March 10, 2021

Episode 48: A North Dakota nurse speaks out

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Podcast

Description

The state of North Dakota has been an unlikely area of focus in the second half of the COVID-19 pandemic, first for the state’s incredibly high infection rate, then for the governor’s controversial decision to ask nurses who had tested positive for COVID-19 to continue working, and now, as one of the states with the highest vaccination rates. 

Our guest for this episode is Tessa Johnson. Tessa is the President of the North Dakota’s Nurses Association, and she’s been thrust into the spotlight as the nurses in her state have grappled with the fallout from the governor’s executive order. Dr. Nurse Dan chatted with Tessa to get her take on that decision, her thoughts on how things could have been handled differently and lessons learned from being one of the epicenters of the pandemic. She also shares what it’s been like to become the face of the nurses in her state on national media outlets like CNN and MSNBC. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Welcome to the show, Tessa.

Tessa:
Thank you. Thank you for having me.

Dan:
What have you been up to lately? I know the whole country is still dealing with the pandemic, but it sounds like North Dakota definitely went through a spike and it sounds like you guys are doing pretty good with rolling out vaccines, and has the state turned the corner?

Tessa:
We joke around a lot at work, our director of nursing that works with me. There was one day that she said, "I think COVID is done." And we're like, "Okay," and we laughed. But since that day it has drastically changed. We continue to joke around that.

Tessa:
But yes, I think we have. Every day the numbers are so encouraging. North Dakota has done a fantastic job with the vaccine rollout. I'm proud to say that I got my booster dose today. So super excited about that. Things are much better than the situation we were in eight weeks ago.

Dan:
Yeah, for sure. And that's when North Dakota got some press related to nurses being asked to work even if they were COVID positive. Can you give us a background on that and where it stands currently?

Tessa:
Yeah, absolutely. It was shocking to us, and as the president of the association, I got the news just like the general public did from the governor's briefing, and nurses were mad. Very frustrated, feeling very much left hanging out to dry. When that executive order came out and was released we immediately reached out to our association members and nurses in general via social media and just said, "What does everybody feel about this?" And every single response that we got back was enraged.

Tessa:
Nurses were feeling very much used really, that they've been working through this pandemic for seven, eight months and now if I contract the disease, I have to continue to go to work. Just so worried about our own physical and mental health.

Tessa:
The other thing that we heard loud and clear from our nurses in the state, which really broke my heart, was that even though the intent of the executive order was that it has to be the nurses' choice, nobody felt like they could tell their employer no. They really felt like there would be repercussions if they did so. So that was sad to hear too.

Dan:
Yeah. That's how I took it too, and not being in the context but just reading through some of the articles and things, it was like, yeah, on the surface, yes, you can opt in. But nurses don't feel that way. We feel obligated to our patients, number one. We feel obligated to work. We feel like sometimes there's repercussions for making choices for ourselves. We're not always good about making choices for ourselves. It just was very off putting. I actually used it in a couple of press interviews.

Dan:
At the beginning of the pandemic in and from the travel perspective, nurses were looking for pay packages and going to the hotspots and really rallying around, where can I go fix this really quickly? And as the pandemic went on, now nurses are looking for where is it safe? Where are communities following guidelines? Where are hospitals providing PPE and making it a safe working environment? That was a prime example of the fastest way to turn away nurses to come help is make policies like that.

Tessa:
You bring up a really good point, because one of the things that we heard from the veteran nurses in our state was that during that time when they made that executive order and our numbers were so high at the hospitals that the safety risk was terrible, there were some really unsafe practices and untrained people in certain areas. So these veteran nurses were telling the nursing students or the new grads, "Run. Do not practice here. Your license is not safe."

Tessa:
When we're in such a crisis, that's the last thing we want is for nurses to leave. We've been battling a nursing shortage in our rural state for years, and talking about how can we recruit nurses and how could we keep our homegrown nurses here. Then when that happens, we're just really battling.

