Season 2025-- Episode 12: Broken and Brave: One R.N.'s search for meaning in our current healthcare environment

Tiffany L. Smith, RN has spent nearly 15 years on the frontlines of American healthcare, working in ERs, ICUs, hospice, wound care, and more. A nurse, wife, and mother, she has witnessed both the triumphs and the failures of a system pushed beyond its limits.

Her debut book, Broken and Brave: The Fight to Heal American Healthcare, blends memoir and manifesto, capturing the raw intensity of a single 12-hour COVID shift while exposing the deeper flaws harming both patients and providers.

Tiffany is the founder of Broken and Brave Health, a movement to empower patients, support burned-out providers, and spark change in American healthcare.

You can get her book on Amazon.com:

https://www.amazon.com/Broken-Brave-Fight-American-Healthcare/dp/B0FDG35NPG/ref=sr_1_1?crid=2ZKAURV9RKV6D&dib=eyJ2IjoiMSJ9.Eq6EYUV09qenX3xOlhb6J-oYwV85dTurdK8EwgQVyVhGLM-MZTVa1f5k5EIjq4v7UmGvfSkHDrdJCmJFv3DYPrvhWgz7OkMzcaU_bKovijgB_bHTDS6hcKAuNXKOwpP_zP4C8r2Ebdaf9I7HG4WtyGAjXBENLZ18T_UNerSh5niRhNTtZ57_zKVe488XARlKWeUzkl3KHzZeUOSAFA-EInm0qTWwrpJo7thYLmQLHQg.lJ4dfBAoVfQ9ofdwbGerZSHQz2mbwz7ceDVJthGUgeY&dib_tag=se&keywords=Broken+and+Brave&qid=1762816709&s=books&sprefix=broken+and+brave%2Cstripbooks%2C174&sr=1-1

It's a great read and a moving account both of what RNs go through (esp during Covid) and what the system needs to improve.

Tiffany's website is:

https://brokennbrave.com/

Her Facebook:

https://www.facebook.com/brokennbravehealth

THANK YOU FOR LISTENING!
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Original music "Saturday Sway" by Brendan Talian (for all interviews before 2025)

Transcript

Speaker 1  0:35  
Lynne. My guest today is Tiffany l Smith. She's an RN who spent nearly 15 years on the front lines of American health care, working in ers ICUs hospice, wound care and more, a nurse, wife and mother, she has witnessed both the triumphs and the failures of a system pushed beyond its limits. Her debut book, broken and brave, the fight to heal. American health care blends memoir and manifesto capturing the raw intensity of a single 12 hour covid Shift while exposing the deeper flaws harming both patients and providers. Tiffany is the founder of broken and brave health, a movement to empower patients, support burned out providers and spark change in American health care. Special thanks to Andra Taylor for introducing me to Tiffany and telling me about her story. Tiffany is Andre's goddaughter, and I'm really glad that we connected. But Tiffany, I've been dying to meet you. You're the goddaughter, one of my good friends, and she spoke highly of you, and I can't wait to hear your story. So where should we begin? Like, I want to know, like everything, did you major in nursing? Like, did you decide that right away? Or did you switch in college?

Speaker 2  1:52  
Yeah, I switched. I did switch around. It took me seven years to get a two year degree, which is a little embarrassing now as a 40 year old, but I went to school at first for business, and I was really bored with that, and then I went into physician assistant school, or started it. And then, before I was officially accepted into that program, I kind of realized that they were overworked and underpaid doctors is what it seemed like to me. Anyway. I know that that's a very noble profession, but for me, I wanted a family, and so I was nervous going into once I got more into the PA program, that I wouldn't have as much time to be a mom, and so my I actually kind of looked down on nursing before I became a nurse, which is interesting. I just kind of thought like nurses white butts for a living, and that's about all that they do. I had no idea what they really do. And so when I was kind of in the PA school trying to figure out what I'm going to do with my life. My one of my best friends was like, you would make a kick ass nurse. And I was like, mortified that she would say that to me. I couldn't believe that she would suggest that. But the more I thought about it, and then I actually researched it, and I talked to a few nurses, I was like, actually, nursing is really amazing. So I went in, I got accepted right away because I had pretty good grades for the PA program, and so they accepted me into one of the oldest nursing schools in America, actually, in Vermont. So

