Talking Pediatrics Trailblazers:
July 30, 2021
After 34 years of blazing trails at Children’s Minnesota, our beloved vaccinologist and infection prevention specialist, pediatric nurse practitioner Patsy Stinchfield, retired on July 1, 2021. On this Trailblazers episode, we learn about the resilience it took to be one of the first nurse practitioners at Children’s Minnesota, steadily plowing the field for those who would come after her. From her beginnings as a nurse practitioner in the Emergency Department, to her pioneering leadership of Children’s first HIV program, to her fearless and steadfast guidance through multiple infectious disease outbreaks (including Ebola, H1N1, measles and COVID-19) listen to what it took to pave the way with courage, optimism and gratitude.
Dr. Angela Kade Goepferd (00:00): Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. On today’s trailblazer episode of Talking Pediatrics, I’m interviewing nurse practitioner, Patsy Stinchfield. Many of you listening know Patsy. If you’re a loyal listener to our show, you know her as our resident COVID expert this past year. If you’re here in the Twin Cities, you know her as a trusted infectious disease colleague. And if you’re me, you’re lucky enough to also know her as a friend. For those of you who don’t know Patsy, I’d like to take a moment to introduce this amazing woman and her career. Patsy’s about to retire, after 42 years in nursing and 34 years at Children’s Minnesota. Patsy is our senior director of infection prevention and control at Children’s Minnesota and runs the Children’s immunization project here as well. She is also a widely recognized specialist in vaccine-preventable diseases.
Having served as the first nurse voting member of the CDC’s Advisory Committee on Immunization Practices, the ACIP, she’s also the president-elect of the National Foundation for Infectious Diseases board. Here at Children’s, she helped us with Ebola preparedness during the 2014 to 2016 West African Ebola outbreak. She led us through the measles outbreak of 2017, and most recently served as our incident commander for the COVID-19 hospital incident command system. She’s a sought after speaker, lecturer and expert, having given national and international talks on pediatric vaccine-related topics. And she’s given media comment to places like the BBC, The Washington Post, NBC Nightly News and NPR. With a resume like that, it is certainly an honor to have you with us here today, Patsy. Thank you for joining me.
Patsy Stinchfield (01:42): Thank you for having me.
Dr. Goepferd (01:43): So, let’s talk about being a trailblazer. You have achieved so much in your career, much more than I could really even include in that introduction. Many of these things are firsts, particularly for a nurse practitioner. What does being a trailblazer mean to you?
Patsy Stinchfield (01:57): Well, I was really thrilled when I heard you were doing this series and that you named it that, and the reason is, is that I have mentored a lot of people in my career. And especially for new nurse practitioners, where they would come to me and say, “There’s never been a nurse practitioner in the diabetes clinic. I’m the first, what do I do? How do I learn this?” “I’m the first in cardiology.” “I’m the first in the transplant program.” And I’d say, “Well, you’re going to be the point of the plow. Let me explain. You’re going to go through dirt. You’re going to hit boulders. You’re going to have obstacles. It’s going to be messy. It’s going to be hard. And when you have that point of the plow as the first, you’re going to have to make some decisions. You either go over, under, around or through the boulder in front of you. But when you do, and you must, don’t stop just because you hit a boulder, you got to keep going. And when you do, you turn around and you look behind you, and you say, “Look at how clear that is.” And you are making a path for other people.” And I feel like I’ve just been at this point in time, where I’ve been lucky to be that trailblazer, that kind of point to the plow and be able to encourage other people on how to do that too.
Dr. Goepferd (03:19): I love that. That’s such a great analogy I think for anyone who’s kind of cutting their own path and really great advice as a mentor. Did you know that you were destined for this greatness? I mean, did you have a career trajectory in mind? What’s guided you along the way in your career and kind of been the purpose behind all this that you’ve achieved?
Patsy Stinchfield (03:42): Yeah, yeah. I mean, I come from a family of physicians and nurses and public health people in my family. My dad was a chemical engineer and my mom was a planner, a very enthusiastic person. So I think I got both my parents, but I really liked science. And I liked anatomy and physiology. And I really like the profession of nursing. And as I was in undergraduate school, I was reading about this role called nurse practitioner. And this was developing in the late ’70s. So I started nursing school in 1976 and Henry K Silver was a pediatrician out in Colorado, developing this role for pediatrics, especially, needs more time. They need more education, they need more hand holding and things like that. And I was reading about this and I thought that is really cool. So, I eventually went to grad school and became one of those.
