Episode 6: It's Okay to Say No

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Oh, hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation resources and hope. One episode at a time. So today on Nurse Dot podcast.

Katie Duke

We all need to stop tying our identity and who we are and what we do with where we work. It's a tough lesson to unlearn.

Cara Lunsford

Joining us today, Katie Duke, also known as the Katie Duke on Instagram and true to Katie Duke form. This episode is real, raw and relatable. You will hear this in the form of expletives, bleeps, background noise, not to mention the occasional connection issue. I'm your host, Kara Lunsford, registered nurse and VP of community at NASSCOM.

How about we kick this off, Katie?

Katie Duke

Let's just let's just get into it.

Cara Lunsford

Listen, that's exactly what we're doing.

Katie Duke

Yep. We're going to go off script. All right, Well, let's start out with, like, the intro, because I know you and I. We will. We'll be here for 20 minutes and we haven't even given for on it like a proper intro.

Cara Lunsford

Yeah, exactly. Exactly. So, Katie Duke. The Katie Duke. Tell me. Yeah. With that little face. Tell me about. Just tell me about yourself by everyone.

Katie Duke

Thank you for joining us today. And big shout out to Big Cara for having me on the podcast a little bit about me. So I have been a nurse for just about 20 years and a board certified adult and geriatric acute care nurse practitioner for the last seven. But I actually started out as an associates degree nurse, so shout out to all the associates degree nurses out there and then I finished my undergrad at City University of New York, and then I went to grad school at Columbia University.

In fact, that's probably one of the greatest things I ever done. And it was the one thing that my parents were like, Now we can actually brag a little bit about you. So super proud moment right there. But I have spent my entire life of health care in the hospital. I started working on Med Surge. Then I went into telemetry and stepped down.

I did travel nursing for many years. In fact, that's what brought me to New York. I felt like there was something bigger out there for me. I am a big advocate for a lot of different things, which kind of all lead back to the path of owning your life's more vulnerable and authentic moments, owning your bad decisions and kind of working through them.

And today I am not in the hospital full time anymore, and I'm glad about that because it was a boundary that I decided to set recently, and that's something that we're going to get into a little bit today, but a little bit about me outside of the professional realm. I was one of the pioneers of the health care presence on social media, really, when it started way back in the day, at least from a nursing perspective, I've always valued transparency and having real, genuine, authentic conversations about the realities of nursing.

And I've done a lot of keynote speaking. I've given over 50 keynotes in my time. I have presented over 125 graduate nurses and new graduate nurses and new graduate and PS. During my years I was adjunct clinical faculty at NYU for several years for their acute care. NP program. I really value mentorship and the role that it can play in helping nurses transition into different stages in their life, especially with regard to their professional career And where I'm at right now, I'm in the midst of what could be like a pretty big career pivot for me.

So we're going to get into a little bit of that here. But what else? Oh, yeah, I guess I left off like I do some social media brand work and I recently started working with Nurse Dotcom and I also recently started working with things which I'm really excited about. And yeah, I fully embrace brands that support nurses outside of just how it relates to how they can benefit from it.

So I know that's a really long intro, but I'm not very good at making things short and sweet and to the point. Let's just get that out there.

Cara Lunsford

It was an awesome intro. It's just a testament to everything that you have done, which sometimes I think when you're like going through the cap that you've done, you're like, Oh wait, how old am I? Yeah, how have I done so much? Right?

Katie Duke

And I'm 41. That's 43. Yeah. See, again, we always speak the same language and we get it. A lot of people are like, Oh my God, you've done so much. And I feel like I haven't done enough. And I'm like, Bro, you're 23. Chill. Have a seat. You're going to be just fine. Like I had a mentee one time who She's 27 and she's like, Katie, my social media following is not growing.

That much. I'm not working with that many brands. I want to do more things and I'm like, You just started your Instagram page a year ago. You're 27. It is going to be just fine. We often forget that the normal workflow of things is not this overnight fame. It is not this immediate viral stardom.

Cara Lunsford

Yes, yes, yes to all of it. Because as you know, I started a company and a lot of times all that anybody ever sees is that I had an exit and that I got acquired. And they're like, oh, overnight success right now. Yeah. No sleepless nights. Top Ramen. It's a tough, tough time in my marital life. Like all kinds of stuff, right?

