CARE OUT LOUD
Interview with Carole Kenner - Part 1
Mary Coughlin:
All right. Well, I just to kind of kick it off I would love to hear your backstory and, and what was it that drew you into nursing in the first place? How did you come to this calling, if you will?
Carole Kenner:
Oh it's so funny that you would ask me that question because I'm probably one of the few that had a really good family friend that was a nurse that was such a great role model, even as a small child, that I said, that's what I want to do. And I, I thought, okay, I'm going to set my sights on being a nurse. And when I got closer to the time of actually Applying for nursing school. I talked to my family doctor who had been was at the time the chief medical officer of a hospital in in my area, and he said, you could go to medical school, or you can go to nursing school but if you go to nursing school.
Please make sure that you get a college education and of course, when. I was there entering most nurses went through the diploma nursing programs, but I didn't I started out as a baccalaureate nurse, and I decided to go to nursing, because. I saw that he didn't have that much chance to spend time with patients and families, but I saw my friend with the families, with the, with the patients, and that's what I wanted, was spending that time, that quality time.
Mary Coughlin:
It's that human connection, I think, that makes nursing such a fulfilling profession. Mm hmm. Yes. So so you went into nursing and and, you know, how, you know, how did you then kind of veer towards neonatal? Did you start in pediatrics? Did you do general or how did that all kind of unfold for you?
Carole Kenner:
Well, I swore I never wanted to take care of sick kids because I volunteered at Shriners Burns Institute. I worked with very sick, fragile kids. Kids even as I was moving up into nursing and in nursing school, but when I finished my pediatric rotation in the in nursing school my instructor said, Why don't you apply for a job here at the at Cincinnati Children's and I said, Well, I still not sure if I really want to work.
With sick Children, because one of our rotations was on the oncology floor with the pediatric patients. And so again, it was a reinforcement of how difficult this work can be, I mean, rewarding, but difficult and emotionally draining. But two of my friends decided that they wanted to apply, so we all three applied for a nursing assistant position.
And of course, I was naive in those days. The director of nursing called all three of us and said we have openings in the NICU. As a junior in nursing school, we have openings in the NICU. Red flags should have gone off, we don't have enough nurses. But for us, it was like, great, we'll try this. But what the heck do we know about sick newborns?
So my spring break junior year of nursing school, I got oriented to the NICU, which was a level three and those days because we didn't have level fours. So we had the sick of the sickest. It was in the Children's Hospital. So all referrals. And I what I found there was to get over my fear of taking care of very, very sick children.
I got so fascinated By the fact that we were learning all the time we were seeing different things that we never saw in other areas and because the doctors and the geneticists and the respiratory therapists all were working as a team in the unit. We actually talked to each other, not just saw each other on rounds, and we learned from each other.
And that was exciting because I was still in that learning mode, and I wanted to be a sponge, and I wanted to do the best I could. So I got over the fear of the sick babies and never looked back.
Mary Coughlin:
That's amazing. I mean, I can completely connect with what you're saying about learning something new all the time. I mean, it is so fascinating. The, the unique physiology of these amazing individuals. And of course, you know, the pathophysiological states that they, you know, they find themselves in due to a variety of different reasons. So it is really challenging intellectually. But you also still have that. You know, that human connection piece available. How, how was that? How did that play out in your role during your, you know, earlier neonatal nursing years?
Carole Kenner:
I think it reinforced why I went into nursing, because I saw the parents that were so scared, and I could relate to that. You know, when I first started teaching neonatal nurses I always said, I still remember walking in that unit, and in those days having the door slam behind us, and you're locked in.
And I was terrified because I said to myself, I don't even know what I don't know at this point. I don't even know if I've got enough in me to, to know how to care for these babies. And I didn't have an emotional connection. So if I didn't have an emotional connection, and here are parents that have never been inside a NICU, and suddenly are locked into this glass cage, that's what I referred.
In my mind, it was referred to as a glass cage because we had the sliding doors at that time we had the glass that looked into the unit, not anymore, but that was the case, and you're locked in. And. And all of these sounds and the monitors going off that happened in those days and all of those things, but even today with the single room that still that fear factor is there.
And I remember clearly to a parent coming in once and saying, Oh my gosh, I can't find my baby. I can't find my baby. Well, we moved the baby because we had a more critically ill baby that we needed closer to. The the nursing station at the time, we never thought that that would send them into a panic. So that was another red flag for me early on to say, you know, remember how scared you were.
Think about now that this is their baby, and they have no context for this unit. And that was a driver for me. And it's still a driver today to have that human connection to never forget what that feels like.
Mary Coughlin:
I love How you're presenting this because I think that really, I mean it speaks to so many different things, you know, within nursing but also within our human community of really being able to draw compassion from your own lived experience from your own understanding of how a situation felt to you, and then imagining how that may feel for another person, like intentionally, You know, taking the time to think about that, because I think, you know, many folks don't, you know, for a variety of different reasons.
You know, don't, don't take the time, don't don't even understand the relevance of taking the time that, you know, I'm sure you've heard this, you know, from That your colleagues as you go, you know, move through your professional career. You know, we're trying to save lives, you know I don't have time for that fluffy stuff.