Speaker 1  3:32  
wow, that's such a cool story. I had a funny feeling that you that you didn't go right away into

Unknown Speaker  3:38  
it. Yeah, took me a while,

Speaker 1  3:42  
and it's such a great profession, especially for people that really care about other people. You get to do the science of you have to have that knowledge, but you get to have more. I mean, some doctors are great with that, but a lot of doctors are not, you know, they don't connect in that way with their patients. I remember when I had both my kids at Hunterdon Medical Center. The nurses were amazing, and they just got me through. And that connection is so lovely, you know that that side of nursing. So how long were you a nurse before you started to say, well, I'd really like to write about this. Yeah.

Speaker 2  4:18  
I mean, I've always been really into, like English and writing, and I've actually been one of the weird ones that doesn't mind writing papers and stuff, but so I've kind of always wanted that, but I went through some several very rough years in my personal life that I just basically survived. And then once I was finally out of that, I was like, I am going to sit down and write my experience and what I see as a nurse. So that was actually right after the pandemic in 2021 is when I started writing it. And then it took me until, obviously, this year, I published in June. But it took me. You like two and a half solid years of writing. I mean, I didn't write every free moment I had, of course, but it took me a while. And looking back at it, I think the reason why it took me so long to write about being a nurse and healthcare is writing about it almost gave me like PTSD, reliving through all of the, yeah, horrible, hard, difficult times, and so I would have to step away, you know, I'd write a chapter, and then I'd have to step away for a little while, because it's, it was like I was just angry and burnt out and really upset overall, at how healthcare workers were being treated, and at how patients were being treated, and I just would have to, like, take a step back and then step back in and write my next chapter. So it took a little while, but that

Speaker 1  5:52  
makes total sense, because if you're going to write something authentic, then you have to really go back there, right? And you have to live it, relive it, and really think about it, and maybe that I mean that that would be tough. Now you're talking now you started before the pandemic. You started writing, but the pandemic just made it all worse, right? I've heard horror stories about what nursing was like during that time.

Speaker 2  6:14  
Yeah, I started, I started thinking I wanted to write during the pandemic, and then I actually sat down to write right after it in 2021 but yes, it made I will never be the same. I'll never be the same after you

Speaker 1  6:30  
believe what people went through. In fact, my my daughter has a friend who started her career during the pandemic. I have can't imagine going like full force into that really difficult time where you have no minute to even think of yourself and you and just some of the coverage on the news so showed the kind of garb that you had to get into every single day. I mean, how did you get through that? What did that take out of you?

Speaker 2  6:59  
Well, I I worked as an inpatient wound care nurse during the pandemic in a hospital. So I was one of the younger, healthier, more fit wound care nurses on our team. And so I've volunteered myself because a lot of the other women that I worked with were much older than I was, and so I volunteered to go on to the covid units. So I would go on to the covid ICU, which was a horror show, basically, and also the covid med surg unit, which was less sick people, but still too sick to be on the med surg, like most of them, should have been in the ICU, but there was no room. Gosh. And it was, it was awful that it was awful people were dying left and right. And, you know, I talk in the book, I have a whole chapter on covid, of course, because it affected my whole life and many people's lives. But you know, I think one of the biggest problems for me personally, and I know that some people don't agree with this, but the amount of fear that was placed into everyone's hearts and minds by the media was really bad. Like that made it so much worse, because we already were dealing with people who were sicker than we've ever had to deal with before. For a longer amount of time, we were running out of space. We didn't really know what we were dealing with, especially in, you know, march through November of 2020, I mean, we were

Speaker 1  8:34  
beginning that was so scary. It was so scary, yeah,

Speaker 2  8:38  
but I think it was made worse than it should have been. I think that we, we should have, as a medical community, stepped back and and really tried to professionally find out what's going on, instead of, like body counting, which is what it felt like, happened quite a bit. But I, I will never forget. I mean, I would go into someone's room and their skin was like coming off of them because they were just so sick and had no circulation. I mean, I've seen some gnarly stuff as a wound care nurse, as you can imagine, but some of the worst stuff I'd seen was with covid.

