The Sim Cafe~

The Sim Cafe~ Interview with Dr. Tim Bristol

June 19, 2022 Season 2 Episode 23
The Sim Cafe~
The Sim Cafe~ Interview with Dr. Tim Bristol
Show Notes Transcript

Tim Bristol is a faculty development, NCLEX®, and curriculum design, specialist. He has taught at all levels of nursing including LPN, ADN, BSN, MSN, and PhD. Developing new programs, innovations in learning, Next Gen Clinical Judgment preparation, and helping programs internationally, he is an expert in bringing the evidence-base of nursing, healthcare, and education to students and faculty at all levels. Through consultations, writing, and mentoring, Dr. Bristol assists faculty in identifying the competencies needed to effectively enhance programs for optimal student outcomes and practice readiness. He has certification as a nurse educator, is a fellow in the American Academy of Nursing, and is internationally known for bringing excitement through success to his colleagues and students. His motto: "Today, we will learn how to learn."

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Intro:

Welcome to The Sim Cafe, a podcast produced by the team at Innovative Simsolutions, edited by Shelly Houser. Join our host Deb Tauber, as she sits down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb:

Welcome to another episode of The Sim Cafe. And today we're truly blessed to have Tim Bristol. Dr. Bristol is a faculty development and class and curriculum design specialist. He has taught at all levels of nursing to include LPN, ADN, BSN, MSN, and PhD, developing new programs, innovations and learning, including NextGen clinical judgment preparation, and helping programs internationally. He is an expert in bringing evidence based nursing to healthcare and education to students, faculty at all levels. And I really like Tim's phrase today. We will learn how to learn. I mean, that that's today. We will learn how to learn and, and I love that. And do you want me to call you Dr. Bristol or Tim?

Tim:

Tim, please?<laugh>

Deb:

Thank you, Tim. You go ahead and don't you get our guests started, uh, tell'em a little bit more about yourself and tell them about how you entered into simulation and your story about simulation.

Tim:

I've always followed an unconventional path to most of my<laugh> most of my destinations in life. And so I dropped outta high school in 11th grade. I joined the infantry. I learned really important skills in the infantry. I learned how to polish boots, polish floors shoot big guns and jump outta airplanes. And so when I got out of the army, I had an amazing resume. I mean, just everybody needed those four skills. I accidentally ended up in nursing in a, a big program in the Midwest. I think they wanted more veterans and, and I'm good with that. But one thing that I quickly learned is that for me, putting all the pieces together rarely ever happened, what, what I discovered is I had a great memory and I could memorize, but many times in the practice setting, I'd struggle and I'd struggle because putting these pieces together just was not happening. And so, as I graduated, as I got a master's, as I started exploring teaching, I realized how little I knew. And so what happened when I went to get my PhD, I, I did a PhD in education many, many years ago. I did not do a PhD in nursing, but what I started to discover as I was growing up as an academic, I was standing next to K12 educators. I was standing next to corporate educators and how creative their learning spaces were and how my learning spaces just weren't that creative. And so it was at that time when eLearning was starting to take off, I had to laugh our eLearning for my master's program, involved us recording on cassette tapes and printing off our Excel spreadsheets and mailing them to the school. And the school would make mix tapes and send it back out to all of us. I mean, it was just great, just great. But, um, as, as I went through that process, I quickly discovered that most of my students that were struggling the most were like me, and they needed to see that direct immediate application. I don't know why I remember this from my PhD, but this long drawn out discussion with some other nurses that were in this PhD program about, is it better to learn about ear related issues by memorizing the bones of the ear or by taking care of a patient with otitis media and just these long drawn out discussions about what simulation means and what direct immediate application means. As I went through this, I started to get more and more involved in technology. This was back in the days of second life. This was back in the days where you got to fly to Waco, Texas to go to the l aerdal simulation p lant for your t raining b oy, t hat w as f un. And, u h, we, we were in a s mall town and it's not Waco. It was a smaller town outside of Waco. Anyways, I just remember that there were two bars, two b ail bonds stores and a t a museum from one of the dental professionals that was involved in early simulation. And, u h, I just thought that was so cool. B ut, u m, so as we started watching technology develop over the past two decades and simulation became more and more sophisticated, second life came and went, do you remember second life Deb?

