Dan:
Welcome James.

James:
Thank you so much for having me, Dan, I'm super excited to be here.

Dan:
You are in the COVID hotspot of the world. I think people think of COVID they're like, "Oh, New York, Florida, Michigan." Nope, it's LA. And that's where you are at UCLA working in the trenches. What's going on out there right now?

James:
That's one place I'm at, I'm actually at another hospital too in the community. I will say right now at the time of this recording, things are getting a little better, which is really exciting, though it's all about perspective. Because if you had asked me this question two or three weeks ago, it was the absolute worst that you've ever seen. And I know as people listening who are our nurses or nurse leaders or in the healthcare profession, it's so nice to be able to talk to people who completely understand it, who get it when I say I'm a hospitalist, I'm a nurse practitioner hospitalist at both facilities. And I was seeing 37 patients a day, 34 of them were COVID.

James:
At one hospital, it was just constant code blues, rapid response, constant to the point where we had COVID and non-COVID code blue and rapid response teams. There were four rapid response teams in total and they were constantly busy. It was not anything at all that I ever thought I would encounter in healthcare whatsoever. And I'm thankful that I got through it at least with my physical health together, but it's just really the amount of lives lost and lives changed forever with this, it's just almost unfathomable.

Dan:
So how did you keep it together through that? I had talked to nurses who are seeing three or four patients die a day. Every single shift was just stuff hitting the fan and it takes a toll on you mentally. I remember back to my ER days, we'd have surge capacity for multiple shifts in a row. And you need to take four days off to chill after that. And that's not possible right now. So how did you personally keep yourself going and healthy and sane through the whole thing?

James:
I'm not sure that I actually did do a fantastic job of it to be completely honest, because it was just more than I think any of us had ever thought we would have to deal with. So in leading up to it, si I've been on the front lines, if you will, of COVID since the very beginning and it's waxed and waned. When things were really bad in other places, it was completely fine here. UCLA was having to... They were trying to prevent furloughing people and laying people off and doing all those things with very creative scheduling. And they really did a fantastic job of that. This summer, because census was so low, even COVID census and fast forward six months later, it was crazy. So in the ups and downs, I was doing a really, really good job of keeping things in perspective, trying not to bring too much of it home with me.

James:
I had to learn, I think we all do this. As nurses, we all learn once you cross the threshold into your home, you have to leave work and the energy of work outside and you've got to leave it at work. Because it will quite literally haunt your dreams. But there was probably about six weeks there Dan, So here in LA, probably the entire month of December and the first two weeks of January that it was impossible. I was crying at the drop of a hat. On the way home, in the car, sometimes just in front of people at the hospital, sometimes we'd have... I was having seven and eight DNR conversations a day. My, I don't want to say record, that sounds awful. But the number of patients that died during a time when I was there was five.

James:
It's even hard to go back and think about. And that was just a few weeks ago during a shift, five people died and that's five different conversations with family who aren't there, who didn't get see it, who didn't get to be with their loved ones at the end. But you just got to keep it pushing. You just got to move on. And then the next thing you know, I would be doing something like eating a bowl of French fries was my first meal of the day. And there's tears splashing in my ketchup because I can't help it. I'm just crying while I'm shoving these french fries down my throat before I go to the next code it was not wild.

Dan:
And I think for people that aren't in healthcare, they think it's the ER or the Grey's Anatomy where that's like normal. Yeah, people die every day, but that's not normal. That's not a normal day at a hospital is five people dying in one shift. That doesn't happen every day outside of a pandemic. And it does take a toll. I think nurses are adaptable people and you kind of have to figure out what your coping is and you have to separate it too, because you go home and your family is also dealing with the stress of staying at home and all those things, and you don't want to bring the burden now of this completely other craziness that's happening at work there too. And it's really hard.

James:
It is. And I really do, I like to speak in realities. So when things are as dark and grim as they were, that's what people were hearing from me. And now things are better. I just came off of a week of nights. I do seven on seven off for the most part. And I did a week of nights and we were busy, but I would only say a third of the patients that we're admitting were COVID patients, which is way different than from before. So that is fantastic. I think that it's multifactorial. So the Cal 20C variant that seemed to account for in December more than 50% of cases here in the state of California, and could be as many as 75% of cases in January, as we wrap up that data, I think that variant may have run its course.

