The Bossy Nurse Podcast
The Bossy Nurse Podcast is a show about nurse creators, innovators, risk-takers, and the ideas that shape their success. Hosted by Marsha Battee, Founder of TheBossyNurse.com.
The Bossy Nurse Podcast
5. From Overwhelmed to Stress Free Psych NP with Dr. Claire Ellerbrock
In this episode of The Bossy Nurse Podcast, Marsha Battee speaks with Claire Ellerbrock, DNP, APRN, PMHNP. In this conversation, Claire describes how she moved from feeling overwhelmed in practice to becoming a confident, stress-free psychiatric nurse practitioner... and how she helps other nurse practitioners do the same.
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So I was working with really complicated patients and um right off the bat felt just incredibly overwhelmed and and lonely and uh questioning whether I had you know entered the field that I should have been in. Um often crying on my drives to work every day for months and um felt the burnout much, much quicker than I thought I would as a nurse practitioner.
SPEAKER_00:Welcome to the Bossy Nurse Podcast, a show about nurse creators, innovators, risk takers, and the ideas that shape their success. I'm Marsha Bad T, and on the show today, how Claire Ellerbrock turned a rough start in community mental health into stress-free psych and pee, helping mental health nurse practitioners have less stress, avoid burnout, and treat mental health disorders with confidence. Across psych settings, new and peas can meet heavy caseloads, little onboarding, and complex patients from day one. Claire felt that shock too, moving from school straight into real-world decisions without enough support. So she went looking for steady guidance and reached out to a psychiatrist she'd shadowed during one of her NP rotations. They met on Saturdays, she brought lunch, he walked her through her questions, and week by week, her confidence grew. Those weekly sessions helped, but the habit of doing the work came long before, shaped by her parents' values.
SPEAKER_01:Here's Claire. Yeah, I think the studious mess is maybe something internal as far as wanting to do really well in school, but as far as focused on college, maybe not that particular one, but that very much came from my parents. Um, both of their parents never went to college, and so that was really important that we did. They both went to college, but their parents didn't, my grandparents. And um maybe also a little bit untraditional, my dad specifically really um fostered the importance of of learning and and math and reading. And when I was in middle school, I every day after school, I would go to um maybe some more high school, but would go to, you know, track or cross-country practice. And then after that, I would go to the local uh university, uh, Marybale University, and I would study for a couple hours. Um, and no, none of my friends or classmates were were doing that, but that was sort of something that my dad um, I don't know, it pushed but encouraged and just became this normal thing. So every day after school, after you know, extracurriculars, I'd spend a couple hours. My dad would uh bring me dinner, we'd we'd drive to the the college, he dropped me off, I'd study there at the library with other college students, and then 9, 10 p.m. he'd pick me up, I'd go home, and I would do that nights and weekends and did that throughout um maybe starting like seventh, eighth grade throughout high school. Wow. Um and so I I guess that's a little atypical, also. Same with my my brothers, um, very focused on math specifically. My dad would teach us also math ahead of learning it in school. But um I think the ethic to kind of look ahead to to college came from my dad, probably.
SPEAKER_00:I actually love that approach that your dad had that foresight and probably, of course, maybe has always been that type of person for thinking, but I love the approach of taking you to a college to study um middle school, high school. I I love that approach. And so you're already thinking as a young child or a teenager or preteen that, hey, I I can actually see myself doing this. And it seems like it would have been an exciting experience. How did you feel on the campus? Did you like study in the library or did you study in different areas of the college? How did you feel about that?
SPEAKER_01:Mostly in the library, and really it felt really normal. It's sort of all I I knew. It didn't feel that odd to be there with other college kids. It was evenings also. I would just head off into the library or the cafeteria area and just pull out my study materials and then and then just work. It just was very routine and and normal, and it happened most days of the week for years. And so um looking back, it was a little bit odd to think that there's just like a little high school or middle school just on the campus working. Um, but it felt very normal for me and it definitely had the foundation for sort of structure that came later in college and um being really used to knowing how to study um and that lended itself to good grades and things like that in school um and getting into college, I suppose.
SPEAKER_00:Yeah, that's that's really really interesting to me. Um and and curious, is that an approach that you would take with your own daughter? That's so interesting. I've not talked about it. And congratulations. And congratulations.
SPEAKER_01:Thank you, thank you. I have a three-month-old daughter named Ryan. Um, interestingly, probably not. Um I I think there was such a drive by my my parents, my mom as well, but my my dad, that I do well in school that I think I think that kind of came at the detriment of me trying to find what it was that I was interested in. And so I was studying in order to get the grade, not necessarily to find my passion. And I think as a result of that, it's been a little bit difficult to find what it is that I'm interested in. Like I mentioned, I I ran cross-country and track. That wasn't necessarily because I was really passionate about that. That was to look good on an application to sort of check a box. And so I think with my daughter, um, certainly learning is really important. And the emphasis is on learning and and the love for learning and how you instill that, I'm not sure. But I think the structure of what I did was a little bit extreme and rigorous. And so I could see myself having her lean more into the arts. I think maybe because I was so much pushed into the sciences and math, that I could I could see myself wanting her to try a little bit of everything and having a little more of a hands-off um approach in that way of letting her find her way and what she's interested, interested in.
SPEAKER_00:Yeah. Well, I really appreciate you taking the time. I know you were taking some time off from work and your business to do so. So I appreciate that. Um, curious then, since you were having some challenges with figuring out your way moving forward, how did you figure out what was it that you wanted to do in college? Like you already had the dream of going to Washu and you already knew that from a younger age. How did you know at what point did you figure out what you should major in? And I know it wasn't nursing, right? I know you first started off in something different.
