Vital Views

Joe Gaccione 0:03
You're listening to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. We are at the end of the fall 2022 semester and that means it's graduation time. This December, our undergraduate and graduate students will walk across the stage to complete their nursing school journeys. But how does it feel to finally complete the process from your first day in class to fully realizing your dream of graduating? We have two very special guests with us today, both undergraduate students getting ready to walk across that stage next month. We have Nikole Taylor and Marielle Cuenca. Nikole is the Nevada Nursing Student Association president and a member of UNLV Student Nurses Association. Marielle is not only the president of the Student Nurses Association, she is also the secretary for UNLV Nursing student government. Thank you both for coming in.

Nikole Taylor 0:48
Thank you for having us.

Marielle Cuenca 0:49
Yes, thank you.

Joe Gaccione 0:51
So, let's talk the final semester. I've heard from other students that the final semester, as busy as it is, is not necessarily the hardest semester. Do you both agree?

Nikole Taylor 1:01
I will have to agree. Yeah, it's not the hardest semester, but it's just very front loaded with busyness, busyness at the front, and then you starting to realize like the downhill slope, and it's like, wow, time is really passing by.

Marielle Cuenca 1:14
Yeah, I definitely have to agree. And I'm thankful for it. Like, we're just so close to the finish line. And the School of Nursing works with us to get us to cross that line.

Joe Gaccione 1:24
What made you both want to get into nursing to begin with?

Nikole Taylor 1:26
For me, I was always interested in healthcare, medicine in some form. The first interaction for me, it was like always doctor, doctor, doctor. And I remember when I got my first degree, I did biology major and it was like my second semester of freshman year. And I was like, “Oh, organic chemistry can't be that bad,” and I saw a group of students in a library with their whiteboard, writing down everything. I'm like, “What is that?” and they told me, “Organic chemistry. You’re biology?” I was like, “Yeah, but not anymore. I'm gonna go see my advisor now.” So I went and changed to nursing and I started doing the classes for that. I was like, “Yep, this is it. This fits me right to the T.”

Joe Gaccione 2:07
What about you, Marielle?

Marielle Cuenca 2:09
I've always wanted to become a nurse. My mom was a nurse. And so, I'm following in her footsteps. I remember first grade Career Day, we had like a little Career Fair, little, little talent show. And so, we all like wore costumes to be the person you want to be. I took my mom's scrubs and like, they were huge on me. And, you know, kind of kept following that ever since. I did a nursing assistant program in high school as well. Nicole did that as well at the Career and Technical Academies here in Vegas. And so, from getting my CNA license, and then getting into nursing school, it's been an awesome journey and I can't wait to, you know, further pursue the career. Unfortunately, my mom passed away 2019, and so, she passed away from end stage renal disease. And so, I kind of consider her my first patient and so ever since, like, I saw, like how she took care of people, as a nurse herself at Sunrise Hospital as a PACU nurse in recovery, I was kind of inspired by then seeing the roles flipped when she had to be taken care of by other nurses, like my freshman year of high school, and then my freshman year of college, she passed away. And then, you know, that even made me want to pursue the career further, in order to fall in her foot, follow in her footsteps. And remember that, you know, to take care of my patients, how I took care of her.

Joe Gaccione 3:33
Well, it makes total sense. And it has to be hard on you, but also, if you say there's a silver lining, and if you want to use that phrase, it's like it's more motivation to keep going. And like you said, it's in some way she was like your first patient. So, you're, you're still getting experience. I'm just looking at it objectively.

Marielle Cuenca 3:49
Oh, yeah, absolutely. You got it spot on, I, I want to, you know, not take it negatively. I don't want it to negatively impact the effort that I've already put in from when I was younger, to high school, to now college.

Joe Gaccione 4:03
What's been the biggest surprise for both of you and nursing school?