James:
I think people were really getting it. And I think unfortunately we know that people did things during the holidays that we were hoping that they would not do. And so we suffered the consequences of those, but now there haven't been any holidays. So people have been staying home, not gathering inside better. Like it or not, and I can really only speak for California, but I know Gavin Newsom was not popular, but he shut it down and he shut it down hard. I have to think that in some way, shutting down even outdoor dining, things like that helped to some degree, I think there were weather change things that happened here. Contrary to popular belief, it does get a little bit chilly and gross here in January. And so it was rainy and cold and I think people just weren't doing things. I think that helped too. This multifactorial approach really has helped stem the numbers and slow everything down, which it's been incredible. We can finally sort of breathe.

Dan:
Yeah, I was looking yesterday and this won't come out tomorrow, so it's all relative. But we went from in California, like 60,000 infections, a day to there was 17,000 or something. It's just such a dramatic drop that I'm hoping that continues. And what about the vaccine? So how are you seeing that rolled out in your view? I know we're trying to get healthcare workers now, parts of California doing 65, some are doing 75. What's the view on the ground of the vaccine rollout and how do you think that's helping?

James:
Man, this is for me, definitely a case right now of two really big stories. So I feel like the headline are it was completely bungled and mismanaged from the beginning and trying not to be overtly political, although sometimes we have to be. There were things that were done with this vaccine roll out that were just flat out lies and follow through. We always talk about in business and in healthcare and leadership and whatever, you try to under promise over deliver, if you can. It was the reverse, it was over promise way, way, way under deliver. Also, so without any federal leadership guiding states, which could then guide local county public health departments, everybody's doing something differently. And the rollout was awful, but it's already starting to get a little bit better.

James:
And I think it's because Pfizer and Moderna in particular are giving us a little bit better transparency into what they're actually manufacturing and what they're actually going to be able to deliver so that states and local county public health departments can plan better for that. I think attitudes around the vaccine are starting to change a little bit in the general population, which is helping. And I think frankly, people aren't growing third arms.

Dan:
Right, it's that adoption curve. It's like you have your innovators who are like the nurses, like, "Hell yes, sign me up." And then you have your early adopters who are like, "I'm going to wait and see and make sure they don't grow third arms." And then you've got your late majority who are like, "Oh, well I'm going to wait like six months to really make sure they're not dying off in mass numbers." And then you have your people that'll just never adopt it. But I think we're seeing that curve play out with this.

James:
I certainly hope so. And I think things like in LA County where I am, there are really robust, awesome public health infrastructure in place that is really working to help ramp this up. Communication has really, really unfortunately been poor just across the board, but that's changing. I do also really feel passionately about how we've got to figure out a way to vaccinate the people that need to get vaccinated and racial and ethnic minority communities that are being disproportionately hit by this pandemic are not getting the vaccine. So for instance, here in LA County, there's one of the mass vaccine centers is at The Forum, which is an Inglewood, which is a predominantly Black and Latin X neighborhood.

James:
And the majority of the people getting the vaccine there are white. They don't live in that neighborhood. And so we still have to keep working on that and we have to parallel path this whole thing about, "Yup, let's just vaccinate everyone who's willing to take it right now, but then also let's fix how this approach was screwed up in the first place so that we can really get everyone vaccinated and get this immunity in the population."

Dan:
Yeah, so you have a great viewpoint there. So you're part of the Black community, you're part of the LGBTQ plus community. And there's definitely discrepancies in information, in access. What are some things that nurses can do or nurse leaders can do to help level the playing field and engage those communities into the vaccine and into ending the pandemic?

James:
I think a lot of times there's-

Dan:
That's a loaded question maybe.

James:
I'll say, do you want the 17 hour podcast? Or do you want the 419 years of racism podcast? So right, we can talk about those things. But I think it's really important to just cutting to the chase to do more than just lip service. I feel like even since last summer, and this is really controversial, I know some of your listeners might not like me after this, but I called last summer and all of the protests and things after the George Floyd murder the great white awakening. All of our very lovely well-meaning white folks in our lives woke up to the racism that the rest of us Black and people of color have been experiencing our entire lives. And everyone was like, "Oh my gosh, this system's broken. Oh my gosh, things are super racist. Oh my gosh, this is bad, we should fix it."

