Analysis and Interpretation Worksheet

Speaker 1 ( 00:03 ):

Good evening everybody. This is Edens. Tonight I'm doing a part two of my interview. Tonight I have participant B she's a nurse that I have worked with and a good friend. I'm an ex military. I'm a veteran, I'm a disabled veteran. I work at the westbound VVA. And let me introduce you to system B. Hi, how you doing? Participant B. I'm doing good. Thank you. Can you tell us a little bit about yourself?

Speaker 2 ( 00:48 ):

Yeah. I'm participant B. I work with Palm beach VA and I have been working since 2013 as a registered nurse work in different facilities. I started there in medical surgical floor seven, eight, and I worked there for a few years. And then after that, I B got a new position in outpatient surgery. And right now I'm working in outpatient surgery, surgery unit

Speaker 1 ( 01:34 ):

Participant B, can you tell me what motivates you to get up and go to work? Every single day

Speaker 2 ( 01:43 ):

I work, I'm a nurse and I work in a hospital and our hospital is veteran's hospital and I work with no different. I have an employee, they are veteran and I have a patient. They are veteran and I, I work with them and I can make a difference in their life every single day, helping them. And, you know, they are so happy whenever, you know, they feel good whenever they come to hospital with their problems. And whenever we, I am as a nurse, try to solve their problem. And, you know, whenever they feel better, they feel so happy. And that motivates me every day to get up and work. And every single day is like a new day for me,

Speaker 1 ( 02:47 ):

When you help a patient get well and make, make them full and they have a full recovery. How do you feel

Speaker 2 ( 02:58 ):

The best moment? You know, happiest moment in my, you know life or, you know, time as a nurse in, I feel very good. And recently, you know, I had an incident about a Y with one patient. He was so worried because, you know, he he's a, he's a lab work was a little bit out of control. And then he was worried about that and he was keep calling me. And then one day he made an appointment and came to me and then, you know, I made an appointment with the doctor and about his concern in because, you know, I can't help him on that matter. And then I make an appointment with the doctor and then, and doctor, you know, explained to him about his lab results. And then we did a lot of lab work on him and after seven, I think, seven days later, and he came back to me and, you know, everything was under control and he was so happy. And then, you know, and then I feel so good about that because I, you know, could help somebody because he was so worried about that. He was older, you know, like 80 years old. And then an every time, whenever he comes to respond via he come to see me and thank me. And that's why I feel so blessed that time. I feel so good. Okay.

Speaker 1 ( 04:48 ):

At times you feel that you need more help to understand the complex treatment procedure?

Speaker 2 ( 05:05 ):

Yeah. Sometimes, you know sometimes, you know, yeah. Sometimes, you know, I, sometimes they come, you know, I'm a nurse. I can help him. I can help as far as I can, but sometimes I can't, they know that time also, I try to help if they need medical, medical attention right away. I can't, you know, I can make appointment with the doctor, concerned doctor sometimes, you know, even I, she know I work in a special procedure clinic, but it's still in know sometimes you know, that now that doctor doesn't belong to my clinic still, I sent a note from our, from patient chart to his doctor, concerned doctor. And then you make them aware what I know, what, what is my concern about that patient? And then I will notify, notify the patient also and tell them, you know, I already notify their doctor. And sometimes I call his nurse primary care nurse, make him to go and see them and help them out. Not com

Speaker 1 ( 06:33 ):

Can you tell me a little bit about the time you work in the ward, like seven, eight? How was, how was that experience? How what's, what's the difference between that experience in the and the outpatient clinics,

Speaker 2 ( 06:52 ):

Inpatient clinic and outpatient clinic. It's totally different inpatient clinic. You know, whenever we start, whenever I normally know I start at seven o'clock in the morning, and then I get normally six patient and I have different kind of patient different, you know, I started six patients and I have different kinds of patients. Patient has some patient needs, maybe medic nausea medication. Some patient is getting into biotic every six hours. And, you know, they need constantly, you know, our attention no whole 12 hour. And that was 12 hours. And we, we weren't like each patient in between. And sometimes we have to go with doctors round and carry out order. And in eating patients and one patient has different doctors, like, you know, they have a cardiac consult, nephrology, different kind of, you know, consult. And then we have to carry out all the orders from different doctors.