Deb:

I do. I do remember it because they were, they were talking about it at Chamberlain. There, there was a couple people that were really big into it. I, I got hired into simulation. Like I just understood it a lot better and it just seemed to make sense to me. So I didn't, I didn't at that time spend a lot of time looking at the virtual reality kinds of, uh, platforms.

Tim:

Yeah. It was such an interesting platform. I mean, there were big we're talking dude, we're talking Washington state that were building their entire libraries in second life. People could fly into your pharmacology lecture and we were also building sim labs in second life. But you know what we discovered there was no easy button, which meant if you weren't a Deb getting into that lab was almost impossible. I remember I had the hardest time opening and closing doors. I got trapped behind so many doors where I would just sit there and my little avatar just kept moving and moving and moving and wasn't going anywhere.<laugh> I mean, you know, so the problem with that is Deb, as much as I love second life getting in and out of a door had nothing to do with critical thinking. And so, as we watched these technologies evolve, one thing that became incredibly apparent is we needed to find a way to make it more accessible to more faculty and definitely more learners on a moment by moment basis. And this is where we started working a lot on bringing clinical to class and helping the learner learn by sitting next to a patient, helping the learner study by studying next to a patient, as opposed to based on the inputs of the academic process. And those inputs could be things like textbooks and videos, and yet learning by input versus learning by output. And basically what I'm doing Deb is I'm summarizing the new I'm using air quotes. I, I know we're on audio, the new competency based education approach, we knew 15 years ago, Deb, that if our learners weren't focused on the output that many times the learning was incomplete, we knew that. And so as we go through this whole process of understanding simulation, I think that that whole competency based approach really speaks a lot to it. So my journey into simulation was trying to find a path to make it more accessible. One simple story. I was helping thousands and thousands of nurse educators learn about these new things called academic EHRs<laugh> and these academic EHRs. I think there's about a dozen of them out there now. And I, I remember in this one situation, we would literally pay to fly faculty into a training center for two, two full days of training on how to use everything in this academic EHR. And then we'd go visit them six months later, those two faculty were still trying to get ready to start using the tool. Now, not to mention the other 18 faculty at that school didn't even bother opening. The rapper and simulation is like that. A lot of times we put so much into that and saying, okay, here's every no dream big start small act now. So we rearranged our trainings. We rearranged our trainings and we said, here's what you can start doing every week, every day of lecture with your academic EHR for 10 minutes, have students log in and just enter a blood pressure done. The simulation is over, go back to the rest of your lecture, right? Cause that's what we're comfortable with. So what is that dream big start small act. Now when it comes to simulation and, and I think a lot of times as nurses, if it's not perfect, if it's not the moon, many times nurses feel guilty. I'm only having them enter blood pressures. Why even do it? It doesn't matter. Well, it's a step. And so we, we learned that well over 10 years ago to, to start doing it more of that phased approach team approach, but how do we get any bit of clinical in, into the classroom?

Deb:

That's excellent. And you've changed so many, I'm sure students. And I think about, you know, myself and I'm gonna kind of come clean on this one too. When I, I went to Loyola university and my first course I was asked to reconsider my major. I mean, they said, okay, out of you guys, there's 300 nurses here at the end of the day, look to the left, look to the right. Only one of you guys is gonna make it. And it was really hard for me to get through nursing school. I know though, had we been able to use simulation? It would've been like, oh yeah, I get that. I can do that. Yeah. The rope memory thing never worked for Deb.

Tim:

Yeah. It's most of us are, are learning for a goal. And if there's any way to incorporate that goal in what you're doing right now today in lab right now today in class, you instantly take that to the new next level. And that's not nurse Tim speaking. We knew this in the fifties with Malcolm Noles, he said it, Malcolm said it way back in the fifties, make learning applicable, make it relevant. And all of us that went to grad school had to learn all about Malcolm Noles androgogy and all that other stuff. And yet we still have learning experiences that just aren't at the bedside.

Deb:

Oh, amazing. Thank you, Tim. I'm gonna ask you my next question, which is, tell me about, or describe, uh, your favorite or most impactful simulation.