SPEAKER_01:Yeah. I did, I did. It took a little bit to find, and I felt kind of silly a couple of years into college of other people who were really passionate and knowing what they were going to do beyond college. And my goal was just getting there, and I hadn't really thought beyond. I was just excited to be there. Um, but I think it was a class I took in just I started taking classes in psychology and specifically in a in a normal psychology class I took. I was just fascinated by what I was learning. It didn't feel like I was studying to take the test and get the grade. I just was interested. I would go to the professor's office hours um after class and ask questions and see ways that I could learn even more beyond what I was learning in the class. Um, and that's what led me to think like, okay, I think I could see myself going into some area in psychology. And so I spent my summers working as a research assistant in the school's psychology department, um, where I would help sort of set up um studies for participants. So handing out surveys and and getting them in the right uh spots. And I thought I would go into research. Um and I think after a little bit of doing that a few summers, um I realized that I don't love research research as as much as I would need to. I don't know if they're um and so I I was sort of trying to figure out what else I want to do after them. And my brother, who was in medical school at the time, um, brought up the idea of becoming a nurse practitioner. I'd never heard of a nurse practitioner before, and it was curious to me. And so I did some shadowing at a local um hospital, shadowing some and asking questions and thought, wow, this is really cool. It lets me um interact with people more. That's the thing I didn't like about research, it was very much isolated and not really interacting with others. And um it seemed exciting. I don't have any nurses in my family, and my brother is really the only medical professional. And so um it was sort of just that small experience that led me to say, okay, let me go into nursing. And so I finished my degree at Blashu, and then I packed everything up and um drove across country and um selected a school that was supposed to be a top school in nursing and did a direct entry program. So two years as an RN and then two years as um for my MSN. And I always knew I wanted to go into mental health, I think with that psychology background also, just um always interested in the mind and um why and how we do what we do and when that doesn't go well, uh how that manifests emotionally and behaviorally. And it was just a very natural fit for me. And so um that sort of kind of unfolded a little bit randomly as far as how I ended up in in nursing.
SPEAKER_00:So psychology was at first your major um and then you did some internships or I mean sorry, working as a research assistant at the colleges uh during your studies. When you graduated, did you at first go into research a little bit or did you go you went straight into a nursing program? You did you have any time in between that that thought process of I didn't switch over? Okay.
SPEAKER_01:And as someone who was so planned to get into college, it was a little bit stressful for me because it was a pretty quick turnaround of I'd missed deadlines to apply to other colleges. Um so it was uh, and I could have waited longer and and not jumped. I think I felt the pressure to just move from college to the next thing and not have any sort of gap. And looking back now, I wonder if I'd breathed a little bit and had a little bit more time, what that would have resulted in. But um I yeah, I went straight from finishing my degree to to um heading to to Cleveland to to start my nursing program that that fall.
SPEAKER_00:Okay, awesome. So when you get into nursing or get into the nursing program and you did a direct entry program, when you got into the program and um discovered what sort of nursing may be, did what your brother sort of told told you, what he told you, did it sort of resonate and feel like it was something that actually became something that you wanted to do? Or did you have any challenges in the very beginning when you made that decision and you started going to classes and seeing what it was about? Or was it something that was a natural fit?
SPEAKER_01:That's interesting. Um, well, I think a lot of my focus the first year, especially as an RN or as a as a nursing student, was just kind of getting through classes. There was just a lot of material to keep on top of. And so um, from the perspective of just someone who knows how to study and is really good at it, I felt at home and natural for me. Um, it wasn't until clinicals that I was trying to find my way and which which seemed interesting to me, which area. I know I didn't really love med surge um or um uh I I know on my psych, my psych rotation, just feeling that this is something that I could do. I I I've always really been interested in working with patients with with psychosis, and um I that just kind of felt like an interesting fit. Um but and it's also interesting that my brother happens to be a psychiatrist. There was no influence as far as me going into um the the mental health space because of him. It's just sort of funny that he also is in the mental health space.
SPEAKER_00:Um I don't know if that's answering your question, but I yeah, it is. And and I'm actually curious. Um, so why why not psychiatry versus mental health? Just curious about that if you want to share.
SPEAKER_01:A lot of questions that I haven't been asked before. Um so why why didn't go to medical school instead of music school?
SPEAKER_00:Honestly that you had your brother, you know, who was he's done it, and you know, now you're going into the same field and just curious at um the decision of nursing versus medicine.
SPEAKER_01:Yeah, yeah. Honestly, I I think I doubted my ability to be able to go into medical school. Um I I think I kind of I didn't even attempt to. It was just something that was just like that is too difficult for me, um, which is interesting because as I look back, I'm so grateful that I am a nurse and I am a nurse practitioner. I couldn't imagine it any other way. I think nurses being able to work at the bedside and develop the relationship that we do allows us as nurse practitioners to provide a different kind of care. Um and I'm so proud of that. But um yeah, the reason why I didn't pursue or just even attempt um medical school is I didn't think that I was I had the ability to to get in. It makes me a little bit sad that I that I didn't um uh make the effort to to kind of go that route. But I think things happen as they should and for a reason. And um I I I I feel very comfortable and confident with where I am right now in in life.
SPEAKER_00:Thank you for sharing that. I know um there are probably listeners who may be having that same struggle of which path do they take. And um I think it's really a personal decision and it really just depends um personally where your heart is driving you towards. I feel like, and I probably have said this on several different podcast episodes that I've had with guests, that I think nursing is the best career decision that I've made. And I think it's one of the best career decisions that anybody can make because there's so much you can do in nursing. There's so much flexibility with nursing, whether you're working in hospitals, clinics, or working behind the scenes and health plans, so many avenues working in tech now. Tech is health tech is is pretty big. So much that you can do in nursing that I think you made the right choice.
SPEAKER_01:Oh, absolutely. If I have to say so myself. I I also appreciate having my brother in in the medical as a physician to sort of act as a backdrop for me because I I'm able to see what his experiences were like, what his challenges were, to be able to appreciate the work of a physician. And we work very side-by-side physicians and nurse practitioners in practice. And so to have a psychiatrist whose journey I've been able to see much more up close than you know, a physician colleague, psychiatrist colleague, um, has given me sort of a different perspective that I think allows me to be more um understanding and appreciative and um uh collaborative when when I work with physicians in practice.
SPEAKER_00:Amazing. Amazing. Also, do you ask your brother for advice on do you like talk about challenges with patients' care and how to deliver the best care? And since you're in the same field, do you often reach out to him for advice?
SPEAKER_01:Sometimes, sometimes. Um, he he has his own practice. He he's in in the Boston area. Um, it's funny though, we don't spend a ton of time talking about patients or cases or work. I have a mentor who was instrumental in my career as a nurse practitioner with meeting with me every weekend to discuss difficult patient cases, my first year of practice in that really difficult transition that I can talk about. But um that's that's the physician that I that I talk to whenever I have difficult patient cases to to run by. Yeah.
SPEAKER_00:So let's talk about that. Let's talk about your nursing, nurse practitioner journey once you've finished school, got your nurse practitioner license, passed your boards, all of that good stuff. So, what did you do as soon as you got out of school?
SPEAKER_01:Yeah, yeah. And just to clarify, um, I worked as an RN for a couple of years when I was um becoming a nurse practitioner. It's important for me that I had that context of what it was like to work as a nurse for two years. So I worked in patient behavioral mental health working nights. Um, but when I graduated, um, wow, that transition was really, really rough. And that was sort of the foundation that led to my business. But um I could tell my last few semesters of school and P school that I didn't feel like I had the tools that I needed. I just didn't feel ready for practice. And I wasn't sure if that was insecurity within me. But I didn't feel like my clinical rotations were robust enough, or the grades I was getting in school didn't feel like they necessarily translate into providing really quality, you know, patient care for complex patients. Um and that sort of became a reality, those concerns when I entered practice. I um graduated in 2018 and my first job as a psych and pee was working in community mental health um in a really small distressed um uh community working with underserved patients. Um, I worked outpatient and then on a crisis stabilization unit one day a week. And there wasn't a whole lot of support um or mentorship on the job kind of thrown in. It's like, okay, there's 18 to 20 patients a day. And um Wow, that's a lot. It was a lot. Um, and they weren't necessarily simple cases. I would be inheriting patients who were on high doses of benzos that needed to be tapered off, or um patients with psychosis who were on complex regimens, um, some on clozapine, which requires really careful blood monitoring, um, or um patients with really intense PTSD who who needed treatment. And so I was working with really complicated patients and um right off the bat felt just incredibly overwhelmed and and lonely and uh questioning whether I had, you know, entered the field that I should have been in, um often crying on my drives to work every day for months and um felt the burnout much, much quicker than I thought I would as a nurse practitioner, just was not expecting that at all. Just very, very um stressful time of of my life, those those few years transitioning.
SPEAKER_00:Now, I've actually, and I can't remember who the nurse was, I spoke to a nurse practitioner a few years ago, and she told me about how she panicked, like her first day was coming up, and she was about to go to work for the very first time as a nurse practitioner. And she found herself overnight looking up so many different things in a clinic, and she found herself looking up things like how to treat bee stings, how to treat so many different ailments, how to treat a nosebleed. She was panicking the night before because she was so, she felt so unprepared from you know the didactic to the actual clinical work. Um, when you talk about how challenging that was in your first year, can you give some of the listeners who may be nursing students or maybe in their NP program, their psychiatric mental health nurse practitioner program, or maybe just coming out as a family nurse practitioner, because I know you work with family nurse practitioners too, who sometimes in the environments they're in, there's a shortage of psychiatrists and nurse practitioners or therapists who can support them in their journey through their mental health challenges. Can you share a little bit about what it was like or some instances where you felt like you needed support? Court and what you spoke of and what that tangible challenge was.
SPEAKER_01:I mean, it happened right off the bat. I I uh the clinic, I mean, they didn't start me off with 18 patients a day. It started with just a couple, but I remember my very first patient was someone who had been seeking mental health services for a long time. And so they weren't, um, they weren't new to the process of doing an initial psychiatric evaluation and the questions asked and the meds. Um, and they just did not want to chat. They they were not making it easy for me, and they could tell that I was new, I think. And just in the back of my head, I was trying to think through what. Um, they'd recently been uh discharged from an inpatient hospitalization, a very serious one, and um uh bipolar one disorder, just very complicated. And I just remember in the back of my mind trying to think through the diagnoses of okay, what could this be? Is this the discharge paperwork says this, but is this is this really bipolar one? Is this some sort of depressive major depress depression? Um, is it okay that I just continue the meds that they were discharged on? You know, I'm the provider, should I be making adjustments? Or they were discharged, so they're stable, so we just keep those. Um and sort of just thinking through like I want to develop rapport, but I also need to type while I talk. Um, and I want to make sure that I get these um, you know, orders in before they leave. And um I just remember having more questions and and feeling like I should know a lot more than I did. And I think after that, those first couple days, I I very quickly needed to have some sort of um support that I wasn't having. And that's right, I did reach out to my brother um and ask kind of what can I what can I do to feel more confident because this is um stressful, but also doesn't feel safe for my patients. Um and he recommended that I engage in um private supervision or or consultation. It's something that psychiatrists or physicians do often. I feel like we don't talk enough about it as can you share what that is for the audience and for myself?
SPEAKER_00:Sure. Sure, yeah.
SPEAKER_01:So often it happens with physicians, but you eat it either in a group or one-on-one, you meet with a more experienced colleague to discuss difficult cases. And it happens on an ongoing basis, um, a sort of a mentor of yours. They don't have to work at the place that you do. Um, so he suggested that I find someone to do uh private supervision with, which um was incredibly helpful. Um, and so I thought back to my clinical rotations. And was there an NP or a psychiatrist who I could reach out to to ask if I could do this individual consultation or supervision with? And there happened to be a psychiatrist at um one of my rotations, I was on an eating disorder unit. And he, I remember during that rotation, he was always willing to answer all my questions. I always had tons of them. He seemed to always have all the time to answer all my questions, made my questions not feel silly or dumb. Um, and just seemed really personable and loved to teach. And so I sent him an email, or maybe I had his number and I texted him saying, Hey, I'm I just started my my job as I can pee. I'm feeling a little bit overwhelmed. I was wondering if I could pay you to do um, you know, private supervision with, and I would pay you on an ongoing basis. And um, he was incredibly kind and and agreed to to do it. Um, and he actually agreed to do it for free. And so in exchange, I would bring him lunch. Um, and so every Saturday we'd meet um at his practice and I bring him lunch and um I'd have my list of questions of what I needed to ask, whether it was related to the cases or how to diagnose something or the meds to prescribe or um other things, like um had a patient who would get really upset about me prescribing something or wanting something that I wasn't prescribing and how to handle that sort of situation. So, not always about the medications, boundaries, and things like that. And um, that was incredibly helpful. And months of that really helped bolster my confidence in um treating patients. And he referred me to resources and I'd read more and learn. And so I felt a lot more confident treating the patients that I did. And over time that that resulted in patients referring their family members to me, which was kind of neat, or colleagues then referring um their complex patients my way, which was so humbling and and um it just felt really good to to to um sort of having getting getting a handle on on this really complicated time and and um it resulting in me actually doing um better than I thought I would, and also being able to to help patients get better and um having the validation of others was was really a neat a neat experience. But um I credit a lot of my confidence during that time to having that that personalized help. And and that's sort of kind of what led me to build what I have currently in my business, um, because I want other people to feel supported and confident as they're treating patients, um as they're learning, as they go.