Speaker 2 ( 08:09 ):

So within certain period of time, and sometimes, you know, even in between, if you have a patient, you have a nephrology consult and then that patient has critical, you know, potassium, sodium potassium means patient has low potassium. Then we have to, doctor is going to order, you know, potassium. And we have to give that potassium in period of time. And then sometimes, you know, patient complain about burning infuse that potassium, and we have to take care of that. And so in between we have a discharge and then discharge, we got to do within, you know, within one hour you, because we are getting new patient, that patient discharged and we are going to get new patients. That's why we have to do in certain period of time. And then we go to do that. And after that, we are going to get new admission. And then now we've got to get ready for new patients.

Speaker 2 ( 09:13 ):

Whenever a patient comes, then we do admission, admission procedure complete physical, you know, assessment, any food we need to start. Ivy patient has stat in the Medicaid application. Inpatient is totally different than outpatient surgery. When I moved to outpatient surgery, outpatient surgeries, you know, it's busy as totally different, but, you know, we have certain time for one patient doing the procedure. Like, you know, if we are doing MRI fusion biopsy, we have one and a half hour. And if you are doing my prostate traditional prostate biopsy, we have a one hour time, but that one hour time, I'm just taking care of one patient. And then I can give my full attention to one patient, but inpatient, I have six different patient, different, you know, some patients is like a hip fracture, some patient that’s and a post-op some patient that has like medical patient and different patient. And then, you know, I am, I have to manage my time and take care of all those patients for outpatient is totally different. And then in patient, okay.

Speaker 1 ( 10:45 ):

What, what techniques have you discovered that will make your work easier as a nurse?

Speaker 2 ( 10:56 ):

Yeah. You know, yeah, this is very good question. You know, as a nurse, we, whenever we study, you know, nursing at whenever we are in nursing school and then, you know, we are teacher and they all the time, they teach us like time management team or, and, you know, time, time management and teamwork, and in prioritization of your, you know, patients need, and we have a patient need our first attention. Then we got to go there and do it like, you know, let's say in medical surgical floor and, you know, whenever we have a patient, that patient is going for surgery or in the morning, and then whenever we get report, and then we know we get ready that patient, because we cannot delay the or time, that's why we to get ready for the patient, that patient. And then, you know, sometimes the patient has who are on call antibiotic, Ivy antibiotic.

Speaker 2 ( 12:01 ):

We have to get that antibiotic from pharmacy. Or we know sometimes we have that antibiotic in the Pyxis, we to get rid of that medication and you got to change the patient's, you know, gown and patient has to be on who are down and then, you know, get ready for them and make sure he's NPO. And he's a, you know, anti-convulsant has already stopped everything. We've got to make sure all the chart is complete and, you know, ready to go. We take care of that. And then we go and do vitals and medication and that time management and prioritization of a patient's needs and teamwork. And then we need, you know, nursing is not one, one person job. We need help from our health, you know, health tech and nursing assistant to Clark. And it's a teamwork. And if we have know, if we, you know, work with we'll work with all of these, you know them, and then it's, yeah, it's, it's easy for us as a nurse. Right.

Speaker 1 ( 13:31 ):

What, what incident in your nursing career do you think you did a particular, well, you did particularly well in a assignment.

Speaker 2 ( 13:43 ):

Yeah. You know, you know, one time, you know I, you know, before working with Bambi's VA, I used to work in a West boca medical center as a nurse. I used to work in med tele, and, you know, one day, you know, one day I have one patient I have a patient, you know and then that patient is, you know was in, you know, Beijing he speaks Spanish only. And then, you know and everybody was taking care of him. And then he, he cannot, you know, he normally does, does not verbalize about his pain. He can speak, but, you know, he was not, you know, verbalizing his pain and one in one day I have that patient. And then, you know he's a blood pressure in all the time. It's high all the time. What's high and everybody was giving his medication, but, you know, he looked like, you know, he's like calm, quiet person.

Speaker 2 ( 14:59 ):

And then, you know, one day whenever I had that patient and then, you know, he was on a blood pressure medication, everything, but it's still, his blood pressure was not controlled, you know, and he doesn't say much. And then one day I talked to him and his wife, you know, and all kind of gesture using my GSA because I don't speak Spanish. And then, you know, and I asked him I asked the wife and the lore and I most, so my body part, something like that. And then, you know, he explained to me about, yes, he has pain. And then, you know, after that, I call his primary doctor and I have, and then I asked her primary doctor and primary doctor told me, he never mentioned about pain. His wife never mentioned his pain, and that's why I know that's why they didn't order anything.

