Meet Nicole Reid, Poison Control Nurse

Meet Nicole Reid, Poison Control Nurse

Nurses don’t always find the exact specialty that fuels their passion when they start out on a nursing path. Nicole Reid, BA, RN/BSN, EdM, CSPI, DABAT, now the managing director of the National Capital Poison Center in Washington, DC, didn’t expect her early career work in geography would lead her to a nursing career that she loves. Career opportunities and connections brought her to work as a poison control nurse, and Reid realized she found her place. The career has helped her grow professionally and has also helped her manage to continue to work through health setbacks.

Here, she shares some of her story about being a poison control nurse with Minority Nurse.

Please tell me a little about your background. How and why did your career path lead you to poison control nursing?

I took a roundabout path into poison control nursing. After graduate school, I started out as a geographer and a researcher working for fair housing non-profit organizations. I worked in that sector for three years until 2004 when I was hired by the American Association of Poison Control Centers as a Research Associate. Until that point, I had never had any contact with Poison Centers. As part of my new role, I had the opportunity to visit the National Capital Poison Center (NCPC) in Washington, DC and observe how the Poison Center nurses performed their work and how a poison center operated. I was hooked! The nurses and pharmacists on the phones were true experts in their field and were helping people who were scared or sick or both. At that time, I formed a relationship with the center director and about 18 months later, she helped me form a plan to become a Registered Nurse and work my way into my position at NCPC as a Specialist in Poison Information (SPI).

After a year spent working as a SPI, I sat for my national certification exam and became a Certified SPI. At the time, this exam required the candidate to have worked 2000 hours on the phones and manage 2000 human exposures in order to qualify. It was a whirlwind but I learned so much! Once I was certified, I spent the next six years managing cases over the phone, advising the public and healthcare professionals about how to manage poisonings and suspected poisonings. Thus far in my career, I have assisted 36,000+ callers with their poisoning exposures. I really feel like I have made a positive impact in the lives of others, which makes the work so rewarding.

During those six years, while working on the phones, I also worked on becoming a leader in my field. I gave lectures and created webinars for healthcare professionals; I trained new specialists and created new teaching and orientation materials; I published several journal articles; I had the opportunity to travel to national and international toxicology conferences to present my research and take specialized toxicology courses to enhance my knowledge; I took on a large amount of administrative work at NCPC and worked hard to build my leadership skills.

Seven years into my poison center career, I became credentialed to sit for a board certification exam from the American Board of Applied Toxicology. This exam is open to nurses and pharmacists (but it is mostly geared toward pharmacists) who want to become leaders in the field of toxicology. It usually requires 5-10 years of study and portfolio-building to qualify. With the support of my colleagues at NCPC, I was able to qualify and I passed the exam in 2014 on my first attempt. I am currently the only Registered Nurse in the country to possess this credential.

At this point I was promoted to an administrative position as clinical operations coordinator. Think of a “charge nurse” for the poison center and that is a good approximation of my role. I was responsible for scheduling, shift coverage, producing monthly metrics reports for my team, writing staff evaluations, training, and of course, continuing my work on the phones.

In 2018, I was promoted to my current role of managing director of NCPC. At this time, I transitioned to a more intense administrative role. I became responsible for supervising all of our clinical personnel, for maintaining funding for the center (a 501-c3 not-for-profit organization, maintaining national accreditation of the organization and the clinical staff, optimizing our complex hardware and software and the use of technology in providing our core poison center functions, performing 24/7 toxicosurveillance to search for public health threats in the DC metro region, and taking on anything else that comes up in order to keep the center open and functioning efficiently.

What are some aspects of your nursing role that you didn’t expect?

I became a liaison to several community and regional health organizations, including the DC Health and Medical Coalition whose primary responsibility is to prepare to cope with natural or man-made disasters that may impact the healthcare systems of the Washington DC region. This was rather eye-opening, as it takes an enormous amount of work and collaboration necessary to pull together a functional disaster preparedness plan. I met so many amazing people who donated their time and expertise to the project. I never expected to become an expert on the toxicology and treatment for weapons of mass destruction, chemical and bio-weapons, and radiation-induced injuries, but that was a major focus of the Coalition and my role in particular. I was able to translate this new expertise into training courses NCPC provided for clinicians in our region.

