Episode 11: Consistency in Clinical Outcomes

Lynette E Franklin (00:05.412)
There, okay, now I can. That's bizarre. I can't turn this off. Anyways, hi, nice to see you again. Your hair is getting long.

Cara Lunsford (00:14.864)
I know it's getting so long every time I see someone they're like my gosh your hair is so long

Lynette E Franklin (00:26.17)
Yeah, is it still, like you've still got it cut on the side.

Cara Lunsford (00:29.742)
Yes, it's cut on both sides. It's just that I have so much hair.

Lynette E Franklin (00:32.387)
yeah.

I bet it's like mine, does it grow like this? Yeah, so I just had mine totally thinned out last night, but it was like, yeah, I said I can't, when I lived in the South, it was like a triangle.

Cara Lunsford (00:38.222)
Yes. Yes.

Lynette E Franklin (00:51.3)
because it was just... Yeah, because it gets curly and then it goes whoop.

Cara Lunsford (00:51.428)
Like a little like a little mushroom

Cara Lunsford (00:58.368)
that's so funny. I love that.

Lynette E Franklin (01:00.066)
I've got one picture, I look like a mad hatter. Because my hair is just, I should show you the picture.

Cara Lunsford (01:03.042)
Lynette E FRANKLIN (01:09.626)
Just a sec. I'm not gonna show you the picture. I'm just trying to turn this off because it's driving me crazy. Anyhow.

Cara Lunsford (01:18.649)
my gosh, I'm so happy to see you again. It was so nice to see you.

Lynette E Franklin (01:21.456)
I'm so happy to see you. What is going on with you, Kara? Are you all ready for Christmas?

Cara Lunsford (01:26.041)
I am. I'm ready for Christmas. I decorated. We do not have a Christmas tree inside the house because we have two three and a half month old kittens. And so there's no tree.

You know what? I saw somebody who had a tree. What they did is they suspended it from the ceiling.

Cara Lunsford (01:47.416)
You know what? I heard about that too, that you can like suspend it from, but here's the funny thing. So we have, we have like a farm here. It's so many animals. We have three snakes and two lizards, four chickens and two cats and two dogs. And, and we have a huge, huge snake cage that's in our living room that is like eight feet tall and four feet wide. And it,

literally has just a bunch of, it's surrounded by like kind of like almost like a chicken wire, but very like the small little squares of wire, mesh wire. And the cats have learned to crawl the entire height of the snake cage. And they will sit on top of the snake cage eight feet up in the air.

They crawl, they climb, they get, no, it's not glass. It's like a wire mesh that goes all the way around it, because it's like a homemade snake cage. And they literally just scale the whole thing all the way up.

Lynette E Franklin (02:51.17)
it's not glass.

Lynette E Franklin (03:01.146)
Yeah. Yeah.

Lynette E Franklin (03:07.682)
Isn't that lovely? Just lovely.

Cara Lunsford (03:09.072)
I know. So we did decorate the tree that's inside the snake cage. So we have a really large seven and a half foot boa. And that's who lives in that cage. And then we have seven and half feet long. Yes, taller than you, I'm guessing. Yeah, yes. So

Lynette E Franklin (03:15.088)
We have a tree. What type of snakes do you have?

Lynette E Franklin (03:29.434)
feet so as long as me.

Yeah, yeah. Is it, are they friendly?

Cara Lunsford (03:37.712)
Yes, yes, they're all friendly. We have two ball pythons. so yeah, so we have my my son, a ball python is there. They're about five feet long ish. They are about that big around. So they're fairly girthy.

Lynette E Franklin (03:47.76)
What's a ball python?

Lynette E Franklin (04:00.325)
Okay.

Cara Lunsford (04:03.952)
But they don't really get much longer than five feet. Like five feet's kind of a max for a ball python. And then they really just like to curl up in a ball, which is why they call them a ball python. They like to just kind of curl up in a ball and they're pretty quiet, isolated creatures.

Lynette E Franklin (04:16.825)
Okay.

Lynette E Franklin (04:24.73)
So, have you always had snakes?

Cara Lunsford (04:27.768)
I've only had snakes as an adult. When I was a kid, I always wanted a snake, but my mom was like, absolutely not. You cannot have a snake. I had lizards when I was a kid. I had chinchillas. I had guinea pigs. I had all kinds of like things.

Lynette E Franklin (04:30.704)
Okay.

Lynette E Franklin (04:34.703)
Yeah.

Lynette E Franklin (04:47.386)
things. You had all the prey of snakes.

Cara Lunsford (04:51.096)
Yes, yes, I had all the, yes. And we don't feed our snakes live, we only do frozen thaw, so we don't do anything live. Otherwise I would end up with a bunch of live rats too, because I wouldn't be able to feed them either. I, yeah, so yes, it's quite the farm. It's quite, yes, I have one child. He's totally outnumbered by, he's a total animal lover.

Lynette E Franklin (04:58.66)
Okay.

Lynette E Franklin (05:10.934)
Do you have children?

Lynette E Franklin (05:14.928)
Okay, and what do they think about it?

Lynette E Franklin (05:19.769)
Okay.

Cara Lunsford (05:20.4)
Probably if he wasn't such an animal lover, we wouldn't have quite so many animals. But I'm definitely my mother's daughter because she had so many animals and now I've become my mother. Yeah.

Lynette E Franklin (05:24.782)
Okay.

Lynette E Franklin (05:32.12)
brother. Well, I have one Jack Russell who hadn't barked until I went on to this. And I was like, you little, yeah. And so anyways, he probably will come and join me, but he knows when I'm on the computer talking that he doesn't need to bother me until 5 p.m. And then at 5 p.m. he's allowed, because he's, you know, that's his dinner.

Cara Lunsford (05:38.67)
Well, of course. Yeah.

Cara Lunsford (05:50.935)
He's very smart.

Cara Lunsford (05:55.322)
Boy, you've really trained your... I need to train my son.

Lynette E Franklin (05:57.188)
Yeah, I'm saying that. Yeah, I'm saying that. That doesn't necessarily mean it happens, but that's what it's supposed to happen. Yeah.

Cara Lunsford (06:04.046)
Yeah, that's hilarious. Well, Lynette Franklin, I am like so happy you're here because I know we talked about, yeah, I talked to you a little bit about when we were at Wild on Wounds and we had a chance to connect there and I know we talked a little bit about we should do.

Lynette E Franklin (06:12.912)
Thank you. I'm so excited to be here.