Speaker 2 ( 15:55 ):

And whenever, you know, they never, and then I asked the doctor, maybe his blood pressure is high. Maybe, maybe we can give sometimes maybe, and then doctor order been medication. And, you know, we, and I gave you my pain medication when then, you know, after that, you know, after maybe two hours later and I was doing my rounds, I was taking care of everything. And then later on, you know, you feel so much good and feel better. And, you know, I can see on his face. And then, you know whenever I took my CME and then let me see his blood pressure and his blood pressure was really getting down. And, you know, he, I can see in his face and he is feeling good. You know, I have lot of, you know, incident like that. And then whenever I, that time, if, you know, I helped him and I feel like, you know, that assignment because he was his blood pressure was high for, you know, long time they are giving him different kinds of medication and, you know, and then, you know, later on we found out he has a pain in his back, and that's why, you know, when blood pressure was high and then later on, he was getting better.

Speaker 2 ( 17:28 ):

And then that day, I feel like in a little bit better. And then his wife, you know, see thanked me so many times.

Speaker 1 ( 17:38 ):

Okay. Can you can you tell me a little bit more about the, the procedure, the Moi biopsy? Can you, can you tell me a little bit more about that in the steps?

Speaker 2 ( 17:57 ):

Yeah. Yeah. I know in our clinic we do MRI fusion biopsy, and then this MRI fusion biopsy, normally we do whenever I know patient to patient has abnormal MRI, whenever MRI, Susie, you know he possible cancer, no lesions in his prostate. And that time we do MRI fusion biopsy, and whenever we scheduled MRI fusion biopsy, and then that time, you know, we scheduled patient for two appointment, we need to check, you know, we need to give them education and we need to make sure he doesn't have any infection before doing the biopsy. And then whenever a patient is, you know, ready for MRI fusion. And that time when we give education about, you know, patient on a blood thinner and thinner, and, you know, we asked the doctor if they can, you know, they need to hold that medication, different medication in certain different time, like an aspirin for 10 days and Plavix for five days.

Speaker 2 ( 19:20 ):

And then our doctor, they put the order in the patient chart. And then we give education to the patient to hold those medication. And before biopsy, then we give them antibiotics before, but I've seen, we start an antibiotic the day before. And when that person leaves a day, whenever they come and they checked in and then we bring the patient and then doctor has to see the patient, they get a consent for MRI fusion biopsy. And after that, we take the patient in his screening room. And whenever we go in the screening room, they change and they changed and we check their blood pressure and vital sign everything. And then after that degradation in procedure room and procedure room, they lay on your left side. And then we have a urinal. That's a MRI fusion biopsy. We have ultrasound and then MRI, and patient's MRI.

Speaker 2 ( 20:26 ):

We fuse with the ultrasound and then we take the biopsy on the target. The lesion, whenever in whatever patient has a lesion, some patient has one reason. Some patient has two or three lesions, according to that, and doctor will target those lesions and then take the biopsy. And normally we take, depending on the, how many reasons. So patient has not in normal, you know, normal times we take only 12. And then if a patient has more lesions than we take like 20 biopsies, and then we label them, it's a biopsy correctly. Whatever the correct site is, and then send it to the lab after, you know, biopsy, sometimes patient, you know, do these MRI fusion biopsy patient has to be still if they move. And that picture ultrasound picture and the MRI picture is going to CFT. And then if picture is stiff, it's not mad.

Speaker 2 ( 21:38 ):

And then it's not me. It's not going to be in a correct biopsy. That's why patient constipation. They have to be still for during the procedure and after the patient goes and they can do, sometimes they know, and that time we will put patients on a halo position and, you know, do the vitals and, you know, and then after the season bring them back and they change. And then we make appointment follow-up appointment because it takes two hours to get the result back. And then, you know, after two weeks we make appointment and we gave them an education in discharge instructions after biopsy. This is very important, you know, they cannot draw on jumps. So you, at least a week, they have to take a risk. Otherwise it's going to bleed. That's why we tell them all the instruction. Okay.

Speaker 1 ( 22:52 ):

I know you worked sometime with surgery clinic with the surgery doctors. Can you explain how some of the minor procedures like I've done?