I have been particularly fortunate that NCPC’s leadership has always been dedicated to embracing new technology. Back in the old days, we were one of the first poison centers to develop a website! That was a bit before my time though. During my career, I have had the opportunity to learn the details about how to set up a state-of-the-art call center telephony system and how to rapidly transition to a functional remote poison center model with our staff distributed across three states and the District of Columbia in response to the pandemic. I have learned more about IT support than I ever thought I would have to know as a nurse.

My newest project that combines advanced technology with clinical expertise is webPOISONCONTROL. This is an innovative, free, online triage tool and app that guides users faced with a poison emergency through a series of simple questions to determine the next steps they need to take. It helps you decide what to do when substances are swallowed, splashed in the eye or on the skin, inhaled, or injected.

The tool collects brief, targeted information from the user and provides a recommendation of whether it’s safe to stay home, if the emergency department is warranted (for very serious exposures), or that further guidance from Poison Control (a phone call to 1-800-222-1222) is needed. When it’s safe to stay home, the user is also given information on specific symptoms that are likely to occur and not of concern, and symptoms that should trigger a call to Poison Control or an ER visit, if they develop. The tool also provides automated follow-up to the user and has the capability to provide further triage recommendations based on the interaction with the user during follow-up. webPOISONCONTROLwas developed and is maintained by a team of board-certified medical and clinical toxicologists. Since 2016, webPOISONCONTROL has assisted almost 800,000 people worldwide with their poisoning exposures.

Can you tell me a little about your disability and how that had an impact on your nursing career as a poison control nurse?

I have Idiopathic Pulmonary Arterial Hypertension (IPAH), a rare lung disease that ultimately leads to heart failure and death. Untreated, the average life expectancy was two years. With optimal treatment, the average life expectancy was about seven years. This was the average prognosis in 2015 – but no one has an expiration date stamped on them. There is no cure, but new treatments continue to emerge so I am hopeful. I suffered with symptoms for many years before getting a diagnosis. By the time I was diagnosed at 40 years old, I was in heart failure and was pretty close to death, but as is pretty typical for most nurses, I still showed up to my shifts everyday even though I was exhausted and dragging myself in to work.

After that fateful doctor’s appointment, I immediately went on sick leave and then short-term disability. I was fortunate enough to work for an organization that had these benefits in place. My supervisor valued me enough to work with me to allow me to work part time from home while I was on disability (this was pre-COVID when most people were not working remotely). This was extremely important to my mental health since I had worked very hard in my career and felt that my illness was stealing it away. Also, work served as a distraction from my devastation at being diagnosed with this brutal disease.

After six months of intense cardiopulmonary rehab, and challenging medication and dietary regimens, I decided that I was going to live like I was going to keep living, instead of living like I was dying. I started the process of returning to work. I had recently become a board-certified clinical toxicologist at that time and because of my experience and credentials, I was able to negotiate a return-to-work plan with temporarily reduced hours and more importantly, regular hours instead of shift work.

I had initially thought my career was over, but once I started feeling better I found I could still meaningfully contribute to the mission of the Poison Center. A new chapter began where I assumed more administrative duties and reduced my clinical practice. In 2018, I became the managing director of the Poison Center and along with my co-director, we have run the organization ever since. I am now seven years out from diagnosis and my life and career are still going strong. I continue to lead the organization, publish research, and develop new problem-solving skills. I am extremely grateful for the support of my colleagues and my board of directors. I could not have done it without them.

Have you worked with accommodations or found anything in particular that has helped you succeed in your role?

By 2022, I was working full time in my leadership role when I contracted COVID and became seriously ill. My IPAH made me especially vulnerable and after managing to avoid COVID for two and a half years, it was finally my turn. I developed bilateral pneumonia and was hospitalized but thankfully not put on a ventilator. I spent five days in the hospital and was discharged home on oxygen. I was able to take another five months of disability leave to recover.

