Michael Smith, MD (Host): Welcome to Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness. My guest today is Stephen Callery. Steve is the Clinical Nurse Manager on the Progressive Care Unit, the PCU, at St. Joseph Hospital. Steve, welcome to the show.

Stephen Callery, CCRN, CEN: Thank you for having me. Glad to be here.

Host: So, let's start off a little bit about you. Can you start off by telling us about the PCU and how did you get into this? Like, what's your story here?

Stephen Callery, CCRN, CEN: So, how I got here. I've been a nurse for just under 30 years. Twenty-nine of that has been in the ICU. This past year, I recently just left the ICU and came into a leadership role here in the progressive care unit at St. Joe's. What appealed to me was taking those 29 years and sharing my experience with different group of people and nurture them and help them kind of grow their career here and the PCU is a great place for that.

Host: Fantastic. So, do you think this is a great place, the PCU, for new graduate nurses to start their careers? And if so, why?

Stephen Callery, CCRN, CEN: So, it's interesting that you said it that way. Back when I started nursing, there was a plethora of nurses in the work staff group. It was quite a few people there. So, for you to start off in the industry, you really had to start at the ground level. And a lot of folks started off in geriatric care, long-term care, med- surg. You know, the world and the industry's changed quite a bit. COVID changed just about everything that we knew about health care, and that we really had to adapt post-COVID to our work environment, and that included looking at the workforce. So, we had to kind of change the way that we think.

And now, instead of looking for that ideal candidate that for somebody in the progressive care unit that might have three to five years experience, might have some credentialing and some advanced certifications behind them, that population, that pond is really kind of dried up. It's pretty much non-existent there. So, we had to kind of look at what we needed and what our availabilities were. And we've shifted gears into hire for attitude, and we will teach you excellence. What that means to me is that I am looking for new grads that are a sponge. They want to absorb things. They want to learn. And we get them in the door here. We give them a very extensive training regime for 12 weeks. And during that time, we'll have frequent meetings with them. They'll be paired up with a preceptor. And the idea is to kind of get them a solid foundation for them to provide the best care possible.

Again, the one thing that we really can't teach somebody is about their attitude. So, we look for those people that this is their dream job. We've had four hires in the past month and a half. Each one of those persons somewhere in their interview said this is their dream job. And two of those people are close to coming off orientation, and the other two will be shortly after that. And I tell you, they've been some of our most stellar staff members on the team here. They come into work, they're excited, they're motivated, they're energized and they're just a wealth of fresh enthusiasm that's brought into the unit, and it's absorbing all the experiences. So, it's been a very rewarding and a very successful change of attitude and a change of process that we've kind of come.

Host: Very nice. So if I am a new grad, and I'm thinking, is this a place where I can hone my skills, learn from some good mentors, what do you think about that?

Stephen Callery, CCRN, CEN: Great question. So, a lot of people will ask me, "Well, what's the difference between Med-Surg and Progressive Care?" So, really, the difference here is that when you come into a progressive care unit and let's say you're a new grad, that we'll teach you the foundation. The foundation is all those Med-Surg type stuff, the day to day stuff, the ADLs, kind of the basic ABCs of thinking and care.

Once you've gotten off orientation, we'll start to broaden your horizons a bit. Here in the Progressive Care Unit, it's a larger unit that our average daily census runs about anywhere from 20 to 28 here that we specialize heavily in Cardiac. We have a large population of respiratory issues. We also have a little bit of multi-system failure type material. So, learning that foundation, building it and then establishing it, and then working into subspecialties, again, like the critical care. We have a very robust cath lab here at St. Joe's, so a lot of our patients are post-op cath labs patients with some type of intervention. A lot of angios that we do here, pacemaker insertions, a fair amount of the population that you typically wouldn't see on the Med-Surg floor.

So, here, once you build that foundation in the industry, then you can take it to the next level and progress. A lot of folks use Progressive Care Unit as a stepping stone into other subspecialties like Critical Care or the emergency room. So, you know, we understand that. And when we interview new hires, we'll say, "Well, where do you see yourself in three to five years? Do you see yourself here or do you want to continue your career?" We also support that. You know, if somebody says, "Eventually, you know, I want to get into critical care," so we'll be honest with them. "This is the great place to start. We'll invest in you. You invest in us. You give me two years or so and I'll make sure that, at the end of two years, that you would be a prime candidate for critical care." So, we understand the industry and we try and work with it and that's the culture that we're trying to build here at St. Joe's.