Speaker 1  9:21  
How did you continue? Like, how did you keep going? Like, what got you through that

Speaker 2  9:26  
I don't really know. And when I interview and talk to other nurses, they don't I mean, it's like, you know, oh, I want to help people. Yes. I mean, I want to help people. But really, what makes you continue to walk back into that hospital and punch back in? I don't, I don't have, like, a super solid answer, other than I didn't know who else would do it, to be honest. Like,

Speaker 1  9:50  
that's the thing you feel like, as hard as this is on me, I can't let these people down, because no one else will take my place.

Speaker 2  9:58  
Yeah, and I mean, we're. Already low on nurses, and then to have this type of influx of patients, I mean, it felt like a it felt like a mandate, you know, and I don't think that that's healthy, but I don't, I don't have a great answer for that question a lot of people have asked, and I know so many nurses who either stepped away completely from nursing because of covid, or they stepped into, like, behind the computer roles because they just couldn't anymore.

Speaker 1  10:28  
I just feel like it was so much expected of you guys, and it was so sudden, and it was so much more than you've ever had to see before. I just don't know how everyone lived through it. I mean, it was, I did see, you know, some of the coverage. And then they would have something like a day in the, you know, day of a covid, nurse, covid, somebody working in on a covid floor. And it was just so hard to comprehend how you would go back in there every day. So how did that affect the book? Like, you have a whole chapter on it.

Unknown Speaker  11:00  
Mm, hmm, yeah, yeah.

Speaker 2  11:04  
And so my my book is written in two parts. The first part is written as A Day in the Life of a nurse on a med surg floor during covid. So it literally starts from the moment I wake up until the moment I go to bed. And even though I wasn't technically a med surge nurse. During that period, I was on the floor all the time, and so I saw what they went through. I worked 12 hour shifts, you know, so I didn't do exactly what I portray in the book, but very, very close. So I I wrote that, and that's kind of the fun section of the book. And people have, I've gotten really great feedback that people love that portion of the book. And then the second part of the book, I dive into the specific deeper problems in health care. And the first one is covid, and what I saw that was really messed up during that period. I I am a very much a realist, and, you know, being thrown into reality like that I had it was hard to survive and get through, to be honest, and then I talk, I have several chapters on other things, like what it's like to be a nurse and the responsibilities that we have on our shoulders. And in a time like covid And even now, but especially during something like covid, the amount of things that we had to do, not only know how to do, but follow up on and remember and get completed during your shift, it was literally never ending. And so I have a chapter on that. And you know, big pharma and insurance and so. But I thought that it was very important to have a chapter on covid, on my lot, my live, lived experience of what I saw

Speaker 1  12:53  
during it. I think it's so important to look back and try to learn from what people went through. I think it's really important to let people know how it really was, too, because a lot of us were sheltered. You know, I live in a rural county, and I didn't go anywhere, and it wasn't such a bad time for me, but I saw on the news, and you're right, it made me more fearful how difficult it was, but still, I didn't know the details. And I bet you know, when I do read that chapter, I'll probably freak out because I just didn't know. And I think it's really good to peel back the covers, you know, like there's a lot of us are really upset about health care and the kind of pressure on medical professionals and the amount of time they have to deal with insurance and the ridiculous kinds of claims that get bounced back, and I just feel like it needs a lot of help. So I'm glad somebody like you, who's been there is writing about it. So what was your first of all, what's your book

Speaker 2  13:53  
called? It's called Broken and brave, the fight to heal American health care.

Speaker 1  13:58  
I love that. And how can we get it? Is it on Amazon?

Speaker 2  14:02  
Yep, it's on Amazon. If you just search broken and brave by Tiffany Smith, it'll pop up the cover. The cover is a medical caduceus kind of on fire. It's really a beautiful cover. So you'll notice it right away.

