Ep48: Debriefing to Heal Our Nurses- Tara Ryan Kosmas, MSN, RN, NC-BC, CHSE, SOAR

Ep48: Debriefing to Heal Our Nurses- Tara Ryan Kosmas, MSN, RN, NC-BC, CHSE, SOAR Transcript

Nicole Vienneau  00:00

Welcome, everyone, to Integrative Nurse Coaches in ACTION! My name is Nicole Vienneau. I am your host and I’m also a Board-Certified Integrative Nurse Coach. And today, we welcome Tara Kosmas. She is the founder and executive director of the nonprofit organization Debriefing the Front Lines. She is from Baltimore and beyond.

Basically wherever you are, she is. And we have been seeing each other’s work on social media. I have watched Tara grow Debriefing the Front Lines and see her all over the place doing so many magical things for Nurses, for healthcare. I am so excited that she is on our show today to help us understand more about what she is doing as an Integrative Nurse Coach with Debriefing the Front Lines. So, welcome, Tara.

Tara Kosmas  00:59

Thank you, Nicole, for having me. I am so honored. And I feel like I have seen and listened to the podcast and kind of dreamt and hoped that I’d been asked to be on, and here we are. So I feel filled with gratitude. And I appreciate you and the program as a whole.

Nicole Vienneau  01:17

Oh, wonderful. Well, we are thrilled to have you here with us and to share what you are doing with Debriefing the Front Lines as a Board-Certified Integrative Nurse Coach. So, we love to take a little history… history tour to uncover why you decided to become a Nurse.

Tara Kosmas  01:35

Life as a pediatric burn survivor really shaped my experience and led me to the Nursing profession as a whole. I was 20 years old when I started my Nursing career at West Penn Burn Unit in Pittsburgh, Pennsylvania. And despite my lived experience as a burn survivor, I was grossly underprepared for what I was going to see.

And the burn unit, it was hard, and it was humbling and it was a bit blurry as trauma tends to be. Because of this, over the years, I began to dive into the nooks and crannies of trauma informed care, of dialectical behavioral therapy, of debriefing and peer support.

And I developed this passion for education, preparing Nurses for the emotional complexity of the profession. I had several mentors in my life who identified me kind of as a natural educator, so I obtained a master’s in Nursing education and this is where I really learned the power of simulation debriefing— mirroring reality as we prepare Nurses for practice.

And after completing my master’s from here, I begin my full-time career in academia. And over the next eight years from 2011 to 2019, I would build a simulation curriculum and two Baccalaureate Nursing programs— Florida Gulf Coast University and Towson University. So, I was working as an assistant professor when the pandemic began, and I began receiving an alarming number of calls from former students, from colleagues, who were fearful for the first time.

I was seeing and hearing Nurses fearful for themselves, their patients, their family and the community at large. And 16 days after a global pandemic was declared— I get very teary— I began debriefing the front lines, and it grew into this incredible organization. We have… we are a team of three board-certified Nurse coaches. And we focus on psychological first aid through structure debriefing and emotional wellness offerings through board-certified Nurse coaches.

Nicole Vienneau  02:47

So, in your beginnings, you were a young person that went through being a burn patient. So you experienced the care and from Nurses.

Tara Kosmas  04:32

Yes, absolutely. I developed a great respect for Nurses long before I ever became one.

Nicole Vienneau  04:42

And as you talk about this whole journey, you know, through your Nursing education and someone seeing how wonderful of an educator you could be, and then discovering yes, I am an amazing educator. And then all this experience in simulation, and then debriefing and trauma, understanding trauma and some of the ways in which Nurses are experiencing trauma.

And then COVID hits, and you received so many calls. And within 16 days after COVID, you were debriefing, and helping Nurses. And you became teary at that point. And just, you know, it really touched your heart. And I’m wondering if you could tell us a little bit more about what you were experiencing then.

Tara Kosmas  05:36

At that time, the Nurses that were reaching out, I knew them personally. They were former students who were one to two years in the profession, that I had kept in touch with, that I was, I guess, unofficially mentoring, and colleagues were reaching out. So, these were people that I personally knew.

And because it was such an alarming number, I remember reflecting and asking myself, I remember sitting outside in March, reflecting, asking myself, what skills, what gifts, what medicine do I have to bring into this, what I think, is a sacred profession? And that was debriefing. I felt like I had been preparing, much of my career, for this moment.

