:08:29,285 more experienced nurses and the the continued education, 227 00:08:29,285 --> 00:08:30,584 the residency program 228 00:08:31,060 --> 00:08:34,419 have really really helped our new grads feel 229 00:08:34,419 --> 00:08:35,160 more comfortable. 230 00:08:35,860 --> 00:08:36,360 They're 231 00:08:36,660 --> 00:08:39,639 you know more comfortable asking questions that they're 232 00:08:39,940 --> 00:08:40,419 they 233 00:08:41,379 --> 00:08:42,600 have really really 234 00:08:43,424 --> 00:08:43,924 done 235 00:08:44,384 --> 00:08:44,884 particularly 236 00:08:45,424 --> 00:08:45,924 well. 237 00:08:46,384 --> 00:08:48,404 We've noticed a significant improvement 238 00:08:48,784 --> 00:08:50,804 in their ability to to, 239 00:08:51,664 --> 00:08:53,985 you know, kind of flex on the fly 240 00:08:53,985 --> 00:08:55,745 and handle things as they come up over 241 00:08:55,745 --> 00:08:57,904 the past couple of years as they as 242 00:08:57,904 --> 00:09:00,699 the Education Department has tweaked that residency program, 243 00:09:01,000 --> 00:09:02,860 it has been a big help, 244 00:09:03,720 --> 00:09:05,579 in getting those new nurses, 245 00:09:06,360 --> 00:09:08,860 you know, comfortable and and ready to go. 246 00:09:09,480 --> 00:09:11,720 Well, it certainly sounds like they're benefiting from 247 00:09:11,720 --> 00:09:14,414 all the communication and infrastructure that you have 248 00:09:14,894 --> 00:09:15,875 out at your organization. 249 00:09:16,815 --> 00:09:19,214 Denise, the next and last question I would 250 00:09:19,214 --> 00:09:20,595 ask, it's a 2 part question. 251 00:09:20,975 --> 00:09:23,134 And 1 is, you know, what's getting you 252 00:09:23,134 --> 00:09:25,774 really excited right now, I should say, about 253 00:09:25,774 --> 00:09:27,534 the health care industry in general, and what 254 00:09:27,534 --> 00:09:28,914 is making you a little nervous? 255 00:09:30,929 --> 00:09:34,289 I think that what I'm what I'm most 256 00:09:34,289 --> 00:09:35,750 excited about is 257 00:09:36,370 --> 00:09:36,870 that 258 00:09:37,649 --> 00:09:38,709 there's really 259 00:09:39,409 --> 00:09:40,870 an a lot of collaboration 260 00:09:41,490 --> 00:09:42,549 between organizations, 261 00:09:43,409 --> 00:09:46,445 and I'm sure that it's not just specific 262 00:09:46,585 --> 00:09:49,565 to to our hospital. I'm I'm I have, 263 00:09:49,705 --> 00:09:52,105 you know, read white papers and done some 264 00:09:52,105 --> 00:09:54,285 research and it and it seems as if 265 00:09:54,345 --> 00:09:54,845 hospital 266 00:09:55,545 --> 00:09:56,924 systems are communicating 267 00:09:57,625 --> 00:09:58,845 better with each other 268 00:09:59,250 --> 00:10:00,470 and kind of providing 269 00:10:01,330 --> 00:10:02,470 tips and resources, 270 00:10:03,090 --> 00:10:05,410 because we all essentially have the same issues 271 00:10:05,410 --> 00:10:06,389 going on. And, 272 00:10:06,929 --> 00:10:09,250 being able to reach out to to another 273 00:10:09,250 --> 00:10:11,009 facility and and ask them, hey. How did 274 00:10:11,009 --> 00:10:11,730 you handle this? 275 00:10:12,290 --> 00:10:14,345 You know, what worked for you? What didn't? 276 00:10:15,125 --> 00:10:16,345 That that collaboration, 277 00:10:17,684 --> 00:10:18,504 is really, 278 00:10:19,365 --> 00:10:22,325 really exciting to me. Particularly, I've been in 279 00:10:22,325 --> 00:10:23,144 this role. 280 00:10:23,924 --> 00:10:25,445 It'll be three years in April 0. So 281 00:10:25,445 --> 00:10:28,139 I'm I'm wouldn't say I'm, like, you know, 282 00:10:28,139 --> 00:10:29,120 know all the 283 00:10:29,500 --> 00:10:31,679 things. So being able to have that collaborative 284 00:10:31,899 --> 00:10:34,299 relationship with other organizations, I know I can 285 00:10:34,299 --> 00:10:36,860 reach out to other hospitals in the Seattle 286 00:10:36,860 --> 00:10:39,419 area or other places in Washington and kind 287 00:10:39,419 --> 00:10:40,799 of say, hey, you know, your 288 00:10:41,165 --> 00:10:43,404 your facility looks about like ours. What are 289 00:10:43,404 --> 00:10:45,644 you doing to help solve this problem? And 290 00:10:45,644 --> 00:10:47,425 it it really helps. 