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K: Okay, let’s get started. This is an interview with Yejema Nwaheri [PH]?

Y: ‘Waheri’...

K: So, the “N” is slight.

Y: That’s okay.

K: So, this is Wednesday, June 9th and it's around noon. First of all, just some basic
background questions. What is your basic degree in nursing?

Y: Bachelors with Science and Nursing.

K: Where did you get that?

Y: University of South Florida.

K: That’s right. In what year?

Y: Uhm...07...August 07.

K: Okay, kinda new. So for the past three years you’ve been a nurse?

Y: Yesh.

K: Have you worked all those three years at the University?

Y: Yes.

K: On Three North?

Y: On Three North.

K: Okay. You’re a tech?

Y: I was a tech while I was in nursing school at University community, maybe about two years.
I think two years was going to be October and I graduated in August.

K: What floor?

Y: I floated all over. I was prn because of school and it worked out really good, actually.

K: Did you like it?

Y: Yeah. Because I used to you know...especially when school was out. I could pick up hours
and work maybe one or two days a week to stay on the payroll, but it was really flexible, like I can
work when I wanted. There was a lot of experience, you know? I mean along the way.

K: And you work days?

Y: Yeah.

K: Twelve-hour days?
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Y: Twelve-hour days. Full time.

K: Three twelves?

Y: I work four actually, but.

K: Oh, you guys do... _____ [00:01:32]. I don’t know how you do it...forty-four hours per week.

Y: I get bored living here at home, so I am like I might as well work and do something.

K: And what is your position here?

Y: Uhm...just a staff nurse.

K: Staff nurse, okay. Do you charge at all?

Y: Yes.

K: Relief charge...or are you designated?

Y: Uhm...some days on the schedule I am designated, but most of the time it's relief charge.

K: Well, let’s get started. The first question – can you just tell me a little bit about your unit and
what types of patients that you see there and what kind of care you primarily give to your patient

Y: Uhm...Three North is mainly a progressive care step-down ICU. I have heard so many
words used to describe it, but when I tell people it's a step-down ICU unit. We got to take a wide
range of patients with cardiac and respiratory problems. Every now and then we get the med-surg
patients and I think that’s mainly just to keep us – you know keep us staffed so we can actually
keep the staff that we have, because if we fall under _____ [00:02:36] then people have to float
and so on and so forth. Uhm...real familiar...its all the nurses with cardiac drips, met patients, trach
patients...more recently we have been getting a lot of surgical patients...things that you
know...happen to go wrong during surgery and then they come back to us...where they might not
be as critical to go to the ICU, they come over to our floor. It's just a wide range of medical things.
Yeah, it's a lot.

K: Uhm, hmm.

Y: Mainly, I basically just serve the role as the primary nurse, carry-out physician orders, help
my nurse techs and they help me...its a lot of teamwork on our floor and I like that. Being a nurse
and also being a friend, because sometimes the patients they just want somebody to talk to, for the
most part they won’t leave you alone because they want somebody to talk to. You talk to them and
they are happy. So, I try to look at the overall picture...

K: What made you pick Three North to work on?

Y: Uhm...because of the variety. I knew I didn’t want to work on a med-surg unit and get the
same type of patients all the time, so it was mainly because of the variety. I just wanted to see
different things and I still do want to go to ICU and so I felt like it was gonna be a big help, as far as
getting me along that path. You get to take care of the critical patients and the not so critical and I
find it help to build your critical thinking too. Every day is a learning process on my floor, so literally
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every day I am there I am like...what? I don’t know...that’s cool. You know it's cool that you can
learn new things...see new things and look it up if you don’t understand and there’s people there to
answer your questions, as long as you ask.

K: Yeah. What was one of those most recent new things you learned?

Y: More recently there was a patient that we got from actually _____ [00:04:32] Heart Center.
They were post CABG and uhm...they were post CABG and there was something that went on...I
can’t remember the details, but they were like – cardiac was my very weakest point in nursing
school. I just didn’t like it at all and I was like I don’t understand this, I hate it, it sucks. But the
cardiothoracic surgeons that came over you know...I walked up to them and I am like you know...I
know we don’t get these type of patients a lot, but what exactly happened. I mean he sat there and
explained it to me for like almost thirty minutes, exactly what went on during surgery. I was asking
him, you this a common thing and he’s like, well you know – he gave me the statistics
one out of every so many people, you know...such and such and things like that. Another thing I
learned more recently...I had...we touched up on it in _____ [00:05:25]...about
complications that can happen during labor, prelabor, as far as HELLP syndrome and
preeclampsia and eclampsia and uhm...we had a patient that went into that over in the Women’s
Center – went to the ICU and then she came to our floor. So, it just researching all of that.
I was even calling the Women’s Center and was like how rare do you see this and they were
like...we barely see it, but it does happen, it can happen, it's a complication. So that was kind of
cool – to like go over that stuff that you are going to just breeze through in nursing school, because
it's very rare. Little things like that.