There was also an element of guilt that I think is important to be honest about. Although I was not working clinically in the ICU at that time— I had left the bedside two years prior— I knew that I had those skills, and that I could, if need be, go in. But I felt like that wasn’t what I was being called to do. I was being called to support those who were on the front lines.

Nicole Vienneau  07:10

What are some of the things that Nurses would come to you with?

Tara Kosmas  07:16

Initially, it was single incident trauma, but very quickly, within I would say, three months time, it evolved into what our organization has termed cumulative caretaking trauma. And this is the overexposure, day in and day out, to abnormal and traumatic events, with no time for acknowledgement, discussion, processing, and recovery, that leads to emotional, physical, and spiritual suffering.

And some of the factors that played a role in cumulative caretaking trauma is Nurses feeling institutional betrayal— not having enough PPE, not having enough resources. Policies, procedures, changing very quickly, because this was the beginning. And we were learning as we went, kind of, what worked and what didn’t work.

However, many Nurses felt a lack of safety in this, a lack of emotional and physical safety in this. And clinically, proning was very hard for many Nurses. Proning the patient was very hard for many Nurses to see. Because depending upon how long you’ve been a Nurse, we weren’t doing this much anymore until the pandemic.

Nicole Vienneau  08:47

What about that particular thing, proning— where the patient is on their belly— what about that was alarming to the Nurses?

Tara Kosmas  08:58

I think it was the quickness, the swiftness in which it had to be done so that the patient could breathe. I think it was the newness— not ever seeing an intubated and sedated patient lay on their stomach, not seeing their eyes, not seeing their face. I think that all of that played a role.

And the lack of help and resources too. If you remember, when the pandemic began, Nurses were the ones really going in the rooms. There were some disciplines who were not going in the rooms. Some physicians were not going in the room at that time. And there were elements of betrayal in that as well.

Nicole Vienneau  09:49

Yeah. So as you saw the pandemic go on, you mentioned at first it was just single incident trauma— one thing which was very traumatic, And then it becomes cumulative events, more and more and more, this betrayal, the system, lack of resources, new policies and procedures quickly changes happening so fast. And Nurses left to show up every day, while other caretakers were doing things remotely, and not being at the bedside.

All of those things piling on to Nurses. And time goes by. We saw a lot of things on the news, you know. And then there’s our Nurses at the bedside. And so as you have gone through these last few months, where COVID is slowly out of the news and dissipating, what are you seeing in your discussions with Nurses now?

Tara Kosmas  10:58

We have found that the cumulative caretaking trauma, the unsafe staffing conditions, the limited resources, the lack of mentorship, and at times the verbal abuse experienced, we have found that Nurses are not able to delineate where one trauma ends and another begins. They’re feeling the weight of being asked to do an impossible job. They have increased anxiety, unable to rest, feelings of continual urgency.

So they’re activated and experiencing nervous system dysregulation because they have worked in this stressful environment with little time for processing. And with this comes a lot of shame and guilt and unworthiness.

Because they are kind of being asked to do this impossible job, that isn’t this idea of what a Nurse is or what a Nurse should be, or they don’t have enough time to do the job that their heart wants them to do. And this is easily kind of spilling over, you know, spilling over into life outside— affecting their their mood and their wellbeing.

It’s also been interesting, we have found that when Nurses arrive to us for debriefing— we start with Nursing, it connects us, there is this shared language, and there’s also this kind of unspoken understanding because our team are Nurses as well— we have found this kind of exacerbation of personal and childhood trauma. And those symptoms are coming up as a result of this cumulative caretaking trauma.

Nicole Vienneau  13:04

As you were talking about all of this, I couldn’t help but feel my own stomach beginning to twist and turn, and my heart feeling heavy. When you talked about guilt and shame and feeling like you’re just not enough, that the things that you… the things that I got into Nursing for, are now so different.

And trying to wrap my brains and my heart around my love for what I do, but yet the system is not supportive of that and not showing up for me, even though I have shown up for it for many, many years. And that disconnect becomes very heavy. And I felt that as you were describing all of this.

Tara Kosmas  13:55

Absolutely. We talk a lot about in debriefing, where if the Nurse, if the client, if the Nurse chooses to remain at the bedside, it requires a routine of consistency. It requires pre-shift practice, it requires post shift reflection, it might require investing in debriefing, in therapy, in peer support.