Like that. Nobody sees no one sees all of that. They just see the success at the end and then they think, Well, how do I get there? Why am I not there yet? And I think a lot of what we tend to talk about, Katie, is the the journey, right? Because it's long and hard.

Katie Duke

Some times and it's very all over the place.

Cara Lunsford

Yeah.

Katie Duke

And that's another thing. I think it's important to have normal conversation over to normalize that conversation is that a lot of times you don't just wake up one day and have a clear direction of what your goals are, who you want to be when you grow up, or what your purpose is. And it's never a linear path at all, ever.

Cara Lunsford

No, in fact.

Katie Duke

Not at all. No, what I want to do with my life. So here we are.

Cara Lunsford

But you know what you don't want to do, right? Yeah. And I and that probably actually segways us in nicely to how do you figure out what you don't want to do. Yeah, right.

Katie Duke

And today's topic is.

Cara Lunsford

Yeah, today's topic is it's okay to say no, which is a pathway to sustainable practice and a sustainable life. Really is how to say no. And I think that personally it's hard to say no. Yeah, a lot of times for people who give a shit, it's very hard for us to like tell people, No, I can't, or I don't have enough time or no, I don't want to go to your party because I'd rather stay home and Netflix binge or do whatever it is.

Right? But it's very, very difficult to set professional boundaries a lot of times because we fear the repercussions of it. We fear that like we're going to lose our job.

Katie Duke

We also fear a lot of things because our validation and our identity is often directly tied to our job. And that's a boundary that we need to start instructing people to set immediately. That's something that I've been trying to tell people really a lot recently, especially when they talk about how they are so unhappy in the hospital or so unhappy in the clinic that they're at.

And I'm like, Well, then I think it's time to get out. And they're like, But I'm not going to like be a real nurse if I get out or I'm not going to have the respect on my resumé or we have to get away from that mentality so that first boundary that you're really going to often have to set is with yourself.

And I think that that's a really pivotal lesson for a lot of people. But I think it should be a highlight, especially this episode, is, you know, you have to set boundaries within yourself first and then you also have to continually set them with other people, you know, other places of employment, etc.. And something that I tell people often is you have to create your own definition of what it nurses.

You have to stop looking for your validation and your identity in your employer or in what your day job or your night job is. Because as nurses we tend to like really soak up that being a nurse is our whole identity. It's our whole existence. And if we work in the ICU of the number one hospital in the country or the emergency room of the number one hospital, Manhattan, and if we are doing anything outside of that, that we are just not as good or we can't brag about our work, or that we are not utilizing our skills or our degree and it's yeah.

Cara Lunsford

I think that those are really incredible points because when I left my job as a pediatric oncology nurse, I had been that for first like seven years of my career. And it's easy, right? It's easy to go into a conversation like if you're at a party, right, and somebody says, What do you do? And I say, Well, I'm a I'm a pediatric oncology nurse at Children's Hospital, Los Angeles.

Katie Duke

Well done.

Cara Lunsford

Boom. Mike drop.

Katie Duke

Yeah. Impressive. Easy to say. Everyone knows what that is.

Cara Lunsford

Yep. And what I would oftentimes get right after that is, Oh, my God, you are an angel. I didn't even have to prove myself. I didn't even have to prove who I was as a human being. These people that I had never met before, a immediately liked me and then put me up on a pedestal and I did not have to do any work.

So you step away from that role and full transparency, vulnerability. You're kind of like, Oh my gosh, when I go to a party.

Katie Duke

How do I explain what I do or who I am? And I literally just had this conversation literally yesterday. So my my last full time job, I was a cardiology nurse practitioner at Mount Sinai Heart in New York City. It's a top ten heart program in the country, in the world. Everyone knows what Mount Sinai is. It's a huge stroke of ego, truthfully, but it's easy to say that, Oh, what do you do?

Oh, I'm a cardiology amp at Mount Sinai. Oh, my God, That's amazing. You must be so smart. Or you. Oh, my gosh, I. That you've seen some crazy things and immediately, you know, you don't have to explain anything else after that. But yesterday we went to a birthday party, and like I said, I'm not working full time in the hospital right now.

