Good Doctor Lorre Bad Orlando NICU
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Hey everybody, this is Tina again with Good Nurse, Bad Nurse. Welcome back to another episode. If you're new here, we use...

Real stories from the news to highlight things that are going on in healthcare, both good and bad. This week, we're going to be talking about an incredibly tragic case out of Orlando, Florida. But before we get into our story, I do want to introduce my guest host and our featured good nurse for this week, nurse, author, podcast host, and so much more, Dr. Lori Laws. Welcome, Dr. Lori. Thank you so much for having me.

Yeah, absolutely. It's so great to have you. I can't wait to get to the Good Nurse segment. And we're going to get to talk about your work helping nurses with burnout and trauma. And this story that we're going to be talking about is going to just really segue perfectly into your work. Because as we get into it, I think people are going to understand why it does go so perfectly with what you do. Yeah.

Yeah, and such a tragic case and one that we all truly can take note and take some of what we're going to talk about today forward to make sure that this never happens again.

So I have to tell you guys about an experience I had with a nursing student. So you know, I've been doing travel nursing. Well, this hospital where I'm at has a lot of LPN students doing their clinicals there. So one of them was following me around one day, and she noticed my stethoscope. And of course, y'all know the Echo Technology Company that sponsors our podcast, they teamed up with Littman to make the stethoscopes to beat all stethoscopes, the 3M Littman Core Digital Stethoscope. And this is the one that I use now. So she said, Oh my gosh, I've been wanting to try one of those. So

So of course I let her use it and she just could not stop talking about it for the rest of the shift. It was so cute. She was like, you know, I can't hear anything with my normal stethoscope because I have tinnitus. And so she was so excited because she could actually hear what heart sounds were supposed to sound like. She said, I'm going to ask for one of these for graduation. And I was like, yeah, you definitely should. So just so you know,

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Well, having kind of given that introduction, I guess we can just jump right into this story. This is the story of little Joxy Peets. And I really do hope that I'm saying her name correctly. It's spelled J-A-H-X-Y. I'm not sure exactly how to pronounce that.

But I was thinking maybe Joxy. So we're going to go with that. And I apologize if that isn't correct. But she was born prematurely at 24 weeks in June of 2022 at Orlando Health Winnie Palmer Hospital for Women and Babies. So due to her fragile condition, she was immediately intubated and admitted to the neonatal intensive care unit to receive specialized care. So about two weeks after her birth,

Healthcare providers in the NICU observed that her limbs were no longer moving. Now, this is alarming, and it prompted them to request a neurological consultation to investigate the cause of her sudden immobility. So, Dr. Laurie, I've never even dealt with babies, let alone NICU babies. Yeah. Yeah.

Well, I did not either in my practice, although I birthed the NICU baby. My second child was a NICU baby, but she was in the womb too long side of the spectrum. So she was a large NICU baby. But we do know, all of us from our training, that this is a really hyperacute level of care for the infants, the neonates. And I can't imagine coming upon one of my NICU patients and finding them...

suddenly immobile and their limbs aren't working. And so the team did well to immediately get that neuro consult and start investigating. But I can't even imagine what the team who was witnessing this, what they might have been experiencing, let alone the family.

Yeah, exactly. Whoever discovered this, great job for them to be paying close attention and realizing, you know, this baby is not moving the way that they were before. So they did a neuro consult and MRI was conducted on June 29th in 2022.

And the results revealed a devastating injury. Her neck had been snapped. Experts reviewing her medical records concluded that the injury was caused by extreme excessive force. These were experts that were hired outside of the hospital.

So the MRI showed evidence of cord signal abnormality, enlargement, and presumed hemorrhage in both the cervical and thoracic regions of Joxie's spinal cord. The thing is, initially, when this happened...

They didn't really, that's not what they were saying at first, right? The hospital. Right. They were not saying that was possibly excessive force. They were just saying it was an accident and they didn't know, you know, what happened. Do you know if they were forthcoming in reporting this or was it sort of a, you know, in the reports, I've read probably the same thing that you've read and it's very ambiguous. Yes.

as to the degree to which the hospital and their team reported and did they report in a just culture sort of manner where if we're practicing in just culture, then full disclosure, full transparency, immediate reporting is required. And I'm not intimately involved with the case, but what I've read is that it's curious. I'm curious about those circumstances. Yeah.

Especially given the severity of the injury, you would expect some sort of an investigation to be done. But there is no documentation in Joxie's medical records noting that excessive force was suspected or this event or any incident that could have caused her neck to break. There was nothing documented about.

that would have made sense that this injury was found on an MRI. It's a never event of the highest order. Like, let's take never and then, you know, multiply it by infinity. That's the degree to which of a never event that this happens to be. And, you know, my heart is just still.

still aching. Absolutely. And furthermore, the hospital didn't conduct an investigation after the injury was discovered. That raises serious concerns, as you said, about transparency, about accountability. You would hope that, I mean, common sense, you don't have to be a

Suddenly, a baby stops moving their extremities. The healthcare professionals are concerned. They run tests. They do an MRI. The MRI shows a broken neck consistent with an injury. There's no other way that the neck could be broken other than an injury. Accidental, on purpose, whatever the reason.

It is an injury. How could they justify not doing an investigation? I don't understand it. Right. Or if they did an investigation, because based on what I read, we can't really conclude much of anything. But if an investigation was conducted, then again, consistent with just culture, why wasn't it disseminated? Why wasn't it reported? I have so many whys around that.

the circumstances of what has happened and what has been disclosed. And I don't have any evidence to offer, but I have a sense. I just have this queasy sense in my stomach and a little flutter in my heart that suggests that something's not quite right here. And I don't know what that something is specifically, but

But it sure seems, as you said, that a full transparency, full accountability, you know, is what was needed. And certainly by these reports, that's not what happened. Right. And I think that's what was so concerning to her parents. It's one thing for something horrible to happen to your child and have to deal with the aftermath of that for the rest of your life. You will never, ever be the same again.