Cara Lunsford (06:31.824)
podcast, you should come on the podcast. then when I saw your name on our list, I was like, yes, we did it. We did it. We effectively did it. my gosh. Well, as someone who loves to talk about wounds and has been a wound care nurse and has been a hospice and home health nurse and has probably far too many

Lynette E Franklin (06:38.564)
Good! Yay!

Yes, and I'm excited to be here.

Cara Lunsford (07:01.114)
photos in my phone of decubitus ulcers. I'm always telling people, hey, don't swipe through my phone.

Lynette E Franklin (07:05.7)
Yes?

Lynette E Franklin (07:12.064)
my goodness, I'm right there with you, girl. Yeah, and remember I was also in urology. So not only that, I have some other pictures that I've actually had to talk to IT about in the past because I was like, my goodness, you know, I would do Google searches on pediatric diaper rash or something like that. And it all popped up and I was having a panic because obviously that's not who I am, but.

Yeah, the IT people, I knew that the IT people knew me when they're like, Lynette, we've had you on our radar forever. We know that this is you. They're like, we don't like looking.

Cara Lunsford (07:49.163)
my gosh, I know, you know what? I didn't even think about that, but yes.

Lynette E Franklin (07:54.51)
Yeah, yeah. But anyways... Yeah.

Cara Lunsford (07:57.794)
You know what, maybe I should have been notifying IT. I mean, because I was a pediatric nurse too, and like, I'm sure that I was Googling some stuff and looking for some stuff that I...

Lynette E Franklin (08:06.412)
yeah, like I Googled, yeah, there was tons of different things. like, then when you're looking, yeah, anywho.

Cara Lunsford (08:12.728)
Yes, we digress, but yes, you know, so caution to all of you who might be wound care nurses or peds patient, peds nurses or something. Careful what you Google. So, or at least notify someone. so I, I'm excited to talk about this because I think that what we're talking about, like consistency.

Lynette E Franklin (08:15.16)
Yes.

Lynette E FRANKLIN (08:27.162)
Yes. Yeah. Yeah.

Cara Lunsford (08:40.112)
in care and how important that is. And whereas I was just having this conversation with someone earlier today where I was like, love one of the things I love the most about like home health nursing. And when I started going and becoming like I did a mission trip and and I

And what I really loved was learning like tricks of the trade, right? There's something very satisfying, I think, about being a nurse and being like, but did you know that you could do this little trick or that little trick and see better results or it's gonna heal so much faster if you use this or use that? And it might seem a little not customary or certainly like not by the book.

Lynette E Franklin (09:19.866)
Yeah.

Cara Lunsford (09:36.984)
And that can be really, I don't know how to say it. I guess just like fun and satisfying as a nurse to feel like you're resourceful and that.

Lynette E Franklin (09:43.813)
Right, well there's a MacGyver aspect to our job that I think a lot of us, it's our middle name and we all, you know, I always say to people, we learned everything we need to know about wound care, nursing and kindergarten. You know, can you cut? Can you color? Can you draw? So all those different things. Can you follow instructions? And I think that's part of the big thing. But the opportunity to be autonomous and to be a leader is

Cara Lunsford (09:50.692)
Yeah.

Cara Lunsford (10:05.413)
Yeah.

Lynette E Franklin (10:13.732)
quite satisfying, I definitely hear what you're saying. And especially when you're in the home care, where you basically, you're it, you are the eyes, ears, mouth, nose, everything for the patient. And if your experience is different than mine, you won't get in touch with a physician for potentially weeks. So you basically need to have some type of system in place that

helps over that course.

Cara Lunsford (10:45.392)
So that's kind of what I, so I'm always, maybe it's because I'm a Libra, but I'm always trying to like strike this balance, right? Like I, how do you stay consistent, follow certain best practices, right? But also have a bit of that autonomy and like how far outside the lines can you color and still be,

following like a certain standard of practice because I think when we're talking about consistency of care, there's this tendency to want to like, okay, well, I have to do this and I have to do this and I have to do this and I have to follow these very specific guidelines and and that can be difficult when you want to use maybe some of your own historical knowledge or if you've been a nurse for 20 years, you're like, yeah, I know but

one time I did this thing and it really worked, you know, and you want to incorporate that. talk to me a little bit about, well, A, okay, first, back up, back up, Sarah, back up. Let's, I need to have you first introduce yourself and just like, just tell, tell the audience really quickly, like who you are and you know, why we should bother listening to you in the first place.

Lynette E Franklin (11:54.832)
Woo! Yeah. Yeah.

Lynette E Franklin (12:12.976)
Well, that's a very good question. I don't know if I'm gonna be able to answer that but hopefully Some of my credentials will satisfy people. So my name is Lynette Franklin I'm a clinical nurse specialist in adult health and I've been a nurse I graduated in the 1900s so I remember actually where we had to pay to do searches for

Lynette E Franklin (12:42.328)
make for journal articles, which is crazy now because I can do it and get the article without having to go to the stacks and everything. So I became a Lundostomy Continence Nurse in the early 2000s and had the privilege of working at Medical University of South Carolina under the guidance of Carolyn Cutnow.

who's just a trailblazer in terms of practice and in terms of getting it right and in terms of just being a fabulous mentor. So that's who I am. I've done palliative care. I was practicing in the States for 25 years. I'm originally from Canada and actually moved home at the time of COVID, not because of COVID.

But so my practice has spanned four countries and diverse care settings. I've done home health and by home health, not like as a clinician as and also in professional practice. I've done hospice, med surge, and then mainly as nursing as a wound ostomy continence nurse. And specifically I've

ran two clinics as an advanced practice nurse in South Carolina and in Georgia. And so why should you listen to me? you know, yeah, well, no, but yeah, I think, I think, you know, that's one of the things how do you stay consistent? So how do you evaluate if somebody is worthy to be listened to? Because you know, Dr. Oz, he, he has a huge audience and

Cara Lunsford (14:20.644)
Well, that's it. I mean, that's why you should listen to you.

Lynette E Franklin (14:39.802)
question is, should we be listening to him or because all of Oprah does or do we need to evaluate what he's saying based against good evidence and against what other experts in the field are saying? And so the problem is evidence and in wound ostomy continence, it's hard to have the exact, those randomized controlled trials.

Cara Lunsford (14:54.618)
Yeah, science.