291 00:10:48,125 --> 00:10:50,365 First of all, it helps reassure, you know, 292 00:10:50,365 --> 00:10:52,225 me that, hey, it's not just us. 293 00:10:52,605 --> 00:10:55,740 And it helps provide better continuity of care 294 00:10:55,740 --> 00:10:57,500 for our patients. If, you know, we're all 295 00:10:57,500 --> 00:10:59,440 kind of on the same page, we're all 296 00:10:59,899 --> 00:11:01,740 working things out. We don't have to start 297 00:11:01,740 --> 00:11:04,139 from scratch developing some kind of process if 298 00:11:04,139 --> 00:11:05,839 someone else has kind of, 299 00:11:06,154 --> 00:11:08,075 you know, worked through that and, you know, 300 00:11:08,075 --> 00:11:10,394 lets us know what their hiccups were. It 301 00:11:10,394 --> 00:11:13,115 is a real big turn, I think, for 302 00:11:13,115 --> 00:11:13,855 health care, 303 00:11:14,394 --> 00:11:16,254 which it benefits everyone. 304 00:11:16,875 --> 00:11:19,294 Along the lines of what makes me nervous, 305 00:11:19,910 --> 00:11:21,990 as I mentioned previously, we have adult and 306 00:11:21,990 --> 00:11:22,970 pediatric patients. 307 00:11:23,750 --> 00:11:24,250 We 308 00:11:24,790 --> 00:11:27,830 don't have a lot of pediatric patients, and 309 00:11:27,830 --> 00:11:30,889 the majority of our pediatric patients are, respiratory 310 00:11:30,950 --> 00:11:32,389 patients. So we get them during, you know, 311 00:11:32,389 --> 00:11:34,975 the flu season with RSV and that sort 312 00:11:34,975 --> 00:11:36,735 of thing. We are seeing more kind of 313 00:11:36,735 --> 00:11:37,554 post surgical 314 00:11:38,414 --> 00:11:39,955 patients, you know, here for appendectomies 315 00:11:40,335 --> 00:11:42,514 or, you know, a cellulitis patient. 316 00:11:42,894 --> 00:11:45,235 But what makes me the most nervous is 317 00:11:45,455 --> 00:11:47,294 the amount of time that it does take 318 00:11:47,294 --> 00:11:50,014 to orient and train our nurses just based 319 00:11:50,014 --> 00:11:51,899 on the low number of of pediatric patients. 320 00:11:52,759 --> 00:11:54,860 Even a lot of our more experienced pediatric 321 00:11:54,919 --> 00:11:55,419 nurses 322 00:11:56,759 --> 00:11:58,200 are kind of like, hey, you know, it's 323 00:11:58,200 --> 00:11:59,639 been a long time since we've had a 324 00:11:59,639 --> 00:12:02,040 peds patient, you know, because maybe they didn't 325 00:12:02,040 --> 00:12:04,040 work the week that the the patient was 326 00:12:04,040 --> 00:12:04,934 here. And so 327 00:12:05,254 --> 00:12:07,414 what makes me the most nervous is making 328 00:12:07,414 --> 00:12:08,715 sure that that 329 00:12:09,254 --> 00:12:10,475 my nursing staff 330 00:12:11,174 --> 00:12:12,154 stays comfortable. 331 00:12:12,455 --> 00:12:14,715 They keep their skills up, which 332 00:12:15,815 --> 00:12:17,995 I working on that with our pediatricians, 333 00:12:18,375 --> 00:12:20,529 you know, hey, what can we do? What 334 00:12:20,529 --> 00:12:22,129 other resources do you offer, 335 00:12:22,529 --> 00:12:24,950 in the kind of downtime between 336 00:12:25,889 --> 00:12:26,950 pediatric patients? 337 00:12:27,410 --> 00:12:29,029 But that is kind of where 338 00:12:29,490 --> 00:12:32,529 the the nervousness comes in for for me 339 00:12:32,529 --> 00:12:33,830 in our organization. 340 00:12:35,235 --> 00:12:37,475 Denise, you have been incredibly generous with your 341 00:12:37,475 --> 00:12:39,715 time and your insights today, and I want 342 00:12:39,715 --> 00:12:41,475 to thank you for that. We absolutely cannot 343 00:12:41,475 --> 00:12:43,394 wait to share them with everyone in our 344 00:12:43,394 --> 00:12:45,075 audience, and we look forward to connecting with 345 00:12:45,075 --> 00:12:46,054 you again soon. 346 00:12:46,434 --> 00:12:48,115 Great. It was a good time. Thanks so 347 00:12:48,115 --> 00:12:49,174 much for the opportunity.