Speaker 2 ( 23:07 ):

Oh yeah. I work with different, you know doctors, sometimes I work plastic surgery, plastic surgery, and, you know, whenever I work with them that time when the patient has a sometimes in a patient, as a mask in a skin lesion, something like that. And then that time they do biopsy and sometimes, you know, plastic surgeon, they do biopsy that is easy. You know, we don't have to do anything. And then, you know, we don't have to prepare that many, no instrument for the sponsor biopsy. And sometimes, you know, they do like opening season biopsy. And that time we set up for plastic surgeon and then, you know, we have a special tray for plastic surgery and we will open those tray for the doctor. And then, you know, they do procedure. And sometimes I work with the hand surgery and then the hands are that time. You know, we eat patient has a cat, you know, normally patient, we see the post-op patient. And normally according to doctor's order, we remove sutures after two weeks. And sometimes, you know, they have a cast and like a month and then we remove the cast and then we put a splint according to doctors. So orders, sometimes we put, put in half a spleen. Sometimes we a put a removable splint according to Dr. Solder. Okay.

Speaker 1 ( 24:58 ):

What's that what's that thing. When you know, how, when you have a patient that comes in after surgery and you have to remove suit sutures, and as you removing the sutures, the patient pass out can you tell us what happens? Like what caused that and what happens?

Speaker 2 ( 25:24 ):

Yeah. Sometimes, you know what, sometimes, you know, patients, they cannot tolerate pain and because of pain, they have, you know, vasovagal effected. That means, you know, there are no blood vessels styling and then John, you know, weekly, and that's why they passed out. And recently I had that incident and know I have one patient and C said, you know, he has C has very high tolerance pain, and she didn't take any pain medication before coming to the hospital. And then, you know, see, has long sutures and see as many shooters on her left arm. And I was removing and she was talking to me and then we were talking and talking and all of a sudden see is feeling a little bit hard. And then, you know, I said, okay, you are a little bit hard. Okay. And he still, he said, yeah, I'm fine.

Speaker 2 ( 26:29 ):

Otherwise, I'm fine. I'm fine. And then I just tried to remote others, nurture and then see was like, I'm feeling hard. And then I'm, I feel like I am going to offend. And that's why I put her and male head, low position. I took a two car blood pressure, blood pressure was low. And then, you know, I asked my friend to bring water and then, you know and then after that, you know, after five minutes, not even five minutes after one minute later. Oh, what happened? Yeah. I'm okay. I'm okay. I know my name. I know where I am. I know what happened. Yeah. I just passed out. That's what she said later on, you know, I was able to remove our sutures and slowly our blood pressure came back and then yeah, we discharged her. Yeah. That incident happens

Speaker 1 ( 27:29 ):

As a nurse. Now, at times you encounter a stressful situation, for instance, when an accident happens and that so many patients come in coming in, how do you handle that?

Speaker 2 ( 27:48 ):

Yeah, that, that time, you know, again, you know, nursing is a teamwork more, we have, we have to prioritize the patient. Do we to patient need our agents most at that moment? That's I know that that time I, I prioritize my patient and then, you know, getting to that, you know, we do our, I do work with my coworker.

Speaker 1 ( 28:43 ):

I did, I went to school for LPN. And I remember when I was in school for LPN and the, the professor told me a lot of times the nurses know more than the doctors, because the nurses are with the patients. They have the time to talk to the patients while the doctors are just trying to do either a procedure or try to get a diagnosis. They don't. So a lot of time the nurses know more of what's gone on with the patients than the doctors. My question is, do you think that is, that is true.

Speaker 2 ( 29:32 ):

Absolutely. That is true. You know, we nurses, we are patient 12 hours and sometimes we are going to get, you know, next day we are going to go to work and we, we did same patient. And then we know we are going to be with them, you know, like, you know, our, you know, time, that's why we know everything, you know, that is very true. You know, sometimes, you know, we are nurses and then we tell the doctor what's happening with the patient is their symptoms, you know, their symptoms sometimes, you know, we help them do, you know, find, find out the diagnosis, you know, diagnose the patient, you know, whenever yeah. I have couple of incident that happened, you know one time, you know, one of my patients he was on blood thinner and then, you know, he was, he was on blood thinner and he's taking his blood thinner, like, you know, new blood thinner, but, you know, he was not making appointment and he missed his appointment with anticoagulation and then he forgot about it.