SPEAKER_00:And we're definitely going to talk about your business. And I want to share with the audience all the supportive work that you do with other nurse practitioners or others in the field who are facing some of those same challenges that you do or you did face. Um, I do have a question about mentorship because that's very interesting to me. Um, and and I know oftentimes for clinicals, when nurse practitioner students are looking for clinicals, other nurse practitioners have that sort of service where they can charge a nurse practitioner student and they get that mentorship and those hours, clinical hours completed. Yours is a little bit different, of course. You were finished with your nurse practitioner program, you were in your first role and you were wanting the support. I'm pretty sure there are so many nurse practitioners who are coming out of school feeling the same way and wanting that support. And you reached out by email to someone you trusted, someone you thought about in your past and working in your um other roles that would be that support for you. When reaching out, and I I commend that nurse practitioner. Did he, was he already working on Saturday and you just came to the office like when he was done working, or was that something he just did out of the kindness of his heart and sort of came and met you at the clinic?
SPEAKER_01:Um he was he was a psychiatrist and he had a private practice. And during his lunch break between seeing patients, he would see me and that was it. I would bring him lunch. And so he had an opportunity to eat and just chat, and we became good friends and he attended my wedding and has been a has been a friend of my life over the years. Um but um yeah, it kind of fit into the structure of his day. He kind of fit me in.
SPEAKER_00:Yeah. Okay. So just some advice for some of the nurse practitioner students who are maybe possibly almost graduating by the time they probably hear this episode or gearing up or trying to do a job search. What type of advice would you give to reaching out to psychiatrist or other nurse practitioners, psychiatric and mental health nurse practitioners who may be doing this work? I know you said you emailed, but what other tips and strategies could you give around that? Because I know this is something very That's a great question.
SPEAKER_01:Yeah, that's a great question. Yeah. Um, I think when I reached out to him, uh uh a first tip is not necessarily to, I mean, you can ask to do consultation with that person, but also ask if they know of someone else, another colleague of theirs that can connect you with. Um, I also think it's really important to um show appreciation for those providers that you meet with during your clinical hours um during your rotations. Um, you know, they're not necessarily getting paid more for that. And at the end of each of my rotations, I would write a thank you card and send a box of chocolates to them on my last day to them for no other reason than just to express my gratitude because I needed those hours, and some of those hours I had to find on my own. And as many of the people listening who are students know that finding preceptors is very difficult. Um, and so there's a chocolate shop in in Cleveland called Mally's, and I'd give a box of Mally's chocolates and a thank you card to each of my um uh uh uh preceptors. Um, and so I wonder if that's how uh this provider remembered me as well. But I think showing appreciation in that way and then just keeping a list of of who you've connected with and and and uh fostering those relationships. And I think that could be a great place to circle back when you're done with with school. Or if you worked as an RN somewhere, was there an experienced provider, physician, or a nurse practitioner who you worked with that you could reach out to and ask if if they could or if they know of anyone who you could connect with? Um I think that could be helpful as well.
SPEAKER_00:I was gonna say, I bet it's about rich relationships and keeping those relationships intact, not only when you leave, because it may be a challenge, of course, to keep those relationships after you've left your clinicals, but actually fostering those relationships in the work every day with them while you do that. And it's it's great to know that it doesn't have to be a nurse practitioner. You're actually working with a psychiatrist who was part of your rotation. So I would assume one tip would be, you know, you know, expand your circle of um circle of trust. I don't know why I'm that's coming to me, meet the Falkers for some reason. But good movie. But expand your circle. Um, you know, maybe reach out to providers as well.
SPEAKER_01:And what's funny about that is actually at that rotation at the eating disorder clinic, this provider who ended up being my mentor wasn't even the person assigned to me. I was assigned to the clinical director and he just didn't have time. And so I I he was giving me the hours, but I never got to meet with him hardly ever. And so I sort of got kind of funneled off to kind of engage with the with therapist and and this psychiatrist. And sort of I asked, like, hey, like, is it okay if I follow you around and ask you questions? As you're seeing patients, I'll kind of hang out in the background. And so he wasn't even my preceptor. I just sort of took the initiative to ask, to ask him questions and to see him and shadow him. And so I also think looking outside the box of other people who maybe aren't your assigned preceptor to ask questions to engage with, to develop relationships, because you'll never know where those where those will take you. And fortunately for me, this one led to uh a mentor and and ultimately a friend.
SPEAKER_00:Yeah, thank you so much for sharing that, those tips. I'm sure they'll be very helpful. So moving out of community health, I know you've done community health. I think it was like two years you were working within community health. And then where did you end up next? And and was it because you made the transition because of the burnout?
SPEAKER_01:Yeah, it it was the burnout that sort of led me to pivot. I knew that something had to change, and I thought maybe this patient population was uh part of the reason why I was feeling burned out, other than the lack of support. Um, interestingly, as I look back on all the places I worked after, I think my favorite patient population to work with is working with community mental health patients and providing quality care. Um and so I'm trying to think of what happened next. Um a year and a half into working there at this first job, I was getting frustrated that I had such limited time with patients and I couldn't provide the quality care that I wanted to. And so I opened up my own practice, um, brick and mortar practice, and started seeing patients there. A very select few, and a few followed me from the community mental health center to my practice. Um I was actually in school to get my DP at the same time, also. So a lot of balls sort of juggling in the air, but I was frustrated that I wasn't able to provide the quality of care that I wanted to. So I opened my own practice and I thought that would help me a little bit feel more confident providing quality care. It did because I could decide which patients I got to see. I got to decide how much time I spent with them. Um, I didn't have any sort of um uh parameters to hit of how many patients I would see and how much time. And that was really, really important to me and still is. Um and so I started my private practice and um I think juggling the full time was actually also um that sounds wild as I think back at it, but I was feeling like frustrated that I wasn't able to always influence outcomes of patients, that me prescribing medication didn't always result in them getting better. And so I thought, you know, a patient has all of these things happening with them, and I just prescribe, you know, uh tablet is all often they're not getting better. There needs to be something else that I could be doing to help make them feel better. And so that's what led me to take a year-long CBT class to become certified in cognitive and behavioral therapy to help patients also. Um, and so I was doing that during the time as well. Um, and as an aside, I think a something that I've learned over the years is that I'm not solely responsible for the outcome of my patients. I think I put a lot of that on myself for if a patient's not getting better, it's because of me and I don't know something. And so I just need more knowledge. And so I'm someone who constantly gathers information. Um, so during that time, all of those things, I couldn't juggle all of them. And I ended up um leaving the community mental health job and then taking job working um at an outpatient substance use disorder treatment setting, uh, partial hospitalization program. So fewer patients there also had my practice, was finishing up school. Um, when COVID hit around that time, I um I took a step back from from that and actually wanted to pursue travel um work as a nurse practitioner. Um, I think I was still struggling with um burnout at the time, still juggling all of these things. And I thought maybe the reason why I'm feeling burned out is I'm not working with the right patient population. Maybe seeing what it's like providing care in a different state will be helpful. And so I moved to Connecticut for three three months and I worked in a MAP program, medication-assisted treatment, providing um treatment to patients struggling with opiate use disorder at a very busy program, um, which did not help with burnout. It was just me. And I was seeing lots of patients learning a new electronic health record. Um, and so it really forced me to get really good at charting efficiently. Um and after that three months, I did a couple stints of other travel work. I uh a really neat one was working in Wisconsin, working at a tribal clinic, uh Native American population, um, similar MAP program um providing care. I learned a lot about um that particular tribal clinic and the culture, and that was really neat because it's very different than caring for other uh patient populations. Indian health services. Yeah. Okay. Yeah. Um and uh I had a I had a stint working with eating disorders. I I think I was just trying to find what would help me feel supported and also not as burned out. And I think I was also just doing a lot. I was doing a lot of things. And in I I I think working in different populations and different states and settings helped me see what it was that I enjoyed. And I think I like the change also. I I think I'm someone who wants the freedom to be able to work in different settings and not stay in one or have a structured day just seeing patients back to back. And so this period, these six or so years had had really allowed me to explore different settings and populations.
SPEAKER_00:Yeah. And um, just a step back, um to do that. I know we know about travel nursing. Um, there's another role that you can do as a nurse practitioner is a locum tenants. And I'm assuming that's what the type of work you were doing. Can you tell, you know, the audience a little bit about locum tenants' work and how does that work? Sure.
SPEAKER_01:Yeah, locum tenants literally means, I think it's Latin, it means to take the place of or hold the place of. And so um you work with a recruiter and um you you can reach out to a place and let them know what you're looking for, and they'll find opportunities for you. Often they're very difficult assignments because they're they're open positions because people who are local do not want to or aren't able to keep it fully staffed, often because of the challenges there. And so you're going into a place, maybe you're paid a little bit more, but you're working in a very challenging setting, often with limited support. And so I wouldn't necessarily recommend a new a new grad take this position. That's something I've been asked before. Um but it yeah, it allows you to travel and see different um cities. And um, some of these places will will cover the cost of um of housing for you. Some won't. So I had one of the radiations did and the other didn't. Um, but it allows you to work in a new setting and it's often fast-paced, and your ability to adapt and and learn quickly is really important, but you also get to see um different different part of the the country or world, which is which is pretty neat.
SPEAKER_00:So um as a travel nurse, I've been a travel nurse before. As a travel nurse, you you go in head first and it's expected that you're familiar with the specialty that you're working in. And so local attendance, I imagine, would be the same thing because you go in and you probably maybe get some support the first one or two days that you're there and then expect it to just sort of fly on your own right afterwards, I'm assuming. Yep.
SPEAKER_01:At this job in Connecticut, I was taking over for a psychiatrist, which was intimidating. She was incredible, she knew what she was doing, and she was it was I had a day with her, maybe it was two, and she was going through her cases with me. Yeah. Um, and I'd never worked with the electronic health record. She was tossing my way, and it was just very intimidating coming into that space. And so those those first few weeks were rough with staying up very late, catching up on documentation, turning around, waking up a couple a couple hours later to go back in to work. And um, I don't think that helped with burnout for me, but it did help add clarity to maybe the the type of work I wanted to do.
SPEAKER_00:So, with all the burnout, because you it sounds like you had a busy time. You were in DNP, getting your DMP, you were taking on um different travel assignments for being a nurse practitioner. You were experiencing a lot of different specialties, specialty areas, eating disorders, substance use disorder. How did you handle your stress? How did you find some type of resolve and all of that work and all of that stress?
SPEAKER_01:That's such a good question. Um, I I got really I ran in in in college, and so running was really helpful. Also got into meditation, specifically something called transcendental meditation. Um, you learn it from a teacher and it's a 20-minute practice twice a day, kind of fallen off in the past few years, but that was really helpful. Uh, it's called TM for short. Um, I was started doing therapy, and I think that's something that all providers, especially a psych uh nurse practitioner, um we recommend therapy all the time to patients, but like when you do it yourself and you care for yourself, that's so key because we are the instruments. We don't have our stethoscope, we have our bodies and and well, our our minds that we're using to help people and to help with, you know, uh counter-transference, it's really important that we're in a healthy space. And so uh therapy was really helpful for me also. Um sort of those, those have were were helpful grounding pieces um throughout the period and still are. I'm sort of off and on in all of those things. Um yoga more recently um is something that I like to do. Um, my little one makes that tough uh past few months. But when I can, yoga is probably the most grounding thing um that I that I do to kind of help keep me balanced.
SPEAKER_00:Wonderful. So at some point though, you decided you're going to help nurse practitioner students or nurse practitioners with their with their balance as well. So when did that first spark come to you? And I imagine it wasn't probably in the chaos of all the work that you were doing, maybe when you were calmed, or when did that spark come to you to sort of start a, you know, want to help students? How did that come about?
SPEAKER_01:Yeah, well, I think in the back of my mind, when I started that first job, I remember being incredibly frustrated by how blindsided it was. I worked so hard in school and I was fortunate enough to have a full scholarship to my undergraduate degree, but nursing school and my MSN was was like, you know, out of pocket. And that was six figures of student debt. And so I I thought that I'd leave school feeling really solid. And I, I I went across country to a top school. And so I really thought that I would get that foundation. So I was really blindsided when I didn't have the support that I needed when I entered practice. And so I think that frustration really stuck with me. And talking to other providers, they, nurse practitioners, they felt similarly to how I did. And that felt so wild to me that there's this significant gap that we don't really hear about. And it's only when you're finishing up school or maybe partway through and then entering practice that you really see that, okay, there's we don't have residencies that are standard practice that physicians have, where they have a couple of years where they're working closely with experienced colleagues to make sure that they're providing quality, safe care. Um, and so that was always sort of in the back of my mind. And on my drive, I think this was 2019, 2020, I was driving to work one day, listening to a podcast about entrepreneurship and um online courses specifically. And I'd never taken an online course, but the idea of packaging up your information to be able to provide to someone else seemed so appealing to me. And as someone who loves taking classes and is a good student, the idea of being able to create that and help someone seemed really cool to me. Um, and so combining my interest in learning with filling this gap that is so needed, I merged the two and I just built a course. I didn't um consult anything, I didn't talk to anyone and get uh thoughts on what it should be. I just in a vacuum spent months building this course on how to transition to practice, all the steps. I think there was eight steps to go from graduation, um, board certification, um, credentialing to interviewing and negotiating job offer contracts and managing day-to-day and avoiding burnout. It was this stepwise course that I spent months building that I then released into the worlds, and a total of two people purchased my course. That first course that I grew up.
SPEAKER_00:Woo! Hey, we're gonna celebrate that. But we're celebrating that because it it it worked, you know, the the hard work paid off. That's fair. Um, you helped two people. I did. And yeah, so we're celebrating that.
SPEAKER_01:That's fair. I I think I I think I had that such higher expectations of of what it would be that you create the thing, you build it, and they will come. And they they didn't. And there's a lot that I learned along the way from that. But that was sort of the first foray into it. Um, and I can kind of speak to what sort of happened next and where I evolved to. But um, yeah, that how I kind of transitioned into it was just listening to this podcast and the frustration that I felt over the past two years and knowing that um nurse practitioners deserve to feel supported. We want to help people, but we need the tools in order to help people. And I I felt that and feel that very strongly that um support shouldn't be there to provide quality care and it shouldn't feel incredibly stressful throughout the process.
SPEAKER_00:Yeah. So I'm I'm curious at the work of putting the course together. There are lots of people listening who probably have played with the idea of putting a course together. Sometimes it can be easy because if you already know, you know, what you want to teach, it can be very easy to put your knowledge in in one little package and sell it out to the world. But sometimes it can be a challenge if you've never done it before. And you've you were listening to podcasts on your way to work and just sort of getting tips and strategies that way. Um, how did you actually? So you got those two people, but how did you build that course? Could you let us know how how it happened? Did you hear stories of people doing it in their car? You know, recording. We had one guest on who was talking about her$15 microphone that she used on her very first, you know, entry into business. So, how did you do it?
SPEAKER_01:Yeah. Um, so I would spend my nights and weekends working on the course curriculum. And now looking back, there's definitely a way to curriculum is something that's developed around the way people learn. And so we need to keep how people learn. People learn in very different ways. Um, and so I didn't have any of that in mind. It was just sort of like putting all my information into these little buckets and then creating little modules and lessons um using PowerPoint and and Zoom to record them. Um, I was definitely very hesitant in the beginning to show my face just because I struggle with anxiety. Um, and that's throughout, you know, my life, but also throughout building my business, that has sort of held me back and slowed things down because it takes me a long time to put myself out there, a lot quicker at that as time's gone up, gone on. But um really struggled to put my face on camera um in the beginning. And so showing up on things like social media to promote things was difficult in the beginning for sure at first. And if I had just pushed myself, you know, a little bit harder earlier, um we would have grown a little bit faster. But um yeah, I was just spending nights and weekends, you know, uh pulling this together and then creating PowerPoint slides and then recording them and putting them together in a course platform.
SPEAKER_00:So it it sounds easy. I know there's a lot of work behind, you know, sometimes building a course. Sounds easy, but you can actually start with a tool like Zoom, which is how we're recording this episode. Um, you can actually do Zoom for free if you're doing like probably courses uh with lessons less than 40 minutes. I think there's some Zoom packages where you can actually just do it for free. So you start it with Zoom, you start it with PowerPoint. Those are tools that everybody has. So it's, I think it's really good advice that you um, well, you just started. Um you just got started. And I know that there are lots of challenges around visibility. How did you eventually break out of the visibility factor? And and do you feel like you've broken completely out of it and you're able to just go on online and talk anytime you want, or you still have some challenges with it?
SPEAKER_01:Great questions. Um, I I think I just started getting frustrated that I wasn't being seen or that people weren't seeing my things. And then I was wondering why. And I think um, you know, when you're when you're hiding and that makes it really hard to be found. So I had to I had to just at some point, I I think uh a year or maybe more into it, it's like, okay, I need to put myself out there more. And so it was just sort of a, you know, pushing myself to do things anyway. Um, and and it's something that I that I still struggle with, absolutely. Um I think anxiety makes it tough to put myself out there. And um certainly for anybody, visibility when you're going into business without anxiety, it can be very difficult to put yourself out there. And um, you know, there's fear of rejection and being vulnerable and putting out something you've created into the world to then be critiqued, or um, you know, people aren't always friendly when they receive things. And so I think I think it's just uh something that my my desire to to create something that was valuable that I know could be really helpful was more uh was stronger than sort of the anxiety. And and over time that has become easier to do. And so even things like podcasts, like this one, um, you know, I I don't think I jump at them, they don't excite me, but it but I I I know thank you for coming on the show though. But I know I've listened to podcasts and found so much value from them and and I I put myself aside. This is not really about me, this is about providing information that can be helpful to someone else, and that feels incredible to me. And so keeping that at the forefront is is is helpful for me, but it's it's something that I do ongoing of kind of working through and wrestling with and entrepreneurship um has challenged me in so many ways and helped me grow because nothing is within my comfort zone and I'm constantly having to learn and and change and shift and push outside of it. And I I love to do that, I love to self-improve. And so um yeah, I think I think that's sort of um an ongoing sort of thing that I that I worked through.
SPEAKER_00:So, talking about the shift you just mentioned, I know you started off with the course at first where you had those two wonderful people who trusted you. You've shifted, I know, from that course to another. And what was the shift and why why the shift? Did you feel at the time that you weren't giving enough or not giving it in the right way that you needed to shift the course to another thing? And what was that shift?
SPEAKER_01:Well, I think I had a hard time marketing that first course. Um, I think that for nurse practitioners who are in school sometimes, you don't realize how difficult the transition will be until you're on the other side. And so I think I was trying to market something to people who didn't know it was going to be a challenge yet. And that was really difficult. Okay. Um, although in retrospect, if I were to put that course out now, I think with what I've learned over time, I could certainly do that a lot easier. But I think I was trying to create something that I had to work really hard to explain why it could be valuable. Um truly, what what psych and peas struggle with is sort of the nuts and bolts that we don't always feel confident about in practice, which are the things that we need to be able to do, which is diagnosing a patient with mental disorder and treating them effectively with effectively with medications. And so the new course that that I currently have is called the Mental Disorders Crash Course, and it helps people do just that. Um Psych and P students, um, Psych and Ps in practice, and also Family NPs who treat mental disorders, um, it sort of addresses those things. And it was a monster to build because it's a lot to put together to do those, um, to effectively help a provider feel confident in those things. And so that took quite a bit of time to put together. But um, I also had a coach, I hired a business coach in that time in between those two courses and helped me pivot um starting with the name, actually, the branding. It used to be called NP for NPs, nurtured path for nurse practitioners. And that was sort of confusing and vague, and people didn't always understand what the hard to say. Hard to say, yes. And I was very nuanced, trying to be creative, like NP for NPs. Each of those letters stands for nurtured path for nurse practitioners. And so that's actually still my business name, but my doing business as is what it currently is, which is stress-free psych and pee. Um much more easy to understand what who I help and what I'm hoping to help them do. Um, so business coach was really helpful, who also helped course creators specifically, wanting to create businesses and so course businesses. And so working with him was helpful to put together sort of um marketing pieces and um the course itself and making some shifts. And so that was incredibly helpful also.
SPEAKER_00:I love the name too, stress-free psych and pee, because you know exactly what you do from the name of your business and just the name of the website. You know exactly. And so tip for all of those business people out there who are looking for ways to communicate what you do, I think that's a good way to model what you've done, which I I really love at stress-free psych and pee. So um looks, yeah, yeah. I uh getting out of creativity. Um, yeah, and for creative sake to to a little bit more direct was was helpful. It resonates, the wording resonates. So I'm curious about the mental disorders crash course that you built. From the first course, it seemed like you built that before you even sold it. With this one, you said it was, you know, a lot of work. Did you do the same thing? Did you build it first and then just put it out into the world? Or what was your process around the changes that you made for this particular course?
SPEAKER_01:Yeah, I I wish I hadn't built it for have built it first. I I built sort of my first version, which took a long time. And then I found my business coach who then suggested that I, that I sort of workshop to see if people want this and what changes could be made to it. And so we suggested I do a boot camp. And so um I found four or five nurse practitioners um who were interested in the course who could go through it for free to give feedback. Um, and how it worked was they would, they would give me, uh, they would pay for the course. Um, and then if they go through it and meet with me weekly to discuss questions that they had and for me to help them through it, they would then get refunded that um at the end of the it ended up being an eight-week um boot camp. And so that sort of gave me a lot of ideas on changes to make in the course, what wasn't clear, um, ended up getting a few testimonials at the end of it, which were really great. Um and so I wish I hadn't built the course yet because I think I would have built it a little bit differently had I gone through the boot camp first and then built it as I was going through the boot camp. But having already had the course, allowed people to go through it, and then I could make tweaks on the back end. Um, and that was really helpful for making um the course um even better. And it's gone through a couple iterations since that time, but that's the first go-around.
SPEAKER_00:I love how you did that as well, where you had people come into the course saying it's a free course and then making, of course, them pay up front. And I'm assuming that's some guarantee for you that they actually complete the course so you can get that feedback. Correct. Have them pay it first. Okay, have them pay it first, go through the course with you, meet weekly, which is really a great way to do it, genius way to do it. And then if they stick through it and give you the feedback, then you have a better course because of that. Absolutely. Awesome. That's an awesome way to do it.
SPEAKER_01:I wish I could take credit for that, but that was my business mentor as well.
SPEAKER_00:Okay, great. Awesome. Awesome. So with building the course and getting that feedback from your students in the course, when you when you really built it, how comprehensive is that course? And this is just a plug, a shameless plug for your course.
SPEAKER_01:But how comprehensive was it? It's big. Or is it? Yeah. And maybe too big. Um, it's it's it's 13.1 credit hours. And so 13 hours each credit is one hour um of content. It's AA and P accredited, which is pretty neat. Got that last year. And so people who go through it can get continuing education credits. Um, but I really wanted it to cover um, it covers 12 to 14 of the most common mental disorders you encounter. Okay. From like depressive disorders, some depressive, major depressive disorder, persistent depressive disorder, bipolar disorders, and then disorders within that, um anxiety disorders, um, adult ADHD treating that, and um, a little bit of substance use. But I do think that while it's big, it is certainly a lot less daunting than um learning it all on your own, or you know, going learning, spending your nights and weekends, learning all this information or meeting weekly with a provider to discuss difficult cases for years on end. And so um sort of short circuits that amount of work. But uh it is quite extensive, a little bit overwhelming, but um there's sort of a choose your own adventure that lets you kind of self-assess to see where do you need help in particular. So it's not start to finish, it's you take the assessment, what patients are you seeing? What are you most unsure of? Go listen to that module, take the cheat sheets, apply what you're learning, and maybe that's all you need. Great. You can come back to the course anytime, you have lifetime access. And so just wanted it to be as um uh comprehensive as possible, but also take what you need. And if that's not a whole lot, great, just apply that and have this as a resource for later.
SPEAKER_00:Yeah. For anyone who wants to join this particular course, is it on a cohort basis or is it always offered for nurse practitioners?