Dan:
Yeah, definitely. There's multiple stories like that across the country as well, where nurses licenses are put at risk and people are like, "Well yeah, why can't you take seven, eight, nine patients, ten patients?" And you're like, "Well, because it's not safe. It's my license, not yours. I've got to make choices to make sure I can deliver that care and keep myself and my patients safe."

Tessa:
Of course. Like you've said, we're nurses, we want to help. What can we do? But putting all of a sudden ... If I was to work in an ICU today, it would not be safe. I haven't worked on the floor in a situation like that ever. I've never worked in an ICU. I can do basic nursing skills, but I would not feel safe doing that either. I don't think that there was a choice sometimes, and that's really scary.

Dan:
Do you have thoughts about how the state could have handled it differently? I think there's the one side of the story of what else do we have? We can't just magically make nurses appear. There's not enough people to take care of these patients. What would be a better way to go about that?

Tessa:
What we had said all along and I think what was so frustrating, is the intent of that idea ... I came from long-term care was my understanding, and I work in long-term care so that's scary to me as well. But I just don't think that the intent and the rollout was done well. I think if the governor's office felt like that was an only solution, that they could have come to more nurses and we could have helped explain that and we could have helped roll it out more seamlessly with creating less panic about it.

Tessa:
Again, I think there's places that it may have been okay and it may have been acceptable and there may have been nurses that would say, "Absolutely, I have zero symptoms and I'm happy to help take care of these COVID patients." But I think first and foremost, we were never brought to the table for those discussions. When your crisis managing a pandemic as a government official and you don't bring the nurses to the table, that's a huge problem.

Tessa:
So I think that's where we should have started, and then we could have talked through some of those situations together about how does this look and how can we roll this out and how can we help get the nurses on board? The nursing workforce in our state is going to trust their association and their nursing leaders. That was the biggest problem from the beginning, in my opinion.

Dan:
Yeah. It's an interesting example of an opportunity for nurses to be at the table. From that experience, how have you and the association reset expectations or engaged with the state to maybe be at the table next time?

Tessa:
When that happened, when that executive order came out, it was overnight that media was reaching out to us and nurses were reaching out to us. I think it really taught us all something. I think it taught the nurses in our state that it's important to have your voice heard. I think even as the association president, I never fully realized how important my point of view and my voice was and how people generally wanted to listen. I think that taught us that, that people will listen if you talk.

Tessa:
So immediately we started reaching out. We did reach out to the governor's office. We did call out our own press conference, because we were asking for things that still weren't happening.

Tessa:
The governor's office did and finally have a meeting with us. It was a little too late at that point, honestly. But I think even moving forward when the mask mandate was going to expire, I reached out and said, again, "We want to make sure you know our stance on this and we think it's too soon." They did extend the mask mandate from the original date that was planned.

Tessa:
I think it goes on both sides. We have to be the ones to reach out as well. But in my very humble opinion, that is my volunteer job. So I feel like those elected officials need to be the ones that brings us to the table. We need to have continuous conversations. We need to have our voices heard in a situation like a pandemic.

Dan:
Yeah, exactly. I love the fact that you were able to get there, hold your own press conference, provide the perspective from the profession that's in the middle of this, and advocate for not only other nurses, but also the public and get a policy to be extended. That's awesome.

Tessa:
Yeah. It really was humbling. It felt great, and I do truly believe that. After we held that press conference, that was when we finally got a call from their office saying, "Okay, you've got our attention, let's hear it." It took a lot. It took a lot of conversations to get our voices heard. I think that really taught people that we're not going to give up. You're not going to silence the nurses. There's too many of us and we feel too strongly and passionately for our careers.

Dan:
That's so cool. I love that description of nursing. How was it for you personally to be thrust in the spotlight? Were you like, "Yes, let's go do this. Put me on camera. Let's go, the world's watching?" Walk me through the emotions and your thinking behind all that.

