Dan:
Welcome to the show, Dr. Lawson.

Scharmaine:
Thank you, Dan.

Dan:
I know you're up to a ton of things, but I'd love to hear. What are you up to today and lately?

Scharmaine:
Well, today, I just did some shooting for a fun project along with the National Black Nurses Association, or NBNA. They're doing some PSAs on some of their members. So they had a film crew come and film me just pretty much doing my regular day to day operations at work, and did some footage with me and the books, Nola the Nurse. And it was great, so I'm doing that. I did that literally just today. And I'd say the most exciting thing that I have going on for me right now is that we're working on the cartoon series to go along with the book, Nola the Nurse, that series. We're working on the cartoons to complement the series and to further expand the impact of nursing to children who otherwise would not hear anything about the world of nursing. And that's the overarching theme of Nola the Nurse, is to spread the word far and wide and global, into all languages, about the roles of the advanced practice nurse. And I'm pretty excited about where we're going with that.

Dan:
That's so cool. I've been following the creation of Nola the Nurse. It's so cool, it's just such a needed thing.

Scharmaine:
It is.

Dan:
There's a lot of information out about nursing, especially with the pandemic. And you can go online and see all kinds of stuff, good and bad. I mean, if you go through Instagram, you see a lot of negative things around nursing, so I'm glad that we're setting up that positive message from an early age saying, "This is the impact you can have as a nurse and here's what we do." And that's really great. How did you come up with the idea, kind of blending your practice and now this idea for the children's book? How did that come to be?

Scharmaine:
It's really just organically kind of evolved into that. Once I adopted my daughter, I wanted to have some books to show her what Mommy did. And I particularly wanted books that showed her minority nursing, or minority professionals, and I just could not find any. And so I said, "Well, I guess I've got to do something about that." We nurses, we fix everything. Right? And so I said, "You know what, I'm a problem solver at heart." And I said, "Let me just come up with some stories." And so that began the birth of Nola the Nurse, Nola is short for New Orleans, Louisiana. And I wanted the book to just be just an introductory level for children, so they can know. Look, can they at least pronounce nurse practitioner? Do they even know that a midwife exists? And so the book journals Nola, she's a seven year old little girl, who follows her mom around on house calls, of course. Yeah, very original of course.

Dan:
Stories come from life.

Scharmaine:
Right, literally. So she follows her mom around with house calls and sees her taking care of sick patients. And she says, "I can do this." But of course, she can't take care of real humans. So she says, "I'm going to play and pretend to be a nurse practitioner with my friends and take care of their sick baby dolls." Soon, everybody starts calling her to take care of the dolls. But what's again true to life is that every home she enters, she discovers a new culture. And that's just how it is true to life. Whenever you make a home visit to see someone, to care for them, you're entering their world and you need to respect that culture and be sensitive to the cultural norms. Right?

Scharmaine:
So she discovers new cultures and gets to eat a meal from each culture. And just to push the envelope a little more, like I always like to do, at the end of every book, the meal that they eat, I have the recipe there.

Dan:
That's cool.

Scharmaine:
So you know that when you go into somebody's home, everybody, eating is social. So they're going to say, "Honey, I don't want to talk about blood pressure medicine right now. Come sit down and have a beignet. Or come over here and have some gumbo. I don't want to talk about my blood pressure pills or anything. I want to know how those babies doing." So you've got to have this little talk before you treat. And that's all a part of the world of nursing as well. Nursing is caring. We're not just about, "Here's your medicine. Take your prescription and go." No, no, no. It's holistic. We want to address the social. We want to address the mental, the spiritual, and of course, the physical, which a part of that is writing the prescriptions.

Dan:
I love how complex that is. I mean, that's just such a cool concept. And it just dives in, it really is the embodiment of what nurses do every day. Right?

Scharmaine:
Yes.

Dan:
I think so many people think you just go in and you give the pill, or the shot, or the IV, or whatever, do the assessment. But you can't do that without building relationships. And you hit it, it's the food, it's the culture, it's, "How are your kids?" Yeah, that's so cool.

Scharmaine:
And that's how it is.

Dan:
Yeah, that's how it is. And I can imagine those recipes in the back, knowing New Orleans food, wow. Just get it for that.