Speaker 1  14:15  
Oh, perfect. And in the back of your mind, like, what was your goal to do to write this book, like, what did you hope to get across to people?

Speaker 2  14:26  
The my first version was catharsis for me, I needed it was almost like therapy. I had to get it out. And Andra actually was one of my beta readers, my godmother, so cool. Probably tell you like it was a little angry, you know, I just didn't have tons of guidance. And I, that was obviously my first book. So I, I, when it was edited, she my first editor was like, great. It down, like a lot of but

Speaker 1  15:03  
it was totally good to get all that out, right? It's just good to get it out. I have then later, yeah, you can decide to bring it down. That's very good way to write, because you're just getting the real emotion out,

Speaker 2  15:13  
right? Yeah. And she was like, hey, we need to chill a lot of this out your, you know, your language or your tone or whatever. And so we did. But the real, deep reason why I wrote that book is for awareness, because I don't think that people have basically any idea what health care workers go through. I really don't think that they know. And so I I wanted people to be aware of what it's like to be a nurse, and the main reason why I wanted people to know that is that people are incredibly abusive towards nurses, like it is a horrible time out there for nurses. We are the most abused profession, and it's the way that we're treated by patients and their family members. It's just getting worse and worse as time goes on.

Speaker 1  16:10  
I had no idea. I mean, I know that happened with flight attendants. I was reading about that, and that seemed to like spike during covid.

Unknown Speaker  16:19  
What's up with that. Do you have any idea?

Speaker 2  16:23  
I have several things that I mentioned in the book and that I think in real life is is going on, but I think it's entitlement. I think that I think that, as we have shifted from a hospital is a place you go where professionals and and educated people fix you or try to fix you, we've shifted from that mentality, which, in my mind, is where we should be at, to a people pleasing. Was your TV bright enough? Did you get iced water quick enough? Customer service based system, and we really well. I mean, obviously we need people to be happy and okay during their their hospital stays. We don't want people miserable. I'm not saying that, but I think that the shift into customer service based health care has destroyed it.

Unknown Speaker  17:23  
So it's, it's not a hotel.

Unknown Speaker  17:26  
I literally say that in my book. I literally

Speaker 1  17:29  
say that go to get better. Yeah, people are focused on making you better, and it's not a hotel. We're not here to serve you or, you know, give you ice. I mean ice water, of course, because you need it. But we're not here to, like, fill it up on time, or be your servant. That's so interesting. So that kind of permeated, it now permeates the hospital environment. So are you still a nurse?

Speaker 2  17:50  
I am right now. I don't work in the hospital anymore. I got way burnt out. I was working full after I did the wound care during covid. I took a full time job in the ICU and the covid ICU, and I just, I had to stop doing that for my brain and soul. And so now I do home hospice.

Speaker 1  18:13  
Wow, but that doesn't sound super easy either. That sounds pretty heavy duty. Also,

Speaker 2  18:17  
it's heavy, but it's a different heavy. So I say, you know, I know my husband is an ICU nurse and loves it, but I for me, I felt like I was constantly torturing people, like I felt like in 70% of the cases, I was just torturing people to life. That's what I used to say. I'm torturing people to life, and then their quality of life after a ICU stay. You know, the the percent of a great quality of life after that isn't great, and so I just, I needed to reframe, and hospice has always been very close to my heart, and what I can do in hospice that I couldn't do in the ICU all the time. I did get to do it a few times, but what I can do all the time now is have the honor of helping someone die peacefully, comfortably and surrounded by family. And that's such a