SPEAKER_01:Um always offered. Um it is self-paced, and so you go through at your own pace. I have some people who who purchase it um while they're in school and don't have time to go through it, and so they'll go through it after they graduate. Um, I have others who um I also have a community element to the course. And so while it's self-paced, some people, and I think many want the ability to troubleshoot cases that they're working through with other nurse practitioners and myself. And so there's a community that I have as well that's included, um, which I think people find really helpful to be able to discuss those cases because not everything can be covered in in the course, and also each patient case is so unique. And something that I really value and I'm proud of is that um I have this atmosphere of there's no such thing as a dumb question. All questions are good questions. And I think that's what has made me a good provider as well, is I've never been afraid to ask questions. And I think we get further faster by doing that. And that's something that I think uniquely nurse practitioners have as a superpower. I think sometimes physicians might feel like they should know the all the answers and have all the answers, and so might be afraid to ask questions, whereas nurse practitioner, nurse practitioners sometimes might not feel that way, or at least I don't or did and didn't. And so the the community has that element of of being able to um yeah, ask and share anything. And I think that's beautiful too.
SPEAKER_00:And so we'll share. Yeah, go ahead.
SPEAKER_01:I was gonna say it doesn't have to be in this space. So there are there are other avenues for getting, you know, supervision and and support as well. Um, not exclusively, my course, obviously. But um, yeah.
SPEAKER_00:Yeah, and we'll share all of the details about your course in the show notes on your podcast page over at the bossynorse.com. So make sure you check out Claire's course. And it sounds like it would be a good course, even if you're in if you're a nurse working in mental health spaces as well, just to get a general knowledge. So yeah, why not?
SPEAKER_01:Definitely more geared towards a nurse practitioner, but certainly, yeah, you would I I've I've had therapists take my course um and physician assistants also. It is tailored to nurse practitioners, psych and family and peas, but um you'd learn a lot as as an as an RN taking this course, I think.
SPEAKER_00:So, how is the transition for you from um, or I should say, are you still working at the bedside, or now is your course, your course business something that you do full-time, part-time? So, what how does that work for you right now?
SPEAKER_01:Strong. So the first several years I was working full-time in practice and also building the course. Um, let's see, a year or so ago, the the income from the course has been able to replace my income as working full-time as a Psychon P, which is something I was really proud to be able to do. Um, and in order to keep growing the the course business, scaling back on clinical care um was necessary. And so I did that for a period of time and and um I've been on a fertility journey for a couple years. And um, when I became pregnant this past year, I scaled back even further and I'm on maternity leave right now. And so not doing clinical practice right now, I'm easing back into working on the business, but we'll return at some point to clinical care as well. Um I'm just sort of cherishing this time with my little one as I raise raise her. And so um finding a new balance, but um at some point plan to return to that as well.
SPEAKER_00:Yeah. So what's a um what's a delightful moment you've learned about motherhood? Man.
SPEAKER_01:Um I think the ability to uh I think uh so many. Uh I think patience is a huge one. Um having someone so dependent on on you and needing you for all things. Um and I me wanting to show up as my best self, needing to stay present. Like you're only in that moment. There's nothing else, there's no past, there's no, there's no future. You're in that moment. Um, and right now we're kind of working through sleep challenges. And so I'm I'm not getting a whole ton of sleep, but kind of in those moments during the night when it's hard to sleep, um just caring for the little one, staying present, which is something to carry throughout life in general. When I do yoga meditation, being present is really key. And so um, I think the positive spin on that is that I'm I'm learning to stay a little bit more present in in the moments because it does go by fast. And she's actually three months old today. Which is wild. Happy birthday, right? Ryan. So the time has gone by fast.
SPEAKER_00:Yeah. Well, thank you for sharing. I do have a final question. Um, what's a nursing moment that sticks with you to this day, whether it's within caring for patients, your own nursing journey, your nurse practitioner journey, your journey in business as it relates to nursing, what's a moment that sticks with you that still comes back to you when you think about the work that you do?
SPEAKER_01:Yeah. Maybe, maybe a heavier one, but when I was working as a nurse, we had a patient who struggled with hallucinations, who who passed away from a cardiac um event. Um, I was working night shift uh on the inpatient unit, and he was transferred out um to the hospital. And when I came back on my shift the next day or a couple days later, he hadn't returned and I learned that he'd passed away. And I long story, but I I think it was a failure of of um our healthcare system um that led to his death. Um individuals with severe and persistent mental illness often die earlier than than other patients, um, don't often take care of their physical health. But I this this patient had been struggling for a while, and there are many, many opportunities where he could have um had more interventions um that would have led to him be alive to this day, I believe. I think that's where my my passion and advocacy for mental health for um severe and persistent mental illness comes from. Um also interested, interested in um uh uh um policy changes on on sort of a larger scale to to help patients and help people with mental health and also help nurse practitioners uh gain full scope of practice in all states. But um I that that patient in particular, he was just he was just the sweetest um individual, really um, really friendly and um easy to connect with. And um I just I it was very disheartening to and sad to find out that he passed away. And um I think about him whenever I provide care and wanting it to be quality and making sure that they're not just having their mental health covered, but their physical health too, and connecting them to services, to primary care and to caseworkers. Um, and I sort of keep that patient in mind when I'm when I'm providing care to make sure that quality always always remains high.
SPEAKER_00:That was Claire Ellerbrock, founder of stress-free psych and pee and psychiatric mental health nurse practitioner. And something Claire is looking forward to.
SPEAKER_01:I have always been interested in traveling, and I've always had a dream of living abroad. Um and uh hopefully not too distant future is that my family lives abroad through this um this program called Boundless Life. Um, it allows families to who are able to work remotely um to live in different parts of the world where you already have the housing you'll stay in and you're doing world schooling. So your kids have a place that they go to and you can connect with other families in a different culture. Um, they're often for three-month stints in in different locations around the world. And um I'm I'm really passionate about getting to know other cultures, and so um the tentative plan in the next few years is to do something like that um through Boundless Life.
SPEAKER_00:Okay, thanks so much for listening to the show this week. Please make sure to rate and review this episode in your favorite podcast app. And don't forget to click the follow button so you won't miss an episode. This episode was produced and edited by yours truly with administrative and research support from Liz Alexandria and Renan Silva. I'm Marcia Batti, and you've been listening to the Bossy Nurse Podcast.
