Good afternoon, and welcome to the IUPUI Center for Translating Research Into Practice Scholar of the Month Series. My name is Steve Veg and I'm the Associate Director of the Center, and it's my pleasure to welcome you here today for this amazing opportunity to learn from one of our colleagues. About what's happening here at IEPY and Translational Research. The center was founded way back in 2003 by doctor Sandra Petrono. Doctor Petrono is a world renowned scholar in the area of communication studies, particularly feat featuring and understanding privacy management and how we all handle our information and what happens to it when we share it with other people. And the current director of our center is former Chancellor Charles Banz, who has while serving as chancellor for our campus, was extremely committed to identifying, supporting and promoting research that is what we would consider translational, meaning it's interdisciplinary, or multidisciplinary, and it's generating or using generated knowledge to solve complex problems in our community. So we're glad to have you here today. And we're going to be hosting today a dear colleague of ours Lindsey Haske who I'll tell you up front, is in transition. Lindsay is going from the moving from a faculty position adjunct position in medicine, and now she's a pre doctoral student in nursing, and she's going to share her research with us today. But first, we want to share some information with you about our meeting. First is a reminder about Zoom etiquette. So we're all familiar with Zoom, but please go ahead and keep your microphones muted. You're welcome to leave your cameras on, especially when we get to the conversation part of the program. And you're welcome to type your comments and questions in the chat. But we will have a chance to get to talk with Lindsey and ask her questions, and we hope that you'll join us with that. Our sessions are recorded in case you want to refer back to this later or send friends and colleagues and students to this as well. It's hosted on our YouTube channel. And we want to remind you that we'll be sending out a post event evaluation. Everybody does it. We all ask that you fill them out, but please take a moment to give us your feedback about this and other events. If you're interested, you can sign up to get continuing education credit for participating in today's or any of our other scholar of the month events. If you just look for I U expand, you'll be able to sign up and get credit for attending. Please follow us on all the things that we're doing at the Center for translating and research into Practice. You can find us on Twitter, on Facebook, and we've even expanded now. You can see a lot of our past events on our YouTube channel, and we've even branched out to Instagram. I don't know if we'll go into TikTok quite yet. Not sure what we would do, but please follow us and share, share our social media hashtags with your students with your colleagues with your community partners. Now, in the center for translating research and to practice, we are partnering with the library and our featured scholars have what we call a scholar Works profile. And Scholar Works is a place where our faculty and members can list all of their journal publications in a freely accessible format. So you can invite folks to go to the page, click on the Scholar. It'll bring up what they have so far, and that's through Scholar workks that is accessible easily to you out in the public. And you can also click on their other link, which takes you to the IUPI Scholar Works page. We even have a section for translational scholars in there as well. So it's an easy way for you to get folks to see the scholarly publications about the various research topics here at IUPI. We have lots of events coming up. Please check out our website, but coming up in June, we're excited to have Professor Genevieve Shaker, who will be talking about contributing to fund raising practice through multi dimensional research. And that'll be on Friday, June 24. At noon, our usual time for our conversations. So we're very delighted today to welcome Lindsey Haskett, who, as I mentioned, is a pre doctoral student in the school of nursing, and she's going to talk about some timely research here around understanding health care and COVID. So I'm going to unshare and invite Lindsay to turn on her camera and open her mic and share her screen so that we can learn more about her exciting and important translational research. So welcome. You're mute, Lindsay, so you have to unmute, so we can hear you. There we go. Every time, right? Yeah, it's 2022. Okay. So thank you so much for the introduction. And thank you all for being here today and for the opportunity to share this study, experiences of secondary traumatic stress among frontline nurses caring for COVID 19 patients in three countries. This study was conducted by a collaboration of nurses from Indiana University, Moy teaching and Referral Hospital and Elder at Kenya, in the University of Texas at Austin through the Ampath Partnership. And we don't have anything to disclose. Nurses spend the most time in direct contact with patients. They witness death and suffering and are familiar with traumatic encounters. But some traumatic experiences were unique to the initial stages of the COVID 19 pandemic. We know that repeated empathetic engagement makes nurses vulnerable to physical, emotional and psychological stress, and this can cause prolonged sadness, guilt, helplessness, and even major depression. In the early stages of the pandemic, traditional traumatic experiences were compounded by a lack of resources, and this was a new experience for nurses in many high income countries. Resources in short supply during the pandemic were health care providers, mechanical ventilators, oxygen, personal protective equipment, and inpatient hospital