Host: Just to make sure, Stephen, that the listeners here, and if there are some young grads thinking about this, can you just give me-- I don't want to put you on the spot. I'm not going to say one sentence or something, but just like a few sentences of the difference between the ICU and the PCU.

Stephen Callery, CCRN, CEN: The difference between the ICU and the PCU. So, well, you're right, I can't do it in one sentence, but what I can--

Host: That's right. I'm putting you on the spot, Stephen.

Stephen Callery, CCRN, CEN: But, well, what I will share with you is a lot of our patients come from the ICU. And sometimes some of our patients go to the ICU. So, there's a lot of crossover and there is a gray area in between some of our patient population. Some people may come here for a short period of time, and we'll try and stabilize them. We may be successful or we may not, depending on their disease process and what's going on. And some people we can turn around and stabilize them. And if not, then they'll progress to the ICU. And a lot of folks that have gone through their event and recovering, they're on the right track to recovery, but they're not quite ready to go home yet or maybe not ready for rehab, they'll come here. So, it's a transition and our world kind of revolves around ICU, the critical care area.

Host: Stephen, what you just said right there was great. I think that's going to be helpful to those that are listening that this is kind of that step-up. Maybe they're ready to go home. Maybe they're not. That's the PCU. You guys make that decisions and your nurses are right there helping with that.

You've kind of touched on this a little bit. So, I want to go back. If I'm interested, I'm a new grad, everything's sounding great. Walk us through a typical day. We don't need all the details, but what does it look like for me? What do I do in the morning, evening? Like, what's going on?

Stephen Callery, CCRN, CEN: So, a typical day of a PCU nurse would kind of start off with, getting your assignment, learning a little bit about your clients, your friends. I call them. You know, after 30 years, I've developed nicknames for a lot of my patients and they're all my friends.

Host: That's great.

Stephen Callery, CCRN, CEN: So, you learn about your friends. You'll get a sign up from the night shift. We do a warm handoff at the bedside. We review any drips or infusions that may be going on or go over anything that might need four eyes on to make sure that continuity care is complete. You'll start off that day after that with an assessment of patient and your clienteles. Take in your typically one to four patients. Part of that is is our staffing ratios here are different than Med-Surg. Typically, the day staff here will have a one nurse for every four patients. And on the night staff, we'll have one nurse for every five patients. And that's a big thing. A lot of people like to know what the nurse patient ratio is here. And typically, in the ICU, it's one to two. In some of the Med-Surg floors, those numbers are higher. So, we adjusted those numbers to create a matrix that would best give us the ability to take care of the patients adequately.

So, get your sign off from the night shift creates the continuity of care, meet your patients, plan your day, medicate them, get your assessments of the day, and then you'll be an intricate part in their care throughout the day. You'll help navigate them through the system, whether they need to go to some type of possibility of an intervention or diagnostic test during the day. You'll help them with assessments and learning.

There's a lot of education in the PCU, not only for the staff, but for the patients. So, the nurse becomes the patient's right hand for a learning tool. They'll educate them through the disease process, any new medications that they might have, procedures that they have had or will have. They'll help them learn about the disease process and the things that they'll need to do in the future. We'll also start help facilitating discharge planning. What do we need to do to get this patient out of the hospital?

But, most importantly, not out of the hospital quickly, but one time. We hate trying to have patients that go home, they're unprepared, or don't have the education, or the processes, or the equipment that they need once they do go. So, that discharge planning starts from pretty much the day that you come in, and it's through a multidisciplinary approach where we work with case management, respiratory, and the physicians to make sure they get the care that they need here and at home.

Host: That sounds great. And you do believe that working in the PCU at St. Joseph's is a good stepping stone to critical ICU nursing, or even maybe into Med-Surg, right? You think this is a great starting point, right?

