An Interview With SHIFT Talk’s Nacole Riccaboni

Nacole Riccaboni is a board-certified RN and critical care nurse practitioner with a passion for professional advocacy and community building. She’s also the host of Shift Talk. Sponsored by the Robert Wood Johnson Foundation, this new podcast brings together nurses to talk about the challenges they’re dealing with — on and off the clock. We sat down with Nacole to talk about the importance of communication in nursing. For too long, nurses haven’t shared their stories, with the world or with each other. Nacole believes that has to change. Because when nurses understand and communicate with each other, patients receive better care and real systemic change becomes possible.

SHIFT: Nacole, you’re a nurse influencer with over 40,000 followers on Instagram. What inspired you to develop this part of your professional identity, and how did you grow your audience?

NACOLE: When you graduate nursing school you have all these people that you know, have the same interests, but then you all get jobs and you fall out of touch and do your own things. Back in 2010, I was a new nurse on a unit, and I didn’t know anyone. I didn’t know if me being scared was a normal feeling. I didn’t know if I was doing stuff right. So, I was like, I’m going to record this and see how it goes. And if I fail, it will be like a documentary of what not to do (laughs).

I created my own virtual community of people, because I’m always looking for advice. When you were in school, what did you do about this? How do you balance that? It was more of a selfish thing at the start, but it resulted in people creating their own communities, too. And now I am able to return the favor and help people, so it has gone full circle. It makes me feel good that I get messages from people and they say, “Oh, well, I was going to drop out of this program. But you told me to hold on, and I did. I passed.”

People think that if you’re a nurse, you have never failed at anything. I just try to be as honest as I can. I have ADHD. I have issues focusing. I have two kids. I work night shift. I don’t have an optimal lifestyle to be going to school full-time and working full-time. But if that’s what you want to do, you can make it happen. It’s not always great and when you’re okay with sharing that level of honesty with people, they start tuning in and watching your journey.

SHIFT: Your social media is all about starting conversations. Why do you think it’s so important to get nurses talking to each other?

NACOLE: People think that because you work in a hospital, you’re always going to be able to cope. They don’t understand the emotions that come up. I mean, with my friends who are nurse practitioners and nurses, most of our conversations are about what we’re experiencing. Last time I went to brunch with my friend, we talked for five hours — just about COVID. Trading stories, asking questions. What are you doing? What’s working for your patients? What’s working for my patients? How are you destressing? How are you balancing things? We’re just people trying to survive. Trying to make it through. Trying not to get sick. And the life stressors still get to us. We aren’t perfect, and to hear someone else say, “I’m stressed out, too, what are you doing, what are you stressed out about?” — it just makes you feel okay. I’m allowed to love my job and dislike aspects of it at the same time.

SHIFT: Can you say more about the kinds of conversations nurses are having or need to have?

For me, the most important conversation is always about how I can communicate better. I ask the nurses I work with all the time, “How can I help you do this faster?” or “What recommendations do you have?” Because communication is really big. Whether we’re doing a code or we’re talking about a patient, if I don’t communicate what I want, then it’s not going to happen. Assumptions and inferences are where you can get into trouble.

When I think back on being a bedside nurse, I think they just want to be heard. On all the levels — whether it’s communication about what they’re short on, what they need, what they feel like they’re lacking, their schedules. They just want to be heard, because they’re the ones doing all the physical, task-oriented work. When we get those COVID patients that are being paralyzed and proned on the ventilators — I don’t do that. I put in orders to prone. I type it up, make it pretty, but it’s the bedside nurses that turn the patients. If no one’s there to ask them their opinion, that’s where stuff gets murky and things get missed.

Because a nurse is only one person. The more you burden them with more patients, the more tasks you give them, the less time they have to assess their patients. You can give a nurse as much money as you want. They are still just one human being doing 900 things.

SHIFT: What made you say “yes” to hosting SHIFT Talk? What were the problems in nursing that you thought that we could help with?

NACOLE: Honestly, it was the opportunity to talk to other nurses. I don’t know about anything outside of my specialty, critical care. And critical care is great and it’s cool. But when I talk to a community NP, or a diabetic NP, or a school nurse, I have no point of reference. I don’t know their patient population. I don’t know what hurdles they face. I don’t even feel like I really understand bedside nursing outside of the hospital.

Nurses in different places are so disconnected. I think this podcast is going to shine the light on that. You know, it’ll show that inpatient nurses are not the only people that do cool things — all these nurses we talked to outside the hospital, they do cool things too. Just knowing that there are all these other routes outside of the hospital — that if you don’t like bedside in the hospital, you can do so many other things — is as an awesome thing within itself.

SHIFT: What would you say the top issue is in nursing?

The lack of understanding in terms of what each field or each part of the profession is going through. I mean, we’re all nurses. But clearly what we do varies. The issue is that we don’t have perspective, because most of our friends work with us. Most of my friends do critical care, except maybe one. Most people who do labor and delivery? All their friends do labor and delivery, except maybe like one ED nurse. We run in groups, we have our packs of friends (laughs).

If we could get all these different kinds of nurses to understand each other, the nurses and the patients would be happier. I feel like sometimes as a profession, we’re very fragmented, because we all do so many different things. We butt heads because we think we know better. “No, no, no. This is more important. I know more than you do.” But I think with the SHIFT Talk interviews you see that we’re all just trying to help people. We do it differently. But maybe shining a light on how everyone has these difficulties will help us understand that you aren’t the only ones dealing with certain things. People might even spark with a role or job that they never thought of or even knew existed.

SHIFT: You’ve asked all these nurses this question, Nacole, and now we want to ask you — what is your vision for the future of nursing?

NACOLE: Well, mine is that we all come together more. I feel like a lot of us are hard on each other in this profession, but we are all doing the best we can. There are nurses out there who are facing psychological and/or physical burdens or barriers. We’re not perfect. And I feel like maybe these SHIFT Talk interviews will help nurses understand that we might not all have the same problems, but our goal is still to help people. This isn’t a contest of compassion. It doesn’t have to be adversarial for you to feel good about yourself. We can all feel good about ourselves together as a team.

Visit the SHIFT website to learn more about Nacole and to listen to the first episode of the SHIFT Talk podcast! New episodes air weekly.