Chaplain Linda Stetter: Well, good morning, everyone. It's Chaplain Linda here at San Juan Regional, and I am delighted to introduce Carrie Wassel to you this morning. She has a Bachelor of Science in Nursing and was a nurse for about 23 years. She became fascinated with public health, and of course, that means taking good care of human beings. So, she has a Master of Public Health, and now she's working on a doctorate in nursing practice.

And she has selected San Juan Regional Medical Center for a very special project. And so, welcome to us, Carrie. Can you tell us a little bit about how your professional journey has given you some very special interests that you're wanting to follow and help us with?

Carrie Wassel: Yes. Thank you so much, Linda, for that warm welcome. Yeah. I have been in critical care for about 23 years, mostly in ER and ICU and flight transport. I have a heart for teaching, orienting new nurses, bringing people into the profession, and then retaining them in the profession. I've been doing this long enough to know that this is hard work that we do, and really working toward retention, preventing burnout, and supporting each other in this work.

Chaplain Linda Stetter: Wow. We can certainly all relate to that, and we all need some good mentoring. So, can you tell us a little bit about your project here and how it's going to unveil?

Carrie Wassel: Yes. So, I'm working with the ER staff here at San Juan Regional in Farmington, and that is my population. This includes nurses, providers, security staff, patient care techs, community health workers, and even the security staff and the flight staff as well, because they're all an integral parts of making our ER function and run smoothly.

So, my work is involved in bringing them something called trauma-informed care. And trauma-informed care isn't just taking care of people who have been in car accidents. That's what everyone thinks. Trauma-informed care is actually taking care of people who have experienced trauma, and that can be a variety of things, from a car accident to domestic violence, to physical abuse, to fleeing a country that has been in conflict, to parents going through a divorce. All of these things are trauma. And to some extent, we all have this trauma somewhere in our background.

We're also going to be talking about something called ACE scoring, which is adverse childhood events. They found that the higher your ACE score is, i.e., the more trauma you had as a child, the higher levels of morbidity and mortality you experience from physical illness as adults. So, people with higher ACE scores actually live shorter lives, and we see this patient population in the ER time and time again.

Another topic we're going to be talking about is the neurobiology of trauma and how the brain actually changes. The biochemistry and the neural pathways in the brain change when people experience trauma and when they don't move through that healing process. So, these are all topics that I'm going to be educating the ER staff on

Chaplain Linda Stetter: And what was it that precipitated this? Somewhere there was a turning point where you just absolutely knew that this was something you had to do. What happened?

Carrie Wassel: Well, two things really. One was the pandemic. Working through COVID. At one point, I was working in three departments at a local hospital. I was flying full-time for the flight transport team. I was picking up overtime shifts in the ICU, and I was working as a sexual assault nurse examiner in the ER. And being stretched so thin I mean, there was nothing else to do in the pandemic, so I might as well have worked a lot because everything else was closed.

But I also started to see some of the fractures in our healthcare system and wanting to do more preventive and education and upstream approaches to helping mend some of those fractures and helping to come up with some solutions on how we can better provide care to our patients, but also to our healthcare workers because strengthening the healthcare workforce is just imminently important and something I'm very passionate about.

The second turning point was just more, like, personal and professional changes in my own life. I've been doing this work for 23 years. I really am interested in pivoting into education and academia and, hopefully, joining the nursing faculty at Fort Lewis College, and then just some personal family changes as well. It was time to move away from the bedside and more into healthcare promotion and prevention.

Chaplain Linda Stetter: So, you used a term that not everybody might know, but it is really important to the success of this work, and that is the word upstream. Can you explain the difference between treating symptoms in the present moment and really working upstream to solve a problem?

Carrie Wassel: Yeah. I like to say a downstream approach to any illness is fixing the broken bone, giving the medication, you know, drawing the labs and finding out, how to cure that disease. Well, the upstream approach of that is how do we prevent that from happening in the first place?

And I liken it to people on a river trip that are having a good time going down the river, and they hit a bunch of rocks, and they go flying, and they hurt themselves, and a helicopter can come in, swoop them out of that river, and take them to tertiary care. Well, what could we have done to help them from hitting that rock in the first place? How could we have given them better tools? Maybe they should have navigated a different part of the river. Those are upstream approaches to help, whereas the helicopter is the downstream approach.

Chaplain Linda Stetter: And so, I think you're saying that we have to do the downstream because that's what we do to have to fix people in the moment. But at the same time, we need to be mindful and understanding of where we are upstream so that we can essentially meld the two processes.