Tim:

Mm. I have so many, so a simulation with a group of students where they were working with a standardized patient. They weren't working with a mannequin and the patient was, uh, I think the patient was having a headache and there were a few other neurological symptoms. And we told the patient to go ahead and have a seizure as best as this as this student could. It was another nursing student, uh, had a seizure or her understanding of a seizure. And two of the students were just like this isn't I, I'm sorry, Dr. Burst but this isn't supposed to happen. And I'm just thinking to myself, you know, how does that translate into the bedside? And so, yeah, i t, and it wasn't a high l evel simulation. We didn't have a high fidelity mannequin that we were controlling all of those toys and tools, b ut it was kind of a improv, okay, go ahead and have a seizure. And let's, you know, let's see how they respond, you know? So it just, it just kind of, the academic process was so ingrained i n these students a re like, o h, C ES, wasn't supposed t o be a part of this. You know, guess what the statistics now that National Council is presenting on what's happening at the bedside speaks directly to that issue. And when simulation isn't truly happening on a moment b y moment basis, a lot of times the students get stuck in that academic process and they become nurses who are stuck in an academic process that doesn't exist at the bedside. So that was just kind of telling to me another situation I was with a group of seniors and we were working on a patient in class and the take h ome message was this patient is demonstrating orthostasis. So you should be concerned that the patient mentions that she's cutting back on her fluid intake. And one of the really smart students in the class, an a student actually s ays, excuse me, D r. Bristol, that's actually not correct because I do know what the parameters are for orthostasis and those blood pressures and pulses don't match those parameters. So again, very telling on what our students are up against. If our students are being told, memorize the parameters of orthostatic blood pressures, they are unable to apply it in a clinical setting and, or they would've let that patient stand up and fall down.

Deb:

Right.

Tim:

Um, and, and so again, just some telling situations in recent memory.<laugh>

Deb:

Right. Tell us a little bit about how you started the company and how you, my belief is that it was your passion for these nursing students and to help them find a better way. So why don't you share with us, how and your passion and mission about NurseTim.

Tim:

As I was getting my PhD virtually now master's was distance ed with some virtual that was way back in the nineties. And then my PhD was virtual as I was going through that and learning about education. Those were my first education classes. My master's were all clinical classes and clinical focused and nursing theory focused as I was going through these education classes. And I'm watching, I was teaching in an inner city school, inner city nursing program. And these students that were failing and, and just not understanding and had so many barriers, I'm like the way I'm learning in my PhD and what I'm learning in my PhD. They need it. And a lot of it had to do with bringing clinical to class. And so, as I was exploring this and learning about this, I got together with a few buddies. I'm like, Hey, what are you doing? Hey, can we try this out together? We started exploring a couple of other schools, heard what we were doing. And we started branching out and working with faculty and in different places doing a lot around e-learning and starting to, to reconceptualize, how can you manage your in-person classroom? How can you manage your lab to take students beyond just memorizing steps with simulation? Yes. Even though you've got a big SIM, your students still only get four days of simulation. What do we do the rest of the semester? And remember a day of simulation means 15 minutes with a patient, even though there's a couple hours of pre-briefing and a hour of debriefing and a couple hours of homework, it's still only 15 minutes with a patient, maybe 30 minutes. And if you're a Deb, you might get them next to that patient for 45 minutes. But still we knew how limited we were. So we started doing training around this, and a lot of that training has to do with bringing clinical to class and getting simulation to be more of a, a norm, more of a curricular thread than okay, that's Deb's job. And so this has taken a lot of work because we've had to have faculty reconceptualize, how to take students to clinical, our challenge, whether we're doing a, a training in a conference, whether we're doing a webinar, whether we're on site in their program, our challenge is always allow your students to take care of a patient for 10 minutes per hour. And that's the priority of that hour of lecture. And we do the same thing with lab just because they've been in the lab, taking vitals for an hour. Doesn't mean they've taken care of a patient. Doesn't mean that they've truly learned in context. So we always leave with that challenge. So that's the nurse, Tim side of it. And as of last year, we usually train about 40,000 educators every year in some way, shape or form, whether it's online in person, nurse think was born about five years ago for students specifically, because what we realized is that as we worked with faculty, the students need this paradigm shift as well, cuz many students in your program, the only reason they're in your nursing program is cuz they did a good job memorizing a and P they did a good job navigating those pre nursing courses. Well, now when we're saying to them, you've got to study while sitting next to a patient, you've gotta take notes as if you were taking care of a patient, you've gotta learn by doing patient care. So this takes a paradigm shift because most students are like, okay, just tell me what five chapters are on the next exam. Okay. Okay. I'm doing trach care tomorrow in lab. I have now memorized the proper 32 steps of trach care. As recently as last week, two weeks ago at a big university with an amazing sim program, them coming to grips as a faculty with the idea, students need to learn health assessment, realistically not based on a well person. That's revolutionary for many programs, many programs are like semester one. You're gonna learn health assessment by learning on well people. The problem with that, according to the research, and we've got over 20 years of research now from national council, from the incls people that says what you learn in semester one is the most important set of topics to the work of a new nurse. And, and that, that research has beared itself out. They do research on thousands of new nurses, constantly on a, on a, every three year cycle. And then when they did the new clicks, they did it on so many new nurses. It came out that semester one and we've known this for about 20 years is the most important semester. So think about it. You're learning the most important topics, the most important concepts at the lowest cognitive levels. Wow. When you're in lab in semester one, do not protect your students from reality. The reality is that learning how to take a blood pressure and trend blood pressures is most important when your patient is suffering from sepsis, not when your patients a healthy pre-hypertension, whatever, whatever. So the idea here is allow students to learn realistically. So we've built an entire suite of tools that even if faculty are unable to make that paradigm shift, the students can start to learn clinically themselves and take the learning with, we have a notebook that's called a clinical judgment journal. They literally use the same notebook every day of class, every day of lab and in every clinical post conference, if they can use it in simulation debriefing way powerful, and they take notes, watch this, they take notes on the same pages. So think about it for a moment, arterial sclerosis. Okay. Let's just use something simple that shows up in every fundamentals course. But when we're learning about nutrition in labs and diagnostics, that shows up in lab because in lab, when we're learning to take vitals, we're taking it on a heart patient. It shows up in clinical post-conference, there's a simulation on a patient with heart disease. They literally take notes on the same sheet of paper or in the same location in the app. And they take those notes with them to the next semester and the next semester, as opposed to, okay, labs sits over here. Clinical sits over here, Sims are over here and the classroom's back there. This allows them and they're doing it clinic based on the new clinical judgment model out of national council. So the, the nurse think part of it gives the students the ability to learn clinically. I wanna speak for a moment, Deb, it's really important that sim instructors, sim professionals, lab directors understand what happened with the new NCLEX. They spent millions of dollars researching what's going on in practice. And, um, big reasons, 50% of new nurses are involved in a medical error shortly after passing NCLEX. Wow. 50%. I mean, you know, think about that in 2019, there was a series of studies done called crisis and competency in 2019, only 11% of new nurses were practice ready when they were evaluated in the clinical setting, incl is changing to address those issues and they built this model of clinical judgment. They went out and got Lasseter and Tanner and Benner and put'em all together. They built this new model of clinical judgment and simulation instructors should love this new model, because what they're saying is clinical judgment is the doing that happens after critical thinking. We've spent the last three decades trying to measure critical thinking next GCL, National Council, state boards of nursing, just leapfrog right over it and said, what are they doing? And so the big part of this is, and, and National Council will say this, you know, your students learned something in your program. Otherwise they wouldn't have graduated. They learned something otherwise they wouldn't have passed Thele, but when they get into the clinical setting and they've got five patients and they're about to get into mission, something happens and things start to fall apart. And so we've built an entire what we call it, CJ SIM, it's actually a NextGen quizzing app that does exactly what National Council's doing. It's really interesting when National Council could have built avatars and augmented reality and videos and animations, they didn't Deb, they built an EHR. And, and what they're saying is they're measuring clinical judgment based on students interaction with and response to an EHR. And the interesting thing is, as of February, they've now piloted this new model on over 800,000 test takers and it's working.

Deb:

Wow.

Tim:

And, and so we built an entire quizzing tool. It's called CJ SIM, where the students go into an interactive EHR, they have to navigate, and then they take one of these next gen questions. So they're learning, using this, this model of doing, and we wanna give students the power to do that. Yes. I still require chapters 38 to 42 for your unit three exam, but please give your students permission to do patient care in the process and our tools, help students do that. You don't change your curriculum, you don't change your syllabus. You don't even change your lesson plan. If you don't want to just please give your students 10 minutes per hour, 10 minutes per hour of lecture, 10 minutes per hour of lab to really engage a real patient. And that's where a lot of what our focus is helping to get to the learner to do that.