And then on top of that, to have it in the back of your mind, all of the possibilities that could have happened, everything sort of swirling around in your mind at three o'clock in the morning, laying awake, wondering, things popping into your head, this could have happened, that could have happened, all of the things that are possible. But if there's no investigation done, who knows?

Right. Well, and we'll touch on this in more detail, I'm sure, later. But it really, there's a type of nurse-specific traumatization that is called system-induced. And it's not just for nurses. It just happens to be a nursing middle range theory, right? Yes.

But what we have is really system-induced trauma, where the system, independent of how this precious little baby's neck and spinal cord were injured to this degree, but the family was further traumatized by the system itself in the handling. Yeah.

So now they've got like, it's a double whammy of trauma for this family to navigate and try and heal. Part of it's the incident itself, and then it's the system heaping more trauma upon them by how the case was seemingly mismanaged and not wholly reported. Right. And yeah, and the fact that they were not timely informed of their daughter's injury

As a result of the hospital's alleged negligence, she suffered a debilitating spinal cord injury, which led to paralysis and an inability to breathe on her own. She did die on November 25th of 2022. She was 165 days old. They are accusing Orlando Health of malpractice and wrongful death.

They say that the hospital failed to fulfill the duty of care that it owed Joxie, particularly in failing to appropriately monitor, manage, and handle her, leading to the fatal injury, and failing to train hospital and NICU workers, which would prevent injuries of excessive force when handling newborns.

Again, I haven't ever worked in a NICU. I haven't ever worked with newborns at all. I've had three children. I've had three babies. And I remember when my babies were born being scared of how the nurses handled them. I thought they were rough. Terrified, especially my first baby. Terrified. I kind of remember feeling that the nurses were sort of arrogant about it. Like, they were sort of like, proud of the fact that they could just like,

you know, hold them any which way and they weren't, they're not going to break. Yeah, you know that. You understand that. You're a professional. You've been doing this. I get it. You've been a nurse for 30 years. I'm so proud of you, you know, whatever. But as a new mom, I don't know that. And for you to just be walking around holding my baby with one hand and

and think that I'm supposed to be like, oh, well, I guess you're the professional, you know this. No, that you're literally striking fear into my heart. I don't understand. I don't know who you are. I don't know you. I don't know that you don't have ill intent toward my baby. And I think this is a little too commonplace because it happened with all three of my babies and I had my children, all three different hospitals. So at different times. So I feel like sometimes nurses, I think at different times, different healthcare professionals can be kind of like

and arrogant when it comes to, you know, how they handle situations because they know more than you do as a lay person, you know, or even as another healthcare person. Well, yeah, it's secondary. It's secondary. It's all, you know, it's like me typing on my keyboard. I don't think about typing on my keyboard because I type on my keyboard all day. But somebody who has never seen a keyboard before, you know,

Might need to know. Like you're going to break it, right? Yeah. You're like, oh, you're going to break it. If somebody is not familiar with a laptop, it looks so fragile. My son just got a new laptop and it looks so little, you know, and fragile. Yeah, I could see if somebody had never seen one before, I could see them going, oh my goodness, don't, you know, but after you've had it for a while, you're just like...

All right. You know, another thing that comes to mind about this case that I'm curious about is that, you know, with all of the health care system inadequacies, you know, in every country that I look at,

Among one of the key factors for what we're talking about today is short staffing and insufficient resources. And nurses are being floated to units to meet staffing needs, not patient needs, let's be very clear, to meet staffing needs. And they may or may not have been trained on that particular specialty and are being floated there nonstop.

nonetheless required to work outside of what one would consider the sweet spot of their expertise.

And we also have situations where, and my daughter is a travel nurse, so I am casting no aspersions here, but a lot of times for staffing reasons that travel nurses are brought in and they too may be floated into areas where they're not in the sweet spot of their expertise or they don't get robust training, whether it's a travel nurse or a staff nurse, robust training and orientation and training

I would be very curious, and had there been just culture reporting, we would know. We would know the answer to those questions. Did we have a staff nurse who was acting in malice? Did we have a staff or travel nurse acting in malice? Or was it a horrible accident that sort of went kind of

Or did we have someone providing care that wasn't within the training that they had? Maybe they weren't qualified, but they were assigned to work there anyway. We simply don't know. But this is why the just culture guidelines exist, so that we can learn and make sure that these things don't ever happen. But I'm finding very little evidence that full transparency was reported. Yeah.

In ways that are accessible, at least by you or I, you know, where we could take this into our teams, into our students. We can use it as a case study. I mean, I teach a course at a major university called Safety, Technology, and Healthcare Quality.

And so this is a course I teach, and this would be the exact sort of case study that we would bring in to educate our next generation of nurses to know exactly how to avoid this at all costs. But there's not enough even information that I could find in my limited research to where I could really...

you know, make a difference in terms of whether it's in a clinical setting or in an educational setting to really trace, get to the root cause. Because to know root cause, we really have to know all of the facts and not just a cover story. Yes. And I do believe that we should be working in a just culture environment.

I don't believe that in this day and age, post-Rodin-DeVos, post so many different situations, I don't believe we are working in a just culture. I don't believe any of us feel that we are safe. We don't feel safe? Yeah. No, 100% nurses do not feel safe because all too often they're not safe.