Tessa:
It happens so fast, and I'll be honest with you, I was home with COVID when it happened. I was battling being sick and still running my day job from home and my two kids were home with me, and now I have to ... It was scary the first couple of ones, and then it just became like ... Even our executive director of our association, we have one position where that's her job. The rest of us are a volunteer board and she keeps sending them to me and saying, "Another request. Another request. Please let me know if I can help you." But it got to that point that I was like, "You know what? I'm going to keep going." I'm sick and I have COVID and I'm exhausted, but people are listening. I feel really proud to be able to speak on behalf of the nurses in my state and in the nation because somebody had to do it.

Tessa:
Then my friends and family were like, "Oh my gosh, you did a great job and we're so excited that you're speaking on behalf of us." Colleagues that I worked with years ago would reach out and thank me. It really felt so humbling to know that people were listening and people did actually care what we had to say.

Tessa:
It felt really good. It really taught me a lot. I always want to pay it forward. I think it's a gift that if people want to hear what we have to say, I don't want to tell people no, because I'm so passionate about nursing and even when people ask me what my hobbies are, I say, "Oh, nursing," because that's how I really feel. I always say I'm just a loser with no hobbies other than my love for nursing. But it's been great. It's really been quite the experience.

Dan:
So what was the most exciting interview you did, or maybe one of the bigger ones where you're like, "I can't believe like I'm on this show or with this person."

Tessa:
I did an MSNBC one and I did a CNN one, and the MSNBC one was live. My kids were watching in the living room, again, while I was in the kitchen doing it. That's just a whole nother element to that because I have a ten year old and a four year old, and so when you're live on MSNBC and you have two kids within 10 feet of you, you never know what's going to happen.

Dan:
Yeah.

Tessa:
I don't know how many promises we made and pinky swears that there would be no words and they'd have to be silent. I can remember one where my dog was barking and there was all kinds of chaos. Again, you can't control all those situations.

Tessa:
That one was really the first live big one that I did. Then I did a CNN one, which also I just couldn't believe seeing it. Still, when I see that, it almost feels like it was surreal and it was at my house. It was in my living room. I set up a scene, and it was surreal. But it was amazing to know that even a nurse in North Dakota can have their voices heard if you just speak loud enough.

Dan:
Yeah. That's awesome. I can relate to a lot of that. This year has been a lot of press for us as well as we've gone through some of the COVID and putting nurses all over the country and it is always interesting to talk to reporters, see what they end up taking from what you say, and putting it into a story, how it's twisted and turned and highlighted and quotes that you didn't even remember saying put into the thing. It's just-

Tessa:
Yeah. I had a reporter call me one day. I was back to work, and at that point in my day I was just tired. I just had it with COVID and she asked me what it's like in North Dakota right now. And I said, "Well don't quote me on this, but it's a dumpster fire." And that was the headline of this.

Tessa:
One of my former bosses actually sent me a plastic dumpster fire in the mail a couple of days later. I was like, "Oh my goodness." That's when I learned that they're going to quote whatever you tell them.

Dan:
Yeah. As long as you're on with them in that recording thing's going, it's fair game, I guess. That's funny.

Dan:
There's actually some really good Bitmojis of your character drinking soda next to a dumpster fire. I think it was the official mascot, a dumpster fire is official mascot for 2020.

Dan:
Do you have advice for nurses that may want to get into the media or maybe thrust into those interviews? More and more press is talking to nurses about their experiences across the country. What are some tips for them as they get thrust into that opportunity? You don't learn that in nursing school or leadership school or master's program. It's something you've just got to develop.

Tessa:
You're right. You don't. It's nothing that you can just learn. I always have been fairly comfortable public speaking, but there's nothing that can prepare you for being live on MSNBC, I'll tell you that.

Tessa:
But I think that what nurses have to remember is that you just have to speak from the heart. You do not need some long-winded detailed speech. You just have to speak from the heart.

Tessa:
We know our careers, we know our workforce, we know what we need, and that's what people want to hear. They want to hear our emotions. They want to hear how we really feel and how we're doing. Once I started to just realize that I didn't have to spend an hour preparing for an interview, I could just talk from the heart, that's what really captures people. We haven't been rated the most ethical profession for how many years-

Dan:
Nineteen. It's 19 now.