So, with the decision to stay, it also can be very beautiful because that comes with the decision to care for yourself. And many of the Nurses who have chosen to stay and are caring for themselves are then becoming role models for their units and their floors and their communities. So it’s not all heavy.

Nicole Vienneau  14:52

No, it is not all heavy. And for someone who has definitely done many many practices in order to try to mitigate burnout and heal from burnout and all of that, you know, those shifts in the way that I practice and show up, then show, I think, how the system should treat me. Like I am showing up in a different way. And I am the one who’s choosing.

And so when I have used— I continue to use— all of the skills and, like you say, debriefing and reflection and self awareness and knowing myself and what my limitations are, and my boundaries, then I show up different at work. And when people start to see me in that way, they say, “Hey, what is it? What are you doing? And how can I also do some of that?

Because I see you differently.” And in addition, that then extends beyond just my unit. I feel that it extends like out to the system. And now I’m showing the system how to treat me, instead of them just treating me the way that they want to treat me.

Tara Kosmas  16:06

Absolutely. Absolutely. And, you know, we talk a lot about the failures in the system. I do want to add that there are systems, there are organizations, who have come to us. We have done debriefing trainings, we’ve had contracts with community health organizations, public health organizations, that have supported their Nurses with third party debriefing. So in this, I just want to make sure that I don’t bash every system.

Nicole Vienneau  16:41

Yeah, let’s not bash everybody. But this is such a beautiful discussion, because not every organization has shown up in this way. Right? And  the organizations that are recognizing that this needs to be a part of their programming to support their Nurses, they’re seeing their Nurses become more joyful, more connected, they’re staying longer in their jobs. So how does an organization reach out to you? How does that work? What does that look like?

Tara Kosmas  17:14

So to be honest, at first, I did do some pitching to organizations, because that was… I wanted to reach as many Nurses as possible, and get them the help they needed. However, that wasn’t always met or received as well as I had hoped. Because many hospitals have existing EAP programs. So it seems that what has been most successful is the Nurses that have come to us for debriefing.

They talked to their Nurse manager, they talked to their director, or they are a Nurse manager, they have a leadership role, and they have experienced the power of debriefing. They have experienced the power of being heard, of working with a Board-Certified Nurse Coach. So many of these contracts and opportunities that we have had the opportunity to pursue our through our own clients, who then kind of helped spread the word and the message.

Nicole Vienneau  18:19

I love that. Because once you feel and you receive and you experience this type of work, then you become the advocate for it.

Tara Kosmas  18:31

Absolutely.

Nicole Vienneau  18:33

And if there’s one thing I know about Nurses, if they love something, they are going to tell everybody they possibly can about it. Because it’s so supportive, right? And they feel the value, they see the value, and they feel that in their physically, mentally, emotionally, throughout their whole being. So if Nurses are interested in partnering with you, how would that… what would that look like?

Tara Kosmas  18:59

So, there are a couple of different options. For individual Nurses, we offer single session, we offer debriefing packages, as well as debriefing subscriptions. The subscriptions came to be because Nurses were asking for them. So many Nurses we meet with weekly, bi-weekly, or monthly.

And this is what I was referring to, when I said if you’re going to stay in a particular… if you’re going to stay at the bedside, you know, recognizing that you might need this support. And we always… our tagline is “alone is no longer enough.” And that is really important when you are working at the bedside, or in any Nursing specialty, or outside of Nursing, to recognize that there is so much bravery in asking for help.

Nicole Vienneau  19:56

Absolutely. I really appreciate your tagline. Alone is no longer enough.

Tara Kosmas  20:03

Yes. On a personal note, as a pediatric burn survivor, I entered my first burn support group at 16 years old. I was 16 the first time I met someone who looked like me, who felt like me, who had experienced something similar to what I had.

And it was kind of in that moment, in that moment of pure support, you are alone until the moment you realize you are no longer alone. And it sounds so simple. But that seems to be a reoccurring theme in my own life. And one that I see within Debriefing the Front Lines, as well.

Nicole Vienneau  20:48

Thank you for sharing something personal. Yeah. And I see that in my own journey through Nursing as well. We are very autonomous in our roles. And we do a lot of work on our own. And then we realize at some point, that it’s really hard to stay in doing the things alone. And then we reach out for help. Yeah, or we stay alone, and then maybe our role becomes too burdensome, because we’re alone.

