Christi Welter (Host 1): Welcome to Nurses Connect, a podcast from Children's Health dedicated to exploring critical issues and dynamic topics that shape the nursing profession today. I'm Christi Welter, Program Director of Nursing Communications and Events.

Brennan Lewis (Host 2): And I'm Brennan Lewis, Senior Vice President of Nursing Excellence, Innovation, and Patient Experience. We are your co-hosts for Nurses Connect, and we're so happy you've joined us today. At this time of recording, it's Pediatric Nurses Week. And we thought this would be a great opportunity to talk to a few of our nurses about their journey in pediatric nursing.

Host 1: We have two guests joining us, Kiley Tillery, a nurse from our Cardiology ICU, and Emily Resssman, a clinical nurse specialist in training. Welcome to Nurses Connect, Kiley and Emily.

Kiley Tillery: Thank you.

Emily Ressman: Thank you.

Host 1: All right. First off, we want you to tell us a little bit about your role and how it impacts pediatric patients.

Kiley Tillery: I guess I can go ahead and start. My name's Kiley Tillery. I'm a BSN RN, recently certified CCRN over on the cardiology unit.

Host 2: Ooh, yeah. Congrats.

Kiley Tillery: Thank you. I work a lot with cardiac defect infants. We have a lot of different things like tetralogy of Fallot, HLHS, and there's a variance of so many others, even some things as simple as an ASD or VSD. We work in direct care. We also do a lot of heart transplants as well.

Our main job is keeping our kiddos stable and happy, growing them until they're ready for repair. And we do daily cares too, just, like, basic diaper changes and assessments, giving medications, but we have a lot of special considerations for our kiddos because they don't have a lot of reserve that maybe normal anatomy heart kids would.

Host 2: That's awesome. Did you say how long you've been in the cardiac ICU?

Kiley Tillery: I just hit over a year in July, and I think I'll probably be a year and three months this year, this month.

Host 2: Okay. So, you're part of our nurse residency program?

Kiley Tillery: Yes. The 25 of July program.

Host 2: That's great. Congratulations.

Kiley Tillery: Thank you.

Host 2: All right. Emily?

Emily Ressman: Yes. So, I have been a nurse for 18 years now. I graduated in 2008, and I have been in pediatrics my entire career. Currently, I serve the pediatric ICU as the clinical nurse specialist intern. So, I work directly at the bedside with patients, helping as a consult for nurses and providers to look at things like hospital-acquired conditions and preventative measures for those. And then, also any new technology that we might be needing to apply to our patients and how to best train the nurses in the moment so that they can be familiar with the new product.

Also, looking at nursing practice as a whole and how to translate evidence from research to the bedside so that our nurses can be providing the highest level of care and working at the top of their scope to improve patient outcomes in pediatric ICU patients. I've spent 15 of my 18 years in pediatric critical care. I started my nursing journey as a pediatric hematology oncology nurse on the floor. And I've worked a little bit all over. I was a travel nurse. I am from Louisiana originally and have worked in Louisiana, but have spent the last 10, 11 years here at Children's.

Host 2: That's awesome. And you did a little bit of time in transport?

Emily Ressman: I did. I started here in 2015 on our transport team.

Host 1: So, it's Pediatric Nurses Week. So, I have to ask why you chose pediatric nursing and why did you choose to work with this specific population?

Kiley Tillery: I actually had an externship when I was in nursing school. I went to Texas Woman's, and over the summer between my junior and senior year, they offer externships to do, and I applied for the one at Children's. And I didn't know if I was going to do pediatrics. I hadn't had a pediatric rotation yet. I hadn't had a critical care rotation yet. So, I was very open to where I was going to go or what I wanted to do. And I luckily got a spot. It was supposed to be on the cardiology floor, C8, C9. But I ended up getting a spot on the ICU side, because they said that they had an opening, and they asked, they were like, "Do you want to take this spot?" And I said, "Absolutely." Because I knew I wanted to do critical care of some sort. I just didn't know whether it would be adults or pediatrics or what specific unit.

