Friday, October 14, 2011

Getting back in the groove

I'm finally coming back to the Labor & Delivery questionnaire! Has it been long enough already? I only have a few questions remaining, but am always looking forward to new questions, so keep them coming if you're still curious about the lovely world of Labor & Delivery. There's always something interesting going on, that's for sure!

What's your advice for nursing students?

I'd like to expand this question to include another well-meaning group that often just doesn't understand what's really going on: friends and family members. But first, nursing students! I remember many years ago being in that dreadful place. It's awkward! Being thrust into real life situations with people you don't know and having very little clue as to what's going on. And we nurses aren't always friendly and receptive to nursing students, which makes the process all the more awkward. So first, to all my nursing student readers, I say keep your head up- it'll all come together eventually. (There's a reason nursing school is difficult and the standards are high... just like medical school is (more) difficult and the standards are high(er)- You're dealing with real people! Who really need medical care! Take it seriously!!) And now, some tips to make your experience in labor & delivery more enjoyable and more rewarding.

-Dont just sit there. There's nothing more frustrating than walking by the nurses' station and seeing 3-4 nursing students sitting around talking to each other. Especially if the staff nurses are busy with patient care. Offer to do ANYTHING. Take vital signs when they're due. Get the patient a blanket or some ice chips. Empty the trash can. Just do something! Simply spending time at the bedside, interacting with patients is good for developing your bedside manner. If the nurse assigned to your patient gets up and goes in the room, go in the room with her. Make your nurse aware of your scope of practice and offer to do anything that falls inside those parameters. Don't be sidelined or lay blame on grumpy nurses. You are solely responsible for your experience and can either sit in the corner and play Angry Birds or be assertive and productive and learn something about nursing.

-If you don't know the answer, don't pretend like you do. Better yet, if you don't know something, ask someone! We don't expect you to know the ins & outs of the mechanisms of labor (although you should know some basics- read up before you come so you aren't totally in the dark!), so ask questions if you need clarification.

-Be respectful of your nurse and her time. You will (hopefully) get into situations that are fast paced. Be aware that at that time, your nurse may not have a minute to explain why repositioning and oxygen are appropriate interventions for variable decelerations in the fetal heart rate. Stay out of the way unless you're asked to do something and save your questions for later. Patient care always comes first, obviously sometimes at the expense of education - but - if you pay close attention, you'll pick up more than you think.

And in the same way, it's appropriate for visitors to heed the same tips. There are also ways to help a nurse out: If it's indicated, you can get your pregnant friend some ice chips or help her fluff pillows or keep the room tidy and free of clutter. If you have a question about something, feel free to ask. Medicine changes and evolves regularly and things aren't always done the same way (especially since no 2 labors are ever the same!). If you aren't sure about the plan of care, ask the nurse or ask the physician when he/she makes rounds.

Not only that, friends and visitors should be respectful of the nurse's time. We often have more than just one patient and are continuously multi-tasking to make sure all of our patients have their needs met. Depending on what's going on at the time, your nurse may be stretched thin and only have a few minutes to devote to each patient, so make your needs clearly known (I can't read minds people!!!) and then be aware that the highest priority things will be done first (An epidural takes precedence over an extra blanket).

While I'm on the visitor kick, here's a couple of other suggestions: respect the mom and her husband!! Not everyone enjoys having an audience while in labor, so please be sensitive to the fact that sometimes visitors aren't exactly welcomed. And PLEASE PLEASE stay out of the way in an emergency. Sometimes we have to move quickly and don't get a chance to explain things, but always remember, that the health and safety of a patient is my number ONE priority. This means I will ask for the room to be cleared when a baby is in distress. Be aware that sometimes, emergency situations necessitate care that appears rough or forceful. A nurse never intends to inflict pain on her patient (except for maybe that darn pitocin. A necessