KIRK: Every day is such a learning opportunity. It's encouraging. It's challenging. What more can you ask for as a clinical student?

NARRATOR: In this episode, Abby, a clinical student and Lisa, a nurse midwife, discuss transitioning from students to staff and being lifelong learners.

BROWN: I work for Mayo Clinic Health System in Mankato. I started out as an LPN, and became a registered nurse with an associate's degree and then a registered nurse with a bachelor's degree. I then went back to school for a master's degree in certified nurse midwifery. Amy, another certified nurse midwife, and I have started a Nurse Midwife Practice within the Obstetrics Department at Mayo Clinic Health System.

KIRK: I knew that I wanted to become a midwife even before I became a nurse. I grew up on a homestead out on the mountainside in West Virginia, loving the process of life, and loving the process of birth and being hands-on with that. While I was in school, I had the opportunity to spend 13 weeks overseas at a charity birth center in the Philippines. That was incredible, spending time hands-on with the midwives there and with their students — delivering babies, doing prenatals, doing everything. It was gearing up and getting ready to start a professional nursing career. I started my job at Mayo, and I'm really glad I started on a progressive care unit because that gave me the chance to build up good critical thinking skills. When I was looking for schools for midwifery, I was surprised and delighted to see the University of Minnesota was so highly ranked for nurse midwifery. And I'm so blessed that they have a liaison relationship with Mayo Clinic so I can do some of my clinicals here.

BROWN: They have a rich and strong midwife group at Mayo in Rochester. I found as a student that it was helpful to have different preceptors who had different styles. Because of the atmosphere of teaching and such a rich teaching culture there, I was encouraged to develop a practice style that really fit my personality. That also helped me to see that everyone has gifts they have to share, and while no two people are the same, they are equally valuable and equally important within the practice.

KIRK: The preceptors are exceedingly patient. They help you set expectations for yourself. They give you a lot of autonomy and let you feel your way into the profession as an individual. They all have different ways of doing midwifery, but they work together as this wonderful little unit. And they communicate well. They're very well-rounded and encouraging all around.

BROWN: Everywhere you go, you're not the only student. You're not singled out as the only person who's a student. At Mayo as a teaching institution, there is this sense that everybody's learning. That was a source of comfort for me — that I wasn't the only one who wasn't sure where I was going or what I was doing. I felt it was something that was a real bonus to Mayo Clinic and for students.

KIRK: I'm in the D.N.P. (doctor of nursing practice) program right now. It is an online program. I have at least two University of Minnesota students here in Rochester that I get to work with on a regular basis as well a plethora of other students, obstetricians and other doctors who are learning alongside of the midwives. It's certainly very student-friendly. You don't feel alone in your educational journey. Looking back as a professional, what would you say you learned as a student here that set you up for success as a provider?

BROWN: For me, it was so helpful to be connected to such a strong midwife group in Rochester, and to still have and maintain those connections within the same enterprise so that they were a resource for me. There was familiarity in practice guidelines and protocols. That really set me up to succeed. Coming to Mankato and being able to bring what I had learned in Rochester really helped me to establish a practice with the same kind of guidance.

KIRK: I already have little interactions with the wonderful midwives here in Rochester that I will not forget going into my practice in the future — the conversations that you have after a clinic day, the encouragement that you're doing a good job. It's things like that as well as the excellent teaching that you get day after day.

BROWN: I'm married. I have four children. I live in Mankato, so I wasn't relocating to Rochester for my clinical rotation. For me, the biggest challenge was traveling back and forth and being away from home. I have two college-age kids, and I have two high school students. I feel like that set an example that education's important. We made sure we were intentional about being a family, and I tried to stay connected with them through texting and FaceTime. I'm more of a nontraditional student. Mayo was really helpful in facilitating that for me and knowing that those were my challenges. I also worked for Mayo Clinic Health System in Mankato at the hospital as a labor and delivery nurse. They were all so supportive of me going back to school. That helped and made all the difference in the world for my continuing education. Then I came back as a provider.