I had the 10-week program, and I fell in love with the unit. I met managers, nurses, my preceptors. The way that they spoke about the job, the way that they cared for the patients, the way that our managers cared about the staff, patients, and families that we all work with, it showed me a place that I really felt like I could work and make a difference in. And it was the first time I'd truly gotten to, outside of clinicals, really spend time with families and patient care and have that continuation of care with families and patients. And since I've had that externship, I knew that's exactly where I wanted to go, so this was actually the only place I applied to when I was in nursing school. I had my interviews early in January, my last semester of nursing school. And once I got the job, I bawled my eyes out because I was so excited. And as soon as I started, I knew that it was going to be the right place for me. It was a lot harder than I expected it to be, but I definitely think having that externship and having a little bit of a foundation to work on really helped.

Host 2: I love your story about the doors just kept opening, and you just kept walking through, and here you are.

Kiley Tillery: That's what I do. I always try to make connections and meet as many people as I can, and I feel like it just makes a little branches of things and paths that I can walk across.

Emily Ressman: My story is slightly different. I actually wanted to do NICU when I was in nursing school. I even took an elective for NICU, which back in the day they had. And I'm talking back in the day when we paper charted when we started. So, it's been a lot of changes over the course of my career in just how healthcare works in general.

But I always wanted to do peds, and I enjoyed my ped's rotation. I lost my grandmother while I was in nursing school, and like seeing my grandmother in the ICU turned every adult patient I cared for into a family member. And at the time, I didn't have kids. And so, honestly, like selfishly, kids felt easier for me, because I had just had that experience while in nursing school of losing my grandmother.

And so, I do think that kind of selfishly, psychologically, I preserved myself into going into a field, but absolutely fell in love with it. I got to work as a tech on the pediatric hematology oncology unit that I actually took my first job at. And so, got to know that patient population really well and those nursing staff while I was in school, and really helped make that connection too. To be able to kind of come out of school with a job waiting for me was something not a lot of the people that I went to school with did. We didn't have externships in Louisiana, and we didn't have those kind of opportunities where schools had agreements with hospitals and were able to do that kind of placement while you're in school.

It was kind of you graduate and you go into the hat. And if your name gets called, you're lucky. There was also a lot of nurses coming out at that time. There was the nursing shortage, and let's put everybody in nursing school and everybody graduating at the same time, kind of turned it into a little bit of a minefield whenever you were trying to get jobs afterwards.

But all in all, like, I can't imagine myself taking care of adults. Also, my husband is an adult ICU nurse, or was. He now works here. But seeing what he's gone through, I'm like, "Ooh, no, I would never be able to take care of adults." There are special people that take care of the adults, and there are a lot of adults out there that need care. Just like they think that we are special for being able to take care of kids. So, honestly, I've always wanted to be in the pediatric side of things and have never really sought opportunities outside of peds once I ended up here.

Host 2: I love that you said that because so many, adult nurses say, "I could never take care of kids" and often pediatric nurses say, "I could never take care of adults." Although we take care of big kids, who are like adults, adult size.

Emily Ressman: Oh, yeah. Yes. My oldest patient I took care of was 26, and I think I was 25 at the time, and I was like, "This is not supposed to happen in the pediatric world."

Host 1: What do you think is special about taking care of kids versus adults?

Kiley Tillery: I think it's considering the ages and developments that they're at. A lot of our population on the unit is going to be either infants, toddlers, a lot of, like, knowing the difference between proper development, knowing what school age, how they are going to deal with being in the hospital and knowing how to help them. Our child life specialist on the unit, amazing to go to for any advice I have. Because I don't have kids of my own yet, I've kind of learned how to take care of kids as well in general, not just the hospital side, but learning about development and on that side as well. So, I feel like learning that was definitely a step that I had to take that I wouldn't have in adults.

And also, just making it fun for our kids because a lot of times our kids sometimes are stuck here. We've had kids on our unit that have been there for longer than a year. Some are keep coming back and home and back and home. So just being able to make it fun for them, make it memorable, making posters or birthday banners if they're there for their birthday, making name signs to personalize their room.

And then, I feel like sometimes in adults, yes, you're dealing with a lot of family. But on our side of pediatrics, parents, this is their world. Like, they are young, they're here, these are their children. And in adults, you can have, like, parents of the patients for 20, 30, 40, even up patients. But this age group, they're so delicate and fragile. And so, we're not just dealing with helping the kiddo, we're also dealing with supporting the parents. And I think all the programs that we have here for them is amazing.

Emily Ressman: I think one thing for me is, like, kids bounce back. They are so resilient in a way that we as adults lose. And I think especially starting out in peds hem/onc, like just seeing them on a tricycle towing their chemo or their mom pushing their chemo right behind them while they're still trying to be kids even while in the hospital space.

And I think that the other kind of nice thing is they don't have the exorbitant amount of comorbidities and all of the competing priorities that you see in the adult patients that makes their recovery so much harder. They have their own challenges because they're all such developmentally different. You have to take different approaches. Especially, you know, we serve neonates to adolescent young adult population and especially in the cardiac unit, you get anywhere and in between. And so. you do have to be pretty well-versed in knowing what is expected at each of these different stages, which I think adds an element of uniqueness to the pediatric population. But I really think for me it was just they bounce back so well. And for the most part of the team, and I think that the family approach that we have to care varies from the adult world, which is patient-focused.

And I know that they try to provide family-centered care, but I think it just looks really different in the pediatric world, because we're not just caring for the patient in the bed. We have to care holistically for the whole family unit and how they're interacting with their child in the hospital, and the siblings and everyone else. It's not just affecting them, and they have no say in the care a lot of the times when as far as it comes to, like, legal consents. We do get assent and things of that nature. But legally, they can't consent to things. So, for most of our pediatric patients, that is. So, how do we involve them in the care that they're getting?

And it looks very different than what we're taught in nursing school. And I mean, I'm not sure how it is these days, but pediatric oncology was one one-hour lecture that I attended in nursing school, right? So like, three years of nursing school, I got one one-hour lecture that was relevant to what I did for the first three years of my career. And peds critical care was such a small portion of the knowledge that we get, because it's very much adult-focused in the learning environment, especially back in my day.

Host 2: That's such a good point. You know, nursing school even today, very limited pediatrics. So oftentimes, you have to seek out either a patient care technician role to get some experience in that space if you think you're interested, externships, like you did. That is a really, really great point that you made. I wish there was more pediatrics in nursing school, but you just can't fit it all in.

When I was in school, I worked in a NICU, and I worked as a tech in the NICU, so I thought I was going to be a NICU nurse, too. And it was my last semester. And if your grades were great and you were doing a great job, you got to pick where you wanted to go. And so, I picked children's pediatric ICU to go for, I think, it was just one day. And I was like, "Oh." So, I'd already taken a job at a local NICU, because I was about to graduate, and then I came here.

And when I came to this PICU, I was like, "This is it. This is what I was meant to do." And it was my only exposure, but there was just something about that day that just drew me in. And that's what I did. I became a pediatric critical care nurse. All right. I was thinking about this because our mission is to make life better for children. Like, when you think about that, what do you think about when we talk about our mission?

Kiley Tillery: I feel like it can mean a lot because there's a lot of different qualities that you need to consider for what is going to make a life good for that child. Although sometimes we do have unfortunate scenarios on our unit where the best thing we can do for our child is give them comfort care, give that family as much time as they can, because with HLHS, it's a specific kind of cardiac defect. There's no true cure for it, and there's no, like, actual surgery for it that's going to completely fix it.

Host 2: And HLHS is hypoplastic left heart—

Kiley Tillery: Left heart syndrome, yes.

Host 2: Yeah.

Kiley Tillery: And it's one of the scariest things that you can get as a family. When you hear that, a lot of people don't know what it means, but you're going to learn about it because there are certain things that you're going to have to do. Some families choose not to take any surgeries or do anything, and they'll just let their child spend time with them while they have them, which normally is not a long period of time.

