Starting a Nurse’s Journey: From Nursing Student to New Grad with Rebecca Gustafson and Czarielle Dela Cruz

[00:00:00] Mary Wheeler: On this episode of Nurses’ Voices, we’ll be speaking with a nursing student and a new nursing graduate from Ryerson University Toronto.

[00:00:09] Announcer: This is Nurses’ Voices. Nurses’ Voices is supported by the Canadian Nurses Foundation and by the Canadian Nurses Association.

[00:00:19] Mary Wheeler: Welcome to Nurses’ Voices. I’m Mary Wheeler.

[00:00:22] Gail Donner: And I’m Gail Donner.

[00:00:24] Mary Wheeler: In this, our final episode of season one, we’re going to meet Rebecca and Czarielle.

There’s been much in the media, across Canada, on the crisis in nursing, many nurses, leaving the profession. And on the other hand, many wanting to become a nurse yet not enough spaces in the nursing programs, Rebecca and Czarielle are at the very beginning of their nursing career journey. We’re looking forward to hearing their stories, why they chose nursing as a career, why Ryerson and what needs to happen in the workplace and the educational institution to retain them.

Rebecca Gustafson. Rebecca is in her second year at Ryerson university pursuing a bachelor of science in nursing. She told me on the phone, she’s passionate about providing safe and effective care to people in need. And our other guest on this episode is Czarielle Dela Cruz. Czarielle is a registered nurse and has her bachelor of science of nursing. Czarielle is a recent graduate of Ryerson university.

And she’s been working as a registered nurse since July of this year at the university health network. So welcome to both of you. So I’d be interested. Um, if we start with you, Rebecca, why did you choose nursing?

[00:01:42] Rebecca Gustafson: I didn’t really know what I wanted to do from a young age, I knew I wanted to do something in the medical field. I was really interested in biology–that was my favorite science subject. And I really wanted to make a good impact on the world. By using those three things: nursing! That sounds pretty good. And so I researched it more and it really aligned with what I wanted to do for the rest of my life. My grandmother is also nurse, so that was really helpful to me.

And also my friend decided to go into nursing and she sounded like she was having a wonderful time. So I it’s like, yeah. Yeah. I think that’s the path for me. So that’s why I chose nursing.

[00:02:26] Mary Wheeler: So you’re year two, was that, was this still the good, the good decision?

[00:02:31] Rebecca Gustafson: Yes. Yes. I think so. I’m really happy. Um, that I chose nursing because so far it’s everything that I’ve hoped and more,

[00:02:39] Gail Donner: Whoa.

Fantastic.

[00:02:41] Mary Wheeler: You started in COVID too in your nursing program, but Czarielle you started before COVID and then had to transition in as you were in the program, because you just graduated in July. Can you talk to us a bit about what that was like?

[00:03:00] Czarielle Dela Cruz: Oh my, I guess my education was just. Part of it, of a roller coaster. And so, um, actually during my first year it was the collaborative program.

So technically some of my classes were on the college site and that was the year they had the college strikes. So I already had a virtual class that year, even though I was still a Ryerson student. And so when the pandemic hit towards my fourth year, third year, it was. Was like deja VU, like the strike all over again.

But this time everyone was studying from home. We actually had placements in third year when, when my classes were cut short. So this was last year. So the second semester of my third year. Fortunately, I was able to finish up my hours from other placements. But then when fourth year hit, which is the year where we’re working full time at our placements and more of the practical hands-on learning, it was really difficult.

Oh, everything that we learned in school, this advocating this, um, all these politics that you learn about that affect your nursing care, really came alive. Um, it just so happens that I was involved in an association. And so I got to see a lot of the, the red tape and all the, you know, all the little nuances that nursing students are not sometimes aware of behind the scenes.

So for example, um, a lot of nursing schools decided to cancel placements for students, um, in September of last year, uh, which is understandable considering how we didn’t know anything about COVID and how that would transmit and to protect the safety of nursing students. And then it got to a point during the second way where they realized with all the cases rising, it would not be feasible to not allow nursing students to take care of COVID patients, because then there would be no placements available.

And so just by nature of that role that I had, I was in conversation with nursing students from other schools and actually the Ontario nurses association on, for all of this advocating that we had to do because we were challenged and to have placements for students in their most important year, fourth year, but then also balancing the fact that there were restrictions imposed, based on.

And it was inconsistent, which is, you know, the struggle that everyone had, every placement site was different. Some would allow students to take care of COVID patients. Some wouldn’t, you know, we got into conversations about how these externships didn’t quite meet nursing school, um, standards, which is why it wasn’t considered a placement.

And so now you get into this discussion of you have nursing students who need this need, this educational need. They need to learn. They need to know. They need to learn all these skills, but you don’t have the placements that are consistent because of staff shortages. You don’t have enough nursing preceptors because of all the burnout that happens.

And then you have this other added balance where, you know, your professors are in the middle of it because they’re trying to advocate for you to have placements, but then there’s also a need in these hospitals. And so nursing students are like, are they the need.

[00:06:03] Mary Wheeler: Right.

[00:06:03] Czarielle Dela Cruz: To fill in the staffing need, but then they don’t quite meet the educational requirements that you need to graduate.

And so it’s more like you have to be grateful for what you have at that point. And so I think that’s how, that’s how I cope. I can’t speak for everyone, but that’s how a few of my colleagues coped as well. It’s more of be grateful for what we can get. It was really difficult to consolidate that. And sometimes I I’d be on one side where I would understand where students are coming from, like myself.

And then on the other side, I could. Truly empathize with the professors and the, um, and the faculty who were making these negotiations with hospital sites, because I honestly didn’t know, um, where to stand. So that’s how that affected my education, where you really had to get involved and be aware of the current events, because you needed to know the rationales for the decisions that were being made higher up regarding, regarding our education.

[00:07:00] Gail Donner: If I listen, a lot of politics, which actually there probably are even without COVID, but good for you for trying to get engaged. How did all of what you described affect what you decided to do when you graduate and what you experience is now as a relatively new graduate?

[00:07:24] Czarielle Dela Cruz: Definitely coloured my experiences.

So I was already working at the University Health Network as a student when COVID hit last summer, they were offering, I remember nursing students 20 plus dollars to work PSW positions. Cause a lot of units were short staffed and a lot of my friends were working the job that I was doing at that time, left, actually, because they were higher positions and it was a matter of me deciding, do I want to stay with the organization I’m with, because I value this organization or am I going to choose the money?

And so I stuck it through, even though a lot of my colleagues left their position and, um, there were a few of us that really toughed it out and I guess it speaks to the resilience um, that is really needed both as a nurse and in general, in order to stay with the nursing resource team, because even now, um, shortly, a few months after orientation already half of my batch has either transferred to a unit that they found or, um, has moved on elsewhere.

I learned that I wanted to, to continue that I wanted to really challenge myself. I’m not going to lie. There’s been tears shed. And it’s been quite difficult, but I knew that if I could come out of this, especially with everything that we had to deal with, politics wise, um, on top of the stress of school. I knew that I could come out as a stronger nurse and more importantly, as a stronger person.

And so that’s why I stuck it out with the nursing resource team. I knew it would be difficult. I knew that, cause that’s, that’s what the nursing resource team is. We staff units that are short-staffed. So we don’t know where we’re going with. And just by nature of the pandemic, literally all the units are short-staffed.

And so the patient ratios are actually much higher than they were even prior to the pandemic.

[00:09:06] Mary Wheeler: I’m wondering Rebecca, as Czarielle is describing her situation, what is your world like?

[00:09:13] Rebecca Gustafson: Coming into the nursing program, first year, we didn’t have a lot of opportunity. Our clinical experience was all online.

Which made it really difficult because I didn’t feel like I was becoming a nurse. I felt almost like a fraud. I was learning the material, but had no place to practice it, so it felt like I didn’t know it at all. And then coming into second year, this year, has definitely been easier for me, both mentally and physically, because COVID is not gone, but everything is starting to become just a little bit easier.

I do have in-person clinical, this year, which is really, really helpful because I actually get a chance to practice my nursing skills. And I’m actually got to see what it’s like in the hospital. So now I know that for sure, I do want to go into nursing

[00:10:15] Gail Donner: You’ve learned more probably than you even realize. And, but you had no place to test it out to see whether you could really do it, other than think it.

