[00:00:00] Duncan Lawrence: If you have not taken an anatomy course, do that. A lot of colleges allow dual enrollment, so you potentially could do your anatomy course through the college.

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[00:00:17] Gretchen Roe: Good afternoon, everyone. This is Gretchen Roe for The Demme Learning Show, and it’s my very great pleasure to welcome Duncan Lawrence with me today. Duncan is a new friend I’ve known for a long time. What do I mean by that? Well, Duncan’s mom is a very good friend of mine, and she also happens to be a work colleague. As I have voluntold three of my kids to participate in these episodes of Career Connections, Jonna voluntold Duncan to participate as well. I’m just grateful that he’s here today. I’m going to let him introduce himself.

[00:00:55] Duncan: Hello. Hey, I’m Duncan. I’m a nurse. Right now, I work with Alabama Oncology. Formerly, I worked trauma burden at UAB’s ICU. I’m really looking forward to this. Gretchen is correct. We have proximately known each other for a very long time now, including greetings via proxy.

[00:01:16] Gretchen: Let’s start with your education. You were homeschooled.

[00:01:20] Duncan: Yes.

[00:01:20] Gretchen: Coming into the nursing profession from the homeschooling avenue, you had a different path. I think this is fascinating, the way you started this path. Will you explain to our guests how this occurred for you?

[00:01:38] Duncan: Upon graduating high school, I didn’t really know what I wanted to do. I had an interest in computers. I started pursuing information technology. Going to school was a terrifying prospect. I found– Oh, what is the name of that program? I think it’s changed twice since I left it. Basically, it was taking CLEP exams with the end goal of then going to a remote college for three to five semesters and then having your degree. I was pursuing that, and I got within that last step of actually enrolling in the college. I went, “You know what? I don’t want to take my hobby and make it my job.” I abandoned ship, much to the chagrin of my parents at the time.

[00:02:33] Gretchen: Both of your parents have a background in IT, so it sort of made sense for you to do something like that. Tell us a little bit. How was it to tell your parents, “You know, I’ve decided I don’t really want to do this?” Because sometimes that’s hard for young adults to tell us as parents.

[00:02:52] Duncan: I brought it up two or three times before I finally said, “You know what? It’s not what I’m doing.” It wasn’t an argument per se, but it definitely was a lengthy debate of, “Hey, it would be better if you go ahead and finish this since you’re so close, then do something else than just abandon it now.” Hindsight being what it is, it would have been very convenient if I had already finished that degree.

[00:03:24] Gretchen: Then what made you decide to, because from information technology to nursing is quite a pivot. How did you decide to do that?

[00:03:33] Duncan: Funnily enough, I wanted to be a nurse initially before ever getting to the point of needing to figure out college. I became a lifeguard because it was the closest thing I could do as a high schooler to nursing. I did it for one year and on, did it for a full summer at a summer camp. On the last day that I was working, all of a sudden it clicked that I was responsible for the lives of every single person there. I went, “Oh, I don’t like that. Let’s not ever do anything healthcare-related.”

Scrapped that idea. I was like, “Okay, we’ll do IT. That’s good.” Post IT decision, like I was working at Publix at the time, pursued management there up to the point I gave them a timeline. I’m pursuing management over this time. If I don’t get it by that time, then I’m going back to school. I even extended that timeline by, I think, four months because they were dangling it like, “You just got to go work a little. We’re working on it.”

Finally, I said, all right, and I enrolled at Jeff State Community College to pursue my, at the time, physical therapy degree. That’s when they were like, “We can promote you.” I said, “Oh, too late. You didn’t work with my time.” I started with my physical therapy degree, which is all the same prerequisites. I met a friend. Her name is Nancy. Nancy was going into nursing. Me and Nancy hit it off. Nancy pretty much grabbed me by my collar and said, “You’re coming with me.” As I walked with her into the path of nursing, I protested the whole time. Obviously, I wanted to do it. Looking back, I’m very glad that I decided to go ahead and shift slightly. I don’t think I would have enjoyed physical therapy nearly as much as I’ve enjoyed being a nurse.

[00:05:34] Gretchen: You’ve chosen a field of nursing that’s not an easy field. you worked in oncology. Tell me a little bit about that.

[00:05:42] Duncan: Oncology is my new field. I’ve hit the point where I realize how much I don’t know. A year in, I know enough to go, “Ah, this is normal.” If it’s normal, and it looks right, then I’m like, “Oh, yes, easy sailing.” Whenever something comes through, and I’m like, “That’s weird.” Then I have to go start like, “Let me go figure out why.” It’s such a big change going from working trauma burn ICU, because broken people, it’s the same fix every time. There’s only so many ways you can break a person. Broken bones, they get set, they get healed, and they have usually like a 6 to 8 week timeline to be functionally healed, and then 8 to 12 weeks before they’re fully healed, depending on the person, obviously.