Lynette E Franklin (15:08.932)
with the human body because people live and it's very hard to do different things, but they're done. So I think the higher the evidence, the better. So.

Cara Lunsford (15:20.964)
Yeah, and I think that...

the more that you've been at the bedside and doing the work, or even been on the receiving end, like as a patient. I mean, I don't know if you have much, like if you wanna speak a little bit about just your own experience, but I think that that goes a long way too, is like, have you been on both sides of the care, right?

Lynette E Franklin (15:42.62)
yeah.

Lynette E Franklin (15:55.47)
Yes. Well, thankfully I haven't had chronic wounds. I am a product of spending many a summer without suntan lotion and being a lifeguard and or sunscreen. And I've had a basal cell carcinoma on my face and had to have mose and actually I have a mose coming up again. And so

you know, I'm evaluating, they're telling me to do this and I'm a wound care nurse. So do I really wanna use that particular tape on my face? Or do I want to, you know, pick up something from the drug store? And so there's always that...

Am I an expert or am I clinician or am I a patient? And I think coming humbly into the situation and being able to justify what you're doing but not being a hard head. And I can say with all honesty, I've had problems listening. And I think...

you don't necessarily have to throw the baby with the bath water. It's okay to say, know, I hear what we're doing here, but let's talk about it this way. And maybe we could get something better. And I think that with that humble approach,

and looking at things from that lens, sometimes that's helpful, but at the same time, I think it's also important to make sure that we're doing what's safe. Like there's certain times, like my students will tell me that I've like, stop, know, and patients are like, what are they doing? You know? So it's okay to do that, to stop and reevaluate. And it's also okay to admit I was wrong. I totally goofed this up.

Cara Lunsford (17:55.864)
Yeah, I one of the things that I usually for myself when I'm evaluating whether or not, you know, is this someone I should be listening to? I look to see if somebody what that level of humility is. Am I listening to someone who who is saying, you know what? I used to think this and I used to practice this way. And then. Evidence.

Lynette E Franklin (18:17.424)
Mm-hmm.

Cara Lunsford (18:25.7)
was what I was looking. I was looking at the evidence and that changed my mind and then I started practicing differently.

For me, it's so important that when you're listening to someone, if it sounds like they have never deviated or never been willing to say, used to do things this way, but then I realized that that's kind of an old or an antiquated way of doing things. And then I learned something new or the data didn't support what we used to do. And then we changed. If you're not hearing that,

I personally would question that person.

Lynette E Franklin (19:10.33)
Yeah, I think also how you go about asking. I love that approach, you know, listening to what made them.

change or whatever, I always like to tell me about, not even asking a question, you know, that's really interesting how you did that. Tell me about it. And a lot of times we'll find out that people, especially patients, will actually put measures in place to make it easier. And they just don't know, you know, our patients aren't going to SINHAL or meds, you know, they're going to Dr. Google. And so they...

when you ask them to tell you about it, sometimes you can actually streamline. I've had a lot of patients who have disabilities or different abilities change the way things are done just because they physically couldn't cut or they physically couldn't reach. And so sometimes those things that aren't impacting the care in terms of healing, it's okay to change. And a lot of those things I've actually used to help

help other patients and to encourage them to stay consistent and also allow them the autonomy that they need as promoting their self-care. And so a lot of times, you know, as nurses, as a new nurse, it's really hard to figure that out. Like where's the give and take? And so...

It's also important to talk to your mentors. How would you handle this situation? But at the same time, always trying to improve yourself. As a new grad, I just remember one of my colleagues, when I started out, I was in medicine floor, 33 patients, and it was chaos most of the time.

Cara Lunsford (20:50.189)
Mm-hmm.

Lynette E Franklin (21:09.272)
And one of my, there was a lot of us, the only person who had experience was a charge nurse, and then the rest of us were all new grads. And my friend Kristen would say, well, last night when I looked it up and I thought, my goodness, she's worked a 12 hour shift, she's on her third, but she still looked it up. And I think I...

have taken that and run with it because we have to be looking up things. I was doing long-term care at the beginning of COVID. Coming back, that was one of the needs for nursing where I was living. And it's okay to look up meds. I hadn't passed meds forever, but...

And also, the generic name of a med in Canada was very different than the generic in the States, I don't like. like, generic is generic, but it's not. And so being able to say, I looked it up, and the thing is we need to look it up because so many people aren't. And just take that extra time. know, have a little list. I call it the parking lot. And you write things down on it to make sure that you're checking. Like, have you checked that drug for a while? You know, I forget.

morphine a thousand times, but you know do I remember what the half-life is or what drugs it interacts with? Not always, but and those are things that are important to do.

Cara Lunsford (22:23.001)
Yep.

Cara Lunsford (22:31.864)
Yeah. And you know what's so funny is that, and this is not exactly the ex, it's not the perfect analogy. However, I'm going to use it anyway. I'm going to do it. So, you know, when you're in a fine dining, you know, you're in a restaurant and, and, and the

Lynette E FRANKLIN (22:44.858)
Go for it, girl. Yeah.

Cara Lunsford (23:00.302)
and you have like allergies or you have food restrictions or things like that. And you see the server trying to memorize eight people's orders. You know, and I was like, my God. I was like, just write it down. Like, just like, you're not gonna get an award for like being able to memorize. I'm not gonna tip you more if you memorized everyone's order. We're gonna tip you.

Lynette E Franklin (23:03.834)
Mm-hmm.

Lynette E Franklin (23:15.524)
Yeah. Yeah.

Cara Lunsford (23:29.252)
forgetting the right order, right, you know, not getting something that someone's allergic to, you know, like, and it's funny because like, I think of that a little bit in terms of being like a seasoned nurse. Sometimes we think like, you know, if some young nurse sees me like looking it up in a drug book, like, what is that gonna say?

I'm you know, I'm more of a professional or I I'm I'm a seasoned nurse. don't need to be like looking up drugs I should know all of these drugs by heart and it's like well, no, no, you shouldn't and It's way more important that you look it up

Lynette E Franklin (24:09.744)
Right, right. And the thing, right. And the thing is things change. Like the amount.

change is so constant and I don't know how anybody can stay up to date on everything. So it's important to make sure that you have a variety of sources that you're using, that you're evaluating those sources and making sure that...

you are staying up to date and staying consistent. And I think that sometimes, unfortunately, is when there's inconsistencies that happen is when we actually check. And by that time, it's usually too late. And I hate saying this, but we have to practice.