Speaker 1  19:12  
beautiful thing, and it's one one patient at a time, instead of this incredibly crazy floor of people that, I mean, I can't even imagine absorbing that and taking that home and continuing to, you know, do that over and over. This is more gentle I would imagine, and more suited to your, you know, your your peacefulness, like, that's a very I mean, not everybody can handle hospice care, but I understand that's such a beautiful thing, if you can, because people, families need you too. They need you to be, you know, the one that keeps everything calm and the one that knows what to do, because some people just don't know what to do. I've been reading about like doulas. They have like death doulas, people that literally attend you. And I was. Like that makes so much sense, because I I had a doula both times. And even though I had midwives and I had a doctor, I also had a doula, and it was so helpful. And I know, I mean, I spiritually, I do see, you know, death is just a birth into the next phase, and to have someone like you, like you get to give more of your attention, more of your compassion directly to just one person at a time. And I bet that's so rewarding. So that's your that's what you do now, yeah,

Unknown Speaker  20:29  
yep, it's, it is

Speaker 2  20:31  
my honor and pleasure and privilege to help families, especially, but definitely, obviously, patients, yeah, through that period of time. And, you know, I can teach people about the end of life process and what that looks like, because we do death terribly. Here we do.

Speaker 1  20:52  
I'm right there with you. Yeah, we're in denial, yeah.

Unknown Speaker  20:57  
And I think,

Speaker 2  20:58  
yeah, exactly. We do a grand disservice to people by giving them what I consider false hope. I mean, obviously we need to give people hope. If you have a life ending diagnosis, you need to in in a lot of cases, it is good for you to have hope in your brain and heart that perhaps you'll beat this. However, in that same breath, we should not be telling people that they're going to beat something if they definitely are not going to, because we're robbing them of the time that they have left. And I think that's like almost abusive in my mind, because

Speaker 1  21:38  
I can see that, yeah, you, if you, if you do accept that as your truth, then you're going to say the things you need to say to the people you love while you're still here, and you're going to come to grips with the reality of it and maybe make peace with people or say things you wish you'd said. I mean, if you don't think you're going to die that moment, those things don't get said, it's not fair. It's not, it's not, it's not right.

Unknown Speaker  22:04  
Yeah, and taking

Speaker 2  22:05  
people and putting them through treatments that give them a not great percent chance, but, you know, framing it in the you need to be a fighter and you have a 12% chance of survival. I mean, you're robbing somebody. And maybe they do survive, fantastic. But if they don't, then that period of time that they had left, whether it was six days or six months or six years, could have been them living life to the fullest, like maybe they always wanted to go to Europe. I mean, I don't know. And when you give people this false hope into what a treatment can do, and then notice that it's not actually doing that, but don't want to say that out loud to the patient that robs them of their time left. I have watched that 1000s of times in my 15 years as a

Speaker 1  22:58  
nurse. I don't know how you stand it, and it's not fair. I've seen that a lot where doctors just never consider that maybe you shouldn't do that, right? It's just, it's always like, push it no matter what. And it's not even to be mean. It's just they have no other way to be. They don't have that kind of decision making. They don't think that way Exactly. They just say, well, here it is, we got to try it. And maybe you don't. So that what I like is that you're you're bringing consciousness to the decision you're bringing people need to be conscious of their choices, of of the facts, like I know now this is going back, but I know my, my aunt was never told. I think she was told she had a certain number of years, and then she beat that when she had cancer, and she was never spoken to about it again. She was dying, actively dying, never told her, never It was horrible and horrible. I just don't think that's fair, and I don't think it's it's not good for the family either, because they they get to watch somebody not know, right? But suffer and die. Mm, hmm, I just pointed out, right? I

Unknown Speaker  24:05  
can't tell you the amount of conversations that I've had.

Speaker 2  24:09  
A really quick, really great story to illustrate this is I walked into a patient's house, and he had just gotten home from his last bout of chemo. Literally, that day, they had driven home from the hospital that day, and I went to admit him onto home care, and this was back in my regular home care, not hospice days, and I went to go admit him, and he was literally pretty much dying in front of me, and I was like, Oh, what are we do? You can't do therapy. I was like, You're gonna die. And he started bawling. And he was like, I knew I was dying. I told my doctors, I felt like I was gonna die, and they said they'll see me on Monday for more chemo that I will never forget, that I'll never forget it, because he would have he literally died. 36 hours after my visit, he died. He was done like he was robbed of whatever time he had. It was such a shame. I'll just never and things like that happen so much more often than we understand as lay people like you would just never know how often that happens. And the other major piece that I want to talk about is informed consent. Because, you know, hospitals and doctors talk a big game about informed consent and how important it is, but I will tell you, standing at the bedside of hundreds of patients, the true informed consent like, what are all of your options, not just the one we mostly want you to take because it's best and easiest and goes best with our schedule. But like you also don't have to do this. And I would say in less than 10% of cases that I personally have seen is full informed consent provided to