Tessa:
Exactly. People generally want to hear from a nurse. So I've just learned that I don't have to panic about it.

Tessa:
I'll tell you, I've been the president, just started my third term now and North Dakota does legislative session every other year. So we've always talked about testifying at session and everyone has just [inaudible 00:14:36] and I've never done it either.

Tessa:
This week I did do it on a bill that I was very passionate about. Before I got there I was thinking to myself should I be nervous? I actually had to drive, the roads were really bad and it was 100 mile drive to the Capitol City. I didn't even feel a second of nervous when I got up there anymore because it's just something that is so important.

Tessa:
The people in that room don't do what I do every day. They don't know, and that is my job is to try to convey that to them. I think that's what nurses need to know, is that we even try to tell students that and new nurses that want to be involved in our association, you don't have to have a management job. You don't have to wear a suit to work every day. You just need to be passionate about what you do and the patients you take care of. People will listen to that every time, all day long.

Dan:
Yeah. Your passion definitely comes through. I think that's the secret sauce to public speaking is be passionate about it, and then what you said also is no one knows what you're supposed to say. There's no right way to do it. It's really just being you, talking from the heart, speaking from your expertise and that's the secret to public speaking. S that's some great advice.

Dan:
I'm curious from a nursing, the profession itself, you talked about the support from your friends and family and your state constituents. What was the outreach like from the greater country? Did you get calls from people that were like, "Hey," you're like this is awesome. Get nursing up there.

Tessa:
Yes. That's something I told my husband. I said, "It's the weirdest thing." I got Facebook messages from people like, are you the one I heard on this and this show? Thank you for all you're doing. We support you from lots of other states. I had a text message one time on my phone from a number, I didn't know who it was and said, "Hey, I just saw you on the national news." It was somebody that I partied with in college.

Tessa:
It was just so interesting that people just came back into my life or people who are complete strangers. I got a card at work from a couple who, I think they lived in Arizona, and it was addressed to me at my workplace and just said, "We heard your article or read your article, I don't remember which one it was, but job well done. My wife and I live in this county and we're battling COVID and thank you for all your advocacy."

Tessa:
Those are the things that ... That's why you don't say no for another interview because you truly are touching people and people are really listening and it just feels good.

Dan:
That's awesome. Yeah. That's such a great kudos and what a great reinforcement to get out there even more. That's what keeps us going, right? It's like the letters from the patients and now you get them from all over the world.

Tessa:
Yeah. I had told Lindsay when she reached out to me, I missed an interview with her last or a call with her last week, but we had a really difficult ... That's where I work. I work in long-term care and you're not supposed to have a favorite patient, but he definitely was mine and everybody knew that.

Tessa:
The family asked me to do a eulogy, and still, that was very difficult because there's so much emotion behind that. But when I was done, his daughter said to me, "You just speak so well in such a highly emotional situation." I laughed and I said, "Well, I've had a lot of practice on the national news." We laughed about it, but I just think it's something that you just have to, again, I did prepare for that, but you have to just use your emotions. People will feel that.

Dan:
Yeah, for sure. That's such a great story and it's awesome to hear the connections that we make across the country with our profession and with our patients is just, it's just awesome.

Dan:
From a North Dakota standpoint, what are some of the biggest pieces that your organization's advocating for? We talked about a couple of the ones that are in the news, but what are some of the biggest, big issues in North Dakota?

Tessa:
I think one of the biggest issues right away, of course, was that our state took a really long time to do a mask mandate.

Dan:
Yeah.

Tessa:
Again, people are going to say, "Well, how do you know that's what affected it?" Well, we don't, but we also know that our numbers went from hospitalizations to over 300 to probably today maybe 70 in a matter of six weeks after we did a mask mandate and some closures and some mitigation strategies that needed to be done far before they were. It really, really pushed for safe nursing practice, of course.

Tessa:
That was a thing that we've talked to a lot of nurses about, that if you don't feel safe in the situation that you're in, or you don't feel like you've had the training, you have to stick up for yourself. It's your license. It's your patient.

