Roads Taken

A Place to Land: Shannon Smith-Bernardin on caring for others and determining what is needed

Episode Summary

Feeling as though the only options to her if she stayed in Maine were being a nurse or a teacher—and neither seemed to suit her—Shannon Smith-Bernardin headed for the sun and urb feel of Los Angeles. A bit aimless for a while, she finally found a path that led her to help others and, ironically, to fall into both of the careers she had once eschewed. Find out how opening your heart to the people who need you can sometimes put you where you need to be.

Episode Notes

Guest Shannon Smith-Bernardin, Dartmouth '96, knew she needed to get out of Maine, as the only prospects she saw for herself there were nursing and teaching. With two duffle bags and $400 in her pocket, she landed in Los Angeles and then landed a string of jobs that didn’t feed her soul. In supporting a friend through rehab, she learned more about her own past with alcohol and co-dependent relationships that helped her reflect on how her skills and interests in helping others could be realized in a career in nursing.

Ultimately, she found her place within the community nursing space, helping other people find places to land, if only temporarily. In both professional and volunteer roles, she has developed expertise around the care of homeless populations, the social determinants of health, and alternatives to emergency medicine, particularly the management of sobriety centers. // In this episode, find out from Shannon how finding the community you’re drawn to help can provide you with as much as you give on ROADS TAKEN...with Leslie Jennings Rowley.


About This Episode's Guest

Shannon Smith-Bernardin, PhD, MSN, RN, is an expert in the safe and efficient utilization of sobering centers for caring for acute alcohol intoxication. She is an assistant adjunct professor at UC San Francisco, primarily teaching a course on "street nursing" and currently provides consultation to communities who are seeking help with their homeless populations or are looking to establish or manage sobering centers. She also directs the efforts of the non-profit National Sobering Collective. Find out more at




Executive Producer/Host: Leslie Jennings Rowley

Music: Brian Burrows

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Episode Transcription

Shannon Smith-Bernardin: This one woman who is about 40 years my senior was listening to me again, and finally, she was like, I am sick of listening to you complain about your job and the fact that you have no idea what you're doing. What do you like to do? And within a few minutes, she's like, you need to become a nurse. That's what you're meant to do. And I was like, I have literally no idea what nurses do other than what I see on television. And at the end of the conversation, I was like, I want to be a nurse. 

Leslie Jennings Rowley: Feeling as though the only options to her if she stayed in Maine were being a nurse or a teacher, and neither seemed to suit her. Shannon Smith-Bernardin headed for the sun and urban feel of Los Angeles, a bit aimless for a while, she finally found a path that led her to help others and ironically, to fall into both the careers she had once eschewed. Find out how opening your heart to the people who need you can sometimes put you where you need to be on today's Roads Taken with me, Lesley Jennings Rowley.

Today, I'm here with Shannon Smith-Bernardin, and we are going to talk about finding your community, helping other communities and maybe the fact that those things mix is an insight. So nice to have you here, Shannon. 

SSB: Thanks for having me. 

LJR: OK, so I start this the same way every time. And I ask when we were in college, who were you. And when we were getting ready to leave, who did you think you would become? 