Scharmaine:
I know. Right?

Dan:
That's awesome. So tell me more about your practice in New Orleans. What started you on the path to do house calls? What's that story behind that?

Scharmaine:
I started my house call practice in 2004. Right? And so we were just kind of minding my own business sort of, and just working. And a doctor approached me and said, "Hey, I have about 15 patients that I'm needing to have cared for because I'm going to retire. Would you be interested in taking care of them?" And I said, "Well, sure. You mean like primary care in the home, kind of like Marcus Welby?"

Dan:
Right, exactly.

Scharmaine:
Yeah. Now I just told my age, but it is what it is. Right? And so I said, "Okay, sure." I had experience, a lot of experience doing home health when I worked with the VNA in Southeast DC. So I had some experience, so I said, "You know what, sure. I'll be willing to try it." So I tried it out and realized that it was something that I really love because for the first time, I could actually practice non traditionally, and at the same time, provide holistic care because you go into the home, yes, you're providing primary care. But you're also looking at the diabetic's closet, their food pantry. You want to see if they're hiding sugar cookies. You want to know if they don't have electricity, if they're sharing electricity through an extension cord from their neighbor, which was often the case after hurricane Katrina.

Scharmaine:
So you get to know a lot more about the patient than as what's seen when they come into your office. This is who they are. This is their world. They're in control, and you get to see the cultural norms behind the narratives that they present to you when they come into the clinic because oftentimes, it's night and day. And so that's what I love about house calls. It's totally unpredictable. And at the same time, it's totally welcoming and totally amazing to get a chance go know holistically what's going on behind your patient's blood pressure and elevated A1Cs.

Dan:
Right. It's the context behind those numbers that we don't often see in the clinic and in the hospital.

Scharmaine:
Correct.

Dan:
I remember when I first started, before I even got into nursing school, some volunteer experience that I had was with migrant farm workers in Arizona. And going into homes there on the farms and near the farms, and you would see just a lot of different things that you're like ... Just amazing community, and then also, you see the leg wounds and how the cleanliness of the house is. And you could really make a determination because I talk to that person on the phone, sure. Oh, your leg hurts. You can maybe take a picture of it. But then you see the ants and the cockroaches in the sink, and the unclean food, all those type of things. You have a whole different thing. Okay, now I've got to get you to the hospital. You need antibiotic. So you're not going to be able to just keep it clean here. So you get just that extra data that I think just allows you to be a much better practitioner, honestly.

Scharmaine:
Absolutely. And then you also see what other professionals that you can get on board because you know in order to keep your patient in the home, it has to be a collaborative effort. So that patient in many cases will need a social worker. In many cases, they may need a podiatrist, or they may need home health, or hospice, or any of the other professionals, PT, OT. So it has to be a team collective approach to keep the patient in the home.

Dan:
Tell me a little bit about your patient population. I mean, New Orleans has the range of society all within a very small service area. Tell me about the types of patients you see and what you do there.

Scharmaine:
So most of my patients are elderly, so I'd say the mean age is maybe 72, 73. And I see a wide range. I'm family practice, so I can see a wide range of diagnoses. So we see mainly a lot of hypertension, diabetes, CCOPD, heart failure, and of course, dementia, so that's kind of the ball park of diseases that I see. My biggest goal is twofold, one to keep the patients out of the hospital, and reduce polypharmacy.

Dan:
Yeah. And that's key.

Scharmaine:
Yes, particularly with the elderly population.

Dan:
Yeah, because then you go into things like delirium and all kinds of different things when you have all that going on.

Scharmaine:
Correct.

Dan:
That's amazing. And do you work across the whole city? Or do you have one specific area?

Scharmaine:
No, we are located inside of a high rise senior community. And we were providing house calls almost five days a week until corona came along. And so now we're pretty much, I would say 85% to 90%, we are tele-med. And we're providing visits that way, and going out to make a home visit only if extreme, say the patient is bed bound. So that's how we've had to pivot now because of the pandemic.