Cara Lunsford (24:54.309)
Yeah.

Lynette E Franklin (25:00.032)
such that if we were sitting on a court of law that we would, sitting in a court of law or on that jury, we'd be able to defend what we've said. And having been deposed and sat for hours on the witness stand, one, it's very scary, and two, I wouldn't wish it on my worst enemy, but,

at the same time for the client, I am glad that I had evidence. I'm glad that I was able to back it up. And years later, actually, one of the jurors stopped me in the grocery store, said, you don't remember me, but you're some whole nurse. she said part of it was because you knew the answers and you showed it. And she was a baker at like the local Harris Teeter. So I think...

that ability and also to say, you you don't know, but you'll look it up. Like that's, people say you don't know, but then the second part of that is you look it up. And that's so important. Right.

Cara Lunsford (26:03.438)
I think that that's the consistency, right? Like, so I think people think when they think of consistency, right? They think I'm gonna do things the way I've always done them and I'm gonna keep doing them the same exact way. And that is not the type of consistency that we're talking about. Although, you know, it's good to have some level of consistency in that way, but it's more important to be consistent.

Lynette E Franklin (26:16.048)
Right.

Lynette E Franklin (26:21.892)
Yeah.

Cara Lunsford (26:30.89)
in what you in your dedication to learning and to staying abreast of new ways of caring and providing care. Because really at the end of the day, what we want is consistency in outcomes. Right? And if Kara is over here packing a wound wet to dry, you know, because that's how it was done 30 years ago.

Lynette E Franklin (26:48.59)
Exactly.

Cara Lunsford (27:01.424)
And when actually that got changed from wet to dry to wet to moist, and then, you know, then it went kind of from, I mean, not to say that you don't do wet to moist in certain circumstances, but then there's like negative pressure. then there's like, you know, so if I, yeah, among other therapies, plenty of different types of therapies and different types of...

Lynette E Franklin (27:19.234)
or a lot of other therapies.

Right. Right.

Cara Lunsford (27:29.584)
dressings like those dressings have evolved and sometimes and I don't know if you kind of have that experience sometimes with some of the older like I don't want to say older more seasoned wound care nurses who maybe have been doing it for 40 or 50 years if they're not committing to a their professional development

Lynette E Franklin (27:30.884)
Okay.

Cara Lunsford (27:59.072)
and continuing to take classes and continuing to go to conferences and to learn about new supplies and learn about new treatments, then they can potentially get stuck. And then there isn't that consistency, right, for patients in terms of like...

Lynette E Franklin (28:19.152)
And I think you've just sort of highlighted a whole bunch of issues. I always, when I go in and see a patient, first of all, I ask what are their goals and what are my goals? And then together, hopefully we'll be able to get some type of plan put together. So first of all, making sure our goals are correct.

and that you've written those down someplace that their goals, what their goals are. Because when you've been looking after a chronic wound, a lot of times patients or clinicians get to a point like nothing's happened, but then you look back and you're like, my goodness, the wound area went from this to this. Like it is working, it's slow, but it's working. So that's the first thing. The second thing in terms of dressings and all those things, that's excellent. You're right, all those things are

important but also is your goal to do it efficiently and cost. Cost is huge. Like I have been privileged that I've worked at places that have paid for me to go to conferences and paid my time while away. But if you are in a situation that you can't afford the hotel or you can't afford not getting a paycheck, how do we do that? Like how do you stay consistent and

Or if you've got a patient who has no insurance, how do you, or they live someplace that they don't get delivery. And so I think it's really important that we ask our goals and then also identify the things that are impeding those goals. And so then as wound care nurses as a whole, we can unite and say, hey, this is what's happening. I want to make sure that I'm consistent with my colleagues.

One of the things that Angela Dai at Emory taught me this and she's brilliant. She's a wound care nurse and it wasn't necessarily wound care that she was negotiating, but she was negotiating salary. And I had never really negotiated my salary, and I'm talking negotiate. And so what she had done is got the...

Lynette E Franklin (30:41.568)
it called the WCN.

that document that looks at how much people are making, their source of income and all that. And then she cross referenced it to what they were doing and what the averages in their state were. And she went to her institution and said, hey, you're advertising that we're number one in the state and we're number five in the nation, but my pay salary here is in the lowest 25th percentile. But my education is in the top five.

percentile of the country and so this is not adding up and when you've got those facts and figures it makes a big difference and so I know a lot of times where you know you're taught don't talk about your salary don't talk about what you're getting as a clinician and you have to honor policy and things like that but I think

that we need to not be afraid to say, hey, I'm only making X amount of dollars a year, but they pay for this, this, this, this. And so when you look at that, I'm actually getting just the same. But also negotiating that and bringing that to the table so that people know where we are. And so then that can...

Cara Lunsford (32:04.388)
Yeah, because if we end up, yeah, if you lose those people, if you lose people who have that type of experience and education and credentials and you don't value them accordingly, you end up losing that type of...

mentorship of other nurses who are there, you know, working within your organization. And then that also affects consistency of care, right? Because when you have turnover and you have new people coming in with who maybe don't...

Lynette E Franklin (32:30.533)
Mm-hmm.

Lynette E Franklin (32:40.879)
Yeah.

Cara Lunsford (32:52.57)
have the same set of values and professional development and are not maybe staying abreast of, you know, current trends and the data and all of that. If you don't value those people and if you don't value yourself enough to ask for for what you're worth, then you end up leaving an institution. And there's a ripple effect. To that.

Lynette E Franklin (33:19.524)
Right, exactly. And I think, you know, I've worked in institutions where there's no union. I've worked in institutions with a union. I've worked in private. I've worked for non-profit, for profit. And one of the things that I have seen consistently is when the nurse is valued and...

there seems to be a different approach. Now at the same time, do they complain? yeah. Like, is everything all roses and giggles? No, like there is still stuff hitting the fan like every other job. But at the same time, the level of care is quite different. I'm gonna use an example that happened here in Canada.

because we're socialized medicine during the COVID epidemic, nurses who were working for the province, so in hospitals, anything that was not.

private institution where actually they had a salary freeze. And at that time, so since then they've had a lawsuit and the nurses were recouped that price, that money, but there hasn't been in that.

situation there hasn't been a raise in salaries that is consistent necessarily with the cost of living increases. Whereas I worked for a not-for-profit who we had to raise everything. Part of my job was I had to spend X amount of hours fundraising, either supporting the institution or bringing in money. And I was a bedside nurse, but at the same time,

Lynette E Franklin (35:16.84)
I felt so valued because each, even though I was working for them during COVID, we received a 3 % increase each year because the board voted for that. We also received

validation in terms of nurses week. We didn't get a piece of fruit. We actually had substantial gifts. Now, are those things necessarily gonna make or break? Not necessarily, right? I understand completely that there is different priorities and we might not have the priority to be able to...

support the latest and the greatest dressing, we can still do it a different way. But at the same time, I think we have creativity and a mind that thinks outside of nursing, how can we get the same thing for the same cost? so I think that

Being curious and creative is so important too, but at the same time, and I'm speaking to administrators and I'm speaking to the bedside nurse, I know we're exhausted. I can tell you many times I came home in tears because I just did not have one more ounce to give. But I think we also can use that to our advantage in the end.

