Ep 16: Fertility Nursing with Eliza Ferstendig
Fertility Forward Episode 16:
Being a fertility nurse is not an easy job. You often have to see patients go through great difficulties while remaining a positive, upbeat presence in their lives. The upside, however, is that you get to build great relationships with them, and you have the chance to pass on some of the best news they could ever receive. Eliza Ferstendig, a fertility nurse at RMA New York, is an extraordinary person whose passion for her job is contagious. She has been in the position for five years and doesn’t plan on leaving anytime soon. In this episode, we pull back the curtain to get an inside look into a fertility clinic and a day in the life of a fertility nurse. Eliza shares how she found the profession, despite having an initial aversion to anything science-related. She could not have dreamed up a more fulfilling career and feels grateful to have found her calling.
Rena: Hi everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice for medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Rena: Eliza Ferstendig has been a fertility nurse at RMA of New York for five years. In this episode, we talk about what exactly a fertility nurse does, we get an inside look at a fertility clinic, and we talk about the very important burning question of Is there really a rhyme or reason for the time of day you get that phone call with results, Stay tuned.
Rena: So, Eliza, thank you so much for being on our podcast today we’re so excited to have you here.
Eliza: Thank you for having me. I can't wait.
Rena: Definitely a patient favorite here at RMA.
Eliza: Thank you, thank you.
Rena: So we’re hoping you’ll tell lots of insider insights into what goes on behind the scenes as a fertility nurse.
Dara: But let's start from the beginning. What made you want to go into this field, whether nursing and, more specifically, reproductive endocrinology?
Eliza: So I actually started very far from nursing. When I was in college, I said I wanted to do anything that wasn't related to science. And as I went through schooling and I majored in English literature and communications, anything not related and in my last semester, I decided that that wasn't gonna cut it for me. I didn't feel like it was gonna make me feel fulfilled. So then I turned to nursing and I went back to school, did all my post-bac classes, went to nursing school, and I did feel like going through nursing school, I wanted to do women's health. I loved my maternity rotations. I was very fortunate to get a job right out of school in labor and delivery and postpartum in a hospital. So that was great. And I loved the experience. But the reason I wanted to be a nurse is because I'm a people person and I love people. And although I felt I was making an acute difference in the moment, I wanted something that felt like it could extend a bit further. So thankfully, this job happened to fall in my lap. A friend that I knew worked here. She told me about it and I was fortunate enough to get this position. And it was exactly what I was looking for. I’ve been here for almost five years and I don’t plan on leaving.
Dara: The right fit.
Rena: So it sounds like for sure, you know, you really love what you do.
Eliza: Yes, I definitely love what I do. I remember coming home the first day of starting this job, and my dad asked me how was work. And I said it was great and he was like, What? Who says that?
Dara: And good for you that you figured it out a little bit late that it wasn't right off the bat, it wasn't first year in college and you took that time and look it, you found something you're passionate about, and that's great. cause when you're passionate about something, people see and people get better care that way.
Eliza: it's really great. And although obviously even in the best job that you love there are days, that you're tired and want to come to work. But I never feel, thankfully that I'm just dreading coming to work because I really do love the patient centered care and getting to meet new people and interact with them and really feeling like you're making a difference on a daily basis,
Rena: So what do you love most about the job?
Eliza: I think I love just making the long term connections with the patients. So really getting to see them on a daily basis. There are patients that have been here for years, they come back for baby number 2, 3. I talk to them more than they talk to the family. You know, you really just make these long term connections with patients that I think maybe in other aspects of medicine you don't always get the chance to do. And to me, that's really the most meaningful.
Dara: It's interesting that you say that. When I trained at Mount Sinai, one of the areas that was really challenging for me and it sounds similar to you is you know, you're in a hospital environment and you're seeing a patient, what for all of 5, 10 minutes? And maybe for you as a nurse, you probably do interact with them a little bit more depending on how long their stay is. But then you send them off and that's it. And you don't really get that long term connection, and it's nice that you found a place where you actually get to form that relationship, form that connection that goes well beyond them being active patients.
Eliza: Yeah, and I think fertility is one of those areas of medicine, whether it be fortunate or unfortunate, because most of the time it is a little bit of a longer process than other areas of medicine. But I think it really does lend a lot more to make connections with patients and make a difference in things other than just the medicine aspect of it
Rena: What is the hardest parts of your job?