Speaker 2 ( 30:46 ):

And then, you know, he was not making an appointment. And then one day, one time I had that patient and I saw, you know, all the bruises everywhere. And then, you know, I, you know, patient that was actually in outpatient patient in patient was outpatient is not inpatient. And then, you know, I asked him why he had the bruises and he said, yeah, I get, you know, easily bruised, something like that. And I checked his chart and then I asked him, you know, what kind of medication you are taking? And then I saw he's on two different, kind of a blood thinner, actually one blood thinner. It was stopped. You know, doctor already stopped and he prescribed another medication, but he did not know that, you know, he missed appointment. He did not, did not know that. And then he was received, he received that medication at home and he was taking both blood thinners and then, you know, that's why he was so bleeding and I saw all the bruise and then, you know, and skin, you know, peel off everything.

Speaker 2 ( 31:53 ):

And then, and then I checked his chart and I found out any one of his blood thinner was stopped. And then I asked him, why are you taking all these, all these two at the same time? He said, yeah, I, I, yeah, I'm taking one in the morning, one in the afternoon. He said it. And then, you know, and then I called his primary care doctor about that. And then, and then, you know, primary, I told him, Dr. Bragg primary care doctor told me it has to stop. He's one of his blood thinner was stopped, but he did not stop. And then, you know, I made a point, I made appointment with his primary care and then, you know, and then he, and I asked the doctor, you know, maybe we can do his PT INR. And then, you know, we did BTI in AR and then, you know I helped him on that and he, he was so happy about it. Okay.

Speaker 1 ( 33:08 ):

How many times have you gone to your supervisor to seek for help?

Speaker 2 ( 33:17 ):

Oh yeah. Yeah. You know, it's not too long ago, you know? I work in an outpatient surgery and in outpatient surgery, you know, we had, you know, recently at one of my friends, he got transferred to different unit and then, and we were, and one of my friend, he retired and then, you know, we were four. And then we, that day we were down to two and, you know, we are down to two and we were so busy. And then, you know we have a half an hour and every hour procedure, and then only two of us, well, we had 10 patients scheduled. And then, you know, I went to mines because we couldn't because we were trying to get, you know work, but, you know, patient were complaining because they are waiting for like half an I have now more than half an hour, one hour, they were complaining. That's why I went to my supervisor, not telling him about that. And then my supervisor, he tried to help us, but you know, ours, our special procedure area, they need training. They cannot come and work like in anywhere else. And then, you know, he tried, but that day, you know, and that day, you know, and we try our best and we did it. Okay.

Speaker 1 ( 34:53 ):

I have I'm from the Caribbean, I'm from Haiti and our culture only believe like my parents and people in my culture. They only believe that there's only four main Career that a person should get. Is that you become a doctor or you become a lawyer, a nurse, or a teacher, other than that, nothing else exists to them. What about what, what's your culture, do they do, do they have the same belief or is there a different belief like for a person to be successful

Speaker 2 ( 35:37 ):

Are absolutely right. Yeah. They have same kind of belief, but you know, I want to be a doctor too. I want to be a doctor. And then I tried so hard. I studied hard and then, you know, I'm from Nepal and then, you know, I and then, you know whenever I did my on my time in Nepal, there were not so many medical schools. And then, you know, we have, you know, government on the universities and those, you know, only a couple of them, not too many. And then there, there were highly competitive. And then, you know, I couldn't check your mind. You know I, I, I did good in my entrance exam, but I didn't get into that program. And then, you know, I, we have one day, you know, few, like, you know, we can, maybe we can, we could count in our finger and then in a few private medical school, but they were so expensive.

Speaker 2 ( 36:42 ):

And my parents, they cannot afford for me to go that private medical school. And then I didn't have a choice. I want to be a doctor, but I didn't have a choice. And then, you know, that's why one of my aunt, she was a, she was a nursing that time in Nepal and she was doing very good and, you know, she's very helpful. And everybody, you know, if they have some kind of health issues, everybody go to her and then she is so helpful to, you know, she will help them at any time. And then, you know, that inspire me and to become a nurse so I can be useful and helpful to others. And then that's why I became a nurse. I, I did my, no, I didn't. I did my intrinsic jam. Very good. And then I got a scholarship, full scholarship and university in Nepal, you know, nursing university in Nepal and yeah. And then that's why I became a nurse. Okay.