Tara Kosmas  21:21

Absolutely. And we talk about that a lot in debriefing. One of the components, the three components of self-compassion, is common humanity. And common humanity is the belief that— or is the knowing— that there is suffering in all parts of the human experience, however, it is easier— for lack of a better word— to navigate outside of isolation, and in community.

Nicole Vienneau  21:51

So beautiful.

Tara Kosmas  21:52

Thank you.

Nicole Vienneau  21:53

Your work is very powerful.

Tara Kosmas  21:55

Thank you, I appreciate that. It’s my life’s greatest work. And I feel very lucky because my career— I have grown with my career, and my career has grown with me. I worked in the burn unit. I was able to provide hope to burn survivors. And if you’ve ever been in the depths of despair, you understand how important hope is.

And then I moved to academia, and I was able to help students and learn simulation and debriefing. And I was feeling this inner evolution as well. And that led to Debriefing the Front Lines. I can’t imagine doing anything other than Nursing.

Nicole Vienneau  22:45

Nursing is definitely one of those professions that is embodied.

Tara Kosmas  22:51

And then I found Nurse Coaching and I was like, woah! I am home!

Nicole Vienneau  22:59

How did you find? How did you discover Nurse Coaching?

Tara Kosmas  23:02

So, it’s kind of interesting— through social media. I had not heard of Nurse Coaching, I’m not gonna lie. And I wasn’t big on social media until I needed a way to advertise Debriefing the Front Lines. And I found INCA through Instagram. Someone who had— Heather Thorne— someone who had gone to the program and spoke very highly of it.

And I remember going to the website every day for probably like six months. Like, I don’t know if I was working up courage or commitment or what exactly I was kind of working towards. And then I heard talk of the leaders like Karen Avino and working towards Nurse Coaching being recognized by insurance in the future.

And that was really incredible to me, not really for the monetary reason, but what that meant for our profession, to be seen, to be recognized, that board-certified Nurse Coaching, that Integrative Nurse Coaching is, in my opinion, a form of advanced practice Nursing.

Nicole Vienneau  24:19

Yes. And to be recognized by insurance companies, Medicare, yes. I mean, definitely to be reimbursable shows that we are definitely practicing to the full extent of our licensure.

Tara Kosmas  24:33

Absolutely.

Nicole Vienneau  24:34

Yes. So what was one thing or one key moment during the Nurse Coaching program that really stands out for you as far as learning and as far as your takeaways?

Tara Kosmas  24:47

I don’t know if I learned this in Nursing school. I don’t think I did. I believe the first time I learned of the story theory was in the Nurse Coaching program. And since, that has really given name to Debriefing, to the work that Debriefing the Front Lines does. And I feel like it’s the backbone of how Debriefing the Front Lines kind of defines Nurse Coaching.

Like we as humans are this collection of stories, and Nurse Coaching enables the client to connect with themselves through this intentional dialogue that creates meaning and acceptance in the story, during the good, the bad, and the painful parts. And a lot of it goes back to me being a burn survivor and knowing that the story matters.

And I’ll never forget Dr. Moore— she was my supervisor— she said something, I don’t remember the exact words, but she said something along the lines that people need to tell… people often need to tell the same story for years. They might need to tell the same story for 30, 40, 50 years, a lifetime. And this holds true for myself, as well, as a burn survivor. My story has evolved with my own healing. And I love the idea that Nurse Coaching is a space that we co-create.

And we meet people exactly where they are, and we start exactly where they are. And we love them, and we encourage them to love themselves exactly where they are. And tomorrow, beginning again, exactly where you are. It’s such a beautiful concept to me. And it’s something that I feel as if I have been doing in my life without naming it or understanding that this is what I was searching for.

Nurse Coaching is also the first job that I’ve been able to really show my creativity and be an artist, so to speak. In the programs, we create new courses and new offerings. And I think that I longed for that creativity. And Nurse Coaching allows me to do that.

Nicole Vienneau  27:16

Nurse Coaching is definitely opening up ways of being, different meanings behind stories, connecting on that human level. You mentioned the good, the not so good, the painful, but all of those things and putting framework around those things, like you said, I’m not sure where that came from, but I’ve been living like that. And now I have a framework to kind of describe what that is.

Tara Kosmas  27:47

Yeah. And I remember when I saw the Nurse Coach textbook, I bought it long… like maybe four or five months before I enrolled in the program. And I loved this textbook so much.