Deb:

It's fantastic work. Now, I know you also do a lot as far as humanitarian efforts. Hmm. Do you wanna share a little bit about that with us?

Tim:

Yeah. Always loved talking about that. So I was starting a nursing program up in the twin cities in Minneapolis. A friend of mine said, Hey, there's a nursing program starting just like yours in Haiti. And so I, I went and visited oh 6 0 7. They were very similar, started taking nursing students down there. Our church started sending people down there. The elementary schools in our neighborhood started sending teachers down there. It just a wonderful relationship. Over the years, we've taken over 600 people and this nursing school has served as the hub of this program. But what I love about it the most when I take American nursing students, when I take American professors to Haiti, they get to work in the environment, literally standing next to a Haitian nursing student or a Haitian nurse or a Haitian nursing professional. So it's not uncommon when we do this right now, the country's in a big mess and we can't do it. And it makes me very sad. But when we do this, so Deb and Tim will take down three or four, maybe 10 American nursing students. They will partner with 10 Haitian nursing students, Deb and Tim, each partner with a Haitian nursing instructor. And we all go to clinical together. We all do community work together. We all work in the nursing lab together. It's a blast. It is such a great time. And we, my wife and I have always taken our kids down there. The nursing faculty all know my children. They've watched him grow up. My son, Christopher is, is a nurse. He discovered in Haiti that he wanted to be a nurse. And, uh, he's actually graduating with his DNP here in a few months. So I'm very grateful for Haiti, obviously. Um, and just love working with these professionals. Wow. The, the exciting thing, and you might have experienced this Deb in your work, um, internationally, when you take students overseas, especially to under resourced environment, all they have is the nursing process. They don't have bells, they don't have chimes, they don't have reminders. They don't have electricity many times the water's coming in in buckets. And so for an American nurse nursing student or professor to watch a nurse nursing student or professor work with nothing, just the nursing process that builds clinical judgment, that builds critical thinking. That builds, that builds a true understanding of what nursing really is. And so I just love those experiences.

Deb:

That's fantastic. And congratulations to your son. He's gonna graduate soon. And does he know what he wants to do? Is he gonna,

Tim:

u m, he's got a job as an FMP. And so, u h, it's a five clinic outfit here in the twin cities and he got to do his fall clinicals there. U m, so yeah, he'll be starting that soon.

Deb:

Fantastic. Yeah. And for my last question, where do you see the future of simulation going? What are your thoughts on that?

Tim:

You know, okay. So one mental exercise, Deb, that's really important for every educator to do is what really happens in a day of clinical. And so big university, two weeks ago, I asked all the clinical instructors in the room, you know, what's a, what's a typical day, eight students for eight hours. That's typical day. And Deb is an amazing clinical instructor, of course. And she has this student, Tim, who's a great student, of course. But if we think about a clinical day, how many of those eight hours is Tim making high level decisions? It's not much<laugh>. I had one instructor go, oh, maybe 10 minutes, you know, and I'm going well, okay. Hopefully it's a little bit more, but when you think about a clinical day, even when Tim gets to make a high level decision, professor Deb and the patient's nurse have to approve that decision. So in a clinical day, in an ideal situation, those high level decisions have to always be vetted for the safety of the patient. So out of a clinical day, I might get one or two hours as a student of getting to make high level decisions, but there's always a safety net. It's not enough Deb. It's just not enough. And that's why even in 2019, we saw some of the highest incl pass rates that we've seen in over five years and still in 2019, the third leading cause of death in America is medical errors. It should not be that way in America, Deb. It just shouldn't. And so when we think about the future of clinical education next to the future of simulation, our models of clinical education, as we do it right now, we're struggling, we're struggling mightily. We need more simulation. You know, how resource intensive simulation is when it's truly that it's simulation in the lab. I was at a big, big, oh my goodness. They, they allowed me to put goggles on and I was doing AR and VR with the goggles. I kept dropping my syringe. I couldn't get that IV started to save my life. Big multi multimillion dollar where they, they have this one, it looked like Battlestar Galatica. They had this one circular control center with like 20 seats looking into three operating suites. I mean, it was just incredible. And I said to the Dean, I said, how, how many Sims does your students get every semester? And she said, usually about three. So even with a multimillion dollar workforce grant building this incredible facility, they were still able only to figure out three simulations per semester. Now I've worked with some Deb's that are, you know, probably cranking it out and able to get, you know, five, maybe six Sims per semester. But even that's not enough, even that's not enough. You know what it takes to get a really good SIM 15 to 20 minutes, the students are just, are just really focused and you know what it takes. Yeah. You know, the FTEs and the manpower and all those different things. So if students are going to survive as nurses, if students are gonna be able to master this new influx that comes out April 1st, 20, 23, we've gotta figure out how to have 10 minutes of simulation. Every hour of every lecture, drop the mic and walk away Deb, because if that's not happening, if students aren't learning by sitting next to a patient, we are not gonna change these terrible statistics in practice and, and us changing education because NCLEX is changing. I'm sorry, that's the tail wagon in the dog.<laugh>, we've known about this for a long time, Deb. And that's why simulation has taken off over the past two decades. It's really exploded because we knew what was happening in practice. We knew clinical wasn't enough. So we've gotta figure out how to, just how to, I love doing this activity with faculty, cuz students wanna study guide, right? Give them a study guide. But instead of the study guide, being a list, okay. Emphysema and chronic bronchitis and COPD the study guide is actually a list of patients. And you have Bob that you took care of and you have Jose that you took care of and you have Evans that you took care of. And those eight patients that you took care of the last three weeks of class, they are your study guide for your unit three med surg exam, quit giving your students topical outlines. Because what that's telling them is to go to chapter 38 and memorize all the words in bold. And unfortunately that is not working at the bedside<laugh>. So I think the future of simulation is it has to become every day, every hour of lecture, every hour of lab students are presented with a patient that has many problems. Don't protect your students from reality. Well, today's cardiac. Yep. How many of your cardiac patients have had no other diseases except cardiac, like almost zero. Right? So, so we've gotta make sure that simulation becomes a, a, the norm and not the exception.

Deb:

No, I totally agree. In fact, I taught clinical for, uh, several years and I taught pediatrics and I did it mostly the majority of it was in a simulation lab. It was on a Friday night, like the RDO 11. And I would tell the learners, what I want you to do is when you're in church, when you're at a family gathering, when you're here, there, look for different kids and try and guess their ages, try and, and then see how close you really are to it. And you'll learn to growth and development at a, at a time point. Yeah. And the same thing when you're in, you know, when you're in a group, if you see someone try and figure out what's wrong with them, if they have oxygen or if they have they're pale colored and you know, trying guest diagnoses when you're out in, in the field.

Tim:

Yeah. I think it's gonna take a paradigm shift. I, I don't know, are you familiar with concept based learning or concept based curriculum and big push? Beautiful. I mean, just, it makes so much sense to learn the way you just described. You just described concept based learning. You just described what should be in a concept based curriculum. The problem is Deb. We rebuilt all these amazing curriculum. We rebuilt our syllabi and you go into the lecture hall, you go into the lab, nothing looks different and we didn't help the learners learn. Conceptually, we didn't help the learners experience taking blood pressures. Conceptually. It was based more on an, you know, here's the process, here's the, here's what you can memorize. You know, here's your, you know, take 3000 multiple choice test items and you two can become a nurse

Deb:

<laugh>

Tim:

It's not working. So what you described was concept based learning. You described a concept based curriculum in your brief little discussion. The problem is we all need to do that. We all have to do that.

Deb:

So, yeah. Yep. This has been wonderful to interview you and to get to know you farm or listeners, want to learn more about you or reach out to you for something. Is there any, are you on any social media? Are there any ways

Tim:

We, we are in a couple of places on social media, on Facebook and Instagram, you can find nurse think. Um, and, um, yeah, and many, many faculty have already been to nurse Tim. Uh, so nurse think.com, nurse, tim.com. We love to hear from you, um, answer questions. We're always, we're always looking for new ideas. I always say my best ideas are usually somebody else's,<laugh>, it's all about collaboration and, and us, us figuring out how to get, how to, how to get the students to where they need to be.

Deb:

Yeah. I agree. I totally agree. We don't wanna see that another bunch of nurses come out and then leave the field.

Tim:

No, that makes me say gotta slow that down. Gotta slow that train down.

Deb:

Yeah. All right. Well thank you so much. And this has been wonderful, Happy simulating.!

Outro:

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