SSB: Yeah, I've been thinking about this. When I was at Dartmouth, I was a kid who came from a small town, rather isolated. The town I had was less than 1900 people. And so Dartmouth was massive. I mean, it was bigger. It was twice as large as the town I grew up in. And I, you know, I had a good pre-college experience, but it was fairly isolated. I didn't date. I didn't drink. I didn't really do anything bad. I was the good student, the great student. So I entered into Dartmouth with, like, big ambitions on my head of what I was going to do. And I went in like full blown of like probably premed because good students become doctors. That was kind of the mindset I had. And then college hit. I was not the best college student. I had my first drink my second day. I actually missed the president's address to the freshman class because some guys in fraternity swung by my dorm and a bunch of us gals ended up going to the fraternity instead. And I did a lot of partying. I did a lot of drinking. I think it was the idea of being like a big fish in a small pond from where I came from to suddenly, like literally being in this massive ocean with just big fish everywhere. And I didn't fit in anywhere. And I didn't connect to professors very well. And so I was kind of like mostly lost. By the time I was getting to graduation, though, things started slowly but surely coming together in the middle of senior year. I don't know what it was, like, something clicked. And the friends I was hanging out with, I had a core group that we did a lot of stuff together, and by the time we were graduating, I was just like, OK, my grades have gotten better. I've been paying more attention to classes. I was very excited. And I had a one-way plane ticket to Los Angeles. And I left six days after graduation. There was a ’95 who was out in LA, and I he had a couch I could sleep on. Ironically enough, I think there was a ’94 sleeping on the couch the day I got there. And I had sleep on the floor my first night in LA and that was it. I moved to Los Angeles. I wanted to get out of Maine. I wanted to get out of New Hampshire (Maine’s where I grew up) and just do something different. So that's pretty much what I did. 

LJR: OK, but why Los Angeles? What was the draw there? It was as far as possible away from Maine, maybe San Diego. You didn't know exactly. 

SSB: I was so naive that I thought, literally I thought Los Angeles looked just like New York, but was on the West Coast. I thought it was the exact same thing but on the West coast. I wanted warm weather and a big city. That's all I wanted; those were my only two criteria. I have $400 in my pocket and two duffel bags. I just figured I'd start over someplace else. 

LJR: And what was it about the urban idea? Because you had been so isolated and small, got to this place that, quite frankly, is isolated and small, but you thought it was big. And how do you go from that to a metropolitan mecca?

SSB: I just knew I needed to be doing more stuff. One of the main things in this, which I find slightly ironic later in life, is I knew if I stayed home like in the town I grew up in, the only two options for me that I saw at 18 was to become a teacher or a nurse. And I was just like, I don't want to do either of that. So I need to figure out something different. And I just knew that there are so many more people out. There was also one of the things that Darmouth wasn't very good at, but it was still better than my town was the diversity. So people from other countries, people of all different races and ethnicities, we didn't have that a lot. And I just knew that if I went to a bigger city, I'd be able to meet more people who had just different backgrounds. And that was kind of some of my main focuses is just meeting and seeing different people. So, Yeah. 

LJR: OK, so tell me, with $400 and a floor couch, what do you do to figure out how you're going to have more than that?

SSB:   Job hunting. And amazingly enough, I was able to make a connection with a Dartmouth grad who was I think he was a ’72 or ’73 who worked for a computer company in Marina Del Rey in Los Angeles. And I was able to get an interview and ended up getting a job at that company, maybe three or four months after I'd moved to LA and so, yeah, I got that first job. And I spent the next couple of years there. And that kind of launched the next few years of changing jobs over 18 to 24 months. And I ate ramen noodles two meals a day. I had a $2 a day food budget. And I just kind of made it work, you know. So Yeah. 

LJR: The, the switches and the job changes…all of that because computers aren't going to be your thing, and so you're still trying to find what that was. When were the moments coalescing or how were they coalescing for you to be like, I think I'm starting to see a pattern, a vision of a destination?