Nicole Vienneau  28:02

You should see my textbook. Well, it’s over on my bookshelf at the moment because I was like I’m gonna put this away for now. But I have it folded and highlighted and notes and different markers in there— sharpie marker, a red pen. I love that. Yes, I’m definitely putting the Nurse Coaching textbook in the show notes for people if they would like to just buy one. And you won’t regret it.

Tara Kosmas  28:30

Yeah, beautiful. It’s a wonderful, wonderful text. Absolutely. 10 out of 10.

Nicole Vienneau  28:36

Yeah. 10 out of 10. So, in our last few moments together, I love to ask, I love to ask this question. So let’s take a breath together. What is on your heart that you would like to share with our listeners?

Tara Kosmas  28:58

Something that comes up for me is, many times, we go through difficult phases of life. We go through challenges, we go through darkness, we go through depths of despair. However, there is something very powerful, when you are ready to feel it and when you are ready to receive it, in the post traumatic growth that arises from these challenges. And Nurse Coaching has really enabled me to help others see that there can be growth in these painful experiences.

Nicole Vienneau  29:45

Thank you, Tara.

Tara Kosmas  29:47

Thank you, Nicole.

Nicole Vienneau  29:50

Alright, now I’ve got some fun questions for you.

Tara Kosmas  29:54

Okay. Yeah, this was a heavy one probably.

Nicole Vienneau  29:59

Well, this needs to be talked about. All of this. This is important, important to talk about. And we have to voice, put a voice to all of the suffering and the trauma that we experience as Nurses.

Tara Kosmas  30:15

Yeah, I think it’s important to be ruthlessly honest about the facts of the state of healthcare while still being hopeful of the future.

Nicole Vienneau  30:25

Yes. Stay hopeful and still be truthful.

Tara Kosmas  30:31

Yes, absolutely.

Nicole Vienneau  30:32

Yes. Okay, are you ready for some questions? These are ones you can’t think too hard about.

Tara Kosmas  30:38

Okay, got it!

Nicole Vienneau  30:40

Okay. Sun or snow?

Tara Kosmas  30:43

Oh, sun. Absolutely. I’m from Florida.

Nicole Vienneau  30:47

Okay, how about beach or water?

Tara Kosmas  30:51

Beach?

Nicole Vienneau  30:52

Or water, yeah, beach or…

Tara Kosmas  30:56

Beach. Beach because you get both. Sun, water, sand, seashells.

Nicole Vienneau  31:03

Yes. I love that. Yes. How would you describe Integrative Nurse Coaches in 20 words or less?

Tara Kosmas  31:13

Integrative Nurse Coaches redefine modern Nursing. That’s all. I don’t need 20 words.

Nicole Vienneau  31:21

I was counting! Integrative Nurse Coaches redefine modern Nurses. That was six words, Tara! I love it. Oh, boy. Okay, so, Integrative Nurse Coaches in ACTION! Okay, ACTION stands for some things. It stands for authentic, curious, truthful, inspire, open and nurture. What does living in ‘action’ mean to you?

Tara Kosmas  31:52

Living in action, to me, means living aligned with your core desired feelings. You know how you want to feel, so you make decisions to get you there.

Nicole Vienneau  32:07

Yaaas! Thank you!

Tara Kosmas  32:10

Keeping it concise.

Nicole Vienneau  32:11

I love it. Thank you so much for sharing your time, your energy, your work with us here at Integrative Nurse Coaches in ACTION. I’m so, so grateful for you.

Tara Kosmas  32:28

Yes. Thank you so much. And I just wanted to take a moment and you know, thank everyone within the program. When my community in southwest Florida was hit with Hurricane Ian in September, we had a fundraiser in which we helped Nurses.

We provided them with water and food and shelter. And INCA was so supportive, and it really means a lot to me that they showed up for the community as well. And I just wanted to thank everyone for the support. It means so much, and we couldn’t do this work without you all.

Nicole Vienneau  33:03

 

Yes. Integrative Nurse Coach Academy. Amazing. So, Tara, how can we find you?

Tara Kosmas  33:10

You can find us on Instagram and Facebook at Debriefing the Front Lines Inc. Also, on our website: debriefingthefrontlinesinc.org. And I personally, Tara Ryan Kosmas, am on LinkedIn, as well.

Nicole Vienneau  33:28

Awesome. And we will definitely be sharing those links in our show notes, so you can reach out to Tara and her team at Debriefing the Front Lines. Thanks again, Tara.

Tara Kosmas  33:37

Thank you so much, Nicole. I appreciate it.