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How Telemedicine Helped Me Live My Best Life

Telemedicine offerd a fork in the road and I took it
subbotina/123RF.com

In a time from my “previous” life, which I’ll call “Point A,” I had labels which defined me. Psychiatric nursing professor, clinical nurse specialist, and wannabe writer. In this new life, henceforth to be known as “Point B,” I’ve given myself a whole set of new labels. Just call me a digital nomad, location independent, tele-mental health therapist, and now, published author, too! How did I move myself and my professional career from “Point A” to “Point B?” What did I have to do and why did I do it?

As a full-time professor in a for-profit two-year nursing program, the salary, hours, and working conditions were abysmal. I was tired and miserable and, frankly, tired of being miserable. Something “had to give.” While teaching, I stopped doing psychotherapy and let my private practice “fizzle out.” My exhaustion and misery left me with no desire or energy to see patients at the end of a twelve-hour day or on weekends. My scarce and precious discretionary time was used to do catch up on sleep or doing the laundry.

Three years later, I sit in an outdoor cafe in Guanajuato, Mexico. It’s still winter “up north,” where here, it’s 86 warm, lovely degrees. After a nice dinner with some new friends from my Spanish class, I’ll go back to where I am house and pet sitting for the next two months. Tomorrow morning, I’ll turn on my laptop and work for a few hours doing psychotherapy with some of my already established American patients. They reside in one of the 30 states in which I can legally practice nursing, thanks to the enhanced nurse licensure compact (eNLC). How is this all possible, with them there, and me here, south of the border?

It started with a dream that I brought to fruition, to work on my own terms. I wanted control over my work life. This included no longer having a boss or a time clock to punch, as I did when I taught. With help from technology and the Internet, I was able to liberate myself from a “bricks and mortar” office and traditional 9 – 5 hours. I knew that my “Ivy League” nursing education, board certification as a psychiatric clinical nurse specialist, and skills as a therapist would not fail me. I just needed to figure out how to parlay these into gainful employment and an improved lifestyle.

Not so easy! Doing psychotherapy over the Internet was still in its infancy and not widely accepted by either professionals or patients. Although I was a master’s prepared advanced practice nurse, I had chosen to not pursue nurse practitioner status. As a result, I do not have prescriptive authority, and without it, I am less marketable. Hence, my scope of practice is limited. However, to me, it’s an advantage. I do what I love, which is psychotherapy. It eliminates more potential liability for malpractice. It also made no sense to me to incur student loans at this point in my life!

As an “early adopter” of doing counseling remotely, I sensed the power and potential of the Internet. I saw how it could reach those who might not otherwise engage in face-to-face psychotherapy. This, and my years of facilitating online “support groups,” helped propel me to my “Point B.” So did many other factors. The last time I had taken a “time out” from nursing, I invested $1200 and six weeks of my life to become certified as a teacher of English as a Second Language. That was truly an inexpensive, fast, and easy way to try something different, and maybe, even change careers altogether. I knew I would have to do something in order to finance my burgeoning travel “habit,” as psychiatric nursing would not be easy to do in most other places in the world. I got my first English teaching job in Kagoshima, Japan, and was there for 14 months. I taught children from ages two to sixteen and got to practice my singing, dancing, jumping, and running skills on a daily basis.

On returning to the U.S., I did not want to do traditional psychiatric nursing for many reasons. One – time was passing by too quickly, and at my age I just didn’t want to do it anymore. Two – I was afraid to return to inpatient psychiatry. I feared being injured, with patient acuity on the rise and safe staffing on the decline. I doubted that my “aging body” could handle 12 hour or rotating shifts.

Third – returning to school for a nurse practitioner certificate and a DNP degree (to become a doctor of nursing) seemed completely antithetical to the vagabond lifestyle I wanted and had begun to build. What I wanted to do in my “heart of hearts” was to travel as much and as far away as I could, for as long as possible. Since I wasn’t ready (nor able)  to completely retire yet, I had to find an alternative way to support myself.

It came down to intense reflection and asking myself what I really wanted from life. It was more than just sailing off into the sunset. A complete self-inventory was necessary. For example, where do you see yourself and your life in one year? In five years? When you retire? List your skills, work-related and not. What can you do with them? Be creative! Is going back to school or changing careers a realistic option? Do you want to work in your pajamas? Write the Great American Novel? Tutor English online to Chinese children? Do you enjoy computing? Maybe telemedicine would work. As long as you believe in endless possibilities, breaking free from whatever is holding you down or making you unhappy does not need to remain a fantasy. You, too, can get from “Point A” to “Point B.” With some help from a not-so-small and very unexpected gift from the universe…I was able to do this. I will tell you more about it next month.

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About Marcia Starkman

Marcia Starkman, M.S.N. R.N., PMHCNS-BC, has been a psychiatric nurse for more than 40 years, in a variety of roles in clinical, educational, and administrative settings. She was inducted into Sigma Theta Tau International Honor Society of Nursing as an undergraduate at the University of Miami (B.S.N.1978). Her M.S.N. (Child/Adolescent Psychiatric Nursing) is from the University of Pennsylvania (1983).

Ms. Starkman is board-certified as a Psychiatric Clinical Nurse Specialist in Adult Psychiatric Mental Health Nursing by the ANCC. She is in private practice, and provides online and telephone counseling to women, nurses, and digital nomads. She is also a contributor to many health and psychology related websites.

Perinatal mood and anxiety disorders have been a focus of Ms. Starkman’s work for many years. She lived in Canada from 1988 – 2009. From 2000 – 2003, she served as Vice President of the Board of Directors for PASS-CAN (Postpartum Adjustment and Support Services Canada). In 2005, she was a member of the Registered Nurses’ Association of Ontario Best Practice Guidelines Expert Panel - Interventions for Postpartum Depression. She also participated in the making of the documentary “Pardon My Postpartum” (2008).

Ms. Starkman is an avid traveler and enjoys reading, writing, cooking, knitting, and sailing. She lives and works aboard a 32’ Bristol sailboat, which is currently on the southwest coast of Florida. Her website is aptly named “Sea Your Shrink” at www.seayourshrink.wordpress.com/.