I was still fairly frail when I returned to work, so I was able to negotiate with our disability office to allow me to have flexible hours (flexible start and end times, longer or more frequent breaks during the day)to allow me time to rest. They also granted me the ability to work remotely from home most of the time for a period of six months.

I am feeling much better these days and am working full time again. I am still in cardio-pulmonary rehab (rehab is for life y’all) and though my six-month period of accommodation is nearly over, I have been able to negotiate a plan for continued flexibility. This allows me to continue to be productive in my work while I maintain my health and go about all the activities of daily living. In August I will be taking on a new leadership role within my organization that will help facilitate this flexibility and help me maintain my quality of life.

What would you like other nurses to know about working as a poison control nurse?

Working in poison control is my passion. It’s a hard job and there is a lot to learn but it is so rewarding. Most of what we do as a poison control nurse, we do not learn in school or even on-the-job in a hospital environment. If you enjoy an academic setting and are a life-long learner, this may be a great option for you. Poison center nurses usually have at least two years of experience working in an ICU or an Emergency Department, but nurses in other specialties such as pediatric, geriatric, or transplant nursing can successfully make the transition into toxicology. The most important thing is that you are willing to study and learn.

Also, you need to possess or develop an excellent telephone presence. Most of the work is over the phone. You cannot see your patient directly. You have to picture yourself in the room with them and ask the critical questions that will reveal the heart of the matter and quickly translate the answers into a coherent plan for the patient. Sharp listening and clinical skills are a must. A strong rapport with the caller is necessary to get them to open up and tell you what is happening – even if those things might be embarrassing or even illegal. And I should mention, this all has to happen within about three minutes!

A career in poison control is really what you make of it. Some of our nurses have spent their entire career working on the phones and have helped thousands of people during their career. The clinical focus is their passion and they are dedicated to excellent patient care. Others have a more academic focus and enjoy publishing their research and presenting it at national conferences. Still others prefer the administrative route and work their way into leadership positions. Seek out the opportunities and develop your role.

What additional training, education, and/or professional organization memberships have been helpful in your career as a poison control nurse?

I consider myself a life-long student. I have always enjoyed learning which is what made this field perfect for me. The knowledge base and standards of care are constantly changing and you have to take an active role in staying up-to-date.

The American Association of Clinical Toxicologists has been a great support in guiding the scope of my career and providing high-quality continuing education programs. Their national conference has provided the opportunity for me to present my research and participate in larger conversations about toxicology and patient care.

America’s Poison Centers has informed my awareness of the national Poison Control landscape, especially about challenges that poison centers encounter such as remaining relevant in the face of rapidly changing technology and information (e.g., the advent of artificial intelligence), increasing utilization of our services to prevent and mitigate poison injuries, and obtaining funding to support our mission. It has allowed me to connect with many of my colleagues across the country and develop supportive relationships and facilitate the sharing of ideas to improve efficiency and the quality of our services.

Working as a Poison Control Nurse

Working as a Poison Control Nurse

Sometimes nurses start down one career path and life throws a curveball. One of the many benefits professional nurses have is being able to pivot and change their career focus when needed.

For Joel Myers FNP, CSPI, a career as a poison control nurse happened “completely by accident,” she says. “I injured my knee in nursing school, and I couldn’t do the heavy lifting. I had to steer toward things that didn’t involve heavy lifting because you can’t be in code and have your knee buckle.”

Purely by chance, Myers was at a dinner party and a friend suggested the path of a poison control nurse. She took a chance with no poison control experience but a commitment to a lifelong nursing path. She moved into a grad school track and worked part time at a poison control center in Philadelphia. Working for primary care and family care practices came next, and then Myers switched to poison control full time where she now works the night shift.

Although  Myers has been a poison control nurse for decades, she says the critical thinking and continual learning she does for her work keeps her job fresh. “The amount I have learned on the job is astounding,” she says, “and there are so many things I didn’t learn in school.”