Cara Lunsford (36:51.226)
Yeah. Yeah.

Lynette E Franklin (36:51.856)
I guess I'm saying that to give people hope that it can be terrible, but it can get better, and we can influence change.

Cara Lunsford (37:03.503)
Yeah, of course. the thing is, that one of the things that I wanted to highlight that you mentioned briefly is also socialized medicine versus what we have here. And that

Lynette E Franklin (37:26.938)
Mm-hmm.

Cara Lunsford (37:31.736)
I don't know. Do you think that there's more uniformity in care, in socialized medicine, and more inconsistency?

Lynette E Franklin (37:40.346)
really looked at those. Yeah.

looked at those statistics, but I think if we take the US as an example, a lot of people forget that you do have socialized care. It's called Medicaid and Medicare. And so then you look at them state level. So I happened to work in two states that did not take the government funding from the federal level. So the amount of money expended to individuals was different

Lynette E Franklin (38:13.21)
Medicaid than if I had worked for a state that actually did take the federal incentives. I don't know if you remember all that during the mid-

I guess it was the nots, like the early teens. Anyways, but now working for Socialized and each province is different. Our province, have, it's an organization that does all the home and community resources. So like the occupational therapy, the nursing, all of that. So keeping people in the home. And we, the province,

runs that and it's interesting since I've been back in Canada for five years the name of that organization has changed twice the mandate has changed twice and people are really frustrated because it's this constant turnover but at the same time I see that there's actually big

changes that are potentially positive for the bedside clinician and the bedside patient, but there's also negatives. So how it works is like in the area that you are, there are companies that bid to have the contract to look after people. And up until...

So there were 13 districts and each of those districts had different contracts. So I could go to the Southeast, which is the area I'm in, and I had X amount of wound care supplies. But when I was talking to colleagues in the Northwest, they had a whole different set of wound care supplies. And so having, we definitely had to talk at a generic level.

Lynette E Franklin (40:03.556)
But at the same time, now we're able to have that buying power of the province. we can, now that they're all unified in the new Ontario Health at Home, they have lists that are standard across the province. But.

a lot of people are upset because they've gone with the cheapest and the easiest and so and something that's available to everyone. what does that mean? And so

Cara Lunsford (40:37.282)
Yeah.

Lynette E Franklin (40:39.236)
There's advantages and disadvantages of both systems and there's always gonna be people who potentially fall through the cracks or don't get the care. So how do we make it more equitable? It's not going to be equal for everybody, but what can we do to promote care that is the best in the situation that we're in? And I always...

I remember hearing people say that from like knee-high to a grasshopper and I'm very idealistic. Well, why can't we do it the right way? And as I get older, I realize that sometimes you just have to do the best in what you have with what you have, but the system can change. And so I'm doing the best I can right now, but the goal is to change. And

That can be exhausting, but being a change agent is really important too. And you have to pick your battles so that you're not extended beyond your ability.

Cara Lunsford (41:49.016)
you would you say that because as I'm listening to you talk and I'm thinking about times where I've worked for one organization in hospice versus another organization and at one organization they had certain supplies that that they didn't have at the other organization and when I asked for it they were like no you can't get that that's too expensive and

Lynette E Franklin (42:11.194)
Great. Great.

Right.

Cara Lunsford (42:18.564)
I'm like, but I know that that's the best one to use. that's the, like, this patient is going to fare so much better. They're gonna heal so much faster. And it is frustrating and it can be very demoralizing when you feel like you can't, because it almost feels like you are watching somebody suffer unnecessarily. It's like, well,

Lynette E Franklin (42:21.648)
Bye.

Lynette E Franklin (42:43.642)
Mm-hmm.

Cara Lunsford (42:45.924)
you know, if I just had a, if I just had a wound vac, boy, I'd have this healed up in no time. Versus here I am having to do, you know, all of these, these dressing changes. It's, and the patient doesn't have the type of caretaker at home who can change these dressings out regularly when they get soiled. They're in a

where they're consistently getting soiled because maybe they're on the sacrum or something like that. You know, I need to heal this faster because if I don't get this healed faster, it's going to get infected. And all of this stuff like starts to go through your mind. And so knowing that...

consistency or that the quality of care that it's probably impossible right like under this current the way we currently do things I think that it's probably not reasonable to expect that like every single person is going to get exactly the same type of treatment or care in every single situation because that's just not the environment that we live in right now so

Lynette E Franklin (44:07.088)
Well, I don't think even in the ideal environment that's going to happen because we have the choice of change. We have the choice of autonomy and I think it's so important that as wound care nurses that we don't lose track of the fact that we have to look after the whole patient, the WHOLE.

Yes, having this dressing, as you said, negative pressure, therapy may improve it. You're absolutely right. But if their nutrition is in the toilet and they're not eating and they're constipated that their blue eyes are now brown and they have zero, what? Yeah, so.

Cara Lunsford (44:48.56)
Boy, I haven't heard that one before, but I'm using, I've never heard that before, but I'm using it now.

Lynette E Franklin (44:54.34)
Yeah, I always say we're gonna change your eyes back to blue and people who I never had blue eyes, you know, but So if you're not looking after those other things that wound is not going to heal and also being aware What are their goals in palliative care? They might be at the stage in palliative care. Yes that they have a chronic illness that their quality of life is going to be different or Their length of life might be different. But at this stage

we're still, you know, full steam ahead with the caveat that we're working towards realizing that we want to do the best that we can in this situation. And then as they're closer to death or the end of viable options, we may say like...

our goal isn't healing. So why are we putting a $50,000 therapy? Why are we doing that right now? And it's so much nicer as clinicians to be able to have our clients come alongside of us and explain that, but.