You know, I'm trying to do all of these things. And and even today, I still hear folks say that and The more I, you know, the more I kind of dive into this idea of trauma and, and and trauma informed care, I become more aware of how our own lived experiences and how we respond to those affect how we show up to the lives of others.
Carole Kenner:
That's right. Absolutely.
Mary Coughlin:
I feel it's really amazing to that all of these insights have shaped and I hope I'm not putting words in your mouth, but seem to have shaped how you have now championed and led, you know, neonatal nursing around the globe. I mean, so now you're transitioning from your clinical practice, you know, how, Oh, How has all of those experiences informed your academic role and then in your research and advocacy roles?
Carole Kenner:
Well, I think going back to the very beginning, just as I said before, you're always learning, especially in the NICU, and having worked and taken students to other units that are outside the NICU, what I saw there was that there wasn't a relationship with the medical staff oftentimes, not even as much with the parents sometimes.
Because you weren't as in close proximity and, and so the communication style, the trust level was different. But what I saw in the, in the NICU too, was That, especially if you're in what I call a Mecca, I always say that if you're lucky enough to be in a teaching hospital, and you are really at the cutting edge of research and Clinical trials and a lot of different things that are going on so that you're always in that process of very, very active learning rapid changes and things like that.
I recognized and so did some of my colleagues that we were getting calls from other Nick use. about protocols, about how to take care of, especially a surgical baby, because we always kept the surgical babies at that time, including babies that had cardiac surgery on the, in the NICU. I mean, that changed over the course of time, but there weren't many places that were doing that kind of care.
And so I said, if we have to keep putting together with permission from the hospital to share these protocols, I think we need to. Write a book. So there's out there put them in a book. And of course, we didn't use just that hospitals protocols because there were differences across the country. But we did pull together the literature has said this is how you should take care of a surgical neonate.
So it was really out of the practicality that there was nothing out there and then that led from the surgical neonate book. to the comprehensive book, because then I was convinced that nurses needed to know, especially in community hospitals, needed to know more about the physiology. And as you said in the very beginning, Mary, the uniqueness of the physiology of especially a one pound, 24 weaker, understanding that.
And, and I was lucky in my master's when I went for that. I did a what I've always referred to as a schizophrenic masters, high risk perinatal and neonatal nurse practitioner. So I got to be. On the OB side that I really didn't have a lot of experience on and I saw some of those babies that never got transported because they truly weren't viable, the 22 weekers, et cetera, as you know, and that there was just nothing we could do that they, they died within minutes of birth usually, but that taught me also that we needed to pull together that process, Physiology to understand genetics and fetal development that was really taking off at that time and, and understand, okay, if you're born at 22 weeks, if you're born at 23 weeks, what does that internal organ system look like? What are the vulnerabilities? And so that was, I think that got me to Say, okay, let's pull together experts.
We had 88 people from across the country, nurses and doctors, as you will probably remember to put that textbook together that's now been out since 1993, which is hard to believe, but reality was, there was nothing like it.
Mary Coughlin:
Well, and I mean, that book reminds me of when I was studying for the boards to sit, you know, to become an NNP. That book was invaluable because of its comprehensiveness, and the depth of information that I could get it really. It was, it was critical, I think, you know and it's, it was helpful to, to have it all in one place. Because in the, you know, prior to that, you felt like you were just, you know, catch as catch can trying to thread things together to really get a good understanding, but here it was all together.
And the other fascinating thing about the work that you're doing with that particular book is that with each edition. I mean, just like we both know, right? We're always discovering something new. We're gaining deeper insight. You know, depth of understanding of, I mean, now epigenetics and all of that information. Telomeres, you know, chromosomal changes. I mean, all of this stuff is just really Remains cutting edge in our field that it's yeah, it's just it's amazing to be able to curate and pull such a wide breadth of information into one into one manual. But now that's not the only book that you're you're you've been working on, right? Are you okay to share some of the other projects that you've worked on?
Carole Kenner:
Sure, but just like as you're saying that your own work as you grew in terms of trauma that was really important to start incorporating it into books because there wasn't enough out there about that and so that's that also was a Stimulant for me to always be in a learning mode to look at at different things. So that led to then the my work I I had gotten involved in the national association of neonatal nurses and felt very committed to understanding How to network with people there and of course I worked my way up by accident not by design to be the president of that organization From that, I got invited to be part of the American Academy of Pediatrics coffin committee the committee of fetus and newborn setting the perinatal and neonatal standards.
And, you know, we, there was only one nurse at that time that was on that committee. But that also came because at the same time that I was asked through the Graven's group to be part of the NICU design standards, and of course I had Dr. Bob White and others from that group right in the textbook so that we could start incorporating the recommendations into the textbook for nursing to understand how important that was.
And, and again, That led to then the work with the developmental care and Nan wanted to take on creating a developmental care book. And so Jackie, Dr. Jackie McGrath and I said, okay, we'll, we'll do it. Why not? Let's take it off and take off with this and, and go into the developmental care. And of course, now the third edition of that book just came out. But it was through these networks and these synergies that that book came and out of that, you know, grew, I've done other books, but, you know, those, that's kind of the trajectory there.