And it's crazy for me to say that, like I found myself struggling and I was like, just tell people I'm an MP. And Shaun's like, But they're going to want to know like where or what kind of MP And I'm like, I, I did. I didn't have an answer because you have to give people like a smooth one sentence.

I couldn't just say, well, I'm a nurse practitioner by trade, but really my full time job right now is creating content and working with brands to help advocate for nurses and health care reform. People just wouldn't they wouldn't really connect with that. And in fact, they'd be like, So you're not even like a real MP. So I kind of avoided the conversation.

Cara Lunsford

And it is. Isn't it sad that we care.

Katie Duke

If it is, it's like, why do we care? Be like, I'm a I'm an advocate for nurses there now. That's what the job is like. I know what I do. Why should I give a shit what other people think, right? What hospital you work at.

Cara Lunsford

What hospital do you work at? Immediately. I'll say, Well, I still do patient care. It's, you know, I do more like home health. I'll do, I do end of life. I've been this, I've been that. I need to have like my own little elevator pitch for myself. Like I need to have a little Carol Lunsford elevator pitch. I think you need a Katy Duke elevator pitch that you feel good about.

Katie Duke

Yeah, I think we all do. But I think the less than there is, we all need our own elevator pitch. But we also need to stop tying our identity and who we are and what we do with where we work. It's a tough lesson to unlearn because so many of us are pipeline into working in hospitals and so many of us are pipeline to think that we're just better or we're more worthy, or we have the ability to have more bragging rights if we work on the sickest unit at the biggest hospital and that we have the worst days ever.

And that's just not healthy and so that's why I encourage people to set the first boundary within yourself. Learn how to start telling yourself, No, I will not allow myself to utilize where I work as the main root of who I am as a person and where my value lies. So maybe next time someone says, Hey, what do you do for a living?

Just say what you actually do. You could say something like, I help patients who have had heart surgery, for instance. You know, you can say I helped bridge the gap between the health care community and the education that they need to thrive in their workplaces and as professionals. So exactly saying, yeah, like like I just want us to, like, really disconnect and start saying, no, I'm not more valuable or I'm not more of a nurse or an MP.

If I work at this place or that place, untether yourself, if you will.

Cara Lunsford

Coming up after the break.

Katie Duke

Honestly, the first obvious no, that I always think of is the one where you feel obligated to solve the staffing shortages of the unit.

Cara Lunsford

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Once you have self-love, then you are less likely to allow people to encroach upon or push past your boundaries.

Katie Duke

Yeah, cause you're not looking for them for the approval or the validation because you have that about yourself as baseline. Yeah. And there's a lot of people out there who who don't have that as their baseline and in fact, I mean, that was me for many, many years. I just kept looking for approval from my director. I would have never gotten that.

But because I didn't feel that self-love within myself first. So that that's a solid that's a solid point right there.

Cara Lunsford

Yeah. So starting out with that self-love is how you even get to this next point where we're going to talk about saying no to things. Because first of all, you have to feel like you deserve to draw that boundary. And the only way you can feel like you deserve to draw that boundary is feeling a certain amount of self-love, self-respect and then there are these times right, where you're asked to do something that's outside your scope.

You're asked to take on a shift that you know that you just can't take on one more shift, Like you can't do it and it's not safe for you. It's not safe for your colleagues, it's not safe for your patients. You have to say no. And that there's just situations where and I know you can speak to this where if someone is telling you what you can and cannot do in your personal life and they're.

Yeah, and there's the Katie Duke that I love. And there there it is. So but let's start with like the easy stuff, okay? The easy things that we think these are obvious nos. What are some what are some obvious nos that you can think of, Katie? That if someone asks.

Katie Duke

For honestly, the first obvious no, that I always think of is the one where you feel obligated to solve the staffing shortages of the unit because it is not your job to do that. It is also not your responsibility to fill in the gaps. It is also not something that you're accountable to. And again, shout out to all of the really great leaders out there because there are a lot there are a lot of really solid nursing leaders and there's a lot of really solid nurse managers and patient care directors out there.

And on the other side of that, though, we also need to really recognize when somebody could give a shit less about respecting our personal time off. That's well-earned and very much well deserved and, you know, is really just trying to fill a bottom line at the end of the day. So.