James:
And we're like, "Yeah, we've been trying to tell you this for a long time." So now that people are aware of this, it has to be more than lip service. How you gain trust, particularly from the healthcare system in the Black community, is very different than how you educate and gain trust about something health-related in the White community. And so I don't expect White people at the leadership table to know how to do that. So guess who else needs to be at the leadership table? It needs to be Black folks who understand the community. So it has to be more than lip service. It has to be like, "Oh, well we have a Black executive in our hospital and she is the president of diversity and inclusion initiatives." No, no, no. Your COO needs to understand how this works. Your county public health departments need to be really entrenched in these communities and understand that religious organizations are super important, community leaders are super important, and who understand the history of why Black and Brown folks just don't trust the healthcare system in the United States.

Dan:
Yeah, no, I agree. And I think history always plays a part in this too. And looking back to how vaccines in the past have led to massive ethical issues in those communities and that wasn't addressed well, and it's still in the history, recent history. And so the decision making around this stuff and the trust, I think you bring up is essential for us to address. And I love what you said too, is there's 4 million nurses in the country and they represent every single community and population and group there is. And we need to be better at engaging the most trusted profession to reach out to the groups that they're a part of and be part of that change I think.

James:
Yeah, I think it has to also... Nurse Alice Benjamin is a friend of mine and she sent a tweet out a little while ago. It was like, "I think there needs to be a nurse run hospital. Let's do this." And she's being attacked now by a bunch of physician and physician groups who are like, "Nurses are incapable of this." That's a completely different conversation. But what I do think is really important as 19 years in a row, the most trusted profession, whoever the leadership in hospitals are, physicians, administrators, other nurses, whatever, need to understand that that cache needs to be at the decision-making table early on. So a lot of times what happens is, and this was a part of what my doctoral research was, but a lot of times what happens is a lot of really well-meaning people who heard on a podcast, or in one meeting about diversity inclusion and were like, "The Tuskegee experiments were really, really bad, or J Marion Sims who is, "The father of gynecology," was one of the most evil human beings on earth.

James:
He experimented on doing C-sections on Black women without anesthesia. This is how we know how to do C-sections now. Things like that. So people hear that and people hear that forced sterilization of Black women was legal even in California until the year 2014, that modern. And people hear that and they're like, "Oh man, that's bad." And then what happens is you get a group of very well-meaning white folks together that come up with a plan and they're like, "We're going to help the Black folks get the vaccine." And then they deliver the plan to the Black folks.

James:
And then Black folks are in the community are like, "This isn't going to work for us at all." Also where are the Black people who helped developed this plan? So that disconnect there is something that I think nurses really get, particularly like DNP prepared nurses, nurses who have been in leadership positions, who are from the communities can say, "Okay, in the LatinX community, for instance, don't even come at me with something that's not in Spanish, period. End of discussion." There's absolutely no respect for that. So we have to fix it from a 419 years, at least a Black racism history and the country, while at the same time, figuring out how do we stop the car from running into the wall at 75 miles an hour right now? Which I really do believe is the vaccine.

Dan:
Yeah, 100%. And even if you look at the evidence outside of grouping people, just the evidence of change, if you don't include the people who will experience the change in the change process, it has a far less likelihood that it's going to be successful. And I feel like in healthcare, that's the norm. We get in a room with these, "Smart people," and then we create a solution and we hand it down to the people we think aren't capable of solving the problems that they're experiencing instead of engaging people in the process. Just fundamental innovation and change. Diversity improves innovation, including the people that experienced the problem in the solution improves the adoption of the change. There's science behind this, there's hundreds and thousands of research articles about this. Yet we sit in a room, we write a bunch of post-it notes, and then we hand some plan to somebody and say, "Go execute it." And we wonder why it fails. It's maddening, it's maddening.

James:
It's absolutely maddening. And because Dan, change is hard. Intrinsically as a species, we don't do change well. We don't like it. It's why none of us have been down... Even those of us who have shut down the best and the hardest, stayed inside and worn our mask whatever, that was an abrupt change with a lot of question marks around it. And so lots of people, no wonder there's conspiracy theories, no wonder a lot of people haven't done this, or people have done it by what they think their own rules have been in terms of following recommended guidelines. So change is hard. And the power struggle is very real. So you're telling someone that they have lived in a structure and a system that has benefited them for a very long time and allowed them to get to a particular place of leadership.

James:
And then all of a sudden, you're like, "Okay, well, the system overwhelmingly is designed to benefit you and to hold others down so that you can benefit from it. But here's maybe how to change it." People are not going to rush to do that. As a species, they're just not. And I think that we see that play out, obviously racially, this is very specific things I'm talking about. But then also like you were saying in terms of like healthcare delivery mechanisms and in the hospital system, look at the data and the evidence around community hospitals that do a very good job of incorporating community advisory boards into how they run their facilities. When it's done well, those hospitals really flourish. It's all about the bottom line and they end up making money, but they also have the respect of the community and that ultimately is good for business. So you're right, sometimes people just find this diversity, embrace it rather than sticking to these old antiquated systems that are designed to keep one group of people up and everybody else down, you actually end up getting further.