Mary Coughlin:
Yeah. I mean, I mean, just the contributions that you've made to neonatal nursing over your career Are just a breathtaking and incredibly inspiring.
I mean, I've I've always admired your work and I there's never a dull moment, Carol. You know, I see you on the social media and certainly, you know, new projects coming across. If you were to, I mean, this is probably a hard question to answer, but I'm going to challenge you. What is the best thing about the work that you do now.
Carole Kenner:
Well, I'll continue the trajectory and then answer your question if you don't mind. Not at all. Through my work at NAN and now that NAN was setting standards and we didn't even have NAN yet because the NNP role was just beginning to really take off. And so that came, you know, during the time that I was still very involved with NAN and the leadership role.
But... What I found was that nurses from other countries like Australia that just had their anniversary, that their 30th, I believe, anniversary, Australia didn't have a group like NAN, so they came to NAN. to understand how did you set up this National Association of Neonatal Nurses? And of course, Chuck Raitt, Charles Raitt had set that up in, in 1984, had the vision from a small group of Northern California nurses that said, we need, we need to have standards.
There's no standards out there. So they created, he created NAN Patricia Johnson, Tracy Karp. Those were some of the early leaders in that group. And these nurses now, as I'm NAN president, are coming from Columbia, from Australia, from all these countries, saying, We have nothing. So, from that, I started running focus groups at their different Conferences in different countries as we got invited the UK had the longest standing neonatal nursing association in the world that we knew of.
And so we were invited to go from NAND to Hargett, England. And we, and I kept asking, what do you need? What do nurses need? And even the UK nurses wanted to connect with NAND and wanted to connect with the larger, whatever that was, global community. Nurse from Columbia said to me, I'm the only neonatal nurse I know outside of my unit.
That has any connection, but we can't because it was before email and the Internet. We couldn't find each other. And so we started then working towards creating an organization. And I found that the Council of International neonatal nurses in 2005 and Australia was, you know, not that old at that time.
They wanted to be right there as helping me to create Coin, as we call it and the Canadian neonatal nurses that had been a chapter of Nan, they wanted to create their stronger presence in the global so they wanted to be involved. And for that. That led to where I think I can answer your question because now through to from 2005 to where we are today coin now has a presence at most of the policy tables, not just endorsing documents but actually creating documents that are impacting Standards impacting neonatal nursing visibility in countries that have never recognized it, have had no specialized training.
And we just completed a training program with nurses from Africa, and the neonatologist said, I asked them on a recent call, are you seeing a difference now that the nurses have more education and specialized training and how to take care of the small and sick newborn? And, and they all said from seven hospitals, we're seeing a decrease in neonatal mortality.
That's huge. Now, it's anecdotal. It's not systematically collected yet, and we do need to do that. Yes, I'm proud of that. It's not just me. I want to be clear. It's not just me. I, I've tried to lead the charge, but it takes a village, a village to do it.
Mary Coughlin:
Yeah, amazing. Absolutely amazing. Oh my goodness. I'm, I'm, I'm speechless.
I, I know gee, was it was a couple of years ago that I got to go. It was actually pre COVID now. I went to a COINN conference and there was it was in Vancouver and there was this beautiful presentation of awards to nurses from some of those developing countries. And At least one of them, if not more, were from Africa the African countries.
I forget which ones. But it was just so amazing to watch these nurses speak about the challenges that they've overcome and the service, you know, that they're able to provide now because of their experience with COIN and the global neonatal community that's really enriched and enhanced how they step up their practice, you know, and really can deliver at a, at a higher caliber for patients there. I know they still have lots of challenges. I mean, gee whiz, you know, the number of unlicensed individuals that they're working with to, you know, maintain these NICUs, and I'm using air quotes here that are very different from, you know, a NICU here in the United States, but it is really amazing to hear you share this story of how, you know, just collectively as a global force, NICU nurses are supporting each other with, with standards, with best practices, with, you know, with support, you know, and, and all of, all of what that means. It's just amazing.
Carole Kenner:
Yeah, that's why Mary that we that COINN just produced a book. Julia petty Dr. Julia petty out of the UK is the lead editor, and it's neonatal global perspective, and the chapters in that book reflect.
various regions of the world. We tried to make sure that we followed the WHO regions of the world, but there is a chapter in there that I worked with African nurse leaders to really tell their story of what it's like when they have minimal resources. And so some of the stories that you heard in Vancouver are some of the same things that are incorporated there.
But we really wanted people to say, you know, here's what we have in this. This country. So we have the U. S. Chapter. We have a Russian chapter. We have a Japanese chapter, and I'm forgetting some of the others. But the reality is that, you know, South America was represented the Hawaiian islands and South Pacific was represented.
We all went from a little different perspective, but we wanted people to describe the education. And the practice opportunities as well as challenges and just tell their story. So we're very happy that that came out this year that I think will also help people continue to tell their stories.