Dan:
So let's go into that a little bit because one thing that I've been trying to push nursing to do is get more into telemedicine. I think nurses are underutilized in that technology in general. Part of it's billing. Part of it's just nurses are never thought about as the first people to go adopt things. But how has that changed your practice? Because my platform, I'd love to hear your reaction to it, is if more nurses did more video telemedicine sort of interventions, you get that context in a different way than being there. But you can still get that context. You can do home assessments. You can talk to the family. You can get a lot of data from those things. Have you been able to completely adapt with the telemedicine, do the same, almost the same services? Tell me more about that.

Scharmaine:
Absolutely. Yes, we have been, and it has been great. Now of course, you have some seniors who just, that's not what they're going to do. They are not going to embrace telehealth. They do not want to do any type of video or anything. And right now, Medicare and some of the insurers still pay for other forms of telehealth, which may just be a phone call. You can do telephone calls versus the video, so you have some flexibility there. And it's been working. And like I said, but some patients, not only do they not want to do that, but really, they warrant a visit, like if there's a wound involved. We want to get there and do the dressing change. So there are just some things you're not able to do obviously via electronic modes.

Dan:
Exactly. And the other thing I was trying to push, I was actually speaking at the Dean's Conference for nursing schools the other day. And I said, "We need to embed these skills within nursing school." You need to do health assessment on a person and then go in the next room and do it through video, and then do the next, do it through text and email. But we don't teach those skills, so nurses rely on touching and feeling. And then they're presented with only option now is telemedicine in some form. We don't know what we can do, what data we can get, how to make the decisions. So how did you adapt to that?

Scharmaine:
Just a little bit about me, I'm not sure if you know this bit about my story, but when hurricane Katrina hit, I was one of the very, I'd say a handful, if not the only, and I don't want to say that because I don't have all the data, but providers back on the streets providing house calls. And I was able to do that, able to provide primary care immediately after the storm. I came back in October of 2005. And I was able to do so because I had all of my data on a Palm Pilot. So I was an early adapter of electronic medical records. In the palm of my hand, I had a Palm Pilot.

Scharmaine:
And then I eventually graduated to a pocket VC, of course still in my hand, the data. And it was just rough drafts that I kept every day. Every time I saw a patient, I jotted notes down on them NKDA, A1C, eight, up to date on mammogram, and emergency contacts. Okay, are they allergic to latex? Just small snippets of information on them, in the event something would happen because when you live in cities that are below sea level, you're always thinking of the big one. So it was hurricane season. Right?

Scharmaine:
And I said, "Well, I just need to have this because I want to have something electronic with me." I realized the value of an electronic medical record. I realized that before EMRs were EMRs. Right? And so when I returned, I was able to basically pick up where I left off, while all the hospitals in New Orleans proper were closed because they had no medical records. I was able to just kind of jettison and just get it done and start seeing more. And consequently because I had my information, no doubt, my rate went from 100 to over 500 in three months when I returned. And that was because I know I had the data. And then I was on the ground. I was mobile. I had everything I needed in my SUV at the time, so I was able to provide the accessibility for healthcare, and at the same time, keep the information safe. And it was on me and it was secure, and that's what enabled me to see more patients.

Dan:
I love it. I have a similar story, where I was one of the early adopters of a Palm Pilot in the ER, using it to look up drugs. And I knew what the residents were going to order before they ordered it. And so I don't know, there's something about that Palm Pilot three.

Scharmaine:
There's something about it.

Dan:
That's the secret link to nursing innovation I think. But I love it, yeah. I mean, it's really using the tools at your disposal, thinking on your feet. I call it MacGyver is your kind of spirit animal, where you just put it together and you make it happen, and I love it.

Scharmaine:
Look, you've got to keep the patients' information safe, and you're going to do good quality care at the same time. And you're not going to let the patient know that you don't know.

Dan:
Right, exactly. Right, right, exactly. And that builds that trust. I'm curious what other tools you use. I'm sure you're now using computers and smartphones and things. But are there any other kind of tools, handheld ultrasounds, that kind of stuff that you're using as you go out into the homes?

Scharmaine:
Not really. I had a lot of that. I had the handheld or the mobile ultrasounds before because then we were a provider designated as a provider shortage area right after the storm, of course. But now, all providers are back. And most of the areas have pretty much returned. There's still some areas that are a little weak as far as healthcare. But overall, the city has bounced back in a mighty way. So I don't really have all those extra equipment, the mobile ultrasound. I had a mobile EKG. I don't have any of those things right now. And plus, technology has advanced, whereas now, the EMRs, we don't have to have a separate room for the server. Everything's on the cloud. So you know what I mean, right? We had to have a server in the room and you had to bring it out and bring it back, and sync it. It was just a mess.