But otherwise, they will usually come to a hospital such as Children's, do the three-step process, the Norwood, Glenn, Fontan. But a lot of times, that's not a fixing surgery. There's nothing that's going to say, "Okay," like, "They're totally fine and fixed. Send them home. They're done." A lot of times they have to come back for a heart transplant and sometimes need a device called a ventricular assistive device, because their heart will go into heart failure before they have the chance to get a transplant, or one of the repair surgeries just didn't go as well as we'd hoped it would for them.

So, learning about that, we have so many families that they're so knowledgeable about it because it's their child, and we try to teach them about it as much as we can, but they do their own research as well. And they're interactive with everything about care, medications, therapies, physical therapy, speech therapy, trying to make sure that the kiddos are hitting their developmental marks, while also making sure that they are still technically stable with their heart function. So, I feel like that's some of the main things that we really, like, have to consider in that kind of aspect.

Host 2: There's so much complexity to pediatrics, because you just hit on it. They may have a congenital condition that we're trying to heal or repair post-surgery, and also we're focused on their developmental milestones. Like, how do we keep this child continuing to move forward during this period of time?

Emily Ressman: I would agree. I think that making life better for childrens looks different for every child. And I think that that's one thing for me that's really hits home for nursing is that holistic approach of not just the patient in the bed, but it's the entire family experience. I worked in the neurotrauma ICU. So similarly, there are lots of different patient scenarios where they're leaving completely different than how they arrived. And so, it's not just returning exactly to who they were before they showed up on our doorstep, but how do we maximize where they are now? How do we, you know, rehab them as much as possible to get them as much quality and quantity of life as we can? And how do we help them cope emotionally with how to deal with now this devastating injury that has changed their trajectory in life? But, you know, not just for the patient, but for the entire family.

And that, for me, is, like, a really holistic nursing view of things and how we support, you know, one patient for 12 hours. But not just giving them medicine and suctioning their ET tube and dressing their wounds, but also doing passive range of motion, giving them a massage, like, doing their bath, helping them feel human in the bed and not just as a patient, but really making their life better for where they are right now, and then also how can we continue to move to where they need to be for discharge.

Host 2: I think it's really neat that we have really two ends of the spectrum, you know? We have Kiley here and she's new into her practice, new into her career, and already doing amazing things. And then, Emily, you are 18 years, you said? Eighteen years into your practice. And then, you went on to be a clinical nurse specialist intern. So, what kind of drew you into that part of pediatric nursing?

Emily Ressman: Yeah. So,, I think that one thing that I've always kind of been is, like, the nurse's champion. I loved being a preceptor. I was briefly an educator. And just always being, like, a nurse's nurse. I love being resource, I love being charge, and, like, really being able to be the person that other nurses go to bounce questions off of. Or like, "I can't stand the way that we do this. Why do we do it this way?" And so, I think that that kind of naturally gravitated into the CNS role, which really is about having the time to dig deeper, and that's what I tell staff. I'm like, "This is, like, what I wanted to do in my 12-hour shift, but I also had to take care of a patient."

I wanted to sit there and, like, go down the rabbit hole of, like, why do we turn patients every two hours? Where did this come from? Why is this a thing? Like, who came up with this 75 years ago and we're still doing it? And really, looking into that evidence of why this is best and how it helps prevent pressure injuries, or how it helps with moving the fluids so that we can have better lung clearance and improve our ventilation, so we can work towards extubation and, like, all of those things. Like, really getting into the nuts and bolts of the why we do specific nursing tasks and nursing cares that we do, and how it connects with the medical side of things. And I think that that's really what drew me into the CNS role is because that's really what it's about. Like, really getting into the nitty-gritty of patient outcomes and how to improve nursing care so we can have better patient outcomes.

And then, from a system level, like if this is working here, how do I translate this out of the PICU, out of my silo? How does this one thing apply to the cardiac ICU? How does it apply to the floor? Like, what does it look like in the ED? If it's improving patient care in our little area, how can we translate it out bigger so that all of our patients in this organization can benefit from it? And that's what kind of led me into the CNS role because that's really, to me, what it's about.

Host 2: That's awesome. You summed it up so nicely.

Emily Ressman: that was amazing.

Host 1: I'm just curious, you know, is there a moment in your career that has felt especially meaningful for you? I know that there's probably several moments a week that feel very meaningful, but something that kind of sticks out in your mind.