Burns, you resuscitate, and then it’s all about trying to nurture new skin growth, or doing grafts, and then taking care of those grafts. There’s not a lot of variation. It’s pretty much if this wound, this treatment, and then if you run into a complication in the middle, that’s the only time that you vary. With oncology, you can have two different people with, say, pancreatic cancer. If this person has type A mutation, and this person has the B mutation, then they’re going to get two very different treatment regimens, even though they have the same cancer. Realizing that, basically there’s this infinite rainbow spectrum of the potential treatment plans, and then you can throw, in a very simple person, you can throw a treatment plan that this works, and it might work great for this person, but the same person with the same mutation, it went, “Oh, well that didn’t do the trick,” so then you have to try something different.

[00:07:50] Gretchen: Was working in a burn unit your first nursing position?

[00:07:54] Duncan: Yes.

[00:07:55] Gretchen: Good Lord, you started with the heavy hitters, didn’t you?

[00:07:58] Duncan: Technically, I started with the intern program, and they said, you get to go to three different units to try, and so I went to a cardiac med surg unit, which was really interesting, and I learned a lot, and then I went to the psych board. They said, “Would you like to see every single psych unit we have?” I said, “Sure.” Loved it.

[00:08:17] Gretchen: Really?

[00:08:17] Duncan: Then I went to the trauma burn ICU, and I went, “Oh, this is my chance.”

[00:08:23] Gretchen: Really? What was so attractive about that particular kind of nursing?

[00:08:29] Duncan: It’s very, I don’t want to say clinical, because everything is clinical, but you’re looking at all the numbers, and you’re going, “Ah, this person needs this, this, and this, and this way,” and then you implement it. It’s very, this person’s H and H dropped two points in two hours. They probably are going to need a unit of blood by the time I check it next. Then you’re also managing blood pressures, and A-lines, and sevia. It was just a cornucopia of new experiences for my new grad self. Do I think that starting there was necessarily the best decision? Debatable. I did a good job. I thrived there.

[00:09:14] Gretchen: I would think that would be an enormous amount of pressure for a new graduate to start under.

[00:09:20] Duncan: I won’t lie and say I didn’t cry on my way home from work frequently during the first three months I was there. I think I even called mom once or twice. I was like, “I don’t know if I can do this.” Stubborn old me kept on showing up for work, and by the time that I left TBI, I was one of the people that people would go and go, “Hey, how do I do X, Y, Z thing?” I could then go, “Hey, it’s this, this, this, in this order.”

[00:09:55] Gretchen: Even in your very beginning, you were looking with an impetus of analysis to figure out what the right formula was to serve the patient best?

[00:10:12] Duncan: I hadn’t considered it that way, but yes. Whenever you figure out the formula, then you can turn around to the patient and not go, “Hey, suck it up, Buttercup. It’s going to be fine.” You got to be nicer than that. You can go, “Hey, I know it sucks right now, but it’s only going to be for this timeframe, and then you’re going to be fine, barring complications.”

[00:10:38] Gretchen: How long were you in the burn ICU unit before you moved into oncology?

[00:10:44] Duncan: I worked there for three years before I moved to Alabama Oncology. Now I work at Oncology Infusion, and I’ve been there a year today.

[00:10:57] Gretchen: Congratulations.

[00:10:58] Duncan: Many thanks. I hadn’t thought about it until I looked at the calendar.

[00:11:03] Gretchen: That’s wonderful. In a similar environment, but now you’re dealing with patients that aren’t in the hospital, or are you in the hospital portion of that?

[00:11:13] Duncan: Yes. I’m now outpatient. If things go terribly wrong, then we have to admit them to the hospital. It’s very different. I had, starting out at this place, because I was so used to being where I was at, because in the ICU, you are the top level of care. Especially the ICU I was in, there’s only three things that got you banned off of our unit. Brain drains, they didn’t like doing swans. The super neuro specialties and the super cardiac specialties didn’t come to our unit.

Even then, sometimes we still had them. If we had a patient that had a little bit of a crisis, not a big crisis, and I went, “Oh, I know how to fix this. He just needs this, this, and this.” They went, “Oh, we don’t have those medications.” I literally came to a full stop, and I looked at my mentor, and I went, “Well, what do you mean we don’t have these medications?” It’s because they’re outpatient. That was the learning curve of going, “Oh, I don’t have everything that I could need on hand.”