So now you have the opportunity to get it all, put together. I was just wondering, Czarielle, do you have anything, as you listened to Rebecca, that you’d like to tell her?

[00:10:38] Czarielle Dela Cruz: I hope that the clinical situation has gotten better. I know that after my year we were kind of the Guinea pigs. Um, they were trialing. Based on, so for example, they took, they took nursing students in my year, to new placements that they hadn’t tried before. For example, COVID vaccine clinics and ICU this, but I’m wondering, Rebecca, did you get. Were you guys given, um, options to choose and list your preference for placements for second year?

[00:11:08] Rebecca Gustafson: Um, no.

Uh, we were just told, um, it was sort of last minute, actually.

I remember, I think it was the week before school. I hadn’t gotten a placement yet. So I was panicking. I’m just like, I don’t know, did I not meet the criteria? Was my criteria too late? The week before school started, they said, oh, you got a clinical placement. And I was over the moon, but I didn’t get to choose, but I was honestly just thankful to have a clinical placement.

For me, I know some students are doing all 12 weeks of the fall semester, but I’m only doing six weeks. Um, and then I’m doing clinical online.

[00:11:52] Gail Donner: But what do you do online clinically?

[00:11:55] Rebecca Gustafson: Well, from last year we were basically given patients. So we were given a Kardex and we had to create care plans for them. And then we would discuss it together as a group.

And after a few of them that kind of got a little repetitive. And since we were first year nursing students, there wasn’t very much we could do.

[00:12:19] Gail Donner: Maybe Czarielle, can you talk for a minute about what has all this taught you about who and what you want to be and do?

[00:12:25] Czarielle Dela Cruz: I was one of the students who was assigned to the ICUs.

And that was one of the areas where they have a lot of patients in low-income neighborhoods. And so all my patients at that time for my final consolidation placement were COVID patients and so really getting to see the thick of this as a nursing student. And so I know that after a year of floating around in med surge, um, they do offer you the opportunity to be trained as an ICU nurse.

And actually just, but just by chance that I was lucky enough to have that placement, I realized I wanted to be in the ICU. And more importantly, I wanted to teach. And continue that advocacy role, hopefully with the experience, um, not quite yet, but there’s still so much that I want to get into and at least feel competent with skills-wise, at least an all the floors. I hope that with everything that I’ve learned and all this advocacy and. The little nuances that I’ve picked up throughout as a student. And even now as a nurse, as I try to go through this, I hope that I can perhaps teach and maybe work in more of a focused area. So I don’t think that I will be floating forever.

It’s kind of difficult. It’s kind of challenging to not know where you’re going to be working, but perhaps specialize it in, in a critical care area. Um, I really liked that medical surgical ICU that I was at, even though it was challenging taking care of COVID patients.

[00:13:50] Mary Wheeler: And what about you Rebecca?

[00:13:54] Rebecca Gustafson: Whoa boy.

Um, my goal is to get through these four years first

reasonable. T

[00:14:02] Mary Wheeler: That’s a good,

that’s good.

[00:14:04] Rebecca Gustafson: After I really don’t know what I want to do yet. I haven’t had my mind set on anything because honestly I haven’t practiced it yet. I’m only been in, um, neuro right now. Um, I heard about an OR nurse. That actually sounds really intriguing to me.

I have not researched it yet. I am. I’ve also heard about a float nurse just so I can see, um, what it’s like on different units.

[00:14:34] Mary Wheeler: Now, you know, you know, Czarielle. Yeah.

[00:14:40] Czarielle Dela Cruz: We’re hiring!

[00:14:43] Gail Donner: We’re facing a really serious shortage of nurses globally, not just here in Canada, in Ontario. And there’s also, uh, you know, there’s so much anyone can choose from nowadays.

And, uh, what would you tell somebody if they came to you and said, I thinking of being a nurse.

[00:15:04] Rebecca Gustafson: Well, personally, I tell them just how much fun I’m having right now. It’s, there’s so many different things you can go into. Like you can become an educator. You can work actually in the hospitals, you can be a nurse researcher.

You can work with technology. There’s so many different things.

[00:15:24] Gail Donner: Czarielle?