Scharmaine:
So now everything's on the cloud. I have my tablets. I have my smartphones. And I usually have a messenger bag with the standard equipment, which is a stethoscope, blood pressure cuff, pulse oximeter, and of course, a thermometer. Everybody has a thermometer now, tuning fork, yes, I still use those, just some basic, otoscope, ophthalmoscope, basic kit and a few little wound care supplies. And that's it. And that overall is what I tell my students is what makes the world of house calls, that niche, very attractive because it's probably one of the only specialties you can get started in with little to no money down.

Dan:
Yeah. And it's the core data that you need, honestly, and the history taking is the big piece of it.

Scharmaine:
Yes. And that's what it relies on. It relies on the strength of you being able to make an accurate assessment. So I often tell new grads, I don't know, maybe give yourself a little time to get a good grasp on history taking because that is the core of how you diagnose. What did you get from your history? What did you get from the patient's history, from the familial history? Okay, now we're digging down to the nuts and bolts. Right?

Dan:
Right.

Scharmaine:
You don't just come up with a diagnosis out of the sky. You come up with a diagnosis through your history taking. Right? And this is a skill.

Dan:
Yes, 100%. The communication is a skill. So for nurses who are coming up, and nurse practitioners, who want to be nurse practitioners, how do we move from the Instagram, TikTok, kind of interaction between people, to, or can you use that for taking better histories, by interacting in that way? I don't know. I'd love your opinion on it.

Scharmaine:
It's interesting. Oh, my goodness, what a question. You know what, okay, I'm going to work with it. All right. So there is an advantage to having the ability to be Instagram famous, or into Facebook and social media platforms because that gives you a certain level of confidence. And that's needed in history taking, and that's needed with giving you a certain comfortability at the bedside when you're dealing with patients. So I would say all of the angles and all of the things we're used to doing with selfie sticks and all this in the modern world now, social media, the millennial world, you can take that and harness that into a very positive experience at the bedside with your patients, and giving them that same energy with confidence, and letting them know that you sincerely want to get to know them. You sincerely do care about their familial history and how it has impacted the here and now.

Dan:
Yeah, that's right. And it's just another form of communication that may be very beneficial to be able to navigate.

Scharmaine:
Absolutely.

Dan:
And you can use it also to teach patients. There's a number of nurses and nurse practitioners that use different social media networks to create videos and education and engage an entire audience that never would've seen their work.

Scharmaine:
And they are doing a phenomenal, phenomenal job.

Dan:
What's some advice that you have for students that are interested in becoming nurse practitioners? What would Nola the Nurse say to a person, maybe not even in nursing school, or maybe a nurse that's been a nurse for a few years, who's like, "I don't know. Maybe I want to stay at the bedside. Maybe I want to do management. But I don't know. Maybe I want to be a nurse practitioner"? What's your advice?

Scharmaine:
So my first bit of advice would be to not let anything in your path stop you from forging ahead and making you feel as though it's something you can't accomplish because a lot of times when things have happened to us in our past, or we have a history of something that we may not be proud of, or we may come from a background that's maybe not so rosy, we think that certain skillsets and certain career advances are just not for us. Or you think that's just something, well, that's for someone else. So I would say that if there's something you want to do, think about me because I didn't have a rosy beginning. But look at me now, I'm on The Handoff.

Dan:
If we're the pinnacle, I don't know.

Scharmaine:
I'm just saying. You guys called me. I didn't call you. There's nurses like, "Well, what does that mean?" So what I'm saying is that you get to certain levels because you keep going and you don't let your past dictate your future. And so I would start there. Again, my history was not rosy. I grew up in a single family household, for those who don't know. And we were in the projects. We were in one of the worst projects in the nation at the time, raised by my grandmother, who was the child of a slave. My dad was incarcerated all of his life, so I never knew him. And so by all accounts and by all bets, they weren't on me. They were like, "No, let's bet on somebody else down the street because this little girl here ain't going to make it."

