Michael “Mich” Arnuco is currently studying for his Doctor of Nursing Practice-Psychiatric Mental Health degree at Washington State University-Tri Cities, WA, where he is on track to graduate in the spring of 2024. Born in the Philippines, Arnuco received his BSN from Ateneo De Zamboanga University in the Philippines before moving to the United States.

Arnuco works for a Medicaid based managed care organization, where he has worked for the last eight months. In his position, Arnuco coordinates care for patients with the Health Care Authority and hospitals across the state. He works remotely and supports coordination for patients all over Washington.
WCN recently sat down with Mich to learn more about his nursing experience.

WCN: What inspired you to pursue a career in nursing?

M. Arnuco: I basically fell into nursing by accident. In the Philippines, nursing was a way to get out of poverty. But once I started clinicals in the BSN program, I felt the flame of caring and compassion for patients who needed our care. Caring for patients who are in the hospital and throughout the community, I suddenly fell in love with Nursing.

Living in the Philippines, I was not expecting to move to the U.S., but my dad (who passed away this year, 2022) petitioned my eldest brother and me. I, together with my sibling, joined the military in 2012. After my contract ended, I decided to leave the active-duty component. Since I had my nursing degree, I decided to take my NCLEX licensure exam. The prerequisites for foreign graduate nurses to take NCLEX were heavily cumbersome. To make the story short, I passed the NCLEX and started working in a long-term care facility. I stayed in this setting for a couple of years before transitioning into home health and then to occupational health and public health. As years passed, I decided to be a case manager for people who suffer from mental health illnesses. In these roles, I saw a dire need to care for the mental health of patients in these settings. From these experiences, I decided to venture into a provider level and enrolled in a nurse practitioner program at Washington State University. Additionally, my kid has autism, which led me to choose the Psychiatric mental health nurse practitioner program for my DNP.

WCN: What are some challenges you have faced in becoming a nurse, and how did you overcome them?

M. Arnuco: As a nurse, I continually strive to improve my English to cater to the general population because, as we all know, communication can be a barrier to delivering quality health care. There are also other cultures and races that I must be mindful and respectful of, so I also strive to learn other languages, such as Spanish, at least some basic health care words and phrases.

Low staffing is another challenge. There is a big gap in staffing, especially of CNAs to help our RNs and the availability of RNs to fill shifts. At times in my career, I had to stay on for an additional 8+ hours because they could not find a nurse to cover the next shift. It takes a lot of ethics and heart (compassion) to be a nurse—not just because of the money but because of the patients who need our deepest empathy and care, which are all left behind when your shift ends.

WCN: So far in your career, what do you enjoy most about being a nurse?

M. Arnuco: I enjoy the peer camaraderie. It helps when I need to vent my frustrations. It is also a vital component of self-growth in the nursing community by creating positive memories that are long-lasting in the work environment.

I also enjoy learning conflict resolution strategies and techniques to problem solve complex cases. One great example is the Involuntary Treatment Act under RCW 71.05, where a patient gets detained involuntarily because of a major behavioral health-related crisis causing a patient to be gravely disabled. The goal for discharging a patient who has experienced such a crisis is to engage resources available in the community that help stabilize the patient while in an inpatient status and then get ready for discharge. This process reduces the need for hospital readmission, thereby, lowering healthcare costs. Learning to network with DSHS social workers, the hospitals, and other state services to better plan for discharge has been integral to behavioral health case management. It is a big learning curve, and it takes a lot of practice to get the right resources in place for one patient.

WCN: Why do you think diversity and representation are important in the nursing workforce?

M. Arnuco: I cannot stress enough that diversity plays a big role in Nursing. We deal with patients in a multicultural environment, and often patients have different cultural practices than the other patients. We must respect the unique qualities of each patient and realign our practice, values, and beliefs accordingly to give quality care. Additionally, through my schooling with WSU for my doctorate, I have read studies that state that if we include multicultural voices in our policy decisions, we may find an increased participation rate among the communities we intend to help. When we include culturally different community members in the decision-making process, it promotes trust and snowballs toward quality care and feedback.

