How a positive staff helped an uncertain hospital stay [PODCAST]

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“Hospitals and health systems should bolster the skills of care teams through education to improve patient outcomes by minimizing variations in obstetric care and being equipped to prevent, identify, and address any possible maternal emergency. Our obstetrics team provided invaluable care through communication, physical and emotional assistance, and reliable services. My family would look vastly different today if we had not received such excellent care.”

Vince Baiera is a nurse and health care executive.

He shares his story and discusses his KevinMD article, “Care coordination for obstetrics teams is crucial.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Vince Baiera. He’s a nurse and health care executive. His KevinMD article is titled “Care coordination for obstetrics teams is crucial.” Vince, welcome to the show.

Vince Baiera: Yeah, thanks for having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, briefly share your story and journey to where you are today.

Vince Baiera: Yeah. Well, I started my career as an ICU nurse at the Cleveland Clinic, then Duke University Hospital, moved around to travel nursing, taught at the college level, and then moved to the business side of health care. From there, I’ve worked with a large e-learning company, among other tech providers, and I even have my own small business. Really, for me, the focus over the years has been trying to do things where I can have a bigger impact and reach more people. Between my day job and my side business, I’m able to do both, and it really allows me to reach a lot of folks. That’s what really fills me up, I’ve learned over time: just doing things to try to impact others. So it’s been a fun journey. I’ve moved around a lot. I now reside down in San Diego and am lucky to get to call this place home.

Kevin Pho: Tell me about that transition to the business side, because you mentioned that you were an ICU nurse, and actually, I don’t talk to a lot of nurses who have that business side to them. Tell me a little about that transition.

Vince Baiera: Well, it was hard. You go from making a darn good wage as an ICU traveling nurse to starting at the bottom and trying to earn your keep and build your chops as a sales professional. But I was lucky to work with a strong organization that taught some of those initial sales skills. I really pride myself on being a self-taught entrepreneur who built a business that’s done almost $10 million in sales. All of that culmination has really continued to groom and drive me to be the person I am today.

Again, I take a lot of pride in that craft and in building that craft, because nursing is such a focused discipline, but as you move to business, it really opens up, and you can go in any direction you want. All of those things together have been really fun for me. As much as I love nursing, and love the people and a lot of the things that it offered, I could sit and talk business stuff all day. So I just really love that aspect of where my journey has brought me and what new doors I think will continue to open for me.

Kevin Pho: Did you have any business mentors who helped guide you, or were you completely self-taught, through trial and error?

Vince Baiera: The beauty of today is that you can find a mentor online anywhere, right? Everybody’s putting out content. But I certainly had a few folks individually who were big and influential for me. They taught me some of the basics, helped me avoid some roadblocks, and in short, just continued to push me and really inspire me to push myself. So yeah, I’ve had a few very close mentors, but then a lot of mentors from afar.

I know everybody on here who’s pursuing things is probably investing in themselves and reading a lot, but it always amazes me how many people don’t, when somebody will take their whole life’s learning, condense it into 200 pages, and give it to you for about 15 bucks if you’ll just read the content. Again, I really pride myself on trying to consume and learn quite a bit along the way, so that, for me, has really been the driving force in propelling myself to where I am now.

Kevin Pho: For those health care professionals who are interested in making a similar transition into the entrepreneurial business world, what’s the single biggest piece of advice that you could share with them?

Vince Baiera: Learn how to sell. Take a sales course, read sales books, and get involved with a sales organization. I even found that network marketing, although it sometimes has a dirty connotation, also provides you the framework to have somebody personally invested in teaching you a lot of the basic skills you need to get started: how to set a meeting, how to give a presentation, and how to follow up. They’re invested in helping you grow because it helps them. Again, that was something I did for a few years. It wasn’t ultimately where I felt I would get the most fulfillment and success, so I moved on, but it was certainly crucial early on in my days to learn some of those basic skills.

So selling is going to help you get a better job. It’s going to help you climb the ladder. It’s going to help you sell your idea. It’s going to help you sell products to customers. So there’s a lot that you can really take away from building those chops.

Kevin Pho: All right. Your KevinMD article is titled “Care coordination for obstetrics teams is crucial.” Tell us, how did this article come together?

Vince Baiera: My wife and I found out she was pregnant in 2021, around the summertime, and at 14 weeks, her water broke. She was pregnant with twins. Once we found out that indeed her water had broken, we were devastated, but they gave us a few options on how to proceed. Because both boys still had a heart rate, we decided, “Let’s just wait and see.” Worst comes to worst, one of them demises, and she can continue to carry the other boy. But over time, that boy just never let go. He never gave up, and both boys ended up surviving. She carried those boys from 14 weeks to 34 weeks, which is very rare, and it garnered a lot of attention, not only from the hospital, but also from others who wanted to share that story.

So over time, the birthing process unfolded, and we had a successful outcome, which, again, we can talk more about, some of the ins and outs there. But after the fact, it really was such a blessing, and it was, I believe, something powerful that people could relate to and really gravitate to, because so many individuals have issues during pregnancy, and you don’t really hear about them until you go through them, and someone goes, “Oh, my sister had this,” “My cousin, this happened,” et cetera, et cetera. So when you’re in it, you get a lot of that support, but it’s a little bit taboo. It’s not always talked about, because it’s so painful when you go through a loss.