Nikole Taylor 4:07
I would have to say like your dedication and remembering your purpose like every single day, because each semester, it starts to wear on you as you gradually move forward and you're realizing the time. And in the beginning, it's like, “Oh, I'm in nursing school,” you're very proud and you're dedicated and it starts to fizzle out as you go week by week and I think I had to remind myself each and every day when I'm driving to class my purpose, so why I wanted to be a nurse, why I wanted to be in the program, and why I wanted to be a registered nurse. And I think that was for me and also just like the growth that I've seen myself in clinical aspects, just being in clinicals each semester. It's hard to believe but I was very shy and timid just to do some, something so simple as just like doing vital signs. Just because you like, you're walking into unfamiliar territory, you don't really know your patients, so I think now I'm like more comfortable going in, having a conversation, even with patients and their families, so I'm very proud of that in my growth.

Marielle Cuenca 5:05
Going off of Nikole, I definitely didn't see how much, or wasn't expecting how much I would grow as well. In my aspect, it was based on kind of my academic learning and my critical thinking skills, you know, during our prerequisites, it's a lot of memorization, honestly, of like anatomy and physiology, biology, to build that foundation of knowledge, in order to tackle the critical thinking that the nursing career requires. Like my biggest shock, I guess, during level one was nursing, nursing school questions, like the questions that we have to tackle on our NCLEX or licensure exam. Everyone makes the comparison of like, the question is like, “Oh, which orange is the most orange,” and then all four options are different shades of orange, and you're like, “Uh, what?” So, definitely being introduced to that in level one was a bit intimidating. And then growing through the program, realizing that getting not the highest scores, like how I used to get during prereqs, it's not a measurement of like failure, like failure is now not my personal mistakes, it's actually my learning, it's my growth. Now, looking at the critical thinking skills that I have now, I'm very amazed by the progress that I've had,

Joe Gaccione 6:24
It's hard to be perfect at anything, let alone nursing. There's so much you have to know, so much information you have to retain, especially when you're young. I mean, there are adult nurses that I've talked to, and they say that they're still learning, it's not, even after a doctorate, they're still trying to learn things. And it almost feels like there's a pressure, not, I'm not talking UNLV specifically, I'm just saying in general, there's a pressure we put on all of us to always be the best. And I feel like in nursing that that tends to be the case too, because you want to be the best because you don't want to make mistakes because in healthcare, mistakes can cost lives, you know? Having that, that humility to say, “I'm not always going to be perfect, but I'm going to, you know, work as hard as I can.”

Marielle Cuenca 7:04
Absolutely. And a big thing too with that is that helped me realize my, you know, how hard I am on myself because, you know, I've heard that you are your biggest critic. And with that comes the lesson of self care, self love, and being kind to yourself, compassionate to yourself because, you know, if you want to take care of others, you got to take care of yourself first.

Joe Gaccione 7:29
And you both are involved in extracurricular activities outside of your academics. We mentioned before that Nikole, you're part of the Nevada Nursing Student Association, you're both part of SNA, and Marielle, you're with student government. How did those organizations, ow did those activities help you grow?

Nikole Taylor 7:45
I think with the organizations I've been in, it’s just been more of a love for nursing and what the nurses do for our community and Las Vegas, just not, well within Las Vegas, but also within the entire country. And just appreciate all that they've done even before COVID, but even more now, just seeing inside and talking to different nurses in their professions during COVID and seeing what they do now like, as we're in preceptorship, I'm just very in awe of what our nurses do. And it was just, I'm just very appreciative to be part of all those organizations, because it just really gave me a more profound love of what I'm going to be part of.

Marielle Cuenca 8:23
Yeah, absolutely. For me, I see the biggest thing is my personal growth within the organizations. I remember being in level one and just being very shy and quiet and now I'm in level four, my final semester, and I feel, I'm the president of our SNA and everyone is like, always saluting me like, “Madame President, please speak for our class voice and advocate for us,” and I'm proud to do that for them. I'm proud to represent not only them, my fellow classmates in the School of Nursing, but myself because I see myself gaining more confidence and leadership skills, and I'm very proud of that.

Joe Gaccione 9:04
I wanted to talk about the leadership opportunities, you both being presidents of your respective organizations, and you mentioned, Marielle too, being quiet. You know, when you're a nurse, you can't be quiet, you have to speak up. When was the moment for both of you when that leadership switch just turned on for you where you realized, “I'm gonna need a bigger voice. If I'm going to be an effective nurse.” Was there a moment?