SSB: It was it was around when I was 25. So I'd been there. I was on my third different job. I did a variety of things. I did the computer work. I did insurance for a while. I did finance for a while. I did cell phone rentals actually, before cell phones came back, we rented cell phones to the movie industry. So I used to go on movie sets. And like bring 80 to Nextel cell phones with me, you know, and that's when the stars, they had cell phones. And so I had, like, lots of famous people's information on my laptop for work. It was hysterical. And when I was 25, 26, I had a friend go to rehabilitation. And I went to family and friends day at rehab with them and had lunch with a bunch of the people, including a physician who was sitting next to me at the lunch talking about drinking. Dartmouth comes back up and basically, that's the day I realized that when people talked about blacking out, I thought they meant they can't remember anything that happened the night before. What most people mean when they say they passed out or whatever is that they drank too much, and they remember everything up until the moment they fall asleep. I had had my first blackout where I couldn't remember what had happened, freshman fall. And that happened probably 200 or 300 or 400 more times over the next few years because I had extremely high tolerance. So I could still run around and hang out. But I couldn't remember anything that happened to me. And so I was talking to this physician. And he was like, no, blacking out is like a bad thing. You're not supposed to do that. That's like a problem with your brain and alcohol and their communication does not work very well. And so I quit drinking that day, didn't have another drink again for a little over five years, and during that time had joined Al-Anon, which is the for friends and family of alcoholics. And I did go to AA periodically. But Al-Anon is really where I needed to be, because every relationship I had, including ones at Dartmouth, were very co-dependent. And that's actually probably one of the main reasons why I didn't do so well in college as I was dating somebody who did not do well in college either. And I drank a lot. And so I basically spent a lot of time in Al-Anon in the rooms. And it changed my life. It started making me realize, like, OK, I have to get back to, like, all that energy I have. Moving to Los Angeles. Like, these are all things I want to do. But I wasn't really doing all of it. It wasn't bad, but I wasn't really doing what I really wanted to do. And so I just started figuring, like, what can work and started listening to, like, what was going on in the universe around me and what I was paying attention to and what I liked. And the big day ended up happening where I was. This is how long ago this was: Mamma Mia! had come out into the theater. And myself and 16 ladies from Al-Anon, we're all going out for lunch and to watch Mamma Mia! And I was sitting at the table with all the girls and there's one woman who is about 40 years my senior was listening to me again. And finally, she was like, I am sick of listening. You complain about your job and the fact that you have no idea what you're doing. What do you like to do? And me, her Lucy was her name, and these two other women at the table basically started quizzing me about everything I liked, what I wanted to do, what I like to do, that type of thing. And within a few minutes she's like, you need to become a nurse. That's what you're meant to do. And I was like, I have literally no idea what nurses do other than what I see in television. And so they what I didn't realize is all three of them were registered nurses and they all have extremely different jobs. And at the end of the conversation, I was like, I want to be a nurse. And so the next day I called in sick from work. And I went to Santa Monica College because by that point, all of my sciences from Dartmouth had expired because the game can't be more than five years old or they don't count. So I had to retake anatomy, physiology, all those other sciences again, which was great. It got me back into school. Amazingly enough, I was able to get into anatomy just by signing up that day, which is unheard of right now, because it's such crunch, trying to get into community colleges and went to work the next day and actually got fired because I'd been slightly outspoken to my boss about how I thought the company wasn't doing very well. And we weren't charging enough money for the services we're providing, ironically enough, the company did go bankrupt within a year. So the next day I was like, OK, now I have no job. And I had a joining a EMT for emergency medical technician to work on an ambulance and did a three-week EMT class. And then I spent the next couple of years working on an ambulance and in the emergency department and applied and went back to school. And kind of that was when that whole thing happened. 

LJR: So, wow. So much, so much. So I find all of this really interesting because of things that you've said: that you came from a small town and the only thing that you thought you could be as a teacher or a nurse, and there's a little foreshadowing here, but you've done both. And you also weren't a very good student. And you're going back to almost square one. But it was just this drive that you had. Like now I figured it out. Now I know what I'm supposed to be doing. How did that make you feel?

SSB: Oh, it was literally the greatest thing that ever happened to me because I finally had a purpose, I think, again. And I was so lost in college. I wasn't, I mean, I wasn't lost in high school. But I was the good student, I did everything, I did everything right, then I went to college. I mean, this is the irony. When I went into nursing school, it was an entry level master's program. So you have to have a bachelor's and something else. I'm just going to put it right out there. I was in the bottom 10% of our graduating class, apparently at Dartmouth. I had to start nursing school and academic probation because my GPA was--so I didn't hit a 3.0. So for any of you out there listening. You can still survive and get a doctorate even if you crapped out on college. Yeah, it was awesome. So I just, it finally was one of those things that--back to your question-- nursing and the whole prospect of going into health care and having this realm. I mean, it's exactly what I've been looking for. I've been trying to find something I really wanted to help people. And I've been volunteering a lot like I worked. I worked a lot with homeless agencies in Venice. And in Los Angeles. But I didn't have a big role other than a community member who is trying to help individuals who are homeless in the neighborhood, like have a better life. And nursing was able to kind of really put me on the forefront of what ended up being exactly what I want it to do. So, Yeah. 