So as our outcome unfolded, that story got picked up, and it was something that I believe was intriguing enough for you to pick up, because again, it tells the story of something that doesn’t happen all that often. So that’s how the piece came together. It was certainly a rocky road, and we had a lot of ups and downs, but we’re so thankful for where we are now.

Kevin Pho: Tell me about your interactions with the health care system during that time.

Vince Baiera: I worked for seven-plus years as an ICU nurse, working night shift, 12-hour shifts, so I got very comfortable and familiar with how a hospital works. I got very comfortable going to the hospital every single day. So when this happened and we were in that groove, with my wife on bed rest for five months, three of which were in the hospital, it was a little bit less scary, because I knew what to expect in a sense. But as you get into the hospital, each floor, of course, works differently: the flow, the staff, the interactions, the daily treatment. It’s so crucial, as we all know in health care, to keep ahead of it, to really identify those issues early on before they balloon into something big that you can’t really treat with, say, a small medication and things like that.

So the care coordination was vital, and on the floor that we were on, they did an amazing job. There was really great leadership from the rounding physicians and really great care, day in and day out, by the nursing staff, and even the ancillary staff all played a part in keeping the environment very cohesive and healthy, to allow us to really focus on what we needed to do. I told my wife that all the time. I said, “Just focus on the things that you can control. I’ll focus on some of the other stuff that’s outward-facing, and we’ll try our best to get through this.”

So again, that coordination is just crucial to allow the patient and their family to relax, to calm down, right? We know how important those are to outcomes. So yeah, we were lucky. We were at one of the, I believe it’s the number one hospital in California for number of deliveries. They do about 8,000 deliveries a day. And it was, again, a really good experience.

Kevin Pho: You mentioned your wife was on bed rest for about five months at this hospital, and the outcome certainly was less than certain. What would a typical day be like? Just describe it and take my audience through a typical day during that time.

Vince Baiera: Bed rest for five months, three of those at the hospital, so the first two at home. But the normal day, you know, we always laugh. People think it’s so restful and peaceful and you might get bored. No. From morning start to evening finish, you’ve got nurses, you’ve got your staff coming in to do their morning checks and give your morning meds, you’ve got people coming in to clean the room, and you’ve got doctors rounding. Of course, we wanted to get outside to get a little fresh air, so we’d always try and sneak an outside wheelchair session in when we could. But it was just back to back to back.

I remember we had this misconception that it would be very slow and there’d be a lot of downtime, but there wasn’t. I don’t know how it is on other floors, and again, I’ve worked in hospitals for a long time, but for us, it was just one thing after the other, starting from the morning. So there wasn’t a lot of downtime, but there was enough for us to continue to just let her sit and gestate, as we would say.

Kevin Pho: You mentioned earlier that it was critical to stop problems early on in order to prevent them from blossoming into something big. What would be examples of some of those issues?

Vince Baiera: Well, they would do the fetal heart monitoring, and they would look for occurrences where the fetal heart rate would rise or lower, and just watch and see what that was doing. If it happened so many times over an hour span, then it would start to indicate to them that you may be starting to have contractions. If those contractions were frequent and severe enough, specifically causing pain, then they would start certain medications to try to get your body to stop contracting.

What was crazy, and we didn’t realize it, is that my wife would have these little feelings; those were contractions. She was contracting for months and months, every single day. But one clarifying thing that we learned was that they would ask her, “Are you having contractions?” and she would say yes, but what they meant to ask was, “Are you feeling painful contractions?” because if they’re not painful, they’re not worried. Indeed, we didn’t learn that till, say, the last month, that that’s what they actually meant. So we were saying yes to contractions, and they would sometimes start to get worried, when in actuality we weren’t communicating clearly.

So again, my wife’s a dentist, and even with her level of knowledge, my level of knowledge, and how smart the nursing staff was, there was still room for error with miscommunication. And again, it’s just simple, small things that sometimes can lead to treatment, calling physicians, getting orders, and all the things that we know happen to continue to try to prevent some of those long-term issues.

Kevin Pho: As part of your story, you mentioned that you were a travel nurse, and I assume that you’ve seen a variety of medical institutions and health care settings. The care coordination that your wife received, would you say that’s typical of all the health care settings that you’ve seen?

Vince Baiera: I think that it was typical. I think that on a scale of one to 10, 10 being excellent versus zero being poor, I would say they were around an eight and a half, nine. They did a very good job. There’s always room; we’re always thinking there’s room for improvement. So could it be better? Of course. But as a whole, they did a very good job, and I would say it is typical. But again, Sharp Mary Birch Hospital is a very well-known hospital, again, affiliated with Rady Children’s, which is a top hospital here in San Diego. They do a darn good job. So I would say it was up in that eight, nine range in terms of efficiency, effectiveness, and things like that.