Unknown Speaker  25:55  
these people to patients. A

Speaker 1  25:56  
really good point. Yeah. How can you make a decision if you don't know all the particulars? Right? You can't, and that makes me so sad that he knew he was dying and they were just pushing him through. It's relentless. That's terrible. Is this your next book?

Speaker 2  26:12  
Yeah, I'm definitely going to do another book, and it will be probably around Death and Dying in America and how terrible it

Speaker 1  26:19  
is. I don't think we have enough information about that. I'm very interested. I just feel it on a soul level, when people talk about this, that there's a there's a more natural, human connected way to go, to leave, yeah, and that it's nothing to be afraid of, but we're so afraid of it, like you could do anything to help people not be afraid, you know?

Speaker 2  26:44  
Yeah, so I it's very it's still, even with all of my experience with death and dying, it's still very difficult for some people to hear what I have to say, like they they can't even with me sitting at their dining room table, looking at them in the eye, they still, it's hard for them to digest what I'm saying, right? So it's literally our culture around death and dying. We have no

Speaker 1  27:08  
tools to deal with it, like if you grew up, if you grew up seeing your relatives, you know, losing their strength or becoming ill, and then you see them pass away, and you see everyone grieve and have a ritual, and it feels natural to you like this is what happens. Then it would be different. You would accept, maybe a little more easily when you were older and ready to go. But we don't see that. It's all like sheltered from us. And I remember they didn't even take children to funerals like we were. It was very unusual. I was super close to my great grandma. I was 10, and my brother was eight, and my mother's like, That's ridiculous. You have to come and you have to see her, and you have to say goodbye. And it was so good. It was horrifying, you know, because I had never seen anything like that. But it was also really good, because that ritual that coming together is really important, and how can you have that when you're, you know, on chemo to your last breath, I mean, you're in the hospital and you're, it's horrible, actually, when you think about the imbalance, that's what I'm hearing you talk about. It's like there's a real imbalance that that doctors just know this one road and you know, we're going to try to save you no matter what, when actually there'd be, there could be a more careful and conscious assessment, and I hope you can help us understand that with your with your next book, it's been so good talking to you. Is there anything we didn't mention? Is there anything you'd like to add? I

Speaker 2  28:33  
don't think so. We pretty much covered it all. I really appreciate your time. Thank you so much for letting me talk with you. Oh,

Unknown Speaker  28:40  
I love talking to you, and I love that you're a nurse with a mission

Speaker 1  28:44  
now, right? Yes, and I could tell by just when I hear you talk how important it is to you, and I'm so happy that you shared it, because I know the people listening, they'll think about it and they'll and they'll feel differently about it, and hopefully we can read your book soon and and know even more so one more time, what's the name of the

Speaker 2  29:05  
book? Called Broken and brave, the fight to heal American health care by me.

Speaker 1  29:10  
Smith, Tiffany Smith, and how can people get in touch with you if they have a comment or want

Speaker 2  29:16  
to share some love? Sure, so I am on Facebook at the name is broken and brave health. And then I also have a website, it is broken and brave.com it's the letter N, not the word, and so it's okay, n, n, b, r, A, V, very good. And that has a bunch of links on there to get in touch with me to buy the book. It's kind of a good landing page. So that's

Speaker 1  29:47  
great. I know people will will really get a lot out of it. I can tell by your stories and just the amount of work you put in and the care that you have, it's great. I'm so glad that you're putting these books out into.

Speaker 2  30:00  
The World Well, thank you so much. I appreciate it. I really

Speaker 1  30:03  
like talking to you. Thanks. You too. Bye, bye. You.

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