It's not just a feeling. If you're being asked to practice outside of your specialty, if you're asked to carry unsafe nurse ratios, nurse-patient ratios, if you don't have the resources you need and the list goes on, and we'll talk about how that affects everyone, then yeah, nurses aren't safe. And organizations don't make nurses feel safe and health professionals. And

And so we have a situation where we know what the right thing is. The Institute for Healthcare Quality Improvement, the IHI, has modules that most of us go through when we're in nursing school. We know what just culture is. And then like so many things, we get out into practice and we find that it's not as it should be.

And this is a case that seems to be fitting into the, yeah, we're talking the talk, just culture, but we're not necessarily walking the walk. I think that there is a fine line because we are talking about a situation that happened and supposedly, you know, allegedly. All of this is allegedly. Right. Everything is allegedly. But the hospital did, you know, come forward. What else are you supposed to do? This happens when you realize, when you have evidence,

a healthcare professional who realizes that this baby is not moving their extremities, you have to obviously disclose that. You really don't, how much choice do you have? So in my personal opinion, it appears as though maybe the bare minimum was done here as far as just disclosing what was going on. Medical experts that were hired by the defense team in this case said,

have asserted that there is, quote, no way for this to happen accidentally. The severity of the injury indicated that significant force had been applied. They suspected intentional harm or gross incompetence by whoever was handling Doxy at the time. Obviously, this is allegedly, this happened in the state of Florida. There are laws protecting hospitals and healthcare providers in the state of Florida.

I have personally been an advocate for laws protecting health care workers to prevent us from being charged criminally for making good faith errors, good faith mistakes when we are honest about it. And I have been very clear about that.

in my advocacy that you have to show good faith and you have to be upfront and honest immediately as soon as it happens. Which is quite frankly, in every contract that we ever sign and any policy where, you know, every hospital policy now, now whether, and here's where we don't know because, you know, I'm not a lawyer. And so I, you know,

Did the nursing question report it? Did the legal team squash it? Did the, you know, did the media spin it? There's so, you know, there's so many, there are so many places in which confusion and ambiguity reside that we just don't know about.

And that's really unfortunate because we could learn so much to make sure that JOCSY is honored in the best possible way as we teach and educate and train everyone in the healthcare workforce, nurses and providers and allied health, notwithstanding everyone.

Yes. Before the lawsuit was filed, Orlando Health did admit responsibility for her death under Florida Statute 76.207, and this admission limited the damages the family could recover through arbitration. However, the hospital refused to disclose the identity of the health care provider responsible for handling Joxie at the time of injury. So does that mean that they know who it is?

That's, that's what I found. There are not a lot of details about this. You know, this is relatively new. The lawsuit was filed October of 2023. This happened in 2022. So we still, there's still, there's not a lot, there's not a lot of details out there. But

If they know who, you know, on one hand, I'm like, okay, well, they're protecting the person. And on the other hand, is nothing ever going to be done then? Who's being held accountable? You know, I understand that, you know, in a case such as this, that releasing the person's name might put them at grave risk, right? This is a very, very traumatic event for everyone involved.

what we could do, what could be done is that the name could be withheld for their safety and full disclosure of the facts of the case could be made available without giving that person's name. And I'm finding little evidence that even that was done.

It feels a little smokescreen-ish, to be honest. It feels a little smokescreen-ish. But I do understand, not necessarily naming that individual. It hasn't gone to trial and we don't know all of the facts. But we could say, well, we're not going to release the name of the person or persons involved.

here are the facts of the case. And that could easily be SBAR reported. You know, any attorney, any healthcare worker, we know how to do that. We know how to disseminate facts in a very concise manner, unbiased manner. And that's what I'm really finding that is lacking in the accounts that I am reading. Right. And that's the thing. I mean, maybe there are more facts, I'm sure, because...

her parents, Gianna LaPera and Jamiah Peets, rejected the hospital's admission and they opted instead to file a lawsuit, as I said earlier, on October 17th, 2023, seeking justice for their daughter. Their attorney, Nicole Krugel, explained that if they had accepted the hospital's admission, the case would have been confined to determining the financial compensation or they would have never learned the full truth of what happened. I

I really, really commend her parents for doing this because this is definitely the hard road. They're choosing to take the hard road. I'm so touched by this as a parent of three myself. The quest for the truth, you know, because really that is what is going to be the most important for their healing process, right? They need to know. They need closure, right?

They need facts. They need healing to bring some sort of peace wherever you can find peace around a situation as horrific as this. And they're not going to get that unless they take the hard road, as you said, and having to take full legal action to seek justice in a system

in a system who has been tasked

to provide care. Not only should the event have never occurred, never ever should Jaxie have been sustained these injuries through direct or indirect means. Never ever should that have happened. And then on top of it, we have another never ever should a parent have to go to these extreme measures and use the full scope of the law and all of the expenses to

that are associated to get to the truth. You know, that, I mean, that just, that takes complicated grief to an entirely, entirely new level. And my heart just aches for them. The parent's attorney expressed grave concerns that the healthcare worker who caused Jaxie's fatal injury might still be working in the NICU. How scary is that?

It's a scary thought. I mean, it is hearsay. You know, it's really hard to, you know, you don't want to over comment when we're looking at cases like these, right? You want to be sensitive to the fact that you don't have all of the facts. But in the event that that is true,

I cannot imagine a world and where, where this sort of thing can happen. And then you go back to work the next day. Well, the hospital apparently had not provided any information allegedly to suggest that the responsible individual had been removed from their duties. As far as the parents know, the person responsible could still be handling babies in the NICU. And even if they did, even if they were removed from their duties, um,

It would seem like, to me, the fact they didn't disclose the name, they would, even if they

were asked to leave or chose to leave, it seems like they would be probably most likely free to go work somewhere else if an incident was not filed, you know, if this is not going on their record. Well, I mean, the State Board of Nursing, right? Like Florida State Board of Nursing. It would be really helpful if it had been reported, assuming that the person was a nurse. We don't even know that the person was a nurse, right? That's...