Tessa:
We've had some open forums with our association and nurses calling in and we've just been giving a lot of guidance. People will come to us and say this and this and this happened at my workplace. What do you suggest? So I just feel like we've had that opportunity to give people a sounding board, which has been really nice.

Tessa:
We have on our advocacy platform this year school nursing. It's not huge in North Dakota so that's really something that we're pushing hard for. We really think that's so important that those kids in school, especially of course, we saw the importance of a nurse in a school during a pandemic, how important that role is now.

Tessa:
We have a handful of things on our legislative platform that we're really working on and supporting. Te legislative session has started out busy for healthcare topics. I've already testified twice this week on different topics.

Dan:
Wow.

Tessa:
So it's going to be busy.

Dan:
That's awesome. You're probably one of the states with the most impact from a nursing perspective on the legislature, maybe, I don't know.

Tessa:
I hope so.

Dan:
That's great. The other thing that we've been seeing at least in the news is that North Dakota, and we touched on it at the beginning, is doing really well with vaccinations. What are you seeing on the ground there? What do you think is contributing to the success in that area?

Tessa:
I will tell you, in the community that I live in, our director of our public health unit, I swear she should be a national hero, the amount of work that she's done. I joked today when I went there to get my booster for the vaccine, I said she has been training her entire life for this. We are so incredibly lucky to have her in our community, our state in general. But I just know that in my area, the Southwest region of the state, they made a plan, they communicated well, everything is well planned out and so much access to testing. They just have done such an amazing job.

Tessa:
Like I said, she's been prepared. She's done disaster planning. She had done pandemic planning. She's kept us as leaders in the community trained and ready for this, and I think that's what it boils down to, is being prepared for something like this to happen and knowing how you're going to get through it.

Dan:
From the rollout standpoint of administering the vaccine, is it mostly nurses? Are they using what we've heard from the CDC, which is engage pharmacy, engage MAs, engage with everyone that's possible to put that needle in someone's arm get them on board, or is there a something different that you're up to?

Tessa:
I do know that there's pharmacies. The company that I work for as a national company and a lot of our other properties are partnering with pharmacies. We just partnered with public health here.

Tessa:
Our national guard has been a huge presence in North Dakota with the testing events, and now they were there again today for the vaccination events. So they've been completely supportive and helpful as well. I know that public health in our area would have struggled without them. They've been transporting tests back and forth and they just have really done a great job.

Tessa:
I think the hardest part now is just getting people educated about the vaccine. I spent a great deal of time doing that. I personally turned a handful of people who said they would never get it. To me it's not about trying to get people to get the vaccine. Of course, I'm a huge supporter. I just want people to be well informed.

Tessa:
So I tell my staff all the time, I will respect your decision either way. I'm a huge supporter, but people don't get the right information and that's what bothers me. People get a snippet from Facebook or a snippet from Instagram or a snippet from the news and they run with that.

Tessa:
So whether it's, oh, it causes them fertility, or you're going to grow a tail or all these things. Again, these are the same people, I tell them all the time, that are making a lot of unhealthy decisions and putting a lot of unhealthy things into their bodies. But this is the one thing that we're going to stress about.

Tessa:
So I just really have been passing, we have an infectious disease doctor in the state who has done a lot of public education about the vaccine, and he did a really well done video, so I've been sharing that with people. It took me a week, I think, to get through all of our family members of the residents that live in my building, talking to the families, educating them on the importance in a long-term care facility of getting our residents vaccinated.

Tessa:
I'm happy to say that 100% of my residents are, but my staff uptake is not good. I think we have about 33 staff and I don't even think that we have 10 that got the vaccine. So I have a fairly younger staff and they're just scared. I understand that, but the majority of my leadership team did get the vaccination. I have one that's pregnant so she chose not to and one that is immunocompromised and he chose not to for other health reasons that their doctors they visited with.

Tessa:
But we did a video just saying here's the facts, and this is why I got it. We sent that around to our whole corporation so they could share with their staff and it's been effective in other buildings, but not my own, which is unfortunate.