Eliza: Well, with all those great parts of making those connections, it's obviously very emotionally taxing. You get very close to your patients in a good way, but you also do have to take a step back, and with all the good sometimes there are some bad outcomes, and you have to try not to take that home and take it to heart because you have to keep moving on, and you also have to be the one that's the positive one and the positive support for the patient. So I think that's the hardest part is kind of making that connection, but also being able to separate and be.
Dara: So are you the point person to call up the patient to tell them their results?
Eliza: Yeah. I mean, thankfully, the nurses usually get to do most of the good results. But obviously there are some times, and we have to call with the negative results, but yeah, as a general, I mean, the doctors are doing procedures daily and other tasks. So, you know the nurses as a general are the ones calling you with your medication instructions, your results. It's a lot of education explaining how to do your injections, explaining why you're doing it, why the dosing of the medications etcetera. So, you know, if you’re in that cycle, you could be speaking to the nurse every day.
Rena: So one of the things my patients always ask me - they think there’s sort of a secret timing around the phone calls. You know, if the phone rings after 12 it's gonna be bad if it rings before 12 it’s gonna be good. So can you help dispel any myth around the phone call? Tell us what that's about.
Eliza: Yes. So one of the main things about the timing of the phone calls is about what time the blood results come in and that we have no control over.
Dara: Good to know. For all you listeners,don't think about the time. It doesn't really matter. There's no rhyme or reason necessarily whether you get a good result or about results or that phone call.
Eliza: Correct. And sometimes the labs come back early. Sometimes they come back late. There was an issue with the machine, and we have no control over that. And once the results come in, we also have to have a physician review the results and the plan. So if they're with patients all day and they don't get a chance to review it until a little bit later, that would be a reason why a patient would get a phone call later, not because results are good or bad, not because we like a patient more than another patient. It's kind of just the luck of the draw when the results come in and they’re reviewed.
Dara: I always thought it was first thing in the morning for good and not so great later on the day.
Rena: So I’m so glad you could share this.
Eliza: Yeah, definitely want to dispel any theories about that.
Rena: A lot of factors that go into the call
Dara: So besides that, take us through a typical day or other areas that you work with in terms of patients and your colleagues.
Eliza: So a typical day for a nurse would be, you know, the patients are coming in in the morning for bloodwork, ultrasounds, kind of routine monitoring, depending on what type of cycle they’re in. So in the morning you're meeting with patients going through any instructions they need at that time, or potential instructions making sure they have the right medications, enough medications. So that's usually the morning monitoring kind of process. As the day goes on, you're going to see new patients, you’re going to see follow-up patients that come in to see their physician. They'll be patients that need to come into sign consents, to learn how to do medications.Throughout the day, you'll be reviewing results, basic diagnostic results, results from the day, medication instructions, sometimes we'll be doing in person medication teaching. So that's the general day. It will change with each day and with each team, depending on how that day is set out on your schedule. But as a general, those are the basic tasks you're doing.
Dara: Well, I know when I was a patient almost 10 years ago, there was a video that we had to watch the beginning that kind of gave us an outline of the steps that we have to go if we're doing IVF. Is it still a video? Is it a handout? Is it one on one?
Eliza: So if you’re proceeding with IVF, you’re gonna meet with an IVF coordinator who's gonna give you all the basic information, your basic timeline, a handbook about the things we do here. Once you've decided that that's the protocol you're moving forward with, we then have a series of videos that you have to watch about in general the whole process of IVF, the whole physiologic behind it, the medications and all those things. And you'll do that before you sign any type of consent forms to really so that we know that you really have informed consent. So you know what the entire process will be like. And then we're actually now currently working on creating new videos, medication videos that we do here because although there are a lot of really good videos out there every facility does things a little bit differently. So we're actually working on specializing them to exactly what we do here what our physicians do you here.
Dara: That is so great. I remember when I was going through the shots, there wasn't a specific video and, you know, we're all different types of learners. Some people like to read it on a piece of paper. Some people like to listen to it. Some people are visual learners. I'm definitely a visual learner. And I ended up YouTube-ing asking over how to do the progesterone injection and had no idea. And also, it's true the videos depending where you go or depending on the protocol, it's very different, so it's nice to be able to have a place to streamline it for our RMA patients.
Eliza: And the good thing also is now, it used to be that they would expire after a certain time. We used to have in-person classes, which was a one time thing where we’d potentially have a lot of other couples so you may not feel comfortable, you know, expressing your questions or concerns Now the class and the videos that we have the patient will have access to at all times throughout the cycle so you can always watch a medication video right before you do it. You can always look it over, call back with any questions. So I think they have a bit more interactive access to everything now, which is good.