Dan:
Yeah, and I think the other piece is the systems have to flex beyond what they've always done. And one example that popped in my head was from when I worked at Kaiser and one of the initiatives that Kaiser was working on was getting the Latino community to get more colon cancer screenings. And so initially it was, "Oh, you've got to come in and get your endoscopy and all that." And they weren't seeing that group come in at all. And they dug in with it and they said, "Hey, the community said, look, the act of endoscopy is not something that is culturally accepted." Instead of saying, "Well let's educate them about endoscopy and it's normal and everyone gets it," they switched the policy and actually did the mail out stool sample piece, which the efficacy was maybe a little bit less.

Dan:
It was like instead of 99%, it 96% or whatever the catch rate was, but they got an adoption curve of just off the charts. That type of thinking of the gold standard is endoscopy, but maybe if we switch it, maybe we won't catch 100% of it, but we'll get more people and we'll catch more earlier and be able to have a bigger impact working with the community on what that could look like. I think those are the types of things that we need to potentially look at too, is the evidence is strong in this thing and this is the gold standard, but maybe we can actually help more people by the next solution down or something. I don't know. Do you have thoughts on that?

James:
Yeah, I think that's wonderful, fantastic example. What also frustrates me as a queer person, as a person of color is that that's also, we hear that story so often. A group of really well-meaning people put something together for a different community, and then were like, "Why didn't this work? I don't understand." You can't tell Black trans women who are sex workers on the street, you can't design a program for them to help them gain housing, healthcare, money. If they want to continue to do sex work, how to keep themselves safe, if they want to stop doing sex work, how to transition into other different types of work without involving Black trans women who do sex work. And I bring up that group on purpose because that's a group that I work with.

James:
I'm on the advisory board of an organization called APAIT, which does a lot of work with the LGBTQIA plus community here in Los Angeles, particularly youth who are living with HIV or at risk for HIV. So it's one of the things. And even I brought a lot of fire to this coming into it, and then being on the advisory board of this organization, I learned even more. And so it's another classic example of that from business, everyone learned this. And if you were privileged enough to go to your bachelor's program, at some point you probably learned the Nova experiment with Chevy. Chevy had the Nova in the '70s which was selling like hotcakes here in the United States. And then they ship the car to Latin America and it wouldn't sell because Nova in Spanish means no go, how are you going to sell a car that means no go?

James:
And the fact that things like that are still happening today is part and parcel of why you're hearing individuals like me who are lucky enough to be in a place where our voices are being heard and who are also people from these intersectional communities of queerness and Black and people of color speak up so loudly and say, "This crap has been going on for so long. I could have told you 1,000 times that you can't go to a LatinX community and be like, 'I need to shove this thing up your butt to see if you have cancer.'" Let's just talk about how we talk about cancer in different communities in the first place, it's so wildly different. So I think we just have to keep educating. It's a multi armed approach in terms of educating folks younger so that there are more and more people of color who are going into health care, who are going into leadership, while also really giving the community that you're trying to serve a seat at the table and listening when that community says, "This is maybe how I think things should be done."

Dan:
I've heard arguments that we need to add more of this into nursing education, we need to do more in services around different communities and cultural sensitivity and bias and all this kind of stuff. But at the end of the day, there's so many different groups that require flexing and thinking and doing things in different ways. As a frontline nurse, what's some of your advice to just practice differently or more sensitively or do the right thing in the moment when you might not have all the information at your fingertips?

James:
It's super hard, isn't it? It's really hard. One of the things we have to all do, and I do this myself, or at least I try to, I'm not perfect at it, is that instantaneous gut reaction that you're having to particularly a racially sensitive situation or someone who has a different race or ethnicity than you, or someone who's a different gender identity or sexual orientation than you, challenge that. Allow yourself to open up a little bit to the fact that this feeling that I have, this thing that I've learned about this person might actually be inherently fundamentally flawed. It might actually be wrong. So I think that's one of those things that you have to challenge right away. I'll give you a for instance. It's very controversial pain management in the sickle cell population.

Dan:
Yup, I experienced that firsthand in the ER at UCLA, which has a large sickle cell population, at least when I was there. And there was a lot of weird things that happened. So yeah, please. I think it's a great example.