beds. And these unique experiences put nurses at risk to experience a phenomenon known as secondary traumatic stress. Secondary traumatic stress is defined as the indirect trauma that occurs after witnessing the trauma or suffering of others. And the symptoms of STS are fatigue, burnout, loss of appetite, sleep disorders, irritability, fear, and interpersonal conflict. All of these symptoms can hinder a nurse's ability to provide patient care and cause personal detriment to their mental health. Nurses caring for COVID 19 patients were at risk for developing STS due to many factors such as the unknown nature of the novel coronavirus early in the pandemic, risk of transmitting the virus to themselves and others, social isolation from quarantine mandates, increased patient deaths and witnessing the death of nurses from COVID 19. And lastly, the heightened media coverage that kept COVID 19 in the forefront of their daily lives. In L ight of the fear, death, and uncertainty during the early stages of the pandemic. Nurses were called healthcare heroes and essential workers in the news by their institutions and on social media. Headlines like this were commonplace. Gifts, discounts and other opportunities from retailers were available for firstline responders, and there were many artistic depictions of nurses as healthcare heroes springing up everywhere. This was all in stark contrast to what nurses were experiencing at the bedside during the pandemic. So we wanted to gain a better understanding of the physical and emotional effects of caring for COVID 19 patients, and we wanted to examine the experience of nurses across multiple countries. So we sought to describe the severity of STS among nurses caring for COVID 19 patients during the initial wave of the pandemic. Compare the severity of STS among nurses from different countries, identify predictors of STS and describe nurses perceptions of their experiences caring for COVID 19 patients. We created a survey using the secondary traumatic stress scale. We adapted this survey. We added five specific questions to address the COVID 19 nursing experiences. We asked nurses about experiencing death regularly at work, if they perceived that they had adequate PPE, if they were redeployed to work on another unit, if they felt that their institution had effective infection prevention policies, and if they contracted COVID 19 at work. We added one open ended question to explore nurses experiences that we may have missed in the other questions. We recruited participants through professional nursing organizations and social media to reach nurses across the globe. We used hash tags to render the survey searchable. We used SPSS for quantitative analysis, and thematic analysis was used to look for themes among qualitative data from the open ended questions. 113 nurses responded to the survey initially. Those who didn't complete the entire survey, and those not from our three target countries were excluded. We had a total of 75 nurses in the final analysis. On average, nurses in this study experienced mild secondary traumatic stress. Nurses in Kenya experienced moderate STS, which was which was the highest among all study participants. Nurses in the United States experienced mild STS, and nurses in China experienced little to no STS. A step wise regression model was used to predict factors associated with STS. We found that lower level of education and a perception of inadequate PPE were significantly associated with higher secondary traumatic stress, and this accounted for 26% of the variance. There were no significant associations among years of experience, nursing specialty, experiencing death regularly at work, redeployment, or perceptions of institutional infection prevention policy effectiveness with increased secondary traumatic stress. Our qualitative analysis revealed three themes. And the first theme was that there was a failure of the healthcare system to respond to the pandemic. Which led to negative health care worker experiences. The most frequent experiences nurses reported were overwhelming anxiety, stress, and fear of becoming infected. These experiences were associated with the lack of PPE being redeployed and forced to work in an unfamiliar environment, uncertainty regarding patient care protocols, availability of equipments and medications, job insecurity, and overall, nurses reported feeling very unsupported by their institutions. The second thing we found was that participants reported their negative health care worker experiences led to struggles outside of work. Nurses experienced fear that they might infect their families or others. Because of this, they felt isolated and intentionally stayed away from their immediate family believing that it would minimize the risk of transition. Two nurses reported feeling stigmatized in their communities because of their responsibilities of caring for COVID 19 patients. In the workplace, some nurses reported practicing excessive hygiene after removing PPE or limiting interactions with co workers who did not care for COVID 19 patients, fearing that they themselves might be infectious. The third theme was nurses positive experiences that came from their experiences of caring for COVID 19 patients. Despite the health care systems shortcomings in the wake of the pandemic, nurses reported feeling inspired by the teamwork that they witnessed, because patients could not be with their loved ones due to visitor restrictions. As they passed away, health care team members found ways for families to be together virtually. Other nurses experienced confidence in the pandemic as they were allowed to practice new skills. Nurses described their experiences as meaningful when they supported their patients to pass peacefully, ending their suffering from COVID 19. And overall, the positive feelings from the experience were related