And that, I mean, at least what I'm seeing, I mean, it seems logical. It could have been a physician. It could have been a nurse practitioner. It could have, I don't know if there are really many other people.

professionals that handle a NICU baby. Maybe an allied health. I don't know if they're RT or PT or, you know. Oh, right. RT, yeah. Yeah, so we have different, you know, we have different interprofessional teams in and out of there. But all of us, independent of our role, all of us are licensed and all of us have governing agencies that this organization

Absolutely should have been reported to whomever's licensing board for an investigation and action based upon that investigation. But again, here we don't even have any of that information.

To know, like in a just culture, that would be stipulated that this was, you know, this was a physician. This was a nurse who will not be named and this is what's happening. The case has been escalated and it's been reported and, you know, here's the root cause factors and, you know, so on and so forth down the list. And so we don't know. And the only way that the parents can know is to have to take legal action and

Just out of respect for the parents, they should have been, I think they should have been given all of the details of what happened. Maybe I can see withholding the name, but give them enough details that their mind can be put at ease. And if you don't have those kind of details, why? That's a whole nother Pandora's box we can explore. And why?

The lawsuit that they filed claims that the hospital attempted to cover up the incident. The failure to document the event, the lack of an investigation, and the hospital's push for arbitration all suggest, according to the family's attorney, an attempt to, quote, sweep everything under the rug without revealing the true cause of Joxie's injuries. Her parents are devastated, of course, by the loss of their daughter.

That's stating the very, very least and remain desperate for answers. They want to understand how such a tragic event could happen in a place designed to protect and care for fragile newborns. I don't I want to know that, too. I want to know that we all want to know that. Yeah, everybody wants to know that. And I think anyone who could potentially have a baby and that would need to be put in the NICU. How can you feel safe?

How can you feel safe? And that's what her parents, according to every article I've read about this, that is their goal. They want to make sure, they want to try to make a safer NICU for babies in the future. They don't want to see this happen to someone else, which I think is so incredibly courageous of them. And I really appreciate them for that.

Yeah. As a NICU mom myself, I can share firsthand just the fact that your newborn baby is not with you. And in my case was transported. The NICU in which the hospital which I birthed her, that NICU was not high enough acuity for her needs. And so she had to be transported over an hour away.

And to a higher, you know, NICU plus, for lack of a better description. And as a new mom who's just given birth, there is nothing more terrifying than having your

newborn out of your own care, out of your own sight, let alone in a NICU setting with so many tubes and monitors and people and all unfamiliar to the vast majority of new parents.

And so it's that going and being a NICU parent is, you know, traumatic unto itself, let alone everything that followed. Well, throughout her life, her parents faced significant financial and emotional challenges. A GoFundMe page was set up to help cover the cost of her care before she passed away.

And the ongoing legal battle continues to add stress to their grieving process. They're now seeking over $50,000 in damages through their lawsuit and demanding a jury trial. That just sounds like such a small number when you stop and think about just the

the medical expenses, but think about all of the turmoil. Think about the grief and the trauma that they have had to suffer and will continue to suffer forever. It's something that they're never, ever going to be able to get past. That number doesn't even, it just seems ridiculous. It seems to me that that number is sending a message that this isn't about the money for us. This is about justice. This is about truth.

Because this could very easily, if you look at any newspaper headline anywhere in the country, and this type of a medical lawsuit would be in the multi-millions dollars. And 50,000 to me sends a message that this isn't about the money for us. This is about getting to the truth, to the root cause of

and justice and doing our part to make sure this doesn't ever, ever happen to another NICU family.

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Well, I guess that wraps it up for the bad nurse story. I know it's a terribly tragic story. These stories are so difficult to do. It's so hard talking about other people's tragedies and the terrible, terrible things that happen to people. But at the same time, if we don't talk about it, you know, we aren't able to do anything to affect change. So that's the whole point. So we'll put that story to bed and we can move into the good nurse segment, which is

You know, as we said earlier, this is the story is a nice segue into talking about what you do, Dr. Laurie, in working with nurses. You've written a book. First of all, let everybody know, like, tell us a little bit about you and where you know what you do, your background. Well, I, like you, entered the nursing profession after I had my three children. And so it was my third career, actually. And

And I went on to complete my PhD. And for my day job, my professional role is that of an integrative nursing professor. So I teach at a major university in the nation's first integrative health-focused BSN program.

And for my clinical specialty, I am an integrative nurse coach. And so I'm this kind of hybrid of a nurse coach. I'm a nurse scientist. I do conduct research. And also I'm an educator. And through kind of that alchemy, I started working with nurses, and this was prior to the pandemic, who were coming for support with burnout, significant burnout symptoms.

And the type where I'm thinking about leaving nursing altogether. Like I just can't. I have $40,000, $50,000 of student loan debt, and I just can't do this kind of burnout. And so using all of the evidence base and what we have in there, I really started working with these nurses. And then, of course, during the pandemic, that was an incredibly difficult time for everyone, including nurses.

And what I was observing in my clinical practice was that they weren't responding to the traditional self-caring practices that we've all been conditioned to think, you know, you just need sort of this gaslighting narrative that has been pervasive for decades of, well, you just need to take better care of yourself. You just need to work on your resilience, right? This is sort of like a blaming the victim kind of mentality that

that nurses have been enduring by their settings in the system at large. And so I got very curious about that. I'm like, well, what if it's not just burnout was my big question because they're not responding. They're refractory to the traditional healing approaches. And so that started a five-year research project. Yeah.