Scharmaine:
But I didn't let any of that dictate how high I should ascend to ever. And so that's what I would say, that regardless of your past, regardless of where you come from, regardless of who your mother is or is not, that you can be whatever you want to be. You've just got to put some muscle in it, and you've got to get the hustle going because ain't nobody going to hustle for you. Right? So you've got to do it and believe that you can make it, and it will happen.

Dan:
That's great advice. I think that's a perfect place to start. And something I often hear too is nurses feel like the nurse practitioner route is their only way away from the bedside. And I keep saying, "That's not the reason to go be a nurse practitioner."

Scharmaine:
No.

Dan:
It's not rosier on the other side, it's different.

Scharmaine:
Right, it's different.

Dan:
It's different, but it's not some better than kind of thing. What's your advice on someone maybe struggling with which direction do I take?

Scharmaine:
That's a good question because for me, my very first thought was not to be a nurse practitioner. I was not interested in being an NP. I wanted to be a CRNA. And I worked in level one trauma, I worked in ER, ICU. I did all of those high, high, fancy, really, really charging high adrenaline jobs because I said, "I want to be a CRNA." But then what happened was I had a colleague who was an NP, and she said, "You know, why don't you just come shadow me for a day?" And I said, "Sure, okay," and I fell in love with it. So my point is, you may be thinking about something, but you're not sure, so take a moment to shadow someone in the field. Or call some doctor's offices, or say you're interested in being an allergist, or an allergy NP. See if you can find one in your area and shadow them for one day, half a day.

Scharmaine:
And just get an idea of what it is to be in their shoes. And that little experience taught me a lot about me and my personality. And this is what I'm getting to, you have to know you and your personality. And so my personality was not someone that would stay 12 hours, 10 hours, all day, in there with a patient that's not talking to me. I need that interaction. I need to talk to people. Right? I just never shut up, so I need that. Right? So if you know that you're that person who has the gift of gab, then honey, you don't need to be putting anybody to sleep because: Who are you going to talk to?

Dan:
You've got to talk to the surgeon. No one wants to talk to them. Right?

Scharmaine:
Right. So look at yourself, look at your life. All right?

Dan:
Yeah.

Scharmaine:
And see where you belong. And you'll discover soon, if you really dive deep into your personality, that you know what, I would be better suited for a job that allows me to actually talk to people, and kiss babies, and rub the little elderly, their hands, and roll them down the hallway, all those extra things. See, I'm extra like that. I want to do all these extra things. Right? So there's no surprise that I'm actually doing house calls. There's no surprise that I'm writing books because I always color outside of the lines and make a beautiful story.

Dan:
I love that analogy. And yeah, I think that's a great piece of advice that I follow as well, which is you've got to know yourself. I mean, my first job in nursing I got offered was a neuro ICU job. And then I ended up in the ER as a new grad. And I look back, if I would've made the choice to go to neuro ICU, I don't know how long I would've stayed a nurse, honestly. Just not my thing. And you being an ER nurse, you get it. Right?

Scharmaine:
Yeah. Right. I do.

Dan:
I've got self diagnosed ADHD. I'm all over the place all the time. I can't focus. I don't like details, graphs scare me, Excel is not my thing.

Scharmaine:
I get it.

Dan:
So the ER was my happy place. And when I had 1000 things breaking down around me, I was at my best. And I think we've got to spend more time kind of reflecting on: What in your personal life do you love doing? Do you love doing the budgeting? Maybe ER's not for you. If you like MacGyvering the home improvement object, maybe that's the ER nurse. But yeah, I think that's a great piece. What do you love? Because you're going to do it every day, day in and day out, and you got to love it. Otherwise, you're going to be complaining on social about it.

Scharmaine:
And notice I didn't say, "Choose a specific niche based on money."

Dan:
Right.

Scharmaine:
Do not choose it based on money. Don't let money be your driver. You have to think about internally what's important to you because if you focus on external, which is money, then you're really going to be disappointed and be switching careers sort of within the next couple of years after you become a CRNA, or after you become an NP, and says, "I don't want to do this." And you see them on the gram. You see them everywhere saying, "You know, I'm an NP now, and I hate it. I want to go back to being an RN," and all these things. And it's like, "What?" So do the internal work. Do that first, and then make your decision on which way you want to go.