to nursing care and nursing teamwork. In light of these findings, it's important to note that the media and healthcare institutions identified nurses as heroes, but not a single participant in the study mentioned feeling heroic during the pandemic. Instead, nurses reported feeling unsupported, isolated, and even stigmatized. But there are actions that can be taken to prevent secondary traumatic stress for nurses and other health care providers. First, given the association between perceived adequate PPE and STS, healthcare institutions should carefully consider the availability of PPE, its effectiveness and related policies. Future interventions may include providing nurses with detailed scientific data about the effectiveness of PPE, evidence based methods for implementing infection prevention policies, and contingency plans to provide proper PPE in the future. Secondly, appropriate assessments and interventions for STS are needed to prevent burnout, improve nurse retention, and ensure resilience. The literature about a secondary traumatic stress tells us that growth after experiencing STS is possible and requires a holistic approach. So identifying the root cause of STS in specific settings as necessary to develop tailored nursing policies and interventions to ensure a healthy work environment for nurses. Thirdly, in this study, an association between higher level of education and less STS was found. This finding is contrary to other studies that found a higher level of PTSD among nurses with advanced degrees. One explanation for this. Well, there's a few. It's unclear the meaning of this association. There's a few things to consider. Kenya still utilizes diploma nursing programs to meet that needs of their health care institutions. And these nurses also experienced the highest rates of regularly experiencing death at work and the highest level of STS. So it could partially be explained that their higher level of STS among their level of education is not necessarily related to the level of education, but the cohort of nurses that experienced STS specifically. So there are a few limitations to this study. I think the first one is that the small sample size, it would have been better to have a large maybe 100 participants with equal representation from each country. We had some challenges implementing data collection synchronously, and this could have contributed to differences in nurses experiences and impacted our results. And then we adapted the STS scale and added questions that did not undergo psychometric testing, which would have added strength to our results. And these findings are only from three countries. So it's not really possible to draw global conclusions about nurses experiences since we only have data from three countries. In conclusion, the long term implications of the effects of the pandemic on the nursing profession are developing, but are still yet to be determined. This study found that level of education and perception of adequate PPE was associated with an increased level of STS. Nurses perceived the health care system failing to respond to the pandemic appropriately. They struggled to interact with others outside of work, but they shared positive feelings about the experience, and holistic interventions are needed to mitigate STS and other detriments to mental health of nurses caring for COVID 19 patients. I just want to say a special thank you to doctor Jane Von Guaker, who is the senior author on this study and the primary investigator who mentored and encouraged me along the way. And I want to thank all of you for your valuable time, and I would be happy to take any of your questions. Thank you, Lindsay for a very suinnc and clear summary of what you were able to begin to discover about this important topic. So we would invite our audience to turn your cameras on so we can see each other and to raise your hand or to unmike, we're a smaller group. So we would love to get your questions and to start some discussion about this important topic. So who would like to start? Sometimes Lindsey, they make me start. This is what happens. Can, if that's okay. Great, please, Kristen. Lindsay, that was fascinating, and your findings were really interesting, so it must have been a really interesting study to do. What I thought was really interesting was your suggestion to have ongoing STS assessments. Are there any ways to in that in a work environment that's quick and easy, but also effective, anything that we can think of to start implementing in our own places of work. Can you just say where you're from? We can't see you and I, you know, from what disciplinary perspective, is your question? I am a social work PhD student. I'm in rural Peru, and if I turn on my camera, I might get kicked off my rural Internet. We don't want to do that. Right. Thank you. Go ahead, Lindsay. Yeah. So, Kristen, I think this is a really important question, and I think it's a really challenging question to answer because I think our first instinct is to have nurses fill out a survey and refer them to mental health support. But I'm really unsure if that would be effective or not. I don't know the answer specifically of ways that this can be implemented. I think that it's really resource intensive to provide nurses with time and opportunities to be able. And I think this doesn't just apply to nurses. And I think that's really important also. We're not I'm sure that physicians and social workers and respiratory therapists and even, you know, people that do the important work of keeping the hospital clean had similar experiences during the pandemic. And so I think that it's a really challenging thing to do because, you know, there is a business to health care. And when we think about the resources that would be utilized, I personally think that it would be meaningful if there was opportunities during the day