Kevin Pho: For all those health care professionals who are listening to you on this podcast, and it could be clinicians, nurses, or support staff, I just want to emphasize: What are the things that they did during this experience that stood out to you the most in terms of making the most impact?

Vince Baiera: From my days as a nurse, I think the people who have the best attitude, the best gumption, and the most enthusiasm for recovery were the ones who would ultimately have the best outcomes. I took care of patients with open-heart surgery for years and years, and people who were really close to, unfortunately, not making it. I think what this hospital staff did really well was keep your enthusiasm up. They were very positive. They all had sayings on the back of their sweaters that said, “We grow miracle babies.”

In our situation, there’s very little data. There’s very little information about a woman with twins who has a premature, previable rupture of the membranes, who ultimately carries a child for 20 weeks and then has an outcome. The physicians there would range, right? The group, I think, had nine physicians, and some were very, you know, their outlook, I don’t want to say, was dire, but they would be very cautious in how optimistic they would be, and then others would say, “Oh, I’m not worried. I think you’re going to make it. It’s going to be great,” right? So we kind of had to take the top and the bottom and find that healthy balance in the middle. But so much enthusiasm and energy.

Kevin Pho: Tell me a story that would be an example of such enthusiasm that you talk about.

Vince Baiera: Every week, they would write a certificate. They would print it out, and it said, “Congrats, you made it to 24 weeks,” and all the nurses would sign it: “You got this.” We’d hang them on the door, and we’d have a big line of those.

Other times, there’d be instances where we would be in what we felt was a shaky situation, but the nurses had seen it so many times. They were very calm, very calming: “Hey, we see this all the time. Don’t worry, we got you. It’s going to be OK. Just breathe.”

And then, to take it a step further: When your water breaks, that sac most of the time does not reseal, so as your body keeps making that fluid, it keeps leaking out, almost like your water breaks over and over again. There would be some times when that would happen to my wife, and it would create a large mess, whether it be on the floor as we tried to get her to the bathroom, or in the bed, or wherever else. We would be scared, because every time, you know that your babies’ fluid has now leaked out, and they’re not getting what they need to further their lung development. It’s incredibly scary and challenging. But again, that positive energy and encouragement from those nurses was so important, because they’d say, “We see this all the time. I’m not worried. It doesn’t have any blood in it.” They would point out things that they’ve seen that we could use as reference points to give us that calm peace of mind, even though it was something that was so scary. Every single time it happened, you’re scared. You feel like, “Wow, is this going to be the day that my wife goes into labor spontaneously?”

And every single day, going back to those certificates, we would have a board that would say “26 weeks and two days,” and the first thing we did every day was erase the two days and write three. I’ve never been in a situation where every single day I was so grateful just to get through a day, because we get caught up in our day-to-day process and habits. But that was really a time when every single day was important, and we celebrated every single day, and the nurses were very enthusiastic about that too: “31 and three! Wow, you guys are killing it. You’re past 30 weeks.” So it’s that energy every day. That really helped us keep our eye on the prize, because you realize you have no control, and it’s just about your belief, I believe, at the end of the day, and keeping that positive energy.

Kevin Pho: We’re talking to Vince Baiera. He is a nurse and health care executive. His KevinMD article is titled “Care coordination for obstetrics teams is crucial.” Vince, what are some of your take-home messages that you want to share with the KevinMD audience?

Vince Baiera: I think your attitude controls so much of how you respond to scenarios, and I think some of the beliefs that you put out into the universe have a funny way of coming back. I’ll give you an example from the process. Because Sharp Mary Birch is a learning facility, their NICU team would want to do studies: “For babies born between 26 and 28 weeks, we enroll them in this study, we deliver care and treatment a certain way, and then we’re going to measure it over years and write a paper,” et cetera. They would come to us and ask us, “Hey, just in case you go into labor on this day, are you willing to participate in this study?”

We told them, “It’s nothing personal. We know you guys are doing great work, but we can’t sign that paper, because then we’re putting out into the universe that there’s a chance that the babies could come between these weeks.” They asked us about three different times, for three different studies. There was something about our belief: We didn’t want to give a shred or an ounce of energy to the fact that those boys might come early, because we knew that every day they were gestating, they had a better chance of that long-term outcome.

So it was just our belief. As a patient in a stressful situation, you can only control so much, so really leaning on your belief, and really controlling your attitude and your thoughts, is going to help influence the outcome. And for anybody who’s on the other side, as a provider: Be positive to those patients, and really try to build them up, because they’re going through something that’s probably the scariest thing they’ve ever gone through. You’ve got the opportunity to be the light, or the bridge, right, to get them, hopefully, to that outcome that we all want.

So from the patient side, having that belief, and from the provider side, really being the bridge and having that positive energy, leaving your stuff at home and focusing on their stuff, right, to help them get further, is just something that we’re forever grateful to the staff that was there for, and it’s the message that we try to propel to others. Those would be the things that I think most of the staff listening, and folks, could probably continue to get better at and remember day in and day out.

Kevin Pho: Vince, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Vince Baiera: You got it. Thanks for having me.

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