When I came back, I went to the University of Utah and came back to Minnesota. People were like, “You’re a nurse. What?” And when I started at Children’s, we had a handful of nurse practitioners in primary care, but to think about it in specialty care, was kind of outrageous. And so there were no jobs, but I just loved it and ended up working as a registered nurse in the emergency department. And I’m scared of adrenaline, I don’t like adrenaline. But that was the only job available from 9:00 p.m. to 2:00 a.m. Okay, I’ll do that.
Dr. Goepferd (05:06): Wow.
Patsy Stinchfield (05:08): And then I was in the ER, thinking a lot of this is primary care, like kids coming in with earaches and strep throat. So I wrote a job description. We need nurse practitioners in the emergency room and I was laughed out of the room, that will never, ever, ever happen. Now, of course, we know it didn’t happen then, timing is everything. Today, our emergency room runs because of these levels. So, getting the right person for the right job at the right time. And I really do believe that nurse practitioners are part of a multidisciplinary team to help meet that. And I’ve just loved the ability to use lots of different parts of care, the clinical, scientific, taking a complex topic like immunology and being able to explain it to a seven-year-old and having the time to do that, I just feel really blessed. And I don’t have to explain what a nurse practitioner is anymore.
Dr. Goepferd (05:57): No, that’s great. And I do think you have this, Patsy, you personally have this really great ability to take complex concepts and simplify them. And I think that’s why people love to host you on media spots and have you as a speaker and have you come and give lectures because I think you just have a really keen way that not everyone is good at, about simplifying those complex concepts. Let’s talk a little bit about the field of advanced practice nursing. It has changed, as you mentioned, a lot over the decades and you and I have spoken several times about increased inclusiveness of advanced practice nurses and just advanced practice professionals in general, in our pediatric spaces, in our language and how we talk about it.
I remember our conversation about the attendance certificates at grand rounds, at one time, said physician and non-physician. And we had a very quick and decisive conversation about changing that almost immediately after I took over tenure of medical education. What would you still like to see change? We’ve changed a lot, but where do we have to go from here? How do we continue to promote a really inclusive environment for advanced practice nurses and other advanced practice professionals? What do you have to share with us about that?
Patsy Stinchfield (07:11): One, thank you for being open to saying, “Yeah, you’re right. Nobody likes to be described as what they’re not.”
Dr. Goepferd (07:17): Right.
Patsy Stinchfield (07:18): I’m a non-physician, I’m a non-astronaut, I’m a non-good cook. I mean, I’m a lot of nons.
Dr. Goepferd (07:23): Right.
Patsy Stinchfield (07:24): So, how about we describe what people are? And I also think that as far as going forward, advanced practice registered nurse is a legal title that I have to put down on my prescriptions and my documents and things like that. But nowhere on there does that really describe me or my degree. So, I was never a fan of that lumping that legally we use. And I’m really not a fan of the even more lumping of APPs. If I get called an APP, I just get kind of… So, advanced practice providers, so we’re lumping and what that does is it takes away people’s identity. So, if you’re trying to say nurse practitioners and physician’s assistants, why don’t you say that? Because we say surgeons and anesthesiologists, that’s not too hard.
Dr. Goepferd (08:11): Sure.
Patsy Stinchfield (08:12): But we don’t lump other people. So, I think that I’m a little concerned about, APP is and mid-level providers are… these are like insurance company terms because they want to be shorthand and they want to like, “You know what we mean.” But what that does is, it takes away the academic credentials. It takes away the specific identity. So, a clinical nurse specialist is different from a pediatric nurse practitioner, is different from a certified registered nurse anesthetist. And while they are all nurses with advanced practice degrees, the Board of Nursing lumps them as APRNs for their licensing. I don’t think we should use those terms in our day-to-day working with each other.
Dr. Goepferd (08:51): I think that’s a really valid point and all of us want be seen for the expertise that we have and the training that we’ve had. So, I really appreciate you calling that out. You have seen a lot in your career beyond the advancement of nurse practitioners. What are some of the biggest wins or advances in medicine that you’ve seen over year 40-year career?