for nurses or other health care providers to have a time out where they can have some dedicated time or maybe for someone to cover their duties to maybe sit and talk about what they're experiencing with someone who is qualified maybe a counselor even to talk to them about what they're experiencing, and to be able to verbalize some of this. I think that nurses, while we don't take actual work home with us, the effects of our work, we do take home. And I'm sure that this happens for a lot of other healthcare providers. So I don't know if that resonates with you in your social work realm, but I think it's a really challenging thing because there's a lot of other studies about burnout, and And related to trauma, like post traumatic stress disorder of people work in the intensive care setting. And I know that that is not just unique to the United States. We've seen that in other countries as well. So I don't know, Kristen, if you have other thoughts on that, I would love to hear them. I was kind of hoping you were going to give me the answers, but I really am compelled by this idea of ongoing structured clinical check ins, maybe more than I mean, the field of social work just wrote self care into our code of ethics, but I'm not convinced we have a culture of self care in any of these healing and caring professions. So I really am interested in how we can incorporate that. And this was really fascinating. Thank you for sharing with us today. So, Kristin and Lindsay, I am a social worker as well. That's my background, and my focus is on infant and early childhood mental health. And in that field, there's been a whole push in a body of work around reflective supervision consultation is what it's being called, and to identify and define supervision in a different way, not administrative supervision that we might commonly think about of did you do your reports on time and are things accurate and that sort of thing, but rather to reflect on the experience of the work? And so talking about a dedicated time of reflecting and pausing about what what's happening to me in my work and how am I experiencing it. And it could be all kinds of experiences around maybe feeling particularly close to a particular client for some sort of transference. They look like my grandmother, or it could just be an issue that touches me in a certain way. But to be able to put that into perspective and to use that information to help me feel better about my work, but also keep it separate from my work and in perspective tends to be helpful. That tends to be a useful thing. So that may be a connection there that you're identifying for Lindsay and her work to think about. Like, you know, what are some models that might be useful in a clinical setting where people could have that space. But I like the way you phrase it too, Lindsay as a time out, because I think about even as a parent, now grandparent, how sometimes it's helpful to just put ourselves in time out, and not so much the kids or the people around us, but ourselves so that we can reflect on what's happening and move from there. I notice that Latasha has raised her hand, Latasha Rally. So please turn on your camera, mute, tell us who you are and contribute to the conversation. Well, thank you. Good afternoon. I'm Latasha Raley. I'm a doctoral candidate in Urban Education Studies, and I work in the Office of Community Engagement as a coordinator for Community Engaged research. And a lot of times we interact with folks in the health field, we're in all the industries. But my question is, due to this increase of the STS, has there been an increase in nurses leaving the field? And if so, how is that impacting the nurses that stay in the field? Does that increase their STF? And as Kristin talked about, you know, how do we kind of check in along the way so that, you know, we can, you know, mitigate the leaving because I was just wondering what information you had on that. Yeah, Latasha, this is a really, also, really important question. Thank you so much for bringing this up. I don't have data to support what I'm going to say next. So I would like to put that disclaimer out there. I think that there has been a shift of nurses leading the bedside. But another important shift that we're seeing is an increase in travel nurses. And for those of you who aren't familiar with travel nursing, this is what happens is there are agencies that are hired by hospitals who are short staffed to hire nurses who are not actually part of the healthcare like the hospital institution itself. They are a contracted worker. And they come to the hospital for usually 13 weeks and they take care of patients, and they don't have the same educational responsibilities or unit meeting attendance responsibilities. And so they're kind of on the periphery, but still doing the same amount of care as nurses at the bedside. And this model is a little challenging for morale at the bedside because travel nurses typically make two to three times the hourly pay rate of bedside nurses without the same amount of responsibilities in terms of accountability for continuing education at the hospital. And in some very specialized areas of work, my area of nursing is intensive care, and I currently am a supplemental employee and a cardiac ICU where we take care of a lot of devices. And so the travel nurses are not certified to take care of those devices. And so we have this kind of dynamic where the travel nurses are making a lot of money. We're doing the same amount of work, making a third of the money, and so that's really detrimental for morale. I think that phenomenon has encouraged more nurses to do travel nursing because you're doing the same work for less money. And so that nurse retention issue we're kind of kicking the can down the road in terms of getting these experienced nurses who are part of a cohort of nurses that