Rena: It's great. And I think, you know, I have patients tell me they started watching the videos and they hear certain nurse’s voice every night because they watch the video over and over and over. So...
Dara: You know, it helps calm them down.
Dara: And give them something that’s constant.
Rena: Yeah. I think a lot of times people \feel very overwhelmed and, like, you know, why don't I understand this? The mixing the injections, it’s so hard. And you know, Eliza, you went to school for this, right? You had specific training for it. It is difficult, you know, giving people not in the medical field the responsibility of mixing medications and injections. It's a lot to handle.
Eliza: Yeah. I mean, I always try to tell patients when they start freaking out about it. I say, if I wasn't a medical professional, I would also be freaking out about this. I remember the first time I gave an injection in the hospital, my hand was shaking so much the patient was probably freaking out. But we don't expect patients to walk through the door and everyone to have medical knowledge and know how to do things. But what I try to stress to people is that most of the medications there’s such a small margin of error. And if it was such a big deal and you could mess it up so much, we wouldn't allow the patients to do it on their own. So that's what I try to express to them, that there are very few ways that you can really do them completely wrong. And they're coming in so frequently that as long as they don't feel embarrassed to ask which I implore everyone to always ask questions. You know you can call the office at any time. Next time you come in, ask the doctor, ask the nurse. And you never have to feel embarrassed. Any mistake you've made, everyone's made it and worse.
Dara: And also, they’re probably not the first person asking that question.
Eliza: Definitely not. Also it helps us. Any questions you ask, sometimes maybe you found something that we never even thought of or no one brought to our attention and then moving forward, we can make sure that we clarify that so no one else has that issue.
Dara: And I also think that when it comes to injections, the hardest part is the first time because it's the unknown. And that's what I try to tell patients when they ask me about my personal experience. One of the first things I say is the unknown is scary, but especially with injections after the first time, and you kind of realize Okay, may not have felt amazing, but you can do it. Take your time, there's no rush. And after you’ve done it the first time, it gets that much easier, just like with everything else.
Eliza: Yeah. I always stressed the anticipation is always worse. It’s just thinking about the concept of trying to think of mixing and reconstituting the medication is so daunting, and that on top of then also having yourself pricked with a needle and all these things, and then I always tell them this and I always check in with them when they come back, you know, after doing it for a few days and they're like, You know what, You're right. Once we did it, it was fine. It’s just it’s like with anything, the unknown, it’s scary.
Rena: It's hard, I think. Look, you know your apartment. All the meds come, it looks like a Duane Reade, your refrigerator’s filled with medications.
Dara: What needs to be refrigerated? What doesn’t need to be refrigerated?
Rena: It’s scary and for a lot of people they have past, you know, triggers or trauma experience. Whatever. You know, in a medical setting, it's very scary. But as you said, you know the unknown and once you do it. I remember I sat there. I had my mom come over for my first injection. My mom's a nurse, but I wanted to do it myself because I wanted to feel in control. And I sat there for an hour and I just held the needle there and I couldn't do it. And she's like, looking at her watch like come on already, I got things to do. Literally an hour I sat there. Finally I did it and I was like, oh ok that was no big deal. Sorry for wasting your time.
Eliza: Yeah but you wouldn’t have known until you did it.
Rena: Yeah. It was very scary.
Eliza: Yeah I usually equate it to, at least for me. If I was thinking about like jumping off a waterfall like I went to Costa Rica and we, like, jumped off these waterfalls. It's like you're standing on the edge, you’re standing on the edge, you keep saying, 123-123, but you can't get yourself to jump and then finally jump and you're like, Oh, that wasn't so bad! But it took you, like, 45 minutes to get yourself to jump off.
Dara: And I think part of it also if you can get some support to be there. Even for the first time. I had a friend who came in for egg freezing and she contacted me. She's like Dara, I'm really afraid I'm not a science person. I'm afraid of needles. Can you come over, We can walk me through it together. I'm gonna do it on my own, but I want you to be there. And I think the idea of trying to reach out to someone, especially for that first time who you feel comfortable and confident with.
Rena: I love that and I think a couple things: one is I’ve had a couple of patients reach for support from doorman, their trainers, sort of anybody. I mean, this is a very humanistic thing. You know, asking for help is a very human thing, being vulnerable is scary, but it really appeals to humanity. So I think you know, that's what it is. But that's hard for people sometimes.
Dara: Can be.