Nikole Taylor 9:26
I think for me, it was earlier this year, we had the NSNA, which is like the National Student Nurses Association for the entire country. They have their own annual convention every April, and some of our nursing students from UNLV SNA, we had the opportunity to go and I was fortunately able to go, and it was in Salt Lake City, Utah, and I think for me that was like the pivotal moment to like step up in leadership. Just to see and hear the nurses, what they have endured during the pandemic talking to a few of them in their profession, gaining some insight and just, for me, it was just getting over that barrier of like imposter syndrome, like how Marielle just mentioned before, which is just like very heavy on the pressure, how you mentioned before, nurses always feel like they have to be at the top of their game, because they have to provide the best care to these patients. So, I think it was just a daily reminder for me, even when I'm going in for my shifts, it's like I can do the best that I can, the best way I can serve these patients, and also be of help for my preceptor. And I can only help if I'm confident within myself, but also give self care that I need to myself to do that for the patients. So, I think for me that turning in leadership was in that convention that weekend,

Marielle Cuenca 10:39
I think it was when we had the student government of UNLV nursing, we had a dean's advisory meeting, in which all of us who are representing our cohorts are able to talk to our dean and voice our opinions or concerns in order to advocate for, you know, not only our current students, but for future students to improve the programs. And so, we advocated for, you know, different scrubs, because our old ones were very hard to, you know, move in and wasn't really promoting the best body mechanics. And so, the school really listened to us, the Dean really listened to us, and they change the scrubs that we are allowed to wear to do our clinicals. And so, seeing just that, and like thinking and hoping in the future of my future of continuing these leadership positions in the future of that, how can that be an example of other things that I would like to see change in the nursing profession, like safe patient ratios, and like compact measures and stuff like that? Seeing that, realizing that I can make an impact in such a small way and trying to see what influence I can do as I make my way through the career.

Joe Gaccione 11:57
Nikole, if I remember correctly, you were a nurse apprentice during your time, is that correct?

Nikole Taylor 12:01
Yes.

Joe Gaccione 12:02
I wanted to bring up the apprenticeship because UNLV, for those out there who don't know, UNLV Nursing offers nurse apprenticeships to students who want to get that extra experience, extra exposure in the hospitals and also make some money, admittedly. And the apprenticeships, the way they work is you can only do as much as you've learned. So, if you're a young student, maybe a level one or level two student, first or second semester student that is, you can't do more than what you would have learned in that semester. I just wanted to ask Nicole, how valuable was that experience for you?

Nikole Taylor 12:32
Once UNLV brought that to our attention for the students to start applying, I was all game for that because I want as much experience that I could. I did have a CNA background and I worked there for three to four years, so that was helpful to have that bedside manner and patient care already down with that foundation, but I really had to want to enhance my actual nursing skills, and that was going to be my future career coming up very soon. So, I applied in January of this year, and I found I had got the position in February, I started working in March, and I'm still working there now. I'm just very thankful for the turnaround that I've had, and I feel like working there at Sunrise Hospital on a med-surg floor on adult unit has been very helpful for me to see how quick you have to be on your feet, adapt to change, but also you need to have that teamwork on your unit that is so vital to keep the care going for your patients. And I think I'm very impressed to see that firsthand on my unit, and I'm very thankful for all the skills and the hands on it, even the nurses I've been talking to because they have given me so much insight and experience that I can move into as I become a registered nurse and get through that first year that is so crucial and nerve wracking to think about when there's so much downfall and negativity that comes with it as being a first grad, like a first year. So I'm very thankful for that experience.

Joe Gaccione 13:59
For any young nurse out there who may want to take part in an apprenticeship, how did you hear about it? How did you get involved? Was it through the school, was it through your hospital?