take care of a special patient population, who have extent, you know, longstanding relationships with physicians and social workers and respiratory therapists. And And so it's kind of changing a lot of things at the bedside. And I think that it's I mean, again, don't have data, but in my experience, it's detrimental to morale. But this is one way that hospitals are solving nursing shortage problems is hiring these agencies to provide nursing care. So I think we're seeing people leaving and also people kind of shifting to this other role. Wow, thank you for that. I didn't know anything about the travel nurse situation, so thank you for sharing that. Yeah, thanks for your question. I really appreciate it. I also wonder about just the challenges that it seems all aspects areas are having around employees finding and keeping employees. And I can imagine that's not different perhaps for the nursing profession. So as you're saying, Lindsay, perhaps the travel piece is one way that organizations are trying to keep up with the demand, is like that's another way to try to reach people. Yeah. Nuri Mc Lucas, you're raising your hand. Yes, thank you again for your presentation. It was really good. My question is have you heard anything about hospital administrators, like starting to save PPE for future uses because these outbreaks is nothing new. We had a sine flu, all kinds of stuff. Now, like, monkey pox is coming up. So have you heard anything about, you know, hospital administration, like, starting to save, you know, extra PPE for future use and respirators and such to help alleviate, you know, stress on the workers, hospital workers? Yeah. Another really great question, Ni, thank you. I have not heard anything, but I hope that there are contingency plans. I think there are always been vulnerabilities in our health care system, and I think the pandemic really exacerbated those and are really highly recognized way for the first time in a long time. All of those things have an expiration date, even though, you know, we don't think of them as going bad. And so I think there's a challenge for a lot of healthcare institutions to figure out the balance between ordering in supply and demand, but I am not experienced enough or knowledgeable to know. But I know that in my experience, we haven't had a shortage of masks and you know, the respirators, we are seeing shortages of medications a lot, and I don't know if that's due to shipping because I know there's a lot of shipping challenges globally right now, but we are seeing shortages of medications and and challenges, you know, getting some other supplies. But we haven't had any issues with gowns, masks, or even, like, gloves that I think we were seeing earlier on in the pandemic, but I really hope that you know, that's happening because of, you know, like you mentioned the news about monkey pox. So Lindsay Lindsay, you mentioned you had, I forget what number of responses from the United States. Do you have a sense of where those were geographically, was it targeted or was it across the country, wondering about, you know, the generalizability of what you found? Yeah. And that's actually a really good question that I had thought about when we were writing the manuscript because I know you know, nurses in New York and experienced some really, really, really traumatic events. We did not collect that data. It would have been really nice to do that. One of the things that I think that would have been nice is to have And I mentioned this, a lot more respondents and an equal representation from other countries. Just to get a better overall look at the data. But this would have been another really important thing to take a look at. Yeah. And I'm wondering too, listening to the conversation and thinking about the impact on nurses and the profession. I wonder if there's any data or what your thoughts are around the impact on patients from nurses being under this sort of stress. Yeah. I again, this is anecdotal. I don't have evidence you know, to say, I mean, I suspect that definitely puts them at risk. Anytime that you're experiencing any sort of distress, I think that it can harm our decision making. It can influence our reactions to be able to be supportive. And they always say, you can't feel from an empty cup or you can't pour from an empty cup. I think that's another thing to consider, just in terms of and things that you mentioned, someone mentioned self care. I think it was Kristin as part of the code of ethics. Nurses historically, and I don't think it's historically, I think it's current to not go to their lunch break if they are patients need things. And this is a common practice, or we will do as much as we can because we know our patients. And it's not just nurses, it's physicians, respiratory, social workers, you know, all of the people who, you know, take care of patients will put the patients first and not take care of themselves. And we might see this as a solution, but it's really again, you know, causing us to not heal and not take care of ourselves, which I do think probably impacts our patients. Makes you less likely to maybe be in a hurry for when that call light goes off, or, you know, when you need to send those labs or, you know, to do those other things if you are experiencing some of these negative side effects. Are there other questions, comments? We want to give the make the floor open to folks that are curious or want to add something to the conversation. Another thing I'm wondering about, Lindsay is that you targeted to other countries, and you gave some comments about that. But I wonder what we could learn from that. What do you think are the takeaways from how this looks in different places and what could we learn from how that helps us here in the United States? Absolutely. So there's a lot of things that we can take away, number one, you