Cara Lunsford (45:48.847)
Yes.

Lynette E Franklin (46:00.986)
When I come in, if I'm the first one who said that, they're going to say no. But if we've started talking about different goals and how the goals change and keeping up to date and looking at all the different factors, then I think our opportunities to be less frustrated are more evident.

Cara Lunsford (46:24.634)
Yeah, and you know what, you're bringing up a really good point too, is that sometimes it's not just one clinician that's providing the wound care, right? It's multiple people coming in and it's also, sometimes it's caregivers that are doing it, like when...

family members or caregivers that are doing it when you're not there. And so this is where I think the charting, the communication, all of that is that you are communicating well as a care team. So that, yeah. Yep.

Lynette E Franklin (47:09.84)
And that's a million dollar question, right? As a clinician in the clinics, so...

have patients come in and they've had home health care nurses doing it and the families doing it and especially I see this with patients who have abdominal fistula and you've got these complex dressings that you you have to hold your tongue a certain way to make sure it sticks and the patient says everything was working fine in the hospital everything was working fine in the outpatient clinic but you know I get home and it doesn't work and so

when I break it down and talk to the home health nurse, they never receive the directions from the hospital. Or the patient has 52 different ostomy pouches at the bedside. Half of the bags don't fit with the wafers. Half of the pouches aren't the right size. It's the same pouch that they had when they had the surgery 52 weeks ago. And now things have changed. I think, so what we did is

developed a sheet that actually had everything generically written down so that it didn't matter when they got to the home. Like they could look at their supply list or they could actually go into their local pharmacy or DME and actually get the supplies that they needed that were consistent. Maybe it's not the same brand name, but it's the same style of dressing so that they can actually work towards

consistency. The other thing is making sure that the client has those directions and there are also facts to the upcoming, like the new agency or whatever. And then the client actually takes responsibility. But if you look at what clients go home with, like they go home basically with an encyclopedia of everything from telling them to walk, to talk, to eat, and it's overwhelming. And

Lynette E Franklin (49:16.876)
even as a patient myself, I've gone home and nobody told me that. And then I found the papers like, and looked through it and gone, my goodness, I did have that information, but who has a time to read it? So I think being very empathetic, Brene Brown, I don't know if any of you've seen that YouTube video about going into the hole. And if we've been, yeah, if we've been blessed with good health or blessed with opportunities,

Cara Lunsford (49:36.512)
I love her.

Lynette E Franklin (49:46.911)
didn't demand creative thinking, we might be blind to some of the situations that our clients are in.

and just something easy like reading. They may have very high literacy when it comes to history and wars, but when you start talking about your body, they don't even know that there's three holes down below in a woman. And people are shocked by that. And instead of being shocked, try to come alongside in a non-threatening way. How can we make this work? And sending home a video.

with patients. know, I, so many people have cell phones now and it's okay to say, let's do the video together and then I want you to go home and watch it and tell me what we missed, right? And actually giving people pieces of tangible things so that we can stay consistent. That, and the thing is what matters most. Pardon?

Cara Lunsford (50:49.882)
that's such a good point.

Because when I was doing Home Health, I used to use video a lot because I wanted them to be able to watch it and rewatch it. And I acknowledge that it's a lot to take in and that they're not gonna remember everything that I have to say. And if I don't wanna have to get a phone call at two o'clock in the morning, it's better for me to do the video with them and say, look, just videotape me. Videotape everything I'm doing from start to finish. You can go and rewatch it.

dealing with like literacy issues, you know, where you're not sure whether or not somebody is able to even read, read the writing. Yeah.

Lynette E Franklin (51:32.708)
Mm-hmm. Right. And also checking in with our clients. And I also like to ask, so what did you hear me say? And it keeps me in check because I was like, I did not say that. And...

you know, my body language, my verbal language, all the distractions around. So what did you hear me say? They might have heard you say, especially in a palliative situation, all they heard was, I'm going to die.

where as I said, you have the X amount of, you have this disease, but people live, but let's keep, how we live is going to be different than if you didn't have this disease. And so asking people to remind.

to reiterate what you said, then you can fill it in, but asking in a non-threatening way so that patients don't feel intimidated. Again, we wanna come alongside somebody and help them. And it's the same with our clinicians. You want to you want to gain respect and you want to gain collaboration with people

Cara Lunsford (52:44.037)
Yep.

Lynette E Franklin (52:55.698)
versus being an adversary. And having been on both sides, I have been, it's something I've had to learn. I'm a very forthright in your face, this is how it is, like, what do mean you can't do it? And at the same time, so even though my clinical practice, I was really up to date, I needed to work on my presentation and was really happy with being told about

and able to attend our community listens, which is a national U.S. opportunity to improve your listening and speaking skills and how you present yourself and how to handle conflict and all those different things. And it's free. Like it's free. It's a weekend shindig, right? So people say, you know, I don't have the money or whatever, but it's free and you can do it as a family. You can do it as a community.

Cara Lunsford (53:44.144)
That's amazing.

Lynette E Franklin (53:55.698)
like I think about Charleston, like the people who told me about it, they actually implemented it and now the City of North Charleston actually has that part of their onboarding and part of their continuous training. So that even though it had nothing to do with nursing in the sense that it's not care, it's part of that professional practice and part of that how are we communicating with people and how are we as a society

empowering people to be the best person that they can be and have that consistency.

Cara Lunsford (54:32.462)
Yeah, sometimes what I have found with patients is that they're very quick to highlight when they hear something different. And then when they hear something different, they immediately mistrust. lose trust in the clinician. And so sometimes what I used to say to patients in the home was, you're going to receive care from a variety of different clinicians.

Lynette E Franklin (54:47.472)
Mm-hmm.

Lynette E Franklin (55:00.772)
Yeah.

Cara Lunsford (55:00.816)
Okay, we're all gonna be a little bit different. We're all going to put our gloves on a little differently. We're all gonna kind of set up our space a little bit differently. Sometimes we're gonna use slightly different supplies. You might see that this cap looks different than this cap. But one's green and one's orange.

Lynette E Franklin (55:17.061)
Mm-hmm.

Cara Lunsford (55:29.424)
It's just a different manufacturer. They do the same thing, you know, and, and so there's things that you might see, but here's where you should, you should be focused on. Okay. Did your, did your clinician walk in and go wash his or her hands? You know, did, you know, is there an, is there a certain attention to hygiene, you know, staying clean, setting up, you know, a, a sterile space to be doing a

Lynette E Franklin (55:31.426)
Yeah. Yeah.