A big one. And I started looking. I have a background in social and behavioral sciences. So I started looking outside of the discipline of nursing. Even though I'm a nurse scholar, I started looking in the other areas. And what I started to discover is that we're talking about nurse-specific traumatization.

which is often misdiagnosed as just burnout. And how convenient is that, right? Let's place the burden on the nurses because aren't we responsible for everything, including world peace and solving world hunger, right? And so I started looking at this. And at the time...

At the time, I started changing. I started taking a very trauma-informed approach, and I want to get into that using polyvagal theory, which is probably the single most important thing that every nurse needs to learn in a nursing school that isn't taught.

and how we can learn the language of our autonomic nervous system and our vagus nerve to insulate ourselves from the harsh practice conditions, being short-staffed, under-resourced, being floated to units where we're not trained, all the workplace violence, whether it's from patients, family, or even colleagues, right? No lack of incivilities in the workplaces.

So I really started looking at this through the lens of polyvagal theory. I started doing, I know I'm getting a little geeky here, but that's what I do. I started doing like a symptom cluster analysis, looking at the symptoms of burnout and then looking at the symptoms of nurse-specific traumatization, which at the same time, I'm starting to write this book and it's not a textbook.

I took it outside of academia, and it's for a professional audience. It's going right from my heart, as you and I are talking in first person, into the living rooms of the nurses who need it the most. Because what I discovered is that when we start treating nurse-specific traumatization, for which the symptoms overlap substantially with burnout, the nurses started to heal. They started to improve.

And it requires a completely different approach to self-care because trauma is something that needs to be unwound and supported. You can't meditate or self-care your way fully in a trauma recovery process. So that led me to write the book. And then as I'm writing the book,

Dr. Karen Foley at Purdue University, and I'm throwing this out here because a lot of times we need to have the evidence and the science to stand on, to advocate for change in our units, in our organizations.

So I'm going to drop this nugget, which my book is grounded in, Dr. Karen Foley's Middle-Range Theory of Nurse Psychological Trauma. So we now have a middle-range theory that can drive these conversations, that can drive policy change, that can drive—we can study this—

And I published on this in peer-reviewed journals. Who among us can even find any, you know, in a peer-reviewed journal, find my work? And then most nurses don't even have access unless they work for an academic medical center, right? And so then they're paying $50 for one article when I can write the whole book and get it to them for $23? Right.

and really get in their living room with them as I do with my patients and my clients in my practice, and really facilitate that healing and really teach and train how we can partner with the wisdom of our autonomic nervous system and vagus nerve, our most primitive systems that innervate every body system.

And learn from there. That's like if you think about building a house, right? You start with the foundation, right? You got to have the rebar and the land's got to be level and you got to pour the foundation or the basement, you know. But that foundation is super important to building a house. Well, the same thing holds true with a regulated nervous system. That's our foundation, essentially.

as nurses is being regulated in our nervous system. And then on top of that foundation, we put the self-caring practices that we're all very familiar with. And so what's not being taught in nursing school, what is not being taught when we're onboarding as new grad and early career nurses, what we're not being trained in our in-services is polyvagal theory and how we can use that

Not only to heal and recover from burnout, which is more than likely nerve-specific traumatization that hasn't been adequately supported and healing has not been fully realized, but it just gets like, well, it's just burnout. Go meditate. Go for a walk. Go get a mani-pedi.

And, you know, nurses, I've worked with thousands of nurses now, and they're reporting that they just feel gaslighted by the terms self-care and resilience. Like they don't want to hear it anymore because it's blaming the victim. Well, and it doesn't... So if you're...

You know, it's putting myself back at the bedside for a moment and just remembering I can, I can very easily put myself right back into the cardiovascular intensive care unit, where I had three patients, one of which was a cancer patient who was in complete denial. And so she was

It was in every kind of exacerbation you can imagine and arguing that she didn't need any kind of medication. And so I was dealing with her and then I was dealing, I had another patient who was, you

needing to be intubated. They were right up to the point, we had gotten to a point that they were going to need to be intubated, probably cardioverted. And then I had another patient who had a recent, who came in to the hospital because they stayed at home too long. I live in the Appalachia area. Appalachians do not like to go to the hospital. We don't like to go to the doctor. We don't like to go to the hospital. We will wait it out. And

Basically, it was a guillotine amputation because of gangrene and there was just that it had to be done. And so they the patient had no idea. So they woke up and this is I can say this because no one listening to this could know anything.

because I've taken care of patients like this way too many times. So this is a very common practice, unfortunately. But that patient was in complete shock, complete trauma. They were also on pressers. They also had just been extubated. Their stump was bleeding. You know, I was having a call vascular about them. They were crying about the situation. They had no idea.

When I tell you that day, I left there absolutely crying my eyes out. I could not breathe. I was crying so hard because I could not be in three places at once. And every single one of my patients needed me all day. It felt like I just could not be the person. I could not be the nurse they needed.

And so when you talk about doing self-care, you know, going and getting a mani-ped, that stuff does not fix the fact that I can't physically take care of my patients the way I know they need, the way they deserve, the way that I learned is wrong.

I can't use evidence-based practice to take care of my patients. I am literally just all over the place doing the bare minimum to keep them alive, hopefully, and hoping that, you know, I don't make some horrible mistake because I have too many patients because it's completely inappropriate to have three patients in a CVICU. Right. And so here we get into that middle range theory. Okay.

of neuropsychological trauma and you were profoundly affected

And so as nurses, we've all been trained. You can kind of break it down into two categories. There's avoidable nurse-specific trauma exposure, which is what you experienced. It was avoidable, right? You had too high of a patient load with too high of acuity. It was not safe for you. It wasn't safe for your patients. That's avoidable. Right.