K: So, when you went to get this information on the patient that had the HELLP said you had called the Women’s Center.

Y: Uhm, hmm.

K: What else did you do?

Y: Uhm...after we called the Women’s Center, they kind of gave us like a general overview
kinda thing and then I went on the internet. Uhm...we have like Mircomedics and Care Notes
systems loaded in our computers at the hospital, so I went on there and kinda researched some
more of that. And then I was still kinda like, well I don’t get this. How does somebody just develop
it? And then an OBGYN happen to get on the floor and then he was explaining. So,
like hearing it from three different people, it all made more sense and everybody had their – they
were basically saying the same thing, but they broke it down in a different that I could understand

K: How do you know that that information that you got from these people – how do you know
that it was good information?

Y: Uhm...most – well at the physicians that I was talking to – they were was a lot of
them kept using the evidence-based practice like words. Like research shows and evidence-based
practice this and research this...the Women’s Center, not so much. They were just like, well you
know based on my experience and such and such and such and such and I know more recently
we have like a representative that I guess they’re the company that loads our Micromedics and
Care Notes systems...they were telling us about how often it's gets updated and everything,
because at first I didn’t like...I didn’t understand like how they had just all this new
information...there’s like new medicine like every day and how does it you know...get all this
information. I believe and it came they said there’s researchers that actually put and load that
information every so many months, she said and they look over it and make sure that it's – like it
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complies or correlates with evidence-based practice and research studies and stuff. I really didn’t
know until then.

K: Yeah. Tell me a little bit about your Care Notes. I have not heard...

Y: Oh, the Care Notes is the usually – we use it mainly on discharge or like patients who are
maybe newly diagnosed. It gives us information on who gets started on Coumadin or things like.
It's like a medication or even diagnosis or condition-related site or you can just type in like
whatever you are looking...type in Coumadin and it prints up all this information on Coumadin. It
tells you mainly like the kind of stuff that like the patients when they go to the tells
them how to take the drug – why they are taking the drug. We have the simple stuff like that where
we can give the patient on discharge. And then as far as nurses, when we are looking up like
certain condition, it has like all these links...almost like Google where it has all this big old list of
links and you can just click on it and it goes over research that was done on that condition and how
to read up more on it. It's like a Google site – but mainly for the hospital.

K: What was the last thing you searched for in there?

Y: The last thing – the last medicine that I searched in there was probably Coumadin, because
I discharged somebody yesterday who was newly diagnosed with afib and it was even in Care
Notes. As far as the conditions – the last condition I probably searched in there was the HELLP
syndrome. February.

K: Okay. You’ve used the word evidence-based practice...what does that me to you?

Y: Uhm...mainly research that uhm...people have been working on for quite some time or you
know...its within a period of time and basically based on their research evidence shows that this is
you know...the way – this is the way that things should be or should be directed. It's more –
evidence-based practice is more like research practice that seems to be the best way to go. I
guess that’s a better way for me to explain it. I don’t know if that makes sense.

K: What do you feel about it?

Y: Uhm...its okay to me, I like it, but I like – not that I have ADD, but I just don’t have the
patience to do research. Like I was never a research person...I like science and I like learning and
things and everything like that, but sometimes research can be like this long process and that I
probably wouldn’t have the patience for. Like to see things done like now. You know what I mean?
And sometimes you can’t see that until later on. I guess I am like quick to know things and that
bothers me when I can’t know. But it's okay...I mean I like it and it's effective. It really plays an
impact on the way things are done or the way care is provided if you that a lot of times
they tell us at the hospital that evidence-based practices show that you know – as far effective
hand washing prevents most _____ [00:11:07] infections and so on and so forth and when you
hear those kinds of things, then you know that like you know – the end result is you know better for
you, better for the patient and like there is a positive outcome, based on the research that
somebody else did.

K: Can you give me an example of when you’ve used...

Y: I guess I can say we use it probably every day, as far as just using effective hand washing
and that’s a big thingy...uhm...I know more recently – I can’t remember the effective name for it, but
we started this hourly rounding kind of system at the hospital and when they first initiated
it...everybody was like, you want us to go check on the patient all the time and such and

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such and such and such and like later on when got to understand the big picture of it, it actually
made sense. I guess not only about patient satisfaction, but in the know

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