Lynette E Franklin (55:40.677)
Great.

Lynette E Franklin (55:45.22)
Great.

Lynette E Franklin (55:52.634)
Mm-hmm.

Cara Lunsford (55:59.12)
addressing change that requires some level of sterility. know, and helping them to understand there are some things that can be different and there are some things that should not be different.

Lynette E Franklin (56:13.242)
Right.

Exactly. And I think giving people that power to realize that there's different things. And that goes back to the goals. So you can have your global goals, but you can have your everyday goals. And so a lot of times patients get really frustrated. Well, this nurse said that and that tech said that. And so what I'll say is, okay, let's go back and what are your goals? What are your daily goals? So I want the fistula pouch to stay on for seven hours.

Cara Lunsford (56:19.909)
Yes.

Lynette E Franklin (56:43.98)
and I want my periwound skin to stop hurting. Okay, they don't care about the fistula healing. They don't care about anything else other than keeping the pouch on so that they can go to the movie theater and getting their skin less itchy. So those are the things that you want to address and say, okay, these are the things that we can change. These are all skin protectors, but if you use a skin protector that has petrolatum in it,

It's going to be slidey and you're not going to increase wear time, right? Because Vaseline, I know we're not supposed to use brand names, but Vaseline decreases your adhesion. So,

Cara Lunsford (57:26.148)
Mm-hmm.

Lynette E Franklin (57:28.568)
when you've got those goals all in place and write them down so that the people coming after you are also on those goals and empower the patient to say that. And then you can also say, you know, these are the goals. This is what I think will work.

And so one of the like the big one, I always use the example. So the patient will say, well, I use duct tape, you know, to keep it down. I said, okay, great. So you use duct tape. How did that help for your skin breaking down your second goal? And they're like, well, it hurt. And when I ripped it off, like I took half my abdomen off, but it stayed seven days. I said, okay, so you got one goal, but that one goal impacted your other goal. So let's think about how can we make this

work. Now duct tape if that's all you have and it's eight o'clock at night and you're just exhausted and nobody can come well duct tape might be in that situation. Okay knowing that you might not have the goal

met that you want. I think also giving people knowledge and I think knowledge, this is going back to what I said before, a lot of times people hoard their knowledge thinking that if I know this I will be invaluable. I think that certain knowledge

No, I'm not even going say that. think that knowledge is power. And the more you know, and the more you're able to share that information, the better off other people will be. And I think there's been a shift a lot to getting knowledge from social media and all these other sources, which may be enough to start getting people to ask the questions, but we always have to go back to where are we getting the information from and how will

Lynette E Franklin (59:24.767)
impact people and asking the right questions, right? And helping.

Cara Lunsford (59:28.452)
Yeah. Having that reliable, having reliable places and sources, I think, especially as we are moving into a time of technology, a certain type of technology, AI and everything like that, is that there's good use cases for all of this stuff, but where that information is getting derived from, pulled from, it's all really important because it is, it's,

It can be overwhelming for clinicians, patients, family members, anyone to find what is the right information or the trusted information. So the more we can point people in the right direction, I think the better off.

Lynette E Franklin (01:00:17.05)
Right. And also giving people tools of how to evaluate that information. So, you know, of course there's good things with social media. There's great things with AI. But how do we evaluate if this is a great one or if this is really...

detrimental to our care. During our talk at WOW, Joy and I gave a list of resources so that people could go home and look at them and people are like, I don't have time. Well, as a home health nurse, you know, maybe listening to a podcast in the car or

Just give yourself a goal of reading one article during lunch, just once a week. Start small. You don't have to be reading the whole journal front to back and being on top of everything, but just start small and see if you can. Yeah.

Cara Lunsford (01:01:15.568)
That's actually a great use for AI, by the way. If you have something that is like three or four pages, one of the best uses of AI is distilling down.

large amounts of information into what are the key takeaways from this article. So that is one of the best ways of using AI. so find a journal, find an article that you like, I don't have time to read, you know, all five pages of this, but I'm gonna upload it into OpenAI and I'm gonna ask it, you know, to distill it down to maybe the top 10 takeaways.

and it's great.

Lynette E Franklin (01:01:57.2)
Right. And, and that's good. But also, just to be careful with that, you also want to evaluate, it taking the top 10 that are important? So before you totally trust completely that you actually read the article and see if the top 10 that you thought is the same as what the programmer for the AI thought was the best. Anyway,

It's just another thing that as nurses we have to be aware of. And I think that we're a smart group of people, don't think that we're not. And we have value and we have knowledge and how are we going to use that effectively with the constraints of our healthcare that we have right now.

Cara Lunsford (01:02:45.232)
So Lynette, would be your top three places that you get information from, that you frequent? And that could be a podcast, that could be a website. What are your top three?

Lynette E Franklin (01:03:00.154)
Okay.

Lynette E Franklin (01:03:05.774)
Well,

Being really global, I'd say the top one is societies. I'm a member of the Wound Ostomy Continence Network, the Wound Ostomy Continence Nursing Society in the States and the NSWOC, the Nurses Specializing in Wound Ostomy and Continence Care Canada. And frequent there, first of all, we have the journal through them and also we have wonderful webpages

and their web pages, they offer so many resources to their members. So I would say that's the first. Obviously scientific articles and colleagues, but I also check different organizations that I trust. And so for wound care,

If look everywhere in the world, they have best practice and you're like, well, I'm only in the States. I'm only going to look at the U S ones, or I'm only in Europe. I'm only going to look at the European ones. And there's value in that. But also when you're looking at other organizations, they may pick out something that's really important or they have a different way of viewing it. And that might be also advantageous when you're talking to your colleagues. We're not just nurses talking to nurses. How do I approach this with a pathiatrist who's

also doing nail care while I'm doing the lower extremity ulcer care. So being aware of what other people are being taught is really important. Also...