And then there's another category that's unavoidable. And this comes with the job, right? We get training on secondary or vicarious trauma and trauma from disasters, right? We're all reasonably well prepared for those. It's the avoidable category.

Right.

And then there's the workplace violence. And that can come from the patients or their families. And it also can be calling to calling. It can be lateral in terms of the gaslighting. You know, the first thing if you have a near miss or an adverse event, it's like, or even if you get struck by a patient and you are bruised, battered and bleeding, the first question is, well, what could you have done to prevent that? That's a form of system-induced trauma.

And so here we have this whole cluster of avoidable nurse-specific trauma exposures. And Dr. Foley's theory just came out. It's been 18 months, so it's hot off the press, really, in terms of theory. And this is why I am doing what I'm doing.

what I'm doing to bring this, to disseminate this and get the word out to as many nurses as possible. Know that this, that nurse specific trauma is real.

and you were profoundly affected, you are crying so hard that you can hardly catch a breath. If we look at that through the lens of polyvagal theory, which is Dr. Stephen Porges coined this, and this is from the science of neurophysiology. And how it works is that we have three circuits in our autonomic nervous system.

In our midbrain region, we have this process and he calls it the threat detector. So 24-7, the threat detector is looking for cues of danger.

Are you in danger? All right. And those cues can come from your external environment, right? So clearly that day, as you are with this just extremely difficult patient load, right, of highly complex patients, your threat detector is sending a message to your autonomic nervous system and your vagus nerve that you're not safe, right?

You don't feel safe in your practice. You're overwhelmed. And understandably so, any nurse would be. That was too high of an assignment with too complex of patients. It wasn't safe. So what happens in the body is that

The threat detector is kind of this mid-brainy thing. It's all happening below the level of our awareness. It's sending messages to the vagus nerve and the autonomic nervous system to kind of bring online or offline three primary circuits. The first circuit is ventral vagal. This circuit is where you and I are right now. We both feel safe.

in our settings. We're open-hearted. We can see the big picture. We're curious about the world around us. If we were taking care of patients right now, we could be very present with them, right? Because we're in our ventral vagal state. And this is how mammals, humans notwithstanding, nurses notwithstanding, this is how we are evolutionary hardwired to be in existence.

And then the next circuit that comes online is our sympathetic. And we're all very trained on the sympathetic nervous system, so I don't have to go into a lot of detail there. Except to say that we are supposed to be in this sort of, it's called ventral vagal tone, right?

where we fluctuate between being in ventral vagal, and then if I had a loud knock at my door right now, my sympathetic would come online, right? And I would assess the situation, and I would address it, and then I would return to my ventral vagal tone. So we're supposed to be fluctuating between this ventral vagal tone and the sympathetic stimuli that is manageable, right? But then we go into...

what happens to nurses in practice because all too often we're not safe. I mean, we're just not in many, in a good number. You were not safe that day. You know, your patients, not in the way that we are supposed to be as we've been trained to the full scope of our license and our practice, right?

And so then what happens and what happened to you that day, most likely, was that you go from this sympathetic kind of, I can, I can manage, I can manage the knock at the door. I can manage the difficult patient because, and then I can manage this. But I have kind of a time to return to ventral vagal in between these things. So it's kind of sympathetic, I can, but you had too much too fast on your system.

And so then it goes into the sympathetic, what I call sympathetic overdrive, or the sympathetic, I can't, I'm overwhelmed. And that's what happened to you that day. You probably felt like you were spinning 200 plates while running on a hamster wheel with ice skates on, right? Just trying, and this is so many nurses. And what happens is when we're in that sympathetic overdrive is that we experience

and it's real, that we cannot take a sip of water, that we cannot take a bio break, we cannot nourish ourselves. We can't even take one conscious breath because we are so pinged in our sympathetic, which is designed to be a short-term response, not a 12-hour shift response, not...

a 40 to 60 hour work week response and not decades. And I've, I've been around, I've been around for, for decades. I got my start as a CNA back in the seventies. So, so, you know, I've been, and it was the same thing then as it is now, which really got me curious about this. So what happens then? So that, that day that you left, you left work and you, you like can't stop crying.

And it probably was hard to breathe, probably felt like your mouth was dry and all the sympathetic things, the weight on your chest and your heart is beating and you're dysregulated in your nervous system is what that was. Now, if that continues, if that level of trauma exposure, it's not just stress. This is all the avoidable stuff.

that we aren't intended to carry. This is the system stuff, right? And if that persists, then your threat detector will say, okay, we got to shut her, him, them down. Shut them down. Online comes the dorsal

vagal nerve, the one that innervates like our gut, right? The lower, like deep down low, because your threat detector is now, because it has one job and that is to keep you safe. The autonomic nervous system is very basic to keep us safe.

And so if that prolonged avoidable trauma exposure persists as it has for millions of nurses for so long, then that dorsal vagal circuit comes online because the mitochondria literally cannot produce enough oxygen, enough energy to fuel the demands.

And so this is when you are like, I have all these things I want to do on my day off and I can't get off the couch. I can't like reaching for my remote for a streaming platform and reaching for my phone to get takeout is all I can do. And then we beat ourselves up thinking that it's a character flaw, a personality defect or some other deficit.

But what has happened is that it's a physiological response to too much trauma. And the body is, what it does is when that dorsal vagal circuit comes online, it puts us in this sort of shutdown to conserve energy because the organism, the organism, the cells cannot produce enough energy to meet the prolonged trauma exposure.

So what do you recommend that people do? I mean, what can be... Does your book kind of go into detail about this process and what people can do? If you're working in a hospital that just consistently is putting you in these situations, you have to go somewhere else. I just... If that's their process, then you...

