We’re excited to introduce you to the always interesting and insightful Maria Ingalla. We hope you’ll enjoy our conversation with Maria below.

Alright, Maria thanks for taking the time to share your stories and insights with us today. Looking back at internships and apprenticeships can be interesting, because there is so much variety in people’s experiences – and often those experiences inform our own leadership style. Do you have an interesting story from that stage of your career that you can share with us?

When I entered my graduate nursing program, it was significantly more competitive than it is today. I recall having a clinical rotation in Boston that required a two hour early morning commute. One morning, it was raining and storming extremely hard. I was unprepared, and ended up arriving to my clinical site with my clothing completely soaked. I took off my sweater and hung it up to dry. My clinical instructor looked at me, saw my tattoo sleeves, and told me immediately to put my soaking wet sweater back on. She reprimanded me on professionalism, and told me that it would never be appropriate to show my tattoos to clients. I was not even allowed to have it off before the clinic opened.

That is how repulsive she found my body to be.

I took a deep breath and put my soaking wet sweater on.

And in my career, I have worked to set that notion of professionalism on fire.

Clinical instructors and professors hold an immense amount of power over students. As students, we are vulnerable, often questioning our worth, and really yearn for support, empathy and guidance beyond anything else.

But this woman chose to use her role as an instructor to enforce a non-existent dress-code to appease her own preferences when she could have otherwise offered a shred of empathy to an exhausted student who was worn out and cold after a long, two-hour commute before a ten hour clinical day. Her lack of empathy and bias served as a lesson of the type of nurse I would not let myself be.

Since then I have worked as a both a clinical instructor and nursing professor with my tattoos showing. I own a prominent mental health practice. I am a nurse practitioner. And yes, I am still heavily tattooed. Better yet, I employ other heavily tattooed nurse practitioners and encourage them to NOT cover their tattoos. In my book, professionalism means rejecting conformity and embracing integrity, authenticity and humanity.

Awesome – so before we get into the rest of our questions, can you briefly introduce yourself to our readers.

My name is Maria Ingalla, and I am a psychiatric mental health nurse practitioner by trade. I completed my undergraduate and graduate nursing degrees in Massachusetts, and decided to leave everything behind to start a new life across the country to Arizona with my cat.

I spent years working in community mental health which means the majority of patients had Medicaid. I always wanted to work with underserved populations, and genuinely loved the families I was able to take care of every day. Problematically, I make a really terrible employee. I found myself questioning policies, fighting back on injustices for my patients, and trying to fix a system that clearly had no intention of being fixed.

I did not grow up rich. I idealized nurse practitioners and doctors as people who wielded true power – people who were not easily replaceable. I thought I would have a voice.

In contrary, I found myself to be disposable at these positions. I could easily be pushed out of a position for another naive new graduate who was ready to “help people.” Really, community mental health centers function as pill mills that push providers to see as many patients as humanly possible at the expense of people’s safety. And I was not okay with that. So I continued to be terminated or pushed out at clinic after clinic.

In my third clinic job, I asked to have my pay matched to a male colleague. I was laughed at. I can still see the Human Resources representative telling me that “money isn’t everything, Maria.” I quit without a backup plan. And that night, I googled desert flowers. I found Paperflower — I didn’t know this was another name for my favorite flower, the Boungavillea. And I started the process to make my own practice.

I encountered a lot of homophobia and transphobia when I worked in community mental health. There was an intake worker who would tell trans kids that she would not call them by their chosen name or pronouns — she would use the ones that God gave them. She was allowed to continue. And our trainings for LGBTQIA+ inclusiveness gave off the vibe of “well, you can have your own opinions but here’s what we can teach you.” Other providers made racist commentary. I couldn’t believe the shit I heard.

In making my own practice, I didn’t want that. I didn’t want people to feel unsafe. I didn’t want people to think it was a pill-mill. I hated everything about the culture of professionalism and the culture of mental health treatment that I had encountered. So I said fuck it and made it my own. I put everything on my website as blatant as possible. Rainbow flags. Rainbows everywhere. Black lives matter. Anti-trump. I put it straight out there — HEALTHCARE IS POLITICAL. And my practice is progressive. I don’t understand how people can take care of others and then simultaneously chose to vote to exclude them from society. They vote to destroy their existence and mental health.

In a red state in 2020, this was not done at any other psychiatry practice. And I did not care about the repercussions. I reached out to every liberal agency I could find to network. I did pro-bono asylum evaluations to prevent deportations. And I am so proud of being loud enough at a vulnerable time to pave the path for other practices to exist like mine.

We have now grown from a tiny virtual practice to having tons of other progressive-minded providers, four locations across the state and serving thousands of patients per month.

Any advice for managing a team?

I have always been a terrible employee, but I think I am a pretty good boss. I currently manage a team of about ten administrative staff members and eleven nurse practitioners.

My advice is that you should always be humble, understand that work is a means to live for people, and to put them as human beings first.

In the event that anyone on my team has ever had to cancel work or call off, I have never been worried about losing money. I have never even considered it — what I have considered is that I want to make sure that they are okay. If they are feeling sick, I want to make sure they get rest and will check in with them. If they have had a loss in the family, I send flowers. If someone had a really terrible day or week, I will doordash them some pizza or snacks. And I always make myself available to debrief situations, talk, and be there.

At the end of the day, I am always on their side. And they know I will take care of them, fight for them, and not betray them. I have always been transparent when it came to company finances, pay, and I believe that I have always been fairly equitable.

I respect my team deeply, and I trust them — and in return, I feel the morale has been fairly good.

That, and I take them on an annual trip so we can all connect, bond, and relax together. If you have the funds, I highly recommend that.

Any advice for growing your clientele? What’s been most effective for you?

Networking. I cannot say enough about networking. I believe that as a mental health practice, you cannot exist on an island.

In community mental health, I absolutely LOVED being able to go sit with case managers, therapists and other staff members to chat. When I started a private practice, I was immediately turned off by the isolation. In turn, I visited other therapists at their offices, connected via zoom, and brought coffees or teas to medical practices. I networked and made friendships and connections with many professionals across Arizona.

When you are genuine and show passion for what you are doing, people will send clients to you. When you take good care of patients and they feel heard and respected, they will send their family and friends to you.

I also created a TikTok to do mental health education during COVID for the general public. What started out as a small hobby turned into something much larger. That presence also helped with networking and bringing in clientele.

Contact Info:

• Website: https://www.paperflowerpsychiatry.com
• Instagram: https://instagram.com/paperflowerpsychiatry
• Facebook: http://facebook.com/paperflowerpsychiatry/
• Linkedin: https://www.linkedin.com/company/paperflowerpsychiatry/
• Youtube: https://www.youtube.com/channel/UC3PEJ0BPVNJFg2dITbNLmZg
• Yelp: https://www.yelp.com/biz/paperflower-psychiatry-phoenix
• Other: https://www.tiktok.com/@dr.mariaingalla
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