know, nurses, In other countries, we're experiencing the same sort of emotional implications, meaning that I think health care providers everywhere need more support is the number one takeaway, which ultimately helps our patients. And I think that perceptions of being well protected while you're providing patient care are universally translatable. Whether you're working in the hospital or an outpatient clinic, or in a long term care facility, we all want to be perfect protected, not only for our own well being, but for our families when we go home. And so I think that our experiences can unite us. As health care workers, you know, there are a lot of really stressful things happening in the world outside of the pandemic now, that impact health care workers everywhere, that impact families everywhere. And so when we think about what we can do to support families and to support patients. We can learn from each other. Something that we didn't look at during this study, but I know other studies have looked at is what people did in limited resource settings. Coming from a high income country, we tend to have the ability to use and dispose and use and dispose, and that's not always what happens in other countries because of limited resources. So, you know, we can absolutely learn ways of being good stewards of our resources. And doing more with less resources. And I think, you know, you know, looking at healthcare institutions opportunities to support health care workers, Well, I'm not sure that it's a one size fits all solution. I think that, you know, the results show that everywhere, healthcare workers need to be supported by their institutions, and these are a few ways that they could take action. I also wondered about you had a slide in there with the pictures of health care workers being portrayed as heroes, but yet that didn't come up in the themes of your research. And so that got me curious about, you know, what the impact of that might be nurses. And there was that for that period, and then there seemed to be a shift from that, you know, societally, what impact that might have. That's just kind of my question. No that was in your survey. Well, it's a good question, and it's one of the reasons that I was really interested to do this study because I felt I mean, at the time, I was teaching virtually during the pandemic. I was not taking care of patients at the bedside, but most of my former colleagues and nurses that I knew were, you know, when I would talk to them saying how traumatic it was to see it wasn't young It wasn't elderly people with comorbid conditions. We're talking about 20 year olds, 30 year olds dying from COVID in April of 2020. They didn't feel like heroes. They felt terrible. And I really wanted to be able to put a voice to that without really demeaning the appreciation that people wanted to give to them because I think they had great intentions of building people up. But no one felt that way. You know, no one felt like they were a hero. And, you know, I suspect that even Superman doesn't feel like a hero all the time because the work is hard and it's lonely, and as sometimes seems unappreciated. But it is really interesting. And I'm sure that that added to some moral distress, you know, not being able to do things for these people. I mean, saying goodbye to families on Facetime doesn't feel heroic when you're going to withdraw care from someone who is, you know, dying and you're saying goodbye with an iPad to their family who hasn't seen them in weeks. There's nothing feels good about that usually. And so I think it was really difficult for everyone. And I know nurses are not the only ones that felt that way. This is just the cohort that we happen to study. Well, in a related thinking about how this applies to other places in my experience, during the pandemic, have been in a place of trying to be supportive and hold a space for leaders in the early care education, early childhood world. And I think in a similar vein, some of those folks, maybe a child care or a center or a preschool, some of the leadership there would also be doing what we might call heroic work, right? Whether they're figuring out how to stay open, how to meet the needs of kids who are struggling. Kids are trying to figure out what this means. Maybe they've been in group care, they're not in group care, and now they are. Their staff. They're trying to hold the space for them. The families that are impacted by all this. And those people, much like, I think nurses might be very easily could feel isolated in their own space while trying to be something for everybody else and not having a resource to fill their own cup, as you were talking about earlier. And so what impact does that have? You know, I mean, how do we help folks? So I think this is a good conversation. This is good information to help us think about how do we go beyond just naming you as a hero, but really recognizing the experience and the toll might be taking? And what could we be doing to support folks that are in these kinds of positions so that they're not isolated and they are able to get what they need as well so that they could keep giving it. As you mentioned. I see Debbie has raised her hand, so please join us. Turn on your camera so we can see you. Well, I'm unable to turn my camera on right now, but I loved your presentation. It's such important work. So my question is, what implications do you think this has for nursing education? We've known for I believe it's been about 50 years since the book reality shock was published. And so new graduate nurses have all, you know, they're nervous about entering practice, they're afraid of making a mistake. There's all this whole realm of emotions that they go through. So what implications do you think as educators who maybe work with undergraduate students? What are your ideas about what we can do to