Cara Lunsford

So how do you tell the difference?

Katie Duke

So for one, I look at it like the same where you have like friendships. Do you have friends who only hit you up when they need something, or do you have friends who check in on you every now and then? You know, you don't have to talk every day or every week. But like, do you have friends who check in on you, like here and there?

Are you the only person making effort in the relationship? And if you have people that only hit you up when they need something, then you know, not saying it's always manipulative, but it just might not always be reciprocal. And I think that your relationship with your unit, your director or your manager, it should be something that's reciprocal. And I think that if you have a manager who cares about you as an individual, someone who does check in on you, somebody who does try to get to know you outside of the work you do at the hospital and what you can do for them each shift.

And if you have somebody who has respected your boundaries in the past, that's a good, healthy relationship. But on the flip side, if you have a manager or a director who never checks in on you, doesn't really care to ask you even the simple things like how was your weekend? How was your vacation time? Or to have real conversations with you outside of make sure your whiteboards are filled out and your discharges are done before noon and they really only reach out to you in their time of need.

And during that reach out, they try to put a guilt trip on you or they try to, you know, make you feel bad if you say no. I think that that's classic signs of somebody who's manipulating somebody, especially from a perspective of leadership.

Cara Lunsford

I think that's really helpful information because I can imagine a lot of listeners prior to you giving that explanation kind of going, well, I don't know. I mean, like they seem like they're a nice person or they seem like they're, you know, But I think you gave a really, really good example else of how you know the difference.

Katie Duke

Yeah. Just ask yourself, like, when was the last time I talked to this person?

Cara Lunsford

Yep. Like, does this feel good?

Katie Duke

Yeah.

Cara Lunsford

So I love to, like, quote Brené Brown every once in a while. Oh, I don't know, maybe like every podcast, but. But I love her. She, she talks about, like, this spinning ring that she has, you know, where she has to spin it. I can't remember how many times before she answers someone yes or no. And it gives her a chance to check in with herself.

Like, how do I feel?

Katie Duke

Like over time it is her? Yeah.

Cara Lunsford

Exactly. Exactly. I'm sure that that that, that but in her like Texas accent and so having this spinning ring is this thing of like, okay, check in with yourself first don't just have that response of yes yes I'll do it or you have to.

Katie Duke

Have a moment of pause.

Cara Lunsford

Yeah, a moment of.

Katie Duke

Also, by the way, I'm not always good at that.

Cara Lunsford

Just throw it out there. Me either. I mean, we're over here telling that people we're talking to each other as much as we're talking to you all.

Katie Duke

Oh, definitely talking to myself.

Cara Lunsford

Talking to ourselves, talking to each other, saying, Yep, yeah, stop and think about it for a second. Do that gut check. Do I want to do this? Am I having reservations? Go back into your text thread as you just mentioned, or your DMS or whatever it is, and go, you know what? This person's asked for a whole lot and there's not a whole lot of checking in happening over here.

Katie Duke

And it's okay to call a spade a spade like there are people out there that that will use you in your life. And sometimes it's a situation where you're like, I'm okay being used here because I'm going to benefit some stuff from it. But if you don't feel that way, then like don't always feel so obligated to say yes and learn to set that boundary with yourself.

Cara Lunsford

It is like about being mutually beneficial. Or am I playing the long game? Sometimes? Yeah, like for me, I'm playing the long game. I'm making some sacrifices right now, but I have a goal, I have a vision down the road and I can see how this might be helping me to achieve a certain goal or achieve a certain vision mission for myself or for for my company.

And so I'm playing the long game here. All of these things are reasonable things to consider as long as you're considering them right. You just have to like, check in and be like, Why am I doing this? If it's purely out of guilt? And you're just like, I feel like a bad person. If I don't do this, you know, then that that's a that's a pause.

Because you feeling like a bad person or someone kind of encouraging you to feel like a bad person because you don't want to do X, Y or Z. That definitely requires pause.

Katie Duke

Yeah. Again, like you don't need to feel accountable to fixing other people's problems just because they bring them to you.

Cara Lunsford

I give an example of I do a professional boundaries presentation and I actually did it at the end of this year. It was a learning bite's little section, and I talk about a time when I was a very new nurse and I had a really difficult shift because I had two patients who were actively dying at the same time.