Kiley Tillery: I think mine was the first time I got asked to be on a care team. Care teams are very frequent on our unit since our kiddos are spending months at a time with us. I was probably two months off of orientation, still so fresh. I'd barely dipped my toes in the water on being on my own on as a nurse. And I took care of a kiddo, as an HLHS kiddo. She had a VAD at that point. She had just had a little bit of a rough go, was having a rough time with things. Mom was trying to deal with everything as much as she could. But she was just having a little bit of a rough time, and I remember talking to her and sitting down with her and everything. I took time to be able to explain every single change that we were making. And a lot of times, we don't have time to do that on our unit, or on a shift specifically. We'll have rounding, and we don't get as much time to do that. But I remember I was able to make some time specifically, and build on that.

And I was able to talk with Mom, explain all the medications we were giving, explain all the drips, why we were doing certain therapies the way we were, kind of explaining the VAD, explaining her ventilator because she was still intubated at that point. And the look of gratitude on her face when she was able to make those connections, and she was, like, writing everything down. It felt like I was really making a difference in her understanding of what's going on with her child, and I feel like I hadn't gotten to make as much of a difference at that point, because I was still so new to everything and I didn't want to say anything wrong or tell someone anything wrong.

But I really felt confident enough to explain these things at that point. And she just looked at me and she was like, "Thank you." Like, grabbed my hand, I remember she looked me in the eyes and she said, "Thank you for making me understand this, and thank you for being here for me and my daughter."

And I almost started crying at that point because I was like, "Of course." Like, this is what I've wanted to do my entire life. But actually being here and doing that, it really kind of— like, it was that moment of, like, this is where I'm supposed to be. This is what I'm supposed to be doing. And later that afternoon, she had asked me, she was like, "We have a care team calendar. Like, please sign up for her if you can. We'd really appreciate if we'd come back." And she's doing a lot better today.

Host 2: Awesome. You created that meaningful moment, and that will forever stick with her too, just as it did for you. It's beautiful.

Emily Ressman: I have a few. I think where I am right now, some of the most meaningful moments, one of our educators, I was actually her first preceptor ever when she started here as a new grad. And she still remembers things that I told her that day, that she felt like were impactful for her. And I mean, it was little things. She was like, "You let me hang a bag of feeds." And I was like, "Go get it, sister. Like, that's amazing. You did that by yourself, day one. You're awesome." And then, she was like, "You know, you just talked to me about work-life balance. And you need to make sure you're not burning the candle at both ends. And you need to take care of yourself outside of work, because it takes so much emotionally, physically to be here for 12 hours, and to be pouring into your job."

And as a new grad, you want to do it. You want to pick up extra. You want to be available. You want to be, like, an outstanding employee for the organization and an outstanding nurse, because you're learning so much at that time, and you're a sponge, and you don't want to miss an opportunity. But also, you exist outside of here.

So, just really starting from day one, talking about work-life balance so you don't burn yourself out after a year or after 10 months and are like, "I can't do this anymore. I'm emotionally exhausted." And realizing that this is a career. It's not just a job. And so, you do have to take care of yourself outside of work and pour back into your cup whenever you're not here.

And it's funny because, like, I don't remember these conversations. But she's told me multiple times. She was like, "I remember you day one." And I'm like, that to me is so meaningful because, like, these are conversations that I have over and over again as a resource, as a charge, as a preceptor, as an experienced nurse.

Like, we've all been burnt out. We've all done it too hard. And so, like, if I can help impart that information on a new nurse so that they can feel empowered to take the time for themselves when they're not here to really support themselves and start building in their support systems, because we go through hard things, and you need to have a good support system in place or be a part of that support system, I'm also fine with that. But just helping them think through that, because as a new grad, you're so eager, and you want to be so good at this, and you want to be so good at it right now. But as a new nurse, especially in a critical care environment, it takes time, and it's expected to take time.

Giving yourself the grace to take that time to really get there in a way that's safe and healthy for you and your patients and your friends and family and all of that is really, I think, important. And so, to hear that one person remembers that means a lot to me, because I really hope that I can make an impact on the other nurses.