Rena: And so I think you know if that's not something you’re comfortable with you know, there are other ways to find support. You know, Fruitful Fertility, we're gonna have their founder on in a couple of weeks, and they're kind of a mentorship program. You can sign up online. You could be matched with somebody else who has either gone through the process or going through it. So that's a way to meet somebody. You know, there are various groups you can join. And there's all sorts of ways to meet people and get help. And I think sometimes asking for help, really, is the hardest part.
Eliza: Yeah, I think you're right. I think it’s in whatever way you feel. I've had patients who just will have a friend sit there with them and just watch me do it just to have, like, the moral support of someone sitting there. Sometimes they want someone to know how to do the medication, just in case they mess up. So in whatever way you need to support. If it's someone who's nice, that someone who's done it before you.
Rena: Right. Have someone on face time, have something on speakerphone, whatever.
Dara: I like what you said, Rena, it doesn't have to be a friend it can be someone who you don't really know who you’ve met through a support group who can give you that support that you need.
Rena: Just somebody. And I found myself a big sort of silver lining from this process was meeting other people going through it. And once I started opening up about my experience and what I was going through, you know, people really came out of the woodwork, and I'm really experienced nothing but kindness and made wonderful connections. It really is a unique, shared experience, You know, you. So I say it's like the sorority you never wanted to join you, but you're in it, you know, you find other people, other people understand, and it really is, it’s a very strong connection.
Eliza: Yeah and I think in general, obviously it's a very stressful process and overwhelming to begin with. So I mean the best thing you can have is support and also to feel like there are other people going through the same thing that you are, understanding your struggle. You know, it's a lonely process to begin with, so I think the more people in whatever way that means to you that you can surround yourself with just even just to make yourself feel more comfortable. I think that will help you a long way.
Dara: We’re so lucky to have you, Eliza. Really your positivity and your support. I have such an affinity for nurses training at the hospital. You guys do so much and give so much love, it’s remarkable. So outside of work, what do you like to do? What you do when you're not at RMA?
Eliza: Great question. I mean, I’m always at RMA so I don’t know what you’re talking about…but I love music and I love movies. I love going to concerts or the movie theater is my happy place. I’m very simple in that way. Those things make me happy.
Dara: We have this bond over The Bachelor as well.
Eliza: Yes. I was gonna say, this isn’t my first podcast. I did one about The Bachelor recently.
Dara: I can’t wait to listen to it.
Eliza: It’s definitely a big attachment of mine. Way too many details about it as we were saying before. But yeah, I mean, also I think when you love your job, especially if it has any emotional component. Sometimes it's nice to come home and kind of be able to separate that. And definitely watching the Bachelor is a good way to disassociate.
Dara: It gets you away from reality a little bit. So we always end our podcast with words of gratitude and we wanted to ask you what you are most grateful for today or right at this moment?
Eliza: I know it's gonna sound cheesing, and you’re gonna think I'm making it up, but you can ask anyone my life. But it's true that I always say that really I'm so, so fortunate for this job every single day. You know, I did work in the hospital and I got a lot of experience that I couldn't get anywhere else. So I'm happy for that experience. But it definitely wasn't the place for me, and I definitely came to a point where I was questioning if nursing was even my path. And then I got this job and I really felt like this is what I was meant to do. And I feel so fortunate that I get to do it every day with people that I love coworkers, doctors that I respect. I get to meet amazing people and really feel like I'm making a difference on a daily basis
Rena: I love that! So the stars really aligned. The universe guided you here.
Dara: You were able to find your passion. I feel like when you're passionate about something it really does emanate towards everyone around you. So, we're the lucky ones
Dara: I’m first? Um, what am I lucky for right at this second? I'm lucky for the change in seasons, and I always thought in the past that summer was my season. But I'm so happy that it’s getting into the cooler months appreciating the change in season. Yeah, that's something very random. But that's what I'm grateful for at this moment. What about you Rena?
Rena: You know, I love that. That made me think this morning I was running in Central Park and I smelled apple cider and it was the first time this season I smell that so I knew. It smelled so so good so I was so grateful in that moment to be smelling Apple cider, running outside, being able to run. So I'm gonna say that too.
Dara: Living your best life, Rena.
Rena: Oh yeah. Waking up at five going for runs.
Dara: Well Eliza, we really are so grateful to have you on today. Really. You are a breath of fresh air. Your patients are the luckiest patients,
Rena: The luckiest, and I'm hoping if they’re looking for a Bachelorette, they nominate you! If anyone is listening, Eliza.
Dara: We’re team Eliza.
Eliza: Thank you. Well, thank you so much for having me. I loved being here and hope to do it again soon.
Dara: Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram @fertility_forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.