Dan:
Yeah. And if you're awesome at your job, money will come. More opportunities open up if you just are awesome at something you love.

Scharmaine:
Absolutely.

Dan:
Oh, my gosh. We could chat for hours.

Scharmaine:
Forever.

Dan:
I love this. We've got to do more. This is so cool.

Scharmaine:
Now be careful what you ask for.

Dan:
Hey, I'm in. I'm in 100%. Well, Scharmaine, so tell us a little bit about where we can find you. Where can we find Nola the Nurse? And where can we find more about your journey?

Scharmaine:
Sure. So all of Nola the Nurse products are on Amazon. They are now on walmart.com. You can find them on Target, not in the stores yet, but on the websites. And nolathenurse.com is where you can also find product. It takes us about four to six weeks sometimes to get product out because of the warehouse now with coronavirus. But we do get the books out as soon as we can, and that's where you can get the autographed copies from, from nolathenurse.com. I'm on Instagram, that's dr_lawson_np. Nola the Nurse is there. I'm on Clubhouse. Where else? LinkedIn, Facebook. Listen, I haven't hit TikTok yet. I'm trying to figure that out. We're coming. I think I have a profile there. But you know what, you guys don't want that trouble.

Dan:
No, I love it. We have a standing joke. Every quarter in our all hands meeting, one of the employees of Trusted asks when we're going to get on TikTok. And our marketing lead is just like, "We're still assessing it." It's just this running joke because we don't know what's going on over there yet.

Scharmaine:
But watch out when you figure it out. Right?

Dan:
That's right. Well, that last thing I want to ask you is: What would you like to hand off to the audience? What's that one nugget that you want to share to kind of kickstart their day tomorrow?

Scharmaine:
So without the risk of sounding cliché-ish, but with the intention of sounding cliché-ish, is that never forget yourself. In everything that you go after and everything that you gain, everything that you achieve, all the awards that you win, never forget you, meaning always, always, always incorporate a measure of self-care every day in your life. And that could be small moments of journaling about: Okay, how am I going to make my next million? Or it could be reading some self help books. It could be maybe five minutes doing a plank. It could be walking on the bayou. Of course, I'm going to say bayou because that's what we do here in New Orleans. Wherever, walking on the river, wherever, taking time to steal away from the hustle and bustle of life because you are all you have. You're it. You're all your family depends on in many cases. You're all your patients have in many cases, especially if you're the only provider in the region or in the area. You're it.

Scharmaine:
So if you're not fulfilled, or if you haven't filled your vessel to where it needs to be to serve others, then you have nothing to give, and you're going to die out. Trust me. I've been there. So take care of you, fill you however you can via self-care. And you will be a much better provider, a much better mom, wife, girlfriend, boyfriend. You'll just be a much better person, and the world will be so thankful.

Dan:
Awesome advice there. And it does, the energy to care for others comes from internal, and you've got to build that reservoir up, or it goes away really quickly.

Scharmaine:
Absolutely. Every day, Dan, every day.

Dan:
Every day, yep.

Scharmaine:
Even if it's 10 minutes, every day.

Dan:
Yep. I know you're doing it. I see you posting your challenge. You're crazy.

Scharmaine:
Look, I'm trying to do it. I don't want to name names, but listen, it's 25 minutes twice a day. It's drinking a gallon of water. It's writing. It's journaling. It's taking 10 minutes of time to read nonfiction. Listen, I'm doing it. I'm going 75 days straight and I'm going to keep going because I've already seen the positive rewards mentally for me. I'm able to focus. Look, as if I need more focus. Right? But it's a focus now. I'm thinking I wasn't focusing before. Are you kidding me? So it's just like, "Y'all not ready."

Dan:
I love it. We're going to have you on after day 75. We'll do another one and see.

Scharmaine:
Right.

Dan:
Oh, my God. That's so awesome. Well, Scharmaine, thanks so much for being on the show. We'll post all the info about your links and Nola the Nurse on the show notes so people can check it out. And check her out on social. She posts some awesome stuff, and it's very motivating, and just wonderful to get to chat with you.

Scharmaine:
Thanks so much, Dan, I appreciate it.

Dan:
Thank you so much for tuning into 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.