Speaker 1 ( 37:56 ):

With the doctors you work with, I know a lot of time nurses get along with doctors, but some of the doctors sometimes have egos. How do you handle that? Like, when a doctor thinks he is better than everything, that's around him and a lot of time, it's you guys that's guiding them. How do you handle that with, how do you handle those kinds of doctors that sometimes feels like they, they don't need you when they actually do need you,

Speaker 2 ( 38:34 ):

You know? Yeah. We have recently I'm working that kind of doctor, that kind of doctor, but you know, all the time, you know, whenever I, you know, I I'm working in that area right now, it's eight years because, you know, I kind of knows, you know, I work, I, I have worked with different, you know, urologist, you know, and then that's why I know the different way of doing the procedure. And then, you know, some doctors will, way of doing procedure is less painful for the patient. They feel good. They don't complain about it. And some doctors in a way of doing procedure, it's a little bit painful for patient and something like that. And then one day when I had the same incident with my, one of my doctor, and then I told him, doctor, maybe, you know, patient was screaming during the procedure time.

Speaker 2 ( 39:32 ):

And then I told the doctor, doctor, maybe we engage. Can we do this way? Maybe it's better because I had we do procedure this that way. So in a way, and then, you know, patient doesn't complain, maybe it can, we do that way. And then he said, I'm a doctor. And then I went to medical school for, for this. And then, you know, and then, you know, this is my way I can, I'm going to do it. That's what he told me. And then, you know, he was keep doing it. And then, you know, later on patient was like, you know, he couldn't tolerate and he was screaming and eating, let him do it. And then, you know, and then, and then he, I don't know what happened to him. And then he said, okay, let's yeah, let's, let's do whatever you way you told me.

Speaker 2 ( 40:27 ):

And then we did that way. And then patient was tolerating. He was living in discomfort, but he was okay. And then, you know, and later on, and then he told me, you know, oh yeah, you're right. You're right. And then, you know, and you're right. He's feeling okay, thank you. Then he said, thank you. And okay, doctor, you know, doctor, I worked with different, you know, kind of doctor and, you know, I know which way patient feels good, which way is the better for the patient. And I book it for the patient feel good and they know, and then we are good. And he said, yeah, yeah, you're right. I, on that point you are right. And all the time, you know, we have an argument and I tell him, you know what is right for the patient. And then, you know, still we are okay.

Speaker 1 ( 41:33 ):

Since you work in the VA, the veterans affair, can you tell the difference between a doctor that was in the military? That's a veteran himself and a doctor that's never been in the military. Do you see any difference? The thing is this, like some veterans, I'm a veteran and I haven't met veterans that feels like, oh, I want to be the doctor that I want to see. I want to, I want a veteran doctor. I want a doctor that was in the military. He'll understand me better than doctor that, that never was in the military. Do you think that is true?

Speaker 2 ( 42:17 ):

Yes. That is true. Some, you know, sometimes, you know, our patients, you know, even, you know, we, we had a couple of incidents. We used to have one new veteran doctor, you know, and then, you know, one day we have a patient and then you was, you know, I don't know what happened, what makes him so upset with something? And then, you know, he was like I think we know we were a little bit behind for the procedure or something. And then, you know, you are so upset. And he was like, you know, I don't know. Maybe it's not, that's not his fault. And, you know, we explained to him, you know, earlier we are running late and I know we are doing our best. And we are telling him what is still whenever we use time came. And then he was like, you know, acting up.

Speaker 2 ( 43:10 ):

And then that time we have a veteran doctor and then, you know, we couldn't handle him. And then not one of our veteran doctors, he came and then he, he asked him, why, what is the problem here? And then he, and then, you know, and doctor told X, you know, he introduced himself, you as a, you know you as an army veteran. And, you know, he explained to him everything and, you know, already staff already notify you and why you are in. And then he talk. And after that, after talking to him, and then, you know, he, my patient was so respectful to the doctor and then he was calm. And then, you know, oh, I'm so sorry. I'm acting up. I'm so sorry. So that's what he said, you know, sometimes, you know, if some patient they feel comfortable with the NA veteran doctor, then the civic game. Yeah. We have seen that. No. So many incident. Yeah. If we have that kind of incident, we'll call the, you know, veteran employee and they come here, come them down easily, then the CV?