Tessa:
But again, everyone keeps saying maybe on the next round so I think people are just cautiously waiting. They want to know how is it going to affect them and then also if I get the vaccine, will I get to take my mask off at work? Will I have to be tested less? Those things are too soon to know, I think, but I think once we start to see some of those rules, so to speak, or guidelines, that might change it as well.

Dan:
Yeah. I'm hopeful for that too. I think it follows that innovation curve. There's early adopters who are like, yeah, give it to me. I'm ready to go. There's the early majority, which are people that want to wait and see what happens to those people and then they'll do it. Then you got the late majority and then you got about 16% of the population and any change is not going to change. There's always that.

Dan:
But I think what you're doing is great, is get that information out there. Don't blast it in their face, but just be informative, use your expertise. I think the biggest thing, and it's just human nature, is you make decisions off the information you're given. So if you're only information is on Facebook with a friend or rumors that are going around then you're not making the right decision necessarily. So just getting the right information out to people is such a great approach.

Tessa:
Right.

Dan:
So what do you want the world to know about nurses in North Dakota? I'm in California so North Dakota seems just a world away. But what's special about the state and what you guys are up to?

Tessa:
I think our nurses, like any nurse, I don't know that this is different in any state that you go to, but they're so dedicated to their profession. Our nurses have really learned how to speak up and grow up and stand their own during this. We've had to muddle some waters together and we've had to learn a lot of things and we've had to test each other's limits and our own, and they've been tough.

Tessa:
In our Midwestern culture, we are tough. We consider ourselves tough people. This has really shown what we can handle and what we can do together, and our nurses have just done such a fantastic job coming together on a state level of, again, I am in conversations with a lot of nursing leaders and I'm also the president for the North Dakota Center for Nursing so I have the ability to talk and network and plan with lots of nursing leaders in this state. From the associations to the board of nursing to the centers to the hospital situations, everybody has just really come together well, and I'm very proud to be a North Dakota nurse.

Dan:
I love it. Yeah. We should do a whole nother show about boards of nursing. How has the North Dakota Board of Nursing responded to the pandemic? There's been several states that haven't changed anything. They made it harder to get licenses, to get nurses in the state to help. How has the North Dakota board of nursing responded?

Tessa:
They've done a great job with the situation they were dealt. They have not made it harder to get licensed. They've been willing to be flexible. They've been willing to work with their legislators to see what they can do to bring in retired nurses. They've been really good advocates for nursing graduates to get their NCLEX done. I know that's a huge problem because the testing centers aren't open. They've worked tirelessly to make sure that those nurses can test so they can start. They've done a great job.

Dan:
That's awesome. Tessa, we'd like to wrap up the show with one of those nuggets that you want to pass on to the nursing profession and all the listeners that may be listening today. What would you like to hand off from North Dakota?

Tessa:
I think a thank you, a heartfelt thank you is much needed. I want all the nurses in the country to know how thankful we all are to do this together and get informed and don't give up on your patients. I know it's been tough, but we're near the end of this and we can push through.

Dan:
Words of advice. Great advice on how to speak to the public, advocate for your profession, talk in front of the legislature. We covered so much. You're a super nurse, and it's so awesome to be able to talk to you and share your story. Where can people find you online? Are you on LinkedIn? Where's the best place if they want to reach out and then connect with you and learn more?

Tessa:
Sure. Yeah, they can find me, I am on LinkedIn. Our North Dakota Nursing Association page has my information, my work page, CountryHouse at Dickinson through Agemark has it. I'm on Facebook. So yeah, they can find me pretty much anywhere.

Dan:
Awesome. We'll put some of those in the show notes so you can connect, and Tessa, thank you again for being on the show.

Tessa:
Yes, thank you so much.

Dan:
Thank you so much for tuning in to the Handoff. If you liked what you heard today, please consider leaving us a review and subscribing on Apple podcasts or wherever you listen to podcasts. And for more information about Trusted, please visit trustedhealth.com. This is Dr. Nurse Dan. See you next time.

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