LJR: And so you mentioned those three ladies at the lunch that day. They all were nurses, but they all had such different specialties are the kinds of jobs they had. But you kind of from that experience, both with sobriety support systems and the work that you were doing community wise in homelessness, you really did kind of start thinking, I know even what kind of nurse I want to be, right?

SSB: Ironically enough, not until after I actually got the R.N. Yes, I thought I want to do emergency nursing because I was doing an EMT. So right after 9/11 ,that next month. I had my first skydive. And so I spent the next 2 1/2 years kind of as a hobbyist doing skydiving on the weekends. And so I was just like, OK, the whole idea of doing flight nursing and working on a helicopter and doing that stuff just seemed very intriguing to me. And so what? I became a nurse. That's when I left LA finally. I moved up after 10 years, lived up to San Francisco and got my first job at San Francisco General Hospital and a sort of emergency department because I thought that's what I wanted to do. And after three months, I realized between myself and the nursing directors there that it just wasn't a great match. I spent way too much time talking to the patients, and I spend way too much time really interested in talking to people who are homeless and had substance use disorders. So I moved up into it's called medsurge, medical, surgical nursing, which is like the standard for nursing. That's kind of where everybody goes. If you go to the hospital because you're sick with the flu or you've got a surgery, most people just go to medsurge. So I went, move there. And I end up loving it. It was entirely unexpected. And over the next few months. I was like, I was really wanting to working with people who were very, very low economic status for most people who came to San Francisco General. And then I was just good at working with people with substance use disorders much better than I thought I was going to be. I just I don't know. I either related to them, but even then I was just good at it. And I really enjoyed working with people who had these situations. And a member of the homeless outreach team had come in one day working with my clients. And I was like, they have big giant HOT jackets on, homeless outreach team jackets. And I was like, who are you guys. And what do you do? And they're like, well, we're almost out. We go to encampments, we do the stuff. And I was like, I want to hang out with you guys. So on my days off, I'd go hang out with the homeless outreach team and kind of go on shifts with them. And then I was doing my master's work. And I ended up on a clinical rotation with a paramedic captain who ran a homeless outreach medical emergency team. And so his home team was basically going out to encampments for, were going out and finding individuals, not just encampments, but folks who were homeless. High users of the medical services like go in an ambulance is a lot. And usually had very complex medical and social conditions. So they might have lots of comorbidities in terms of like heart disease, congestive heart failure, diabetes, that type of thing, but also substance use, potentially also mental health condition potentially. And so I end up doing about a 400-hour clinical rotation with him. By that point was just telling everybody at the hospital, like, I want to work in a job, not in the hospital. I want to go to the community specifically with people who are homeless. If you hear of anything, let me know. And a few months later, San Francisco is opening up our medical respite program. And medical respite is a medical shelter for homeless adults who are medically frail. So they are in the hospital for surgery and pneumonia, flu, whatnot, and they're coming out of the hospital and they're too ill to recover on a sidewalk. Obviously, everyone's too ill to recover on a sidewalk as far as I'm concerned. But they can go from the hospital into this respite program for a few days, up to many months, depending on how ill they are and what their situation is. And so that job was they were opening it in San Francisco for the first time. And so I was one of the founding two nurses at the program back in 2007. And that's how I started getting in the community at that point. 

LJR: Wow and that kind of became your life, the thing you were really focused on both as a profession, but also you were on boards that were dealing with one or the other or both issues of homelessness and sobriety and that sort of thing. At some point, though, and you alluded to this, but so is that something that you knew you would need to ultimately do something else or it just seemed there was some other call. Tell me about that.