You don't have any other choice. You've got to get yourself out of that situation. But that doesn't mean you have to leave the bedside. But because I do believe there are hospitals that do better. You know, one of the things that bothered me about that situation is that I was also dealing with a woman who was very traumatized herself. And I'm very empathetic, as a lot of nurses are. So I was kind of like taking on her trauma and feeling it. And so I was really upset for her. The thought of like waking up and realizing your leg is gone.

Do you kind of go into that sort of thing in your book to try to help people process that sort of trauma? And how do you work through this? Well, and that's, you know, my kind of my, my role as a nurse scientist is to bring forth solutions, right? Like we've talked about, we've talked about the problem, we're all living the problem.

But the first thing to do is update the narrative, update the science around burnout, because the World Health Organization says it's occupational stress that isn't effectively managed. Well, that's the most gaslighting thing I've ever heard. We're not talking about stress here. We're talking about burnout.

avoidable, no specific traumatization. So that's kind of the first thing is really for the readers. And this is all that all of this and more is covered in my book, which is available wherever books are sold. And we'll talk about that at the end. But, but first of all, it's not just burnout in the vast majority of cases. Humanity has, has endured a global trauma.

notwithstanding what nurses have endured for over 250 years, right out of the gate. And so we need to really take a trauma-informed approach to this quote-unquote burnout narrative. And first of all, my job is let's call it what it is. It's avoidable nurse-specific traumatization. Let's call it

what Dr. Foley's middle range theory says it is, right? So let's call it that. And then let us understand that

and let me through my nonprofit, through my book, through my programs, however I can be of service, right? I'm not making any money on this. It's all nonprofit work. Let's come together as a nursing community and first of all, learn how we can insulate ourselves, our nervous system from the practice settings that we've talked about here today. Now, sometimes we do need to leave them. Sometimes we do need to leave the profession.

And sometimes if we learn how to insulate our nervous system so that we're not as affected, so we can stay in that ventral vagal kind of thriving place internally,

in our nervous system. So learning the language of our nervous system and how to navigate it as sort of that foundation of the house, right? It's our most primal system. It innervates every body system. So why wouldn't we start with the most ancient wisdom that our body has to offer?

and partner with that. And so in my book, I present what's called the innate care plan. It's a four-step process that nurses can use to understand

rethink, repractice, repattern this whole burnout nonsense. I've been around since the 70s. It's not just burnout. A new approach. We need to update the sciences in the book, although it's written, you know, as though we're having a cup of tea together. It's not a geeky read. It's me in your living room, like, trying to help with what I know.

and what I've seen. So it starts with nurturing your nervous system. So there's three A's that are involved with that. The first step is awareness. And we've already started that process here today by having this conversation. So not only being aware that polyvagal theory exists, that there's probably more to burnout than the prevailing narrative of

would have us believe that it's our fault, that we have a deficit, that we aren't taking care of ourselves, right? Being aware of all of those factors and then also being internally aware of how our autonomic nervous system and our vagus nerve are responding to the internal and external stimuli. So that's the first day of attending therapy.

of awareness, I'm sorry, the second A is attending. And that is the over 100 practices that can be done in under 30 seconds.

that I guide nurses through in my book, depending upon where you are in these circuits. Are you ventral vagal? Are you sympathetic? Are you sympathetic overdrive? Are you in a freeze? Are you fawning? These are all different kind of variations of the hybrids that come with polyvagal theory. And then knowing which practice that your nervous system needs to be nurtured. I don't use the word self-care in my work.

I don't use the word resilience in my work. It's nurturing and nourishing our nervous system.

and knowing what to do when it's in these various states. That's called attending. And then the third A is called alignment. And that's where we now translate our inner world nervous system regulation and how do we translate that into our external world, right? And kind of this working from the inside out. And then the last part is B. So it's three A's plus B.

So the three A's again are awareness, attending to the nervous system and aligning it with your external world. And then the B is balance. And that's all the self-care things we already know. Physical, emotional, relational health, mental health, financial health, making sure our environments are safe. All the things that we know already.

already. So quit telling us to do better self-care, right? So, but we've built the three A's, the foundation for the inner nurturance of our nervous system. And then on top of that, we put what we already are doing, but it's not working because most of us are just regulated in our nervous systems and we don't know how to navigate it.

We don't know. We don't have the hundred practices. We don't have the science because they aren't teaching it to us, which is why I'm bringing it right into the living rooms of nurses worldwide so that we can get it to people for free. Now, what results? What results? The outcomes. And this is what's so beautiful about how this works are the three R's. The first R is we can be regulated in our nervous system.

And this is when we are practicing and we feel that we are managing an appropriate amount of stress, right? And we don't go into that sympathetic overdrive that you were in that day, that I have spent most of my life living in too, right? Because I didn't know. You don't know until you know, right? So the first thing is that we get regulated. And that has...

huge physiological health and well-being outcomes. Every body system, everything you can think of. If there's a mitochondria involved, you're helping it, right? So that's pretty much everything. And then the second R is that we can then get a sense of reconnection because I bet that day that you left the unit in tears, overwhelmed, distraught, probably difficult to breathe, that you felt disconnected or maybe even dissociated within that.

And it was probably hard for you to connect with your loved ones and your social network for the support that you so desperately needed. Because it's not available to us if we're not in ventral vagal state. So if you're coming out of that shift in sympathetic overdrive for 12, 14 hours, even if the support is there for you, which I'm sure that it was,

You weren't in a place where you could receive it. Your nervous system couldn't receive the support that you desperately needed. And so this is how we can be in our family and social systems of people who love us and there are ride or die people and still feel utterly alone.

because we're just regulated. And so the second R, after we go through the three A's plus the B, right? This is just sort of rethinking it. Then we get regulated, we get reconnected within, and then we get reconnected with others, right? Now you can really fully be present with your people and be supported and be nurtured and have healthy relationships. And then the last R is what I call restoring our healer's heart, right?