KIRK: That's incredible. I can completely relate because it would be pretty much impossible to maintain work and school at the same time without having such a supportive work family.

BROWN: My advice to future students is to be really organized, and to keep track of your paperwork and put it all in a file. Also, lots of communication. It helped me to say: "I've never done this before. Can we talk through that before we go into that patient room," or "I anticipate XYZ. Is that right? Am I on the right path." I wasn't expecting anybody to do my homework for me. However, I always felt like I could ask the questions.

KIRK: I'm really curious as to what you felt were challenges that have changed now that you're a practitioner.

BROWN: Being a provider, that role doesn't end. There's always your inbox, your email, lab work coming back. You need to make decisions all day long. The mental energy of always having something more to manage and handle, that transition took a little time for me. Time management and also allowing myself to check out when I'm not there is important — that is, do the work that I need to do while I'm there and when I leave, I need to unplug a little bit so I can recharge for the next day. As a student, you never stop doing homework.

KIRK: You never do.

BROWN: You never stop. You're always doing homework. It's always on your mind, and you're always trying to grab a few minutes, get this article, look this up. As a provider, it's the same way. However, this is now your new lifestyle. You're always a student no matter whether you're officially in school or if you've been working at your profession for 20 years. You're always a student of your profession.

KIRK: That's excellent advice. You have to be very intentional about getting the rest that you need, being able to take a step back. I really value your comparison of me being a student and always having responsibilities, and never being able to take that mental break from having those responsibilities to life as a provider. It's not going to really necessarily change, but your ability to manage it is what develops over time.

BROWN: I do feel like you go along the spectrum of novice, advanced beginner, expert — that continuum of expertise. I was in more of the expert phase as a labor and delivery nurse. That was a satisfying feeling most days when people would come and ask me questions. I was able to mentor students. I knew my job well. I knew what to do. I knew what my role was.

But I'm stepping into a role where I'm a novice again, and I'm finding my way as a provider. It's very humbling to go back to being a novice when you were an expert. I will always have questions, and I will always be learning. I would say it took a good nine months before I felt like, "I think I have a good handle on this." I don't know that I could have mentally prepared for that any differently. I'm glad that the first year is under my belt. I feel more confident. I feel more like I'm an independent provider.

KIRK: That's reassuring. I've thought so many times about that continuing from novice to expert as I approach that learning curve. Now I have the opportunity to be training again as a novice at Mayo Clinic in a different role.

BROWN: That's a hard thing to do — to be patient with yourself because you want to be perfect right away.

KIRK: Right, and there's a lot of responsibility.

BROWN: Sometimes it's overwhelming — that sense of responsibility. But it's also extremely rewarding and fulfilling. I think you'll find that once you find more of a comfortable place, you'll find your victories in your days and your weeks. It might be, "I did this one thing all by myself, and I remembered something that I learned, and I didn't have to ask another person." Find those victories and savor them. They help you keep going.

KIRK: I feel incredibly grateful for the opportunity to be a clinical student at Mayo. I'm incredibly grateful to be in a setting with encouraging preceptors who value you as a student and work with you. They work with my schedules and my responsibilities. It's really the Mayo Clinic values that I wanted to come to work for 4½ years ago and that I experienced as a new nurse. It's those exact same values being played out so beautifully in the setting of a primary provider training opportunity. It's incredible.

BROWN: I would have to second that, Abby. Every single day, I'm so thankful for my student experience at Mayo Clinic in Rochester because there's no way to replace that experience. There's no way to get that anywhere else.

KIRK: Every time I'm walking into my shift, I walk under these banners that say "No. 1 in the Nation." Almost every shift I walk into work, I have this overwhelming sense of "I get to work here" and now "I get to be a student here." It's something that I'll have with me for the rest of my life.

NARRATOR: Reflect on your career aspirations. Where are you on the continuum of your profession, and do you want to change that?