SSB: Yeah, it was, I had no idea I would go get a doctorate. I mean, I had no idea I was going to go a masters. That was just something that grad school had never been something that I ever even thought about when I was younger. But I was at the respite, the sobering center, for a few years. And so the second part, the rest of it was there. And then the sobering center, which is a community facility for people who are intoxicated in public, can be brought in to sober up for a few hours, four to 12 hours typically. So that was co-located with the respite program. So I was working with both of those. And I was very excited about this sobering center. I actually was that was one I'd known about it prior to starting at the respite. And so that was one of my just absolute loves. So I'm there for a few years. And at that point, I just wanted to do like doing direct service is fantastic. Working with the clients. It just it made it easy. Go to work every day. And I was there sometimes. I was working 60, 80 hours a week. And I loved it. I mean, of course, it's stressful to work that much, but I never regretted doing it. I mean, there was a point where I had to hire a whole new staff. And we had to transition one full staffing model to a new staffing model. And I had to keep the program open myself, my boss and a medical assistant, because we had no staff. All the staff have been in transition to other jobs. New staff had not started yet. We had a full month with no staff and my boss, myself and one medical assistant who could not work by herself. So one of the two of us had to be there with her the whole time. Literally kept this 24/7 program open over 60% And so I camping gear in my office. I slept on the floor like, you know, while the medical system was working. I go upstairs, catch a catnap, come back downstairs an hour later to check on things. It was…And I loved every minute of it. But by that point, it's like there's so many things going on in the system. The system's broken. This is our health care system is shattered. And one of the main things that we don't have in this country is we don't have a safety net. Shelters for individuals who are homeless were created as they were supposed to be, they’re emergency shelters. They're supposed to be someone loses a place to live for a variety of reasons. And it could be 100% not intended, like the house burned down. Need a place to stay. Red Cross will put you up for a couple of weeks, but that's it. This is not going to your house is going to rebuild in two weeks to people whose family throw them out because, you know, we have a lot of folks in the West Coast who came from families who don't agree with their gender identity, with their sexual orientation, so they suddenly lose a place to live and now they're left on the street. And so the system doesn't catch people like this very easily. And many other countries have a social network of money that go to this. It's different health care. And that's a whole different topic, which I'm not the expert in. But I was just like, the system is too broken. And I wanted to be able to influence it better. And so the, UCSF, University of California, San Francisco had a School of Nursing and they had a doctorate in nursing and health policy, which kind of looks at policy, looks at the big picture of, like, how things get done. And I was intrigued. So I ended up applying to the school interview with some of the faculty over there. And it was mainly because I just wanted to have a bigger impact than the single program I was in. And I had started focusing more and more on the sobering center side of things. And not a lot of people knew what a sobering center was. Most people still have no idea what a sobering center is. And so I kind of started looking at that.

LJR: Very cool. And I mean, you talked about the workload that just seems grueling. But you keep saying that I loved it. I loved every minute of it. But there is a real emotional labor to this work. And so how are you able to I mean, there's no balance to that, but how are you able to manage that while you were in face to face services, also as a doctoral student? Talk to me about that. 