Nikole Taylor 14:06
It was through the nursing school. I didn't think I was going to even get it as quickly as I did just because I knew I, we’re not the only nursing school in Las Vegas. So, when I found out about the opportunity, I was checking Sunrise Hospital because I knew I wanted to work there post-graduation. So, I was very dedicated checking their website daily, if not weekly, and when I saw the opening, I went for it and see what happens. So, when I got an email back that they were considering me for the interview, I was shocked, but I was very excited. But it took me a while to just grasp how to get into your routine of nursing because I see it in clinicals, but it’s just a different outlook as a student, but now like I'm actually on the floor helping the nurses as much as I can. So, it was nice to be on the unit with the nurses and helping the nurses as much as I can on the unit because I see the patient ratio is not the best right now when it comes to any unit, but specifically on my unit it’s very poor right now. But I think as time and as we're growing and more nursing students are starting to graduate, I think it's starting to change the tables around. But all in all, I'm very thankful to have that experience behind my belt, because it really has helped me to be more comfortable and confident in those complex situations. So, I think I overall have grown thanks to the SNAP experience,

Joe Gaccione 15:30
You both are precepting right now. What has been the biggest lesson for both of you getting into the real world, interacting with patients, on a more regular basis?

Nikole Taylor 15:39
I can go first. So for me, I will have to say it has been not until like our third semester it’s been strictly adult setting. So, when we enter the third semester, we finally get into a different population with mom and baby or baby. So for me, I knew before getting into nursing school, I've been telling anyone and everyone, I was mostly interested in pediatric setting. And I got the opportunity with my preceptorship to be on a pediatric intensive care unit. And it's been from the first shift to now about to enter my 10th shift, it's been like a complete 180 for me. I was very timid just to see the baby and just try to do anything with the baby just because they're sick, they're so small, and they're all with their own different conditions. But now I'm walking in, I'm more comfortable to like, change them and touch them and be more interactive with them, but also with their family. So, I think for me, I think that was just something I had to get used to just because it's different from only having like five clinical shifts in your third semester versus having 12 shifts during your preceptorship that's continuous and can see your growth and having someone as your preceptor to supervise you, but also give you that critical feedback that you need to grow. So I think for me, it's been a really good experience, even though it was the most nerve wracking thing walking in my first shift to now, I'm more confident just to continue learning, but also use what I've learned to hopefully use that and become hopefully a pediatric ICU nurse in the future.

Joe Gaccione 17:13
How about you, Marielle? What's been your biggest, what's been the biggest lesson for you precepting?

Marielle Cuenca 17:18
Being confident, definitely how Nicole was talking about earlier, the imposter syndrome. That imposter syndrome has been with me for a long time, but definitely when I first did my when I did my first preceptorship shift, I was like, “I am not ready to be, I know I'm not 100% all alone, but I'm not ready to like not have my clinical group, they're not ready to have like an instructor there,” but I have two great preceptors that have, you know, helped me realize the skills that I have, the knowledge that I have, and the confidence that I have to, you know, transition into the nurse that I know that I can be. And so, I had a 12 hour shift yesterday. And usually my patients have been pretty stable. I'm in the PACU, Post Anesthesia Care Unit, and so it's like recovery after surgery, usually the patients are pretty fine waking up, and they might have some pain, nausea, and you know, it's, it gives, it's a good environment for me to learn how to chart, learn how to assess, and take on an actual patient load. But yesterday was pretty difficult, honestly, we had two patients that were very unstable. They both ended up going to the intensive care units. But you know, me and my preceptor, we tackled on the situation, we did the best we could for those patients. And you know, we did the best we could, but I also was able to see the interaction between healthcare professionals. There are so many doctors, so many surgeons, so many other staff coming to help us. I really saw how much teamwork, not only nursing, but the healthcare profession really shows. So, the confidence that I built within myself was also supported by the people that I have met on the unit. And so, that imposter syndrome, it may come back once in a while, but at least I have the skills to tackle that.

Joe Gaccione 19:18
Five to ten years from now, for both of you, where do you see yourselves in nursing? I know, you haven't even graduated yet, and I'm already talking five, ten years from now. Think of it as wishful thinking, where would you want to be in five to ten years from now?