Stephen Callery, CCRN, CEN: I don't think you can do any better, because it creates opportunities for you. The learning curve is wonderful. I think that the environment that we have here is very nurturing. We've really adopted a pride, respect, and teamwork kind of motto here St. Joe's and, again, it's a good stepping stone.

And there will be some people that will find their career here too as well. We also have a lot of folks that go maybe not to critical care or ER or maybe Med-Surg, but they'll go on, advance their own degrees, and get into advanced practition. So, It's a great place because you get the basic foundation, you don't get overwhelmed with the high end of ICU quite yet until you've built that foundation, but you get that fun stuff in the middle.

Host: No, very good way to put it. We all know the ICU, that's a different world over there. I think you're right. I think the PCU is a great place to start, to move over there. Let's review some of the support and mentorship that you guys offer to help new nurses. Tell us a little bit about that.

Stephen Callery, CCRN, CEN: So, support and mentorship are critical to a successful career and having a good day. So, we are certainly always working on trying to provide that. First, it starts with a safe, healthy work environment. And that one to four ratio, and some of our nurses who might have a heavier assignment down the road, we're trying to build our staffing pool so we can possibly even offer a one to three. And on those days here when we don't have a lot of PCU friends, maybe we're heavier in Med-Surg, we may put some nurses with a one to five ratio so we can support that other nurse for a one to three. So, help and try and provide that balance for patient care is one of the things that we do.

We have a multidisciplinary approach throughout the day. We have a charge nurse with an assignment now, but that assignment, we are trying to build our staffing pool up so that that person can actually have a decreased assignment if no assignment at all is the ultimate future. We have a clinical resource nurse here on days that will help as a liaison between patient care and education. We have an education department here that's an educator that's assigned to the floor as well. And we are in the process of implementing a geographical hospitalist so that we have continuity of care too as well.

So, it's a good program. It's a good model. It's proven to work. And on top of that, taking it to the next level is we do multidisciplinary rounds with our case managers, dietitians, respiratory therapists, the physicians, and we speak on behalf of patient here. And we're even looking at modifying the way that we do that to include the patient and include the family. We haven't done that, but that's our goal for the future.

Host: So, that's wonderful. So, there's to evolve the program to make it even better. And listen, I mean, you already laid out some great stuff that sets this unit apart from others. And, listen, if I were a young grad, I'm not young anymore, Stephen. I graduated years and years and years ago. But if I were, and I heard you call the PCU patient's friends right there, that tells me you guys are giving a personal touch that I think is missing in medicine and that is fantastic.

For nurses considering joining St. Joseph's PCU, like, I don't want to say what's the one thing you want them to know, but what's kind of your-- it's kind of like the elevator pitch, Stephen. You know, you're in the elevator, the door's closed, you're with a new grad, you only have like 10 seconds. What would you say?

Stephen Callery, CCRN, CEN: You make me sound like a used car salesman.

Host: You're not, I can already tell.

Stephen Callery, CCRN, CEN: No. I'll tell you what I say with that 10-second window, and after I'll tell you why I say it. I'll tell you that you want to work here it's because of the culture which we are trying to provide for you to work in. That's it. And why I say that is the reality is we're a community hospital. And if you take a group of community hospitals and you put us all together in a bucket, you're going to notice each of us, the hospitals themselves, offer relatively very similar products and services. So, we're in a group and we're competing with a very tight competition group.

How we differentiate ourselves from other floors within the hospital and within the industry, other healthcare organizations is, the culture in which we provide the care that we do. And that's why I say. We're trying to create a healthy work environment here. Treat it like family. Again, pride, respect, and teamwork is what we're pushing here. And that's the motto. It pushes us to do everything that we do.

And one of the things, I've worked at few hospitals in my time as being a nurse. And I found that St. Joe's is one of the most connected hospitals with the community. They're incredibly connected they're intertwined, they're involved. And with that, we're also trying to get our staff involved in a lot of organizations and events outside the hospital too as well to help kind of make commitment and to that family-oriented type of atmosphere, and that's how we make ourselves different.

Host: You got me sold. Fantastic, Stephen. This has been Wellness First with guest Stephen Callery. Thanks, Stephen, for coming on. This was fan tastic. You did a great job. For more information, please visit stjosephhospital.com/careers. I'm Dr. Mike. Thanks for listening.