SSB: I wish I could say it has been, that I figured it out and it's done. I haven't. I was an emotional wreck for many years. In general shortly before…So after I got married and then basically got married and then was my I started my doctorate exactly one year later as my first day of classes in between that time, right before I started my doctorate, my father committed suicide. And so at that point, I was like, I had no idea what was going on in my life. And so I started this doctorate program working full time right after my dad died. And I was pretty much an emotional disaster at that point. I, you know, compensated. So a lot of what you're talking about. So just the work itself, there's a level of secondary trauma or vicarious trauma that. Yet from hearing and working with people who have their own traumas, it's super true, super real, one of the reasons why I end up going back to get my doctorate was because of some of that trauma of working with people where the system wasn't changing. And so it was like me to go and try to help at a better level. I spend a lot of time like, you know, what's my self care regimen? I exercise like it's going out of style. During that time for school, it was I lived about a mile and a half from where UCSF was. And so I would walk, you know, it was all up and down hills through coal Valley and in the Castro. And I would walk every day with my 25 pound backpack on because I carry everything I own with me. I think every time I have the bag lady from when I was in my 20s because I can't go anywhere without bringing, I could probably survive for a week, anywhere I go based on how much crap I carry with me. It's, it's very funny. So it's tough like not to get overwhelmed. I try to take care of myself the best I can. I cry sometimes. I think the biggest issues when one works in this type of environment. So I am seeing people who I mean, they've lost everything. So many people, if they've lost their families, they've lost their kids. And people end up homeless for a variety of reasons. And some of it. Are you can look at like if you mapped out everyone their lives, you could say, OK, here's your decision point. I probably should have made a instead of B and but the reality is, is if we had a better safety net, we would have caught them in that bad decision. The second thing is that people just they end up there for a variety of reasons. You know, one of my clients. I remember when I was inpatient, he in his 40s, a horrible heroin addiction, horrible heroin addiction. And he and I talked a lot. He was in the hospital for two or three or four weeks for an infection. And he was a totally normal guy. He had been like anybody you knew down the street. And he went to work one day and he came home and he found his wife murdered. And it was a bad situation like what had happened to her, and that was it. He broke and he ended up on the street. And he ended up having an addiction and had not figured out how to recover from that yet. But some of the things that I rely on to feel better about things. And that one. I'm helping to have less trauma is that, you know, this guy is now in the hospital. He's getting three meals a day, he was on an IV antibiotics and he was doing OK. You know, he was not the best still state because we knew he'd be discharged right back out to the sidewalk as soon as he was out of the hospital, most likely. But, you know, did OK that day. Our clients were homeless, have come to medical respite program. They stuck around. They took their meds five out of seven days. Excellent they drank a little bit less that week. Perfect and then some clients do extremely well. They go to housing. They're very excited to fill out paperwork. They're very excited to, like, be like, OK, this is the moment. I want to fix things. Or they finally have the opportunity to fix it. And there's so many people are like, oh, the homeless just want to be homeless. They like it out there. If you've been burned by the system that many times and treated horribly, every time you go to the health care, every time you go to the emergency department, every time you try to go someplace, it's not like you can fill out a form for an apartment and get one. It's just that is impossible. And they have been promised. So many times that, like, don't worry, I hope you will get you into housing soon. And five years later, nothing's happened. I'd be pretty distrusting of the system. Also And so when clients are able to make that next step because the system has responded well to them and/or they're finally ready, like, OK, I'm going to trust you now to make that helped me make this happen. And then we go from there. 


LJR: So so when you got your PhD thinking, OK, this is a step at least toward my fixing or addressing the systemic issue or set of issues, that's still almost insurmountable. So so what do you what do you do with that degree and at that moment? And how is that period gotten to where you are now? 