Lynette E Franklin (01:04:41.912)
I do get a lot of information from vendors, which is important, but also because of the information I've gathered from the societies and articles, I'm also able to ask them the questions that matter because you can, unfortunately, you can say whatever you want. You don't have to back it up and that can be a problem. So you don't want to take all the

information that necessarily and just to give you an example so there was a certain type of wound wash that the rep had been very very very excellent at promoting and so the Agency wanted to change to that wound wash well they did but then

the price kept going up and up. And so every time that they wanted to use that product, they had to present it to a panel and the panel had to, you know, review the situation and say whether or not they could get that wound wash. What came to find out that when that wound wash was delivered to the home, the nurses checked off one.

but when that wound wash had been put onto the formulary, one meant one case. So they were getting 12 or 24 bottles of the wound wash and being charged for that. And we all know that once it gets in the home, it can't be reimbursed, right? But what was also happening is...

Cara Lunsford (01:06:15.856)
You can't take it out. Yeah.

Lynette E Franklin (01:06:21.198)
that case isn't there when the nurses get there. The family puts it in the closet because they just can't deal with it. So the nurses weren't even aware that they had 23 other bottles and that's why costs were going up. so...

Cara Lunsford (01:06:32.708)
They just kept ordering more.

Lynette E Franklin (01:06:37.26)
Assuming and trying to just dig down a little bit if we each dig down a little bit and some things will be able to find that information to make things better so I know that assume always says making an asset of you and me and there's so many times that has happened another example was a patient refused to take pain medicine For his dressing changes and

Now he had been in home health, he had been in the hospital, all these different places. And he refused, refused, refused. And then he was getting his assessment for MAID. So here in Canada, a medical assistant, a medical assistant in death or physician assisted.

Suicide is legal and so part of it was getting an evaluation. It wasn't till that evaluation which was 72 hours before that patient died that it was realized that the reason that he was a He didn't want pain medicine was because he had witnessed his wife and his son Have procedures when they were dying in the ICU and even though they gave pain medicine. It didn't resolve their pain and that they became Delirious and that was his biggest fear and it was so

awakening in the sense that how did we get through all those different people all those months and years of therapy but 72 hours before he died that we figured that out

And what impact would that have changed? Was he still going to die? Yes, but would he have died from natural causes versus medical assistant suicide? I don't know, but I just think it's so important as clinicians that we don't assume, that we ask. And you know what? If we ask 52 times, and I know people get so angry that I just told the doctor that, I've just told the nurse that.

Lynette E FRANKLIN (01:08:44.612)
because sometimes the next person will figure something out that they didn't figure out the first time. And so being patient and kind and how we ask and knowing that balance between being a pain in the abdomen and being a pain versus just letting things go. it's...

Cara Lunsford (01:08:50.99)
Yep.

Cara Lunsford (01:09:06.04)
Yeah. Communication, I mean, it seems like an easy solution in a way where it's kind of like, hey, look, you got to just make sure you're talking to each other, that you're talking to your patient, that you're talking to other parts of the care team, that you're not just leaving things to assumption and...

Lynette E Franklin (01:09:09.36)
It's huge.

Cara Lunsford (01:09:35.18)
And that does go a long way in terms of also creating consistency of care.

This has really been, I mean, such an enjoyable conversation to have with you, Lynette. I mean, you're just a wealth of information. You've definitely been in so many different situations and environments so that you can speak to each of those and in a variety of different capacities, whether it's as an advanced practice nurse or as a registered nurse or, you know,

Lynette E Franklin (01:09:46.762)
good.

Cara Lunsford (01:10:11.228)
in just a different, various different capacities over, you know, decades. So it's so beneficial to our audience to be able to hear from someone who has worked in these areas like you have, and also has been a part of associations, professional development, staying up to date on all of the...

newest types of therapies and types of dressings and supplies and equipment and everything like that. and so I hope if for everyone who's listening, if there's a way for people to to reach out to you or to connect with you, what's the best way for people to connect with you?

Lynette E Franklin (01:11:05.2)
So the best way is email, but also be aware that...

sometimes it takes a little bit for me to get back in touch with people, but my email is Lynette, L-Y-N-E-T-T-E dot E dot Franklin, F-R-A-N-K-L-I-N, so Lynette E Franklin at gmail.com. That's my just generic email. It's best to get me there versus through work or consulting. And obviously if,

people can get in touch with you, Kara, and I give permission for you to give information out. I'm also going to send to you, Kara, and maybe you can attach this to this podcast, but the list of WOW, the Buzz report that we did just this past August, because I think it...

offers a lot of different resources that are evidence-based that are up to date as of that time. Now remember things change so it's not the be all and end all but and also I don't necessarily know so support your local clinicians find out who your wound ostomy continence nurses are find out who is specialized find out how they practice and

keep current. One of the things I loved about being in South Carolina and Atlanta was that we had a very active WOC, Wound Osteomy Continence presence. I just remember South Carolina, we were at a national meeting and somebody goes, that's South Carolina. And not realizing that sometimes we were the unwanted stepchild of the nation and we were a little bit backwards, but we

Lynette E Franklin (01:12:57.824)
were really forward thinking. I just praised those men and women who came before and really put us on the map in terms of wound ostomy continence care and we actually had

practice that was way above what was going on in the nation. so, but we also got together annually. had meetings in the Capitol to just, you know, shoot the breeze, get to know each other so that actually we could call them up on the phone and say, this is what I've got. And also just being available. I've had physicians call me from the OR as our residents had gone to other facilities and said, Hey, Lynette, remember what

that you know and I'm like so you know having that availability is also important if you can but if you're an introvert and that's just too exhausting that's okay we need everybody to be able to practice and make the group better and I think when we support each other collaboratively versus competitively things get better

Cara Lunsford (01:14:13.36)
gosh, that's a wonderful closing remark to such an incredible podcast episode. And I'm just so grateful that you shared this much time with me today. And I really, really look forward to sharing all of those resources. We'll definitely have that on the podcast landing page. So for any of you that are listening, if you want to go and find those resources, we'll make sure to list them on the

nurse.com forward slash podcast. You'll be able to click on this episode and then we'll make sure that any of those resources are available. Lynette.

Lynette E Franklin (01:14:51.6)
It's been a real privilege. I hope it's warmer where y'all are We are having freezing rain right now, and it's in very cold We're in Celsius, so it seems a lot colder up here than when it's in Fahrenheit, but because we're in the negative numbers, but

Anyways, I hope I'm not sure when everybody's gonna hear this but that they have a wonderful Day and week and I look forward to Working with you all in the future

Cara Lunsford (01:15:24.154)
Thank you so much, Lynette. Thank you. Okay. All right. So I'm gonna stop and then I'm gonna just give it a sec.

Lynette E Franklin (01:15:26.468)
Thank you. Have a great day.