James:
Yeah, and I think it's something that at some point in time, I feel like all of us nurses, if we've been in a hospital setting are going to, or have already taken care of patients who have sickle cell. And there's just a different approach to treating patients who have sickle cell. And you just have to acknowledge the fact that it's because most, 99, 98.7% of people who have sickle cell are Black, it just is. And so if there is an inherent racism, there is an inherent biases towards treating someone's pain. And we love in nursing to run around and talk about, "Oh, pain is what the patient tells us," and they use the pain scale and dah, dah, dah, and they treat pain so that it reduces the inflammatory response. We all know the pathophysiological reasons why it's really important to treat pain, but then also adopt that to why it's even more important to treat pain in a patient who is actively sickling.

James:
And even today, 2021, I know providers, physicians, NPs, nurses who will literally wait for a ridiculous cell count. And then that particular site count. It will be through the roof and they'll be like, "Oh, maybe they are really having a crisis." And I'm like, "Okay, so you are going to believe every other person who walks in and is like, 'I'm in belly pain and whatever,' and you're like, 'Okay, I'm going to give you morphine.'" So let's just be honest, a pretty young white woman walks in and is like, "I'm having this back pain or I have massive left shoulder pain." "Okay, well let's treat your pain so we can get you out of pain and make you comfortable until we figure out what's going on with your shoulder," or if someone who's lived with sickle cell for 20 years, walks in and is like, "I'm in pain crisis. This is why my pain crisis looks. And because I've been taking narcotics for 20 years, their tolerance is obviously really high."

James:
I actually love it when the sickle cell patients that I take care of walk in and are like, "I actually, at this stage, I'm needing about two milligrams of Dilaudid every three hours. You can put some Norco underneath that and maybe a little Tylenol. Let's see how this works for the next 12 hours." Great, we have a plan and sometimes nurses like to hide underneath that. "Well I'm scared of their respiratory depression, I'm scared it's going to stop their respiratory drive," and all these things. No, you're not. There's an inherent subconscious racism that is going on there that we're not treating people's pain because they're Black. There are some medical schools that it was just up until 10 years ago were still, in nursing schools, that we're still teaching that people with darker skin actually experienced pain to a lesser degree than people with lighter skin.

Dan:
I just remember the eye rolls that I would see, patients would come in and they would just roll their eyes up, 25 of Dilauded and 25 of demeral, and some Benadryl and they'll sleep for a little while and then we'll discharge them. And then the one time they come in with chest pain, "Oh, now it's serious. Now we got to do the whole workup. Now we're taking it seriously." But at any other time, it was knee pain, joint pain, whatever it was, "No, it's fine. Just 25 of demeral. Just let them sleep. You don't even have to put them on a monitor." It was just this cookbook stuff. And I just remember being so uncomfortable with that. And I was a new grad when I saw a lot of the sickle cell patients. I didn't know how to deal with that or how to advocate her, but I knew it felt wrong.

James:
And then some of that is because we don't address these things in RN programs, BSN, ADNs, whatever, we don't address it to the right degree. And again, I think what happens is it gets a bunch of lip service. So it gets a, "Hey, you guys know that people come from different communities and people experience the healthcare system differently? Okay, great. That was your great 47 and a half minute long lecture, PowerPoint that you snoozed through like everything else. Okay, coming up next is how to manage heart failure." And then people perk up and pay attention. It can't be that. We are beyond not allowing ourselves to be uncomfortable with the status quo because the status quo, it's been exposed. We already had a healthcare crisis in Black and Brown communities and the queer communities. We already had it.

James:
And all the pandemic did was expose that. And so if you were in LA County, you're four to five times more likely to be hospitalized. If you are Black or LatinX, you're three times more likely to die. Those numbers are pretty similar across the country maybe just a tiny bit less. That's a problem. And it's a multifactorial faceted problem that we can't ignore anymore because if we continue to ignore it and I don't care who you are, leadership or not, bedside are not, Black, White, purple, Brown, orange, straight, queer, whatever. If you continue to ignore it, you are complicit in exacerbating the problem. You just are.

Dan:
No, this whole month we're talking about that. We have to bring this stuff up. We have to make people feel uncomfortable because it's the only way people will recognize there is issues and then eventually create change. I t's just science. That's what the evidence says is how you get people to think about things differently. So I really appreciate the perspective on it. We like to say this at our own company, you have to get comfortable with being uncomfortable because growth doesn't happen when you're cruising doing cookbook things. It happens when you mess up and you do things wrong and you piss people off and that's when you learn.