SSB: Yeah, so my focus ended up being for the doctoral work. So still working at the respite care center, my focus was on sobering. So it was on the…my doctoral work was around individuals who are publicly intoxicated who come into the sobering center, specifically the relationship with the EMS system, the ambulance system and how well people did who came to us via the ambulance versus going to the emergency department and whether or not it was a safe level of care, which is something that research had not yet shown. So all my focus went on to that. And during the time I was in school, we had this random assignment. We had to contact an expert. So I contacted a gentleman who's a physician actually out of Colorado springs, Colorado, who had done a research study similar to the one I was trying to do. And I emailed him some questions. I thought it was a silly assignment, I'll be honest. But he ended up email me back within an hour, this massive email back. Look, I'm so excited you email me. Here's a whole bunch of answers to your questions. So I emailed him back. And then I was like, I'm just going to email anyone who's done anything close to this work. [There were] only about three or four people in the country that I was able to find and one of them at a Brown University, we connected. They had a conference in Seattle. He's like myself, one of my colleagues, these two physicians, we're going up to Seattle for a conference. We know some other people that are very interested in the topic of public intoxication. Once you bring up some of your work from San Francisco, we'll all meet up there. I flew up to the conference that they were going to. I did not go to the same conference, but we had our very first meeting of like 20 people in the room who were talking about this sobering center concept. And it was a first time to talk to anyone outside my own program about it. And we continued from that point. That was 2014. We ended up founding the National Sobering Collaborative, which brings together sobering centers across the country who do this work around public intoxication. Two years ago, officially were a 501c3 nonprofit. I run the board of directors, technically, like I'm president and co-founder of the collaborative. And we just, we're slowly but surely like bringing together people across the country that are interested in this work. And so that's kind of like it's gone a lot slower than I thought it was going to do. I don't know. I don't know what I had expected. I did get the doctorate, which is lovely. And then we've continued on with this collaborative. We still are just a fledgling organization, but we have with monthly calls, with programs across the country, and we're putting together standards and toolkits to help communities put together this kind of work. And so that's where I've kind of taken off. And then after. And this is where the next major pivot came. So I'd been at the respite and sobering for almost 10 years. At this point, I finished the doctorate and I was like, I need something different. I kind of expired what I could have done in San Francisco at that program and also some of the staff that had been there for years. They have so many fabulous new ideas. And I was like, I need to get out of the way. There are some people who just needed to take over the stuff I was doing in a new way. And so I started looking at the jobs and found one in Los Angeles. And so I took a job in LA that was going to basically help bring together my clinical experience, the policy experience, and then my evaluation data side of things, from the doctorate. And so I started commuting down there from the Bay area, which was kind of a lot of fun to fly down. I got a little apartment down in LA and had a car down there and just had this whole little second life almost like back and forth between my home up here. And at that point was like, OK, this is perfect. But the job didn't end up panning out. I stayed for a year and a half. For one thing all the nurses really I mean, as a registered nurse, you literally can do anything. You could be a school nurse, you could work in a shelter, you could work at a clinic. You could literally do anything you want to do. But in a county system, or I guess and in a county system, there was just a certain level of hierarchy that happens. Like you're a registered nurse, you're a nurse manager, you're an associate nursing director, you’re a nursing director. And it's very managerial and very administrative, the path that nurses have to take. And that was the path both San Francisco and Los Angeles kind of wanted me to follow. And I don't fit into that box well. I was a manager and I've done a lot of administration, but it wasn't where I wanted to go. I wanted to do more policy. And so two years ago, after a year and a half in LA, I decided I had good conversations with my supervisors down there. The job wasn't panning out the way I wanted it to pan out. And the way they wanted it to, either because we're like, OK, we're all in different pages here. Where are we going to do? And so after we discussed, I was like, OK, I'm just going to I'm going to leave. And I'm going to figure it out. And so I left the job and decided to kind of break out on my own. So now I'm still running the nonprofit. That's happening. So that's one piece of what I do. Gotten back into UCSF as an assistant faculty there, UCSF and many universities, especially if you do research, they don't just pay you full time to go there and do research. You have to bring in grants. So I'm still currently mostly unpaid. I have at the smallest FTE that I've ever even knew existed. But for me, teaching a couple of classes on street nursing and I've done in policy class and such there, so that's a little part of what I'm doing. I've written my first NIH grant. I'll find out at the end of February if I get that which 99.9% of the time you don't get it the first time. So you'll have to do reapply. So that's what I'm trying to get in with UCSF. And then the third thing I started doing was--I hate to use this phrase because it gets treated very badly in my field, but-- consulting. So I help work with communities in specifically in interventions for individuals who are homeless or around public intoxication and potentially sobering centers. So I currently work with one of the counties here on their Street Health outreach teams. And so we have teams that have peer level, individual social work, a nurse practitioner and a registered nurse on the teams, and they go out to all the encampments and help. Work with some of the more medically frail individuals and socially complex individuals who are homeless. I've helped other cities like do needs assessments and business plans around if they opened a sobering center as an alternative to their jails or emergency departments and what that would look like. And so that's kind of mostly what I'm doing at the moment. So it's like the type of things.