Speaker 1 ( 44:25 ):

No. Okay. Okay. Because for me as a veteran I know when I talked to another veteran, like when I talked to one of the patients a lot of times they listened to me because of the, I can't say the tone I use. And from the tone I use, they could tell that I'm ex-military before I even tell them I'm ex-military or certain things I say to them, then they'll know. Okay. He's ex-military but what would the kid do you think ex military doctor or ex-military nurse give the veteran better care? And the reason why I asked this is because I'm I have witnessed veteran doctors. That's ex-military that cares just, they're not, it's like, it's not that they don't care about the veterans, but I sometime I see the doctor, the veteran doctor, or the veteran nurse is they could talk about military all day with the, with the, with the with the veteran. But when it comes to care, it do the bare minimum. They don't I've noticed that. I don't know if you noticed that. And do you think that that is, do you think sometime the civilian, civilian nurse do take care of the veteran better than a military veteran having military nurse or doctor?

Speaker 2 ( 46:33 ):

Sometimes I think, yes, because, you know, with a military doctor veteran, you know, now nurses, you know, they already know, you know, the service. Right. And then, you know, whenever NCV I know as I like in like me, you know, as a sibling, a nurse, and then they can talk about their stories and we listen to them because, you know, we all the time listen to the patient, you know? And then I, we listen, you know, we, we listen to them and their stories and then, you know, whenever they open up about their, you know, situation that time, and then they feel, I think relieved. And then, you know if I listened to them and their story and they feel like, you know, they are taking care of some by somebody and, and then, you know, sometimes yes. Yeah. And you know, they like us, you know, sometimes, you know? Yeah. I think so too. Yeah.

Speaker 1 ( 47:48 ):

This, you worked on both sides, like you worked in the private sector at Boca, Boca Memorial, right. Or both originally yes. West Boca, medical and working at the VA. Can you tell us the difference between, between the private sector? Can you tell us the difference between the VA and the private sector?

Speaker 2 ( 48:18 ):

Yeah. You know private sector, you know, we, we have, you know, nurse, patient, you know, recency, but, you know, we, we it's like, it's not, you know, it's my job, but it's still, I take care of my patient, you know? And, but the, there is no [inaudible] between nurse and doctor and patient, you know, once in a day come and they get better, they go home. And then, you know, we never see them again because they are going to go follow up with doctor's office, something like that. They never right. But here in a VA hospital. And then whenever they come to the hospital and then new after, you know, they get better, they go home and they are, they come from follow-up appointment and still we have in all, we talk each other and they are going to be our patient, you know, our patients all the time.

Speaker 2 ( 49:13 ):

And then, you know, every time in a follow-up appointment, they come and see us. And it's like a family. And, you know, and then our veteran, they feel like their second home is a, be a hospital in second home. And then we feel like, you know, they are our family member because we see all the time, like, you know, now patients are right. Where I work and we do like, you know, bladder cystoscopy and then, you know, bladder biopsies and those big, the patient has diagnosed with the cancer bladder cancer. And then we follow up that patient, like a five, six years, according to their, you know, diagnosis, they know your patient has an aggressive bladder cancer. And we, we follow up them every three months with that is the status could be, and then, you know, for two years, and then we pull up or every six months for two years, and then every year like that, you know, if there's some, some of the patient, you know, I I'm, I'm seeing them like, you know, I saw them in 2000 13, still there coming to see, you know, to our clinic.

Speaker 2 ( 50:29 ):

And then, you know, that's why we know each other very well. And if I'm not there, they ask about me. And then if I see their name out, I know, I know all, everything, even I, sometimes I know their family member what's happened. And then sometimes they have some, some something going on. They, they will tell us, you know, it's like a family member. We have, you know, but in private sector we don't have that kind of you know, relationship with the patient. You know, once they come and get better, they go home. They happy and we are happy doing, or they are feeling good, but we don't see each other more often unless they have some problem and admitted to the hospital. But in VA, we see them.

Speaker 1 ( 51:20 ):

The reason why I asked that question is a lot of time I have when I'm talking to the patients to the veterans and I'm letting them know that the difference between outside, by going to the private sector in the VA, because, you know, they have the option to do community care. And a lot of times, sorry, I'm trying to explain to them that, yes, I, I have no problem. It's your, it's your right. If you want to go outside to the community care, I said, but they have to remember that when they're going to outside that doctor, they're going to see that doctor is just, they just want to see that doctor and the doctor, we're going to see them for whatever it is. And probably set them up for another two or three appointments, maybe four. And that's about it. I said, and I try to explain to them when they come to the VA, you going to be with us for basically for life, because we understand what's going on.