James:
It is when you learn. And and also I was really privy to some fantastic conversations. I got to host some things recently talking with some leadership, former NFL players, a couple of celebrities in the Black community about why the Black community is not taking the vaccine. And as a host, as someone who was hired to facilitate this conversation, we did not wrap up the conversation in an hour with a nice pretty bow. You just can't. And I think that's something that I really think is important for people to hear that it's okay. It's okay for you to be a White person at work, have a Black colleague that you love and adore, and have uncomfortable conversations with them that you can't wrap up in a nice tidy little bow and either have you walk away from over your half an hour lunch, because that's where the growth comes from. And that's where the thinking comes from. And that's where the getting to solutions comes from.

Dan:
Yeah, I agree. And it's about building relationships, not just connections. And so it takes time to build that trust and get to a point of understanding and common ground and all that. Well we talked about a lot, which is awesome. Because we need three more episodes of this, I would love to go... Honestly, I would love to go deep on a lot of this stuff. I enjoy the controversy, but I really appreciate the perspective. And you brought a lot of great things up that are just top of mind across the board. And then, like you said, the pandemic has highlighted so many things, so many cracks in the system. And as leaders and as nurses, we need to take note of those cracks and then do everything we can to fix them. Because going backwards to the way it was is the worst thing that could come out of this pandemic. So I think it's a blessing and a curse at the same time, but I think it's what perspective we take and how we move forward in changing these things. So I just really appreciate your thoughts on all that.

James:
Absolutely, thank you. Thank you so much for allowing me to share them. I appreciate it.

Dan:
Yeah, so we'd like to end with, what would you like to hand off to the audience?

James:
I'm going to piggyback off of what you just said. I would like to hand off to the audience that we're not going to go back to normal and we don't want to go back to normal. Because the normal, pre pandemic, the normal pre Black Lives Matter movement last summer, whether you were a fan of it or not, or somewhere in between, the normal before that was an intrinsically racist healthcare system and intrinsically racist system period, that now has been really truly exposed and we have opportunities to fix. We have opportunities to care for our patients in new, innovative, exciting, fantastic, wonderful ways. We have new science, we have new healthcare delivery modalities, things have accelerated because of the pandemic in so many different ways and going back to normal, when you say that, to me means you want to go back to this place of the system continues to benefit you as a white person and it continues to hold down me as a Black person and a queer person and other folks of color.

James:
And we can all be lifted up together in a new normal. And so I want to leave the audience with even a little bit more controversy, think about when you say, particularly to people in the LGBTQ plus community and to particularly to people of color, that you can't wait to go back to normal, even if you just mean not wearing a mask, there's something about that that is sitting with disparate communities that is troublesome because we don't want to go back to that normal. We want to push forward and make it a better world for everybody.

Dan:
Well yeah, I think you bring up some good points and language matters and we have to think about that and normal is not what we think it's all cracked up to be. So appreciate that. Where can we find you? I know you've got Instagram, you've got YouTube, you're on the media. You are Mr. out in the world. What's the best place to get your content?

James:
@askthenp on Instagram and Twitter is why I'm the most active. I do have a Facebook page, but it's unfortunately been neglected. And I do have a YouTube, which is Ask the NP, but it's also been somewhat neglected. So primarily on Instagram and Twitter, and maybe I'm trying this TikTok thing Dan, I don't know. I think I'm pretty old.

Dan:
That's a constant debate with our marketing team. When are we getting on TikTok? We haven't pulled the trigger yet.

James:
And listen, I can dance. I can dance with the best of them. So part of me is like, "Maybe I just need to start dancing on TikTok," but it almost feels exhausting. Honestly, and my DMS are open on Instagram. I always tell people I created a whole world called ask the NP because I really do want people to ask. So if you have questions about anything we've talked about here, just healthcare in general or whatever, my DMS are open, be patient with me because I do get a lot, but I try to get back to everybody and I think it's really important we have these open, honest conversations about all things in healthcare.

Dan:
That's great. Check him out. He's got some amazing content. I was watching it daily when the virus started and you break it down so easy for people. And I just really respect your opinion and views. So thank you so much for being on the show and yeah, let's create the new world that's way better. And especially a new healthcare system that's not so messed up.

James:
I love it Dan, I'm in. Let's do it. And thank you for having me. Really appreciate it, so honored.

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