Collaborative Atmosphere

As a poison control nurse, Myers appreciates the close collaboration she has with the rest of her team whether that’s the emergency department physician calling, the physician doing a toxicology fellowship, or pharmacists. “It’s very satisfying and gratifying,” she says. “The toxicology fellows trust us to talk to the public and are responsive to us. The nurses and pharmacists who are on the phone help each other. It’s a nice atmosphere.”

And the collaboration helps manage patient levels in the ED. Of the 100 or so calls poison control gets in a day, 25 to 30 are coming from staff at healthcare facilities, she says. And she sees the work of poison control as helping keep the other 70 or 80 people from rushing to the hospital and overwhelming ED staff when it’s not necessary.

In many cases, the work is pioneering. Poison control nurses frequently work with unknown incidents. “A lot of what we do is discovered after the process,” she says. For instance, a patient may come in from an overdose, but may have other medical conditions that come into play. Or a call comes in and involve a new drug that there’s little poison control information for. “Data collection is an important aspect of this job,” Myers says, and with centers working through the American Association of Poison Control Centers, like Myers’s center does, the extensive network is extremely helpful.

Building on Layers of Knowledge

Because of the rapid pace of pharmacology advances and development and the seemingly infinite combinations of medical conditions people can present with, Myers makes a point to educate herself on developments in areas that aren’t directly poison control. She constantly learns about primary care, general medicine, and even ICU medicine for non-ICU professionals.

“I need to know what’s going on when we get calls from healthcare facilities,” she says. “If I get a call from a doctor in intensive care and I don’t know anything about that setting, that difficult.” Myers says nurses interested in poison control will benefit from getting some real experience on the floor so they develop an understanding of how units work. That work experience also fine tunes important skills related to history taking and communication with patients—both essential as a poison control nurse.

Even with the many complicated calls, Myers says some calls to poison control centers are just soothing parents whose child ate dirt, crayons, or bugs, she says with a laugh. “A hundred years ago, people would run next door to ask mom what to do and people don’t have that anymore,” she says.

Before the pandemic hit, many poison control call centers operated from an area within a hospital, although many poison control nurses can work from home. That alleviates any physical demands, especially for nurses who have sustained an injury that prevents them from some of the more physical aspects of nursing work. Myers’s team began working from home a year before the pandemic. As she is based in Lowell, Massachusetts, the frequent snowstorms can cause travel problems for nurses getting to work, so the shift to home eliminated that problem.

And like any other nursing shift, Myers never knows what the hours will bring. “There’s no way to tell what will happen,” she says. “There are certain patterns to things. Medical errors happen first thing in the morning or at night. Kids get into stuff in the late afternoon. Over the holidays, it’s relatives visiting with medication and kids get into a suitcase and getting ahold of pills.” Then there’s the Christmas trees and wrapping paper at Christmas time, glow sticks at Halloween and New Year’s.

Calm Is Key

But whatever the call, Myers has to have the same calm, focused manner people who call poison control depend on. “People are in a panic,” she says. “It’s like calling 911 because something is going on.” She has learned, however, that getting the story is key. “People need to hear something three times before they really hear it,” she says. So when asking what happened, there’s a lot of whittling down information. When a parent calls and is frantic because their toddler downed a bottle of bleach, Myers says it takes many questions to get the actual story—that the child got into the recycling and put an empty bottle to their mouth and possibly ingested a bit of bleach, but not a gallon. “Cutting through that is difficult and takes finessing,” she says. “They can’t show me over the phone, so you have to focus in on what’s important. Those communication skills are more difficult to learn than the pharmacology.”

The past year has been tough on poison control staff and on the medical staff they work so closely with. “Kids are having a hard time with the pandemic and the number of suicide attempts has skyrocketed,” she says. And that can impact the doctors who call her who may have seen their tenth overdose of the night and are stressed.

Myers acknowledges that burnout as a poison control nurse happens. “Sometimes there’s the feeling like nothing I am doing is helping and that things aren’t getting better,” she says.  But then she hears the gratitude in callers’ voices, gets a genuine thank you from them, and realizes how many people she can direct safely from the emergency departments and she realizes her work makes a big difference.