help prepare them for the world that they're entering now? That's also a great question, doctor Mr.. Thank you. You know, I think this is also very challenging because we don't want to Give them negative perceptions of the profession, but I think it's important to be honest and transparent about the challenges. My first thought would be to have dedicated time for Capstone students to talk about some of their observations of what nurses experience and to set, you know, as faculty facilitator or even, you know, the clinical faculty who are doing the check ins with these capstone students to try to talk to them about why that might be and I think honestly, you know, sharing with them ways in which that they can take care of themselves and how they can communicate with their nursing leadership at the bedside. I think one of the highly under utilized tools is the ability of nurses to communicate with their nursing managers, effectively to allow the nursing managers to advocate for them with hospital leadership. And so if we can give nurses nursing students who might be witnessing some of this in a very small scale at the capstone level, maybe to have an opportunity to talk about some of this and have some sort of desensitization to some of these challenges, maybe that would give them an opportunity and some perspective to be able to have that open line of communication with the nurse managers and maybe even encourage them to want to get a PhD or to want to do research to think about how they can solve some of these problems, you know, if they're interested in that in the future. We know that only I think it's 2% of nurses maybe have a PhD here, at least in the United States. And so if we can encourage more nurses to want to be problem solvers of the PhD level when they're early in their career, that would be excellent as well. But I don't know what are your thoughts about the feasibility of any of that or the effectiveness. I think it's a lot of great thinking, and I do think some of those things are feasible. We just have to make it our priority and help bring undergraduate students around understanding how relevant this is that we do want to give them a toolbox. Of course, I love your idea about encouraging them to continue in their graduate education to really be those problem solvers. But I think we need to make the time. And you know, they're very focused on, Oh, I want to start IVs, and right before I graduate, I need to take start as many IVs and put in as many since I know everyone here is a nurse of bladder catheters and those kinds of things, and they sometimes just get so lost in the tasks that they don't understand the things like moral distress and all the other things that they'll be facing. So I really appreciate your thoughts, and I think we need people like you who are going to encourage us. This is important. We have to make the time. We can't say, Oh, that's not feasible. We got to make it feasible. Yeah, thank you so much. Well, it does seem that the experience of a pandemic certainly brings to light a lot to think about and a lot for us to work on. And so it is timely that you've contributed a piece, Lindsey to the discussion about the impact of the pandemic, and what is that about and what can we do? And how do we go forward as we emerge from the pandemic and make things better for our professions and certainly what I'm taking away from your perspective today, although it's focusing on nursing is how applicable this is other areas of practice and discovery as we think about what to do. So I want to thank you for taking the time to be with us today and to share this important piece of information. And even though you shared some limitations, certainly there's been quite a robust discussion and new questions. So I hope that our audience today will Continue to have the conversation, we'll find others, certainly, Lindsay's available. She's in an inquiry mode now as a predoctoral student. This is the time to connect with her and maybe help contribute to some future studies or some other opportunities as she tries to bring along some other folks as well. I heard her encouraging people to be part of this. How do we help everybody else join into the conversation? Whether it's as a community member just with some ideas or desires to help things be better or from the academic side, whether you're a student or faculty member wanting to contribute more to how do we make things better in our communities? Thank you, Lindsey for taking the time to do that. As we conclude this portion of the time, we want to thank you all for joining us today. Remind you that we have the scholar of the month monthly. That's why it's called Scholar of the Month. Join us again next month, we'll be hearing about fund raising, and what does that look like in the area and outcome of COVID? And Please do take the moment to respond to the survey. There was a link in the chat earlier. It'll be there again. But you'll also get a follow up e mail from us with some other information. So we please ask you to fill that out and give us some feedback. So we want to give you the opportunity to prepare for your 1:00 or the top of the hour, wherever you are, whatever's next. But we'll stay on board here for anybody who wants to just have a follow up conversation once the presentations over, we'll be here for the next few minutes chatting with Lindsay about her work. Thank you again for coming and have a great weekend, and we'll look forward to seeing you next time for our scholar of the month or our other activities sponsored by the Center for translating research into practice. Lindsay, I hope you're enjoying all the applause that's coming along and some of the chat comments about what great work you're doing. Thank you for contributing and We'll continue the conversation for those that would like to stay alone. Thank you, everyone.