Katie Duke

Yeah.

Cara Lunsford

One was very little. He was like two years old and the other one was six years old. And the two year old passed, had a brain tumor called HRT. And there was a lot of research going on for that specific type of tumor at the time. And I was asked by the attending who was on service that night, who just happened to also be heading up like some research for HRT.

Mm hmm. If I would go down with the patient to the morgue and assist with the autopsy. Oh, and I had only been a nurse for, like, a couple of years.

Katie Duke

Yeah, like, honestly, I feel like somebody would be on their side of the spectrum, like, Oh, my gosh, this is awesome. I've always wanted to help out with an autopsy versus This is my patient and who I have, like, got to know really well and I do not want to be involved with that. That's too much. Yeah, to.

Cara Lunsford

Be honest, I was kind of straddling that. There was this part of me was like, Oh my gosh, I'm being asked to go down there with the attending and I shouldn't pass up on this learning opportunity. And then the other part of me going, I'm not sure that I want to see him like this. And I ended up leaning towards going down there and doing it.

And in hindsight, I actually attribute that decision to some of my early burnout because I realized that I started saying yes to more and more things like that. And and then I would be asked by families if I was going to be at the funeral or if I was going to. And this happened a lot. How do you say no to a family that, you know, it's like, oh, I'm sorry, I can't be there?

Or, you know, I started going to funerals on my day off and then I you know, so I'm spending all this time in the hospital and then I'm going to like pediatric funerals. I mean, where I'm listening to in our In the Arms of the Angels and the song from Dumbo.

Katie Duke

That's a big It's a big no.

Cara Lunsford

Yeah, it's a big no. So yeah, but you then you have to figure out like, where are you going to grieve, where are you going to process, where are you going to take that energy? If you don't go to a funeral and you don't grieve, where do you go and do that? But I identifying that professional boundary of like, how close do I get to a family is stuff like that.

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Oh. We received a message from a retired nurse who asked why we include validation in the mission statement for Nurse Dot podcast. We really appreciate these kinds of messages because it allows us to elaborate on the why behind everything we do. Validation is important because it's part of the healing process. So many health care providers are really suffering from PTSD, depression, anxiety.

The list goes on and on. They may ask themselves, why are they feeling this way? Because, well, this is the job they signed up for. They knew that they would be witness to pain, suffering, violence, tragedy, death. So why are they struggling, validating a person's feelings and experiences as real is one way of helping them to find compassion for themselves.

A start in their journey towards healing. Okay, so the last thing I was just telling you was about my my very, very poor boundaries and the fact that I said yes to everything because I felt like I should be at all the funerals, that I should go and do the autopsies, I should go and do all this stuff.

And and I had to kind of find out the hard way that I needed to create these professional boundaries. And it didn't mean that I was a bad person, that I wasn't a bad person for like, not coming to these events.

Katie Duke

Yeah, exactly. You're not a bad person if you don't go to those things. And the problem that many health care providers face is that we just feel so emotionally tied to what happens at work and what doesn't happen if we're not there. And that's something that a lot of people can really play into. And it's unfortunate, but it's just what happens when you're dealing with people who are very much emotionally connected to a job and also very driven by things like, well, what if patients don't get the care that they need?

Oh, my gosh, you know, well, what if my colleagues are drowning and we always put our own needs on the backburner, letting other people's problems stay there? Problems like, I'm sorry, manager. That's why you're getting paid 30, 40 grand more a year than me. That's your problem.

Cara Lunsford

It's true. It's true. You know, human resources problem.

Katie Duke

And it's. And it's the problem with the river. The hiring director is. And that's just how it is.

Cara Lunsford

Yeah, absolutely. Absolutely. So we've touched on a lot of those things. I think the last thing I'm going to have you weigh in on here, because I think it's really important is when you get asked to do something by a physician and you either can't do it, don't have time to do it, it's not within your scope of practice to do it.

Just feeling empowered to say, you know what, I'm sorry, I can't do that. And if you have a problem with that, well, you know.

Katie Duke

I have to interrupt you, though. You shouldn't start out by saying I'm sorry.

Cara Lunsford

Yes, you're right.