Host 2: I love that. Sitting here, you telling your stories, my brain is just reminiscing about my own career as a pediatric nurse. Like, it's so fun. We should just sit and have kumbaya and talk about pediatric nursing.

Emily Ressman: Fireside.

Host 1: Do you have an especially meaningful moment that you want to share about, Brennan?

Host 2: Oh, gosh. I think for me, there's a couple. I was critical care nurse, and so back to back I had a couple of—they were both 18 months old, and they both had ALL. I will never forget the care that I was able to provide for them and their family in very hard times. And so, sometimes, you know, those are the moments that stick with us as nurses, even well past, you know, working at the bedside. You don't forget down to what a parent is wearing or what music they were playing or just the details that stick with you and just become kind of the fabric of who you are. And you don't forget those really sensitive moments with them. And, you know, kind of what you were saying, Kiley, it's just you're making a difference not only for the child, but also for that family in what sometimes is, like, the worst moments of their lives.

And I think that's kind of the essence of pediatric nursing. There's a lot of great positive things, too, that happen. And so, there are days, though, that I wish I always knew what happened beyond them moving outside, either, you know, beyond critical care for me, or even once they leave the hospital.

I always am curious about them. And from time to time, I will still see patients that have rolled back in for, like, a follow-up visit. They're grown. One of the patients I took care of her mom actually works here now. And so, now she's a mom herself. So, it's just kind of full circle. Those are some special moments that I'll never forget.

Host 1: That's really awesome. Y'all always amaze me.

Emily Ressman: I was going to say, I have a peds patient moment, if that would be better than my nurse moment.

Host 2: I think your moment was amazing, because you're contributing to the—I mean, you're building, like, the future pediatric nurses, and, like, that role is so incredibly important.

And why, Kiley, you got into it, it makes a huge difference for people like me. And, like, I still consider myself a new grad because I'm barely over a year in this ex- like, field of practice. And I talk to my clinical specialist, my clinical educators. I talk to them every single day. They still round on me. They really shaped how I learned how to be a nurse, and they make such a big difference. And my preceptors, my TLs, like, the focus that they put in on building my knowledge based off of their knowledge and then getting it from so many different people and kind of combining it all into one, I really think it makes a difference, and I think that's why it's so important to have a good experience on orientation and residency.

And I think the residency program that we do here, it's built beautifully. We get to go to classes. We do simulations. And it's not judgmental like nursing school is. Nursing school can be the hardest thing you do. Your professors are judging everything you're doing. And sometimes some people might not get along well with their preceptors or things like that.

This program, I never felt that way at all. I always felt like someone was there to support me, or I could talk to someone about something, and it probably was even more than one person. I knew I could go to pretty much anybody to talk about anything. And it's just really s- it secured in not just wanting to be here, but specifically continuing my career here

Host 1: All right. Is there anything else y'all wanted to talk about involving being a pediatric nurse that kind of has come to your mind at all while we've been chatting?

Kiley Tillery: I feel like we've hit really good bullet points.

Host 2: I think we've recruited a bunch of nurses into pediatric nursing.

Kiley Tillery: I'd hope so. It's an amazing place to work, so please apply. If you think you should, apply.

Emily Ressman: I feel like I need to go, like, sit down and talk to an adult nurse and be like, "Why?" "Show me... Like, explain it to me, because I could only—my only experience is peds." So, props to them. Somebody's got to do it.

Host 2: We need them as well.

Emily Ressman: We do. Someone's got to talk to me.

Host 2: We need nurses of all spectrum.

Emily Ressman: Take care of me when I need it.

Host 1: All right. Well, with that, it's time to wrap up this episode of Nurses Connect. Thank you both for joining us today, and happy Pediatric Nurses Week.

Emily Ressman: Thank you.

Kiley Tillery: Thank y'all.

Host 2: If you want to know more about nursing at Children's Health, we encourage you to visit childrens.com/nursingannualreport. Here you'll find information that summarizes a variety of our nursing initiatives. Thank you to our listeners for joining us today. We'll talk to you next time on Nurses Connect.