[00:12:31] Gretchen: I want to touch a little bit on nursing informatics, because in all honesty, until you came into my life, I’d never even heard of it. Help me understand, what does that mean? Will you be predicting outcomes? Will you be analyzing data? Would you be analyzing data for that?

[00:12:50] Duncan: Nursing informatics has like two subsets. One is the taking of data, looking at it, and then trying to formulate what changes need to be made to better improve patient outcomes. Then the other side of that is taking the, oh, we have predicted that this change, this change, and this change will provide better outcomes. Then taking that and then going to the people who are doing all the groundwork and going, “Hey, dear nurses, lab techs, and doctors, these are the changes we have proposed,” and here’s why. Then, trying to get them on board to then make the changes, so then you can start the process over again.

[00:13:39] Gretchen: That takes you completely then out of direct patient care and puts you in a different aspect of nursing entirely.

[00:13:50] Duncan: Correct. I think that this field of nursing can be summarized as the healthcare worker support. We don’t directly interact with patients, but we make it to where people who are directly interacting with these patients can do their job more efficiently and effectively.

[00:14:16] Gretchen: That puts you in a position of advocacy then for the personnel who care for the patients, which is really cool. What is required for you to do something like that? You have a background in nursing, so that gives you a leg up, but now is this like just taking off one hat and having to academically put on an entirely different hat?

[00:14:40] Duncan: Not entirely. One of the reasons why nursing informatics has been growing so much is because you need people that understand the clinic side of things. I’m not going to necessarily be throwing all of the things that I’ve learned as a nurse to the wayside. I’ll be taking that and then just applying it in a different way. Then, say, because this is the field that I’m pursuing, I’ve been trying to research, “Hey, what is the easiest way I can break into the field short of just some getting lucky and somebody hiring me?” That is, most of them, it’s considered a master’s degree.

[00:15:19] Gretchen: Does this require then another college degree, or does it require an advanced degree?

[00:15:26] Duncan: I’m technically enrolled at UAB right now. I’m looking to try to start at the spring semester working towards that master’s degree. That’s probably the most straightforward path. I was looking, and there’s a certification you can get if you’ve done 30 hours of continuing education in informatics. I’m not 100% sure what that entails. I do continuing education for my nursing license every two years because I transitioned fields entirely after I renewed my license last. A lot of that has been about administering chemo safely, and calculating the dosages the proper way, and so on.

At UAB, some of the stuff was just like, hey, you’re different managing hypothermia or hyperthermia, all the various, here’s the things you do every single day, but now prove that you actually know how to do them.

[00:16:36] Gretchen: They would give you a scenario, and then you had to tell how you would address that scenario?

[00:16:44] Duncan: Kind of. It would frequently be in a digital format with a brief, “Here’s a little class question service center of three to five-question thing at the end.” That would be the equivalent of one to three credits, depending on the length and how in-depth it worked. Yes, nurses to be licensed, have to basically always be engaged in furthering their learning, which in the healthcare field that changes so rapidly.

[00:17:15] Gretchen: Sure, because there’s so many innovations that come down the road, those things, you have to be ready for those innovations as they come along. If I were a high school student, either a homeschooled student or a student who is in a classroom, and I was looking to go into nursing, what would be the top three things you would tell me to do in my last two years of high school to prepare for that successfully?

[00:17:41] Duncan: If you have not taken an anatomy course, do that. A lot of colleges allow dual enrollment, so you potentially could do your anatomy course through the college. Anatomy 201 and 202 is what I had to do to get my associate’s degree to get my nursing license. I loved my instructor. Chemistry is going to be your friend. Bachelor’s degree, they make you do chemistry as well. If you have a rudimentary or even an established understanding of chemistry, that’s going to be to your benefit because it’ll make your life easier going into it. That’s the non-nursing-specific things that I could think of. Those are going to make your life the easiest.

[00:18:32] Gretchen: What does Duncan do in these last few minutes? What do you do for a hobby if tech games and things like that were your hobby before? Do you still do that, or you have to go to a different side of your brain?

[00:18:48] Duncan: The computer that I’m using to talk to you is one that I built myself. It’s like if you’re willing to not always get on top of the line, you can build a pretty decent computer for pretty cheap, which is one of the things I’ve been debating dabbling in.

[00:19:04] Gretchen: What closing words would you have for our audience today?

[00:19:08] Duncan: You can do a lot if you’re willing to put forth the determination and effort, and spite can be an excellent motivator.

[00:19:16] Gretchen: [laughs] Duncan, thanks so much for spending this time with me today. I really do appreciate it. This was amazing. I thank our audience for joining us today, and we thank you for allowing us into your living rooms. We look forward to joining you again soon. Duncan, take care. Best of luck in your career aspirations.

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