Carrie Wassel: Exactly. We need helicopters, we need ERs, we need ICUs. We need all of those things in emergencies because we are humans and we make poor choices and mistakes and accidents happen.

But the upstream approaches of minimizing your risk, reducing the incidence of disease and of accidents, those are all goals of public health. And if we are doing our job in public health, that work often goes unnoticed because prevention causes a vacuum of an instance or a disease, right? But our communities are strengthened, our workforce is strengthened, our patients are healthier if we're preventing those problems from happening in the first place.

Chaplain Linda Stetter: And this is a community hospital, and we pride ourselves on taking care of our families and our neighbors and our community. So, we have a passion for understanding what to do now, but it would be really great if we could pair that with an equal passion for knowing how to join upstream to what we're doing now. So, I kind of take it that's part of what you're doing. And so, now could you please tell us how you're going to go about this project and what you hope we will be able to take away from it when we have heard all of your podcasts?

Carrie Wassel: Yeah. Thank you. So, I'm focusing on something called trauma-informed care. Like I mentioned, that is treating people with a background of trauma. And one of my favorite definitions of that is as healthcare providers, we are moving people to a place of healing at a rate that they can tolerate. And that's a very interesting approach. Not everybody that comes in the doors of the ER is going to want to or be capable of doing the things that we recommend they do.

And that is a trauma-informed approach. Where can we meet patients where they are? How can we give them the tools that they are capable and ready to use? And how can we manage our own expectations about that patient population?

The thing about trauma-informed care is it also reflects on how we treat each other in the workplace. As healthcare workers, we have been through trauma as well. How we work in our interpersonal skills, how we manage conflicts, how we work with people we don't always get along with, that's also trauma-informed care.

And a third layer of it is it becomes internal. How can we give ourselves grace and compassion? How can we give ourselves the space to take time off that we need to get the resources and the supports and the tools we need to keep doing the hard work? So, it's in patient care, it's in interpersonal care, and it's in self-care.

Chaplain Linda Stetter: Absolutely. Loving ourselves so that we then can go out and love our neighbor as best they can be loved.

Carrie Wassel: Right. That's a great definition.

Chaplain Linda Stetter: So what are we looking forward to? I gather you're going to be doing an interesting series of podcasts. tell us what to expect.

Carrie Wassel: Yeah, I hope so. I hope you find them interesting. So once a month for the next six months, I'm going to have a different guest on, and we're going to dig into one of these topics in a lot more detail.

And the guests are all going to be in ER and first responder backgrounds. I'm going to have a physician, a nurse, a firefighter, an EMT paramedic, somebody from the flight team hopefully somebody from the security team. Really a wide variety of disciplines because those are all of the people that help our ER function.

And we're going to have a 30-minute conversation and really talk to them about their background and experience, what's helped them stay in their role, what's been beneficial and what hasn't been, and really just hear their stories.

Chaplain Linda Stetter: There is a lot of power in hearing stories because every single one of those people is going to have had an experience that we resonate with. And so just in hearing our story from somebody else, it does a little healing and helping inside of us. And so, that's an incredible gift that each one of these people is going to be giving to all of us who listen to this. What else would you like for us to know about the project? And what are you going to do with all of this in your degree program? I'm dying to know. What are you going to do with it?

Carrie Wassel: Yeah. So, the short answer of what I'm going to do is graduate in May and hopefully join the nursing faculty at Fort Lewis College. The long answer is be a larger agent of change in my community, in the Four Corners region. I've lived and worked here for 15 years.

I'm very familiar with the beautiful parts of our corner of the state and the difficulties that we face. And I'm hopeful that not only can this project improve employee and patient experience here at San Juan that it can reduce turnover of the healthcare staff, and that this model can be utilized across other departments throughout the hospital. Other high turnover departments include places like OB the ICU, and the flight team. And I'm hoping that this work can provide a framework for leadership moving forward to reduce turnover and burnout amongst their staff.

Chaplain Linda Stetter: Well, that is an incredibly noble outcome, and I hope to see that come to fruition because I don't think there is a person anywhere on any level of healthcare who has not felt traumatized and felt the hurt of moral distress. Whether or not we can actually put the label to it or not, we've felt it. And there's been that little part in us that says, "Help us." And so, you have come to help us, and we really, really appreciate it.

So, I am looking forward to hearing these podcasts, and I'm hoping everybody else at San Juan Regional and any friends that you have that are in healthcare will also tune in so that we can learn together and celebrate the fact that help is on the way. Thank you so much for being with us.

Carrie Wassel: Thank you, Linda, for having me.