Katie Duke

So you're right. But you go through to do something that you don't have time to do or that is not your priority at the minute. That deserves a response of saying, I'm unable to do that for you right now because I need to focus on the priorities of my responsibilities. And you leave it at that. If somebody asks you to do something that's outside of your scope of practice, that's a totally different conversation.

I think for we could have a whole episode strictly on that. But your response to that should be very plain and very competent, and it should simply be. I'm not able to do that because that's outside the scope of my practice and I worked very hard for my license and I would like to keep it. But I can direct you to somebody who can and segway into maybe helping them find somebody who can help them.

Cara Lunsford

Yeah, I think sometimes, especially new nurses can feel very intimidated by bye bye doctors and and I think it's important to remember that doctors are your colleagues. This is a multidisciplinary care team, my friends.

Katie Duke

We don't often realize what the responsibilities and roles are of people who work around us. And sometimes you just need to use that moment as an opportunity to educate somebody.

Cara Lunsford

Absolutely. And you know that you have a nurse manager. Your nurse manager is your boss. The physician is not your boss Physician writes orders. And then we decide whether to implement those orders based on a variety of things. A lot of checks that we do to make sure that it is okay to execute that order, but we don't do it just because we're told to.

So it's it's important to know that that's that you have a license. You have the responsibility to say no. When you see that something is incorrect or an order is incorrect, and that if that at all feels threatened, that, you know, you can say, well, if you have a problem with that, you can absolutely go to my nurse manager.

Minor's manager is my is is the person I report to.

Katie Duke

Yeah, yeah.

Cara Lunsford

So what I really enjoyed about this conversation with you today, Katie will so many things. But the thing that I really enjoyed was that we started, you know, we started talking about boundaries from a very personal perspective, like how do I, how do I first set a boundary within myself? How do I identify? Where do I find myself worth and, and because you have to start with those things, because you can't just jump over here to saying no to a physician, saying no to your manager, saying no to their saying no to that, because it does start with self worth and value.

Katie Duke

We go to work every day and we don't feel appreciated, we don't feel supported, we don't feel safe, we don't feel valued, you know, So we're looking for little seeds of confidence wherever we can grow them. And when you just have that as your baseline, you're going to have a hard time setting boundaries because you already feel you're having to prove yourself or that you have something to prove or it's it's really it's tough.

It's tough, but that first boundary that we set, it has to be within ourself first. And it comes from being confident in what you bring to the table, but feeling confident about who you are as a professional and on a personal level. And again, like knowing that your worth and your value is never tied to what you do to bring home a paycheck, it is so much deeper than that.

Cara Lunsford

So to finish this out, Katie, I'm going to have you very quickly tell me who you are. But you're not allowed to use nurse or nurse practitioner or NPY at all.

Katie Duke

Okay. All right. So challenge accepted.

My name is Katie Duke. I am ou t I got to start over.

My name is Katie Duke. I am an advocate for health care professionals and I help build a safe space to have conversations and dialog about authentic things in a transparent way.

Cara Lunsford

I love it. I love it.

Katie Duke

It's much easier to say I'm a nurse practitioner and creative, but it's okay. We're working on it.

Cara Lunsford

But you are so much more than those things. And what makes you so wonderful and so unique is that there is not another person. The planet that is B Katie Duke and went rah, rah rah. But it's why I love you and everything about all the reasons I love you have absolutely nothing to do with you being a nurse or a nurse practitioner.

Katie Duke

So that right there should be the lesson of the whole day. You are worthy of love and competence and value, and it has nothing to do with your title or where you work.

Cara Lunsford

That's it. What a great takeaway. Katie, I love you. I love you. I love you. I love you. Thank you so much for doing this podcast with me.

Katie Duke

I love you too. Thank you so much for having me. I think that we should encourage people to do this, and I think should make it a challenge. And I think the challenge should be the nurse challenge should be describe who you are and what you do without using your job title or where you work challenge. And on that note.

Let's do it.

Note we did you all to do and tagus when you posted.

Cara Lunsford

That's right. Tag us when you post it. Love you. Have a great day. I'll talk to you soon.

Katie Duke

Thank you. Later by.

Cara Lunsford

If you were a nurse who enjoyed this episode and you have an idea for future episodes, you can connect with me by downloading the nurse dot com app. See you there.