Patsy Stinchfield (09:10): When I started at Children’s St. Paul, they had a medical staff and a nurse practitioners weren’t allowed to be on the medical staff, initially. And then we merged with Minneapolis. Minneapolis had a professional staff, whereas if you had a master’s degree or higher and were making independent decisions, such as prescribing, et cetera, then you would be on the professional staff. When we merged, interestingly, we practiced in St. Paul like a professional staff, but on paper in Minneapolis, it was more allowable. And what we did then was take the credentials and privileges and the professional staff definitions, merged them into one. And then over the years have really gotten to a practice, where we are an interdisciplinary team at Children’s. We do respect people for their different roles and their contributions. I mean, think about healthcare. Not a single person can work in healthcare alone, but it is the most hierarchical environment around.
And you need all of these people, you need different, you can’t just take your car in and they fix it. One person fixes it, but you can’t do that with children. You need the radiologist, you need the nurse, you need the lab techs and things like that. So, acknowledging what a team sport this is and having that respect and flattening that hierarchy has been my kind of personal silent goal, maybe not too silent, over the years. And I think we’ve accomplished a lot and a lot of it, it’s just little things like language and you and I have been on these policy committees, where let’s just pick an inclusive term like clinicians, if that’s what we’re talking about or provider. And people like different words, but we’ve been conscious of that to make sure that nobody feels left out, including our environmental services folks. I mean, if we didn’t have a clean environment, we would have a lot more healthcare-associated infections. They’re part of the team as equal as I am.
Dr. Goepferd (11:06): I mentioned in the introduction that you’ve really led us through a lot of pretty significant health events over the years. Anything there that stands out for you in terms of big moments or big wins or things that you think will really shape healthcare for the future?
Patsy Stinchfield (11:23): Even going back, starting our first HIV clinic. And I was counseled not to do that because people aren’t going to want to take their child to a hospital that has kids with aids. And I remember having that conversation at the time with our CEO and I was just so pleased that he said, “Our mission says we care for the special needs of children. There’s no comma that says, “Except kids with aids.” So go for it, Patsy.” So the confidence and the trust that Children’s has given me, I just feel very fortunate to do, so building the HIV program and explaining to the community what that disease is and isn’t. Certainly the measles outbreaks and three or four of them over the years. And then of course, H1N1 and flu outbreaks and then COVID. With each of these, we have carried forward something that we’ve used the next disaster.
And I think even in our personal lives, I would say for all that we’ve all been through, the entire globe has been through this pandemic, it has been rough. And it has taken a lot out of us, but we’ve also gained a lot. And so making sure that we don’t forget the things we’ve learned personally or professionally and carry them forward. And know that even in bad times, when I look back at my roller coaster of a career, there were bad times. And every time after a bad time, something better came, something that we built was even better. After the measles outbreak, we built the children’s immunization project. After the Somali-focused measles outbreak in 2017, we built our employee resource group with our Muslim employee resources. And have gathered together in the community with that. Now, we have very much attention to equity and inclusion, and we can talk openly about our similarities, our differences, and so good follows bad.
Dr. Goepferd (13:14): It’s true. I mean, the equitable vaccine work that we’re doing now, in COVID, I think in some ways is a direct result of the community-based work that we were doing during the measles outbreak.
Patsy Stinchfield (13:24): Exactly.
Dr. Goepferd (13:25): What do you think will carry forward from the COVID pandemic? What do you think our big lessons are going to be from COVID-19?
Patsy Stinchfield (13:31): I think a lot of people have learned that sometimes the simple things in life really, and truly are the best things in life. Yes, we lost having to travel, but just being able to do some simple things with your family and enjoy things that don’t have to be elaborate. And also, I think people learned a lot about themselves, resiliency and self-confidence and just how to cope. And what’s important. I personally had four people die in my family in this last year, none from COVID, but going through a loss, you just think about how important those people were, how they impacted you.
And I think so many people have lost people to COVID, but not only people, but just our livelihoods and our freedom to kind of go out and do what we wanted to do, never take that for granted, never take your health for granted. Never take that freedom of being able to go and do what you want to in your community or in the world. I hope we learned that.
Dr. Goepferd (14:28): Earlier you said, “Sometimes we learn the most through the hardest times that we go through.” And as you reflect back on your career, what are some of the biggest sort of losses or setbacks or hard things that you’ve been through or seen or had to overcome?