[00:15:26] Czarielle Dela Cruz: No, that’s Rebecca pretty much stole the words right out of my mouth. I didn’t go to nursing knowing that there were all those options. I went into nursing with that, that heart, that passion for caring. Um, not knowing as well, like Rebecca, not knowing what I wanted to do, but knowing that I. I have to be there for people who needed me.

And then when I got into nursing, that’s when I realized, wow, there are so many doors that I did not know. There are so much to respect about this profession that people in my life did not know about that I learned as I went through school. And I’m sure Rebecca is, um, already in, you know, So I would tell anyone that I would say you want to be a nurse.

Well, it’s not what you see in movies. It’s not the hospital it’s nurses are educators. Nurses are, are, are, are teachers. Nurses are researchers, nurses, uh, work in community care. Nurses run, almost all the health care facilities that you could possibly imagine. Uh, they, they run a clinic. There are nurse practitioners, the education and the possibilities are endless.

And that’s, what’s the most exciting thing about this is is you are not confined to one practice and you could literally do anything. And the reward, Rebecca, even as a graduate, it doesn’t, it doesn’t end there like as a student, it was rewarding learning even as a nurse. Now it’s hard. Sometimes it’s, it’s very much depleting like energy wise, because you have to give of yourself so much, but that reward, that feeling of, of giving back and being, and knowing that you were making a difference so far, for me, it has not gone away.

And so that’s why I have no regrets about this. And that’s what I would tell, not just other people, but even my younger self. When in fact, when I was in 12th grade, unsure about what I wanted to do, I’d give myself this pep talk and say, Czarielle, nurses do so much that I don’t know about. So I have to open me or you have to really open your eyes to see that.

[00:17:20] Mary Wheeler: As Gail alluded to, we are in a recruitment and retention around nurses, Czarielle you’re sitting in a hospital, Rebecca you’re in an educational institution.

What Czarielle do workplaces need to do? Maybe one thing so far, I mean, you’re just new in your career, but is there one thing that you could say, this is what a workplace needs to do to retain people like me?

[00:17:48] Czarielle Dela Cruz: Definitely the most important thing, um, that I’ve learned floating around and especially on the units where I’ve noticed there is a higher retention rate of senior nurses and staff where they are less understaffed.

I’ve noticed that the difference is really the management and the support that the nurses feel they have. Um, I’m sure it’s consistent regardless of where you at education-wise and staff-wise, but it’s never going to change. The patients are only going to get more acute, more difficult. Um, the types of scenarios that you face for are always going to change that remains the variable, but what can remain consistent is the management and the support nurses feel.

So no matter how busy it is on the floor, what I’ve found on these units. And the units where I see that NRT, nurses like myself are actually choosing to stay on, is, are the managers, the managers they say, make all the difference. It didn’t notice this as a students because it didn’t really impact me. But now as a new nurse, when I, when I see on my schedule that I’m floating to one specific unit, all I can remember is are the staff helpful?

Did they help me? When I needed the help that I needed, especially as a new graduate. Regardless of how busy it is. I can get the worst assignment ever. Did a nurse on my shift ask me, do do, did I need help? And that’s what I remember. That’s what I remember. And these are the floors that I want to float to. These are the floors where I don’t mind getting a difficult assignment on, or when I did, for example, this weekend, I got a difficult assignment and, you know, I didn’t come out crying because all four nurses on the force stepped in and took care of one of my patients . Did one little thing, could have been the smallest thing, someone gave Lasix to one of my patients. Um, but that. No, that really helps me. Um, and it’s not even what they do. It’s what they say, what they ask one nurse, one of the in-charge nurses at that time said: “Did you take your break? I insist that you take a break, you know, um, I can cover for you for just a few minutes. I think that you should take a break.” So it’s not the patients. It’s do they look out for their staff? Um, when there’s patients who are very difficult to, you know, will file lawsuits or will have complaints about their care, because they’re, you’re always going to get those kinds of patients are very particular.

Um, I noticed that there are managers who advocate for their nurses and protect their nurses, um, to the best of their ability. If there’s evidence there’s only so much you can do, but at least they talk to their staff and say, listen, I am a manager and I’m doing my best to protect you and your license. Um, and I want to look out for you.

And so this is what I think should be done. So. More than anything really. It’s the management.