Marielle Cuenca 19:31
Five to ten years from now? Well, for me, I want to continue my critical care experience. As I said, I want to follow in the footsteps of my mom. My mom was, when she graduated nursing school in the Philippines, she came to New York. She was an ICU nurse at, in New York. And then when she came to Las Vegas, she became a PACU nurse. So I'm trying to find my own way, my own, my own version of that, so I want, also want to get ICU experience and then eventually go into the PACU. Besides like my bedside nursing and stuff like that, I also want to expand into getting a master's of nursing education. I'm very interested in becoming a nurse educator. One of my role models besides my mom was my high school nursing teacher. She's the one that introduced me to the, to the idea, to the goal of becoming a nurse educator. And ever since then, all my instructors that I've met at UNLV have become even more role models for me to strive to be, in order to, you know, guide the future of nursing.

Nikole Taylor 20:39
For me, I would have to say I would be staying in Vegas to just set my grounding, my footing with my career, hopefully, fingers crossed, it would be on a PICU unit somewhere, maybe Sunrise. Then I would like, to my main goal is to go back to Houston, Texas, that's where I had an internship, but at the Children's Hospital in Houston, Texas, their Medical Center, I had an internship for the summer, and it was very, very eye opening to see how these nurses are giving care to like, like, like the cardiac ICU, the PICU. Just, even to the PEDS ER, it was just very eye opening. And I even relay that to a lot of the nurses there, to even some of the charge nurses like I would love to work here if I make it and I would see myself working there. And then I would like to also, follow on what Marielle said, I would like to go back and get my masters as well. I would like to become a pediatric NP. So maybe that's like closer to the 10 year mark, but where I would like to be. But like Marielle just mentioned, there's so many great nurse leaders that we have within UNLV School of Nursing, I would have to give a major shout out to Dr. Leland because she is a pediatric NP and someone that I do look up to just because she's in that profession, and I loved her so much when we had our pediatric class, I just learned so much and how knowledgeable she is and welcoming, her experience even in a PICU setting to being a pediatric NP, she just has so much inspiration and experience that I would like to get from her.

Joe Gaccione 22:22
You could go back and talk to first semester Marielle, first semester Nikole, what's the biggest piece of advice that you would give them?

Nikole Taylor 22:32
I will have to tell first semester Nikole that it is okay to mess up. I still have to tell myself that now, even during preceptorship, a month away from graduating. Like we've been saying throughout this whole interview about impostor syndrome and pressure and wanting to be the best version of yourself. And even as a nurse, it's just a daily reminder like it is okay to mess up. And to me, throughout this nursing program is all about how I recover and pick myself back up. And if I can do that throughout nursing school, if that's failing an exam, not turning in an assignment as good as I want to, and it's going to be a reminder for me as a nurse. If I have a bad day, I know I have a team surrounding me to pick me back up and support me. So, I think that is the biggest thing I would tell first semester Nikole, that it is okay to mess up, you will be just okay.

Marielle Cuenca 23:25
Kind of similar along the lines of that, I would tell first level Marielle, be proud of yourself. It is a hard profession, but also it's a rigorous course of schooling. And, again, the imposter syndrome will set in, but I have to tell myself, as I said in this interview, I'm proud of myself for all the work that I've done, and I will continue to do because this profession is made up out of superheroes, healthcare heroes. Saying that, that superhero part, it reminds me of my high school calculus teacher, he was always like, “I can't believe you're going to be a superhero.” I gotta remember that, that we are taking on a profession that is very, very difficult, but yet, so rewarding, personally, and professionally. And so, I'm proud to say that we're almost done.

Joe Gaccione 24:19
Nikole, Marielle thank you both for coming in. That's all the time we have today.

Nikole Taylor 24:22
Thank you so much, Joe.

Marielle Cuenca 24:23
Thanks, Joe.

Joe Gaccione 24:24
Congratulations again to you and the rest of your cohort for coming to this moment. I know it's been a long time, even though only four semesters but that's still a long time, especially when you're busy constantly, but you're reaching the finish line. You've earned it, so congratulations again. And to everyone out there, thank you for listening, hope you have a great day.