Patsy Stinchfield (14:43): There was a time that we were going through a redesign and I was going to be laid off. So, this was decades ago and it was like, what? This is my place, Children’s Hospital. And this is where I’m going to grow old, where I’m going to retire from. I just had this, like I couldn’t believe it. And so really it was about billing and things like that. And I was in the infectious disease clinic and I was actually seeing more patients than the other two docs combined. And there was just something about that time that they picked certain people to let go. But I went in and I said, “Well here, let me just do the math. If this is about math, here is the grant that I wrote for the HIV program. And here is the Ordway Theater fundraiser for immunizations after the measles outbreak, that was $700,000. Here’s this and this.” So all the money that I brought into Children’s was well over $1 million. And I was not getting paid $1 million.
That was really, probably, one of my darkest moments. And I think most people would have said, “Screw you, I’m going to leave here.” But I didn’t think it was the right thing. And they didn’t think it was the right thing. And the math added up like, “Yeah, we’re sorry. That was a mistake.” And so I stayed and, how can you work in an environment like that? It’s like, well, I’m not here for executives. I’m here for the mission. And this is the mission that has just drawn my heart and my work. And you love what you do and do what you love. And that’s what I loved. And so I just couldn’t imagine leaving. And so I also am forgiving and I don’t look back and just keep trailblazing, keep going.
Dr. Goepferd (16:21): So many people have experienced a setback like that, a layoff or a really significant job change and felt that it was a sign. Maybe they took it to heart that they weren’t good enough to do something. And I really appreciate you talking about one, being really true to what you knew your value was and advocating for that, which I think is a tremendous skill. And also really sticking with the work that was so important to you. And I can’t imagine Children’s Minnesota without you. I’m going to have to imagine it here in a few weeks, but you’ve done so much for us and for this community.
And I’ll just personally share and I’ve never shared this story with you, Patsy, either that I faced a similar time in my career here at Children’s, where I was a new leader and caught wind that there may be some restructuring taking place that would essentially undo the place I had just been put into. And it didn’t feel right to me. And I also felt like, I need a chance to do the work here that I need to do and did exactly what you did and made a case for it. And I want people to know that because I think sometimes people look at successful trailblazers and assume in some ways, that the doors were opened for them. And don’t recognize how many times we have to push those doors open for ourselves.
Patsy Stinchfield (17:39): Right.
Dr. Goepferd (17:40): And I’m sure that there’s more than that one time that you’ve had to push the doors open.
Patsy Stinchfield (17:44): Yes.
Dr. Goepferd (17:44): If you could tell your younger self one thing, what would it be?
Patsy Stinchfield (17:49): It’s a journey and every day is going to be different and there are going to be some really hard days, but you’re going to be okay. That there’ll be some moments where you’re like, “Do I really belong here? I’m the first nurse in the United States at the Advisory, what am I doing here?” There’s a lot of times where we have this imposter syndrome or self-doubt, but just, yep, you’re going to be okay because you’ve done the work. The first nurse president of NFID, that’s volunteer, I don’t get paid a dime for that. ACIP, volunteer, so yep, you are a hard worker and there will be rewards, not financial, not time. All these things take time. My family and I have gotten to take some great trips, being able to do some talks and things like that internationally. And I guess just hard work is important. That’s what I was raised on. I don’t know any other way, but to go 110%. But do enjoy the journey and not let any day go by without gratitude.
Dr. Goepferd (18:50): You’re such an example to so many of us of hard work, of gratitude, certainly, of pushing on despite obstacles like the plow that you mentioned in the opening. Thank you for everything you’ve given to us. Thank you for everything you’ve given to me, as a colleague, I really just loved my 15-year journey working with you so far here. And thank you for all you’ve given to the kids of our community and really, the kids of the world.
Patsy Stinchfield (19:14): Keep your eye on the mission, the children, if you are not sure what to do, just ask yourself, “What is best for the kids?”
Dr. Goepferd (19:21): I hope you go forward knowing the tremendous impact that you have had on pediatric health, so thank you. And thanks for joining me today.
Patsy Stinchfield (19:30): We don’t have to say goodbye. We’ll just say, “Talk to you later.”