[00:20:21] Mary Wheeler: You know what Czarielle that’s reinforced, if you’ve been listening to any of the episodes of nurses’ voices, when we ask nurses, what makes the difference? It’s exactly what you said. It’s the team and it’s the manager out makes or breaks, uh, my experience.

So, so I’d be just curious. When you go to those units, do you let them know, um, how they make a difference for you?

[00:20:48] Czarielle Dela Cruz: Yes. Yeah, exactly. I actually reinforced that. I say, you know, as a new graduate, this is the most helpful floor I had ever floated to. I’ve bought the nurses cookies. ’cause, you know, I, I would not have been able to get through my shift without that help.

And I reinforced that and I say, I wish all the units were like this or something like that.

[00:21:08] Mary Wheeler: So, Rebecca, what, what would be your advice I’m in a role, a leadership role in, in your school of nursing? What do I need to know from you?

[00:21:17] Rebecca Gustafson: The main thing I’d say is definitely around mental health. Because being the nursing student, it’s very stressful.

Especially during COVID last year, I was mainly alone in my dorm room. I didn’t have anybody to room with. So I was basically isolated all day and just the amount of work sometimes can be very overwhelming. My faculty’s really good, but just, I’d say just pushing the mental health. Like even at the beginning of classes, having little meditation periods, just the professors reassuring us that everything will be okay.

And the faculty, just having nursing discussions where we can all talk about our struggles or something like biweekly, it’s very difficult sometimes.

[00:22:07] Mary Wheeler: Gail. Did you have any questions before I’ll close?

[00:22:10] Gail Donner: No, I don’t have any questions. I I’ll I’ll just take the opportunity to wish you both, just every success.

[00:22:18] Mary Wheeler: So I want to thank you both for coming on to this, our final episode of Nurses’ Voices. And it was just so wonderful to meet both of you and hear your stories.

So well, Gail, it is the final episode. And I think we chose two really good guests to bring, uh, bring closure to the season of nurses, voices, especially on the topic of education.

What were the couple of things that stood out for you?

[00:22:48] Gail Donner: The first thing that I think is important for all of us to hear is a theme that has been throughout our whole, uh,season. And by the way, for our listeners and watchers, this is the last one, but not forever. Just for now, of this season, we will be coming back.

I think it’s the importance of leadership. In this instance, they talked about the manager, but sometimes it’s not the manager, but leadership and support. And I think it doesn’t matters. So, uh, This evening. I mean, we talked about, uh, mental health and they talking about the support and the team caring for each other.

And how many times have we heard that in the dozen episodes? Yeah, probably. So that to me is important. And I think as a profession, we need to pay more attention to how are we supporting each other and how are we going to retain the next generation and they were telling us what they need.

[00:24:00] Mary Wheeler: What came to mind for me was our previous work in career development.

And that career continuum, they were really on the start of their journey into nursing. And Rebecca was a great example of how she made choices to move into the learning phase of the career continuum. I’ve got some ideas I’m looking up, my skills. Um, here here’s a match. And then, Czarielle, I thought was a lovely example of that entry phase, where she’s still not sure and made a conscious decision to go onto the resource team to try different things.

And that’s what we’ve always said. Uh, nurses need to try different roles within an organization before they, they settle in. And so that was what stood out for me because I would agree with you what they were telling us and the profession, what needs to happen. And it isn’t, uh, there are a couple of things that need to happen, that might make a difference, but this is also for me, were great examples of, because we’ve talked to a lot of nurses all the way along the continuum, but these were two nurses, right at the beginning. Their enthusiasm, their passion for nursing. Um, and even with the ups and downs, they’re still. In the game.

So, um, I think it was a really nice way to end the season one.

I hope you’ve enjoyed this episode of Nurses’ Voices. This is our last episode in season one. We’re very excited to tell you that Nurses’ Voices has been renewed for a second season and we’ll be launching season two in the new year. You can view and listen to past episodes of Nurses’ Voices on a variety of platforms, including YouTube and apple podcasts.

I’d really encourage you to take a look and meet the 24 nurses who are our guests. And remember, if you want to give us some feedback, please connect with us through nursesvoices.ca and remember to sign up for our email newsletter, Gail and I look forward to seeing you in 2022!

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