WCN: Nursing is a challenging job and often traumatic. What techniques or strategies do you use to build resiliency, remain effective, and not burn-out?

M. Arnuco: Techniques and strategies I use to avoid burnout include maintaining professionalism and heavy application of nursing ethics while I work. I also make sure that I have enough time to practice self-care. Self-care is very important because just the cost-of-living demand in the U.S. is stressful, and the fact that life here is tremendously culturally different from my life growing up in the Philippines. Working is a way of life in the United States for my family and me to survive, but it also takes me away from my family, so I make sure that I make time to go camping and fishing with family and take time off to see the beauty of Washington State.

WCN: What has your experience been working through the pandemic, and what do you think it has taught us about our health care system and what needs to improve?

M. Arnuco: When the pandemic started, I worked in a long-term care setting as COVID spread through facilities here in Central Washington. Staffing was low while many of our patients had severe symptoms, and the quality of care decreased since I was handling 20 to 24 patients (and sometimes 32) and scrambling because of insufficient staffing. I helped move patients, dress them, put them on oxygen, and monitor them because they were desaturating. In 2021, I also helped assist King County in doing mass vaccinations. I also worked with Snohomish County before transferring to King County, where we vaccinated another 100,000+ people. I found that the challenge there was also low staffing and the lack of secure pay for our nurses, who sometimes got laid off from their position.

The thing that I feel we need to improve is how we treat our nurses. The authoritarian type of leadership does not work in a pandemic environment. When it comes to nursing leadership, we must engage ourselves in knowing that every nurse has unique capabilities. To gain your nurses’ trust is to gain independence from micromanaging. We know that behind every situation, our nurses are masking their own sufferings from traumatic events and stresses. Nurses are very good at maintaining composure and professionalism in times of crisis because we don’t want our patients to feel uncomfortable and always put care for our patients before ourselves. I believe that during a pandemic, there should always be an open-door policy where a nurse can talk about things that are bothering them and a free talk therapy service.

WCN: What are your future career goals in nursing?

M. Arnuco: My future career goals in nursing are to advance my knowledge to a nurse practitioner level and help educate nursing students about mental health nursing. It is a less known nursing specialty to the public that needs more recognition and utilization in healthcare. Additionally, the work done by people behind the scenes needs to be exposed and acknowledged for others to be educated and understand the work that mental health practitioners, clinicians, managers, and nurses put into improving the mental health of our society. I have attended several Health Care Authority committee meetings where we discussed on several occasions that Washington state is suffering from the opioid epidemic while our system is still flawed. Awareness around opioid addiction is still low, which causes health disparities among Washingtonians. We still have a stigma among the general population around opioid use, and I want to completely change that perception.
I also want to be a part of increasing the population of nurses in the years to come, so I have decided to become a clinical instructor for Heritage University.

WCN: Given your experience in your nursing program and nursing so far, what advice do you have for those considering a career in nursing?

M. Arnuco: Because nursing is a path involving a lifetime of development, before someone goes into the field of nursing, I would strongly advise them to examine and know themselves. Nursing does not stop when you achieve a degree or when you start achieving a graduate degree. It is also based on a passion for improving healthcare and removing the disparities in our nation. Nursing is an evidence-based practice that strives to give the public a good trail on the achievements of nursing throughout the years. Nursing is more than just a degree; it is a way of living that you share with other people. You will always be remembered by people you cared for.

WCN: Is there anything you would like to add?

M. Arnuco: One thing that I want to emphasize is that we must stop bullying in nursing. It is rampant. Nurses who have been in practice for a while may not notice this as a problem, but it’s very noticeable for new nurses. For nurses just coming into the field, I think expert nurses can all agree and come together to teach great techniques, compassionate care, quality care management, and promote camaraderie. Please treat new nurses with compassion and care so that they do the same for the next generation of nurses.