And this is our why. Our why for what matters to us most, including, but not limited to,

our professional role. I work with BSN students and I'm telling you the first year into practice we all know that nursing school of itself is often traumatic and then the first year into practice is traumatic and their healer's heart as it's been discovered with thousands of students over the years

It's like they've described it as the why for nursing. Why they got into nursing in the first place, it's been described to me in two ways. My heart got put through a paper shredder or it got ran over by a steamroller.

You know, because we can't practice in the ways that we've been trained, the way that we're, that, you know, nursing doesn't have to be a calling. You can be a good nurse and it not be your calling. It's not about that. But it's about the love that we bring into everything that we do, including our practice, that somehow gets trampled on.

and in the system so that's kind of what my work is about and and again bringing it to nurses right in their living room you don't have to go find me in an academic journal you don't have to pay fifty dollars to buy my peer-reviewed publications you go to wherever books are sold i am there you know google my name i am there what's the name of your book

The name of my book is called Nursing Our Healer's Heart. I love that. Yeah, I do too. Thank you. It gives me chills because I wrote from my heart. While it is evidence-based and scholarly, it's a work of heart and love and compassion and support for my colleagues, really. So Nursing Our Healer's Heart, it's a recovery guide for nurse trauma and burnout. It's available wherever books are sold online.

And I'm learning a lot. You know, I'm a scientific writer, and so I know how to do like academic publishing. But what I'm learning is that pre-orders, orders, and reviews drive the algorithm. The proceeds of the book go to my nonprofit, the Halen Academy, which is a nonprofit. We offer programs, recovery programs, healing programs for nurses and other professionals.

So it's one thing to read a book, but most of us need to be facilitated in our healing, especially when it's trauma healing. You know, there's an unwinding and there is, you know, there's a lot of nurturance that needs to happen there where it didn't happen at the time that the trauma occurred. On the day that you experienced this avoidable nurse-specific trauma,

you probably weren't nurtured and weren't supported in ways that would help you integrate that trauma and process it fully, which means part of it still lives within you. It gets stored in the body, right?

And so we find that while the book is good, and you can certainly realize healing gains, a good number of nurses wanted to have a program. They wanted to come together. They wanted to have a place where they could be supported in this healing. And so it's like, well...

It sounds like I need a nonprofit organization. So that's what I am getting towards the apex, or I'm probably at the apex of my career. And I'm getting closer to retirement age than not. And I've reached a point where I'm going to say what needs to be said. I am going to shine a light on what is happening. And we're going to call it nurse-specific traumatization because that's what it is.

And then I'm also going to, you know, I've poured my heart six years, six figures of my own money. This is not affiliated with any institution. I self-funded the research to make sure I could get it into the living rooms of the nurses who need it the most.

And so that's how I'm going out with a bang one way or another, but I'm going to leave a big gift, hopefully, and make a difference in the way that I'm being called, that my healer's heart is being called to do at this time.

Well, I know you guys can see why I wanted to feature her as the good nurse for the good nurse segment. This is you're truly an amazing, amazing person. Thank you so much for the work, the really hard work that you've put into this book to put into everything that you're doing your foundation. And just where can people find you? Just I know you said anywhere books are sold, where can they find your not for profit? Where all can they find you?

Thank you. Everything is on my website. You can find links for, you know, the...

We just updated it. I'm really proud of it. So please do take a visit. It was a labor of love there. And it's drlaurielaws.com. That's D-R-L-O-R-R-E-L-A-W-S.com. And you can connect with me there. There's a contact form. I'm really accessible and so, so willing and so committed to doing my part to

My shtick is I want to do my part to get us to Nursing 2.0, which is the Nurse Safety and Professional Well-Being Edition. That has not been the case for too long. And we need to start working from our healing scars instead of our gaping wounds and coming together as units, as teams, as organizations, as a global profession to

who among us were 30 to 50% of the healthcare system. So there's tremendous power in us coming together and healing together and then leading the changes that we need to see in our profession and not waiting for the healthcare system to fix itself because quite frankly, it's not in the system's interest to fix itself.

To fix itself. It's not. It isn't. Right? No. So that's why I'm working outside of the system. And I'm so grateful that I've had the opportunity just to meet with you and talk about these important things and connect with your community and just thank you.

so much for the good work that you are doing and advocating takes all of us. We each have a grain of sand that we are working on and giving our best to. And together, all of those grains of sand can build something really amazing. That's exactly right. If you guys are struggling with any of these issues, you want to find Dr. Lori Laws,

Her name is spelled L-O-R-R-E, just so you guys know that. It's kind of an unusual spelling. So L-O-R-R-E and then traditional spelling of L-A-W-S. Dr. Lori Laws. Go look her up. Go to her website. See what she's all about. Order her book. Do whatever you can. I always encourage you guys to get out there and advocate. Become advocates. But seek help as well. We, you know...

I think that, you know, sometimes there are people who, when we go into nursing, we tend to want to always give, give, give. I mean, that's what we do. We're servants. But don't forget to take care of yourself. And that's what the work that Dr. Lori is doing to try to help all of us in nursing. And I really appreciate you. Thank you so much for coming on the show. Thank you so much. From my healer's heart to all of yours, thank you for all that you are and all that you do.

And of course, you guys can reach out to me at Tina at GoodNurseBadNurse.com. I'm on social media at GoodNurseBadNurse. And our website is GoodNurseBadNurse.com. And I always have to remind you before we go, even if you're a bad girl or a bad boy, be a good nurse.