LJR: Exactly, I was going to say that's a lot of things that you're doing at the moment. It's just interesting to kind of think about who you thought you were going to be saying, no, no teaching, no nursing, that that's going to keep me too small, right? I think that it wasn't so much probably that those professions didn't speak to you. It was like those are the only things that would keep me in this little town. And and it's probably your desire to fly. And so what would that Shannon say to you, say to all of this that has happened? 

SSB: Yeah, it is funny. And the irony of the becoming a nurse and a teacher literally is something that I hadn't thought about. I really like how you just said that, because I really did have this impression that it would have pigeonholed me into something that I wouldn't be able to get out of. And I didn't see the breadth of what one could do at that time. And coming from a small town, I mean, 1900s people is tiny. And and this is kind of a tangent, but like, I don't have children, I didn't want children. I made up my mind in my 20s that I was like, kids are not for me. I love kids. I love being a aunt. Aunt Shannon's the best. But the idea of being a mom had zero appeal to me. I didn't play with dolls that much when I was a kid, that type of thing. And that was one of the things that really wanted me to get out of the town. I just saw, like one song became a mom. They would lose everything that they had and I'd seen that happen to so many people. And I'm not saying my mom ended up actually being a teacher and had gone got her master's. So she did great. And did exactly what she wanted to do. But I saw that as something that was going to hold me back also. And I don't know if it would have you know, I'm 100% happy that I did not have children. And I'm still very happy to this day that I did not have kids. But it was this idea of being, like, stuck. And I think that's what I'm like, bringing it back to, like, why one of the big city in LA? I just wanted to go someplace where, like, the options are on the table. And even though I didn't know what I wanted to do. And I know this sounds kind of silly, but I just I kept thinking that as soon as I made a decision, that was the last decision. I was allowed to make, right? And that was, it's like, if I'm going to go out going to do this, this is my job. That's it. I was done. And I think some of the focus that we got as kids growing up. And then in college was what's your career going to be? What are you going to do? Who are you going to be? That doesn't it doesn't exist. Like it doesn't exist. Like you could one can go out and find that perfect job. And I'm sure if I decided to go into being a physician back then, I probably would have been a great physician or I would have burned out. So hard core med school because I would have been constantly my brain going, did I make the right decision? Did I make the right decision? Because this is the only thing that matters, because as soon as I made the decision, I was stuck. And to me, I would just want my old self to know: one decision will literally not make or break anything. You can go back. No, you won't go back. You'll just take one will take what they learned in that situation. I've taken what I've learned in life. Was that the best decision? It was the right one at the time. Here's a new decision to make and let's just see what happens. And that's what I go back and tell that person is like, there is no wrong decision. There's just you. Indecision probably is the worst decision. Just doing nothing would have been the worst thing. And doing everything will eventually lead to stuff that makes sense for a while. And something makes sense for 5 or 10 or eight years. Great. Then you keep going, or you change and do something different.

LJR: So well, you have definitely not taken the indecision route and you take it. It seems like you have done everything and are doing everything, even all at the same time. The things you have done and the reasons that you've done them are amazing. And I think we're really proud to have you among our classmates and can't wait to see what the next thing you decide to do with. But that right now, it sounds like an amazing, amazing life. So thanks so much for sharing this course.

SSB: Thanks for having me. 

LJR: That was Shannon Smith-Bernardin, PHD, MS, RN, who's an expert in the safe and efficient utilization of sobering centers for caring for acute alcohol intoxication. She's an assistant adjunct professor at UC San Francisco, primarily teaching a course on street nursing, and currently provides consultation to communities who are seeking to help their homeless populations, who are looking to establish or manage sobering centers. She also directs the efforts of the nonprofit National Sobering Collective. Find out more at and find more stories of people making lots of different decisions to get to what feels right at or with me, Leslie Jennings Rowley, on the next episode of Roads Taken.