Speaker 1 ( 52:34 ):

We more, since it's a close outlet, because it's, it's, you know, it's, the government is a closed outlive. You're going to get to know your nurse, your doctor your social worker, you going to get to know everybody in a somewhat, in a personal level that you'll feel more comfortable to talk about what your problem is, because I know a lot of patients sometime afraid to tell people what their will problem is because they feel embarrassed. But I always like try to explain to them. I says, I tell them that you're in the VA. You're going to see my face for the next 20 to 30 years until I either retire or they move me to a different department. I said, but when you go to the private sector, you might see this doctor today. And then tomorrow you go in and they tell you the doctor's no longer here.

Speaker 1 ( 53:52 ):

That was the reason why I asked the question because I have a lot of veterans that, that, that goes to the community care. I actually, some veterans, even after I explained that to them, they're like, well, Nora, I don't like the VA. The VA is not taking care of me. I want to go to the private sector, send me outside. So I would send them in for community camp. And I bought a month, maybe two months later, I'll get a new console. Patient needs to see a doctor. And when I called the patient and the patient would tell me, oh, you was right outside, is not taking care of what I need. And, and I told them, and sometime I try to explain to them, it's not that they're not trying to, they're not trying to take your, of what you need, what you need is wrong term. And they don't like the fact that every three months, I think it's every six months to a year, you have to, we knew that community care console and their payment, the other thing too, with their payment, with community care, sometime they don't get their payment on time from the government. The government is paying so many different private, private sectors for community care. Sometimes they don't get it on time, so they don't like that. So that's why I asked the questions because the veterans doesn't understand sometimes.

Speaker 2 ( 55:37 ):

Yeah. And I have an incident, you know, one of our patients, you know, we have one, no, not one hour. We have, you know, every day, you know, every time we, we face that problem with them, you know one of our patients, you know, he wants to go community care for his, you know, urology, urological procedures. And then, you know, and that patient is supposed to have his, you know MRI fusion biopsy outside, and then, you know, our provider, you want, he wants it. And then that's why they sent him out. And then, you know, and then he, he went outside and then, you know later on after I think I think it's eight months, we, you know, and that patient came back again. And then not, we've saw that patient, you know, supposed to have MRI fusing, and now everything in community care.

Speaker 2 ( 56:38 ):

And then, you know, he hasn't done anything. And then, you know, we, I, we checked his chart and we found, you know, in his chart, you know, he was, I don't know, some, some something happened in his family member. And then, you know, he had to escape that, you know, appointment. And after that, he never, he was not follow up from that, you know, doctor's office. And then he forgot. He, they, he, they totally forgot about him and he didn't follow up. And he's a old person, you know, he didn't follow up about that. And then he came back to us and then we asked him about what happened. You supposed to have your MRI fusion biopsy, where is your result? Everything. And then he said, yeah, I had a family emergency. I had to cancel that appointment. And I, and after that, I was trying to make that appointment.

Speaker 2 ( 57:30 ):

Nobody, you know, respond to me. And then, you know, and then he came back to us after eight months later, you know, if you know us with us, it has been done and everything, you know, if he had a cancer, he already getting the treatment, but, you know, you went outside, they were, you know, he was not seen by the doctor. You missed appointment and not seen by the doctor. And, but in VA, what we do if patient missed appointment, and then, you know, our clerk, they call the patient. And as a nurse and a patient has a cancer or, you know, possible cancer. And if he canceled the procedure, we call the patient until in we speak with the patient and reschedule the patient. We don't let them go. We make appointment. And then, you know, and their procedures are done the only way, you know, we let them go. Otherwise we don't. And then, you know, outside, they can get that kind of, you know treatment. That's so true. And then, you know, most of them, I know our my tunic, most of the patients, they don't like to go to community care. They told us, you know, yeah, I know. I don't want to go. Now. I will wait.

Speaker 2 ( 58:52 ):

That's what they said. Okay.

Speaker 1 ( 59:00 ):

It's just a participant B, thank you for the interview today. I hope I've learned a lot today and I hope my audience will learn a lot from the conversation from the interview we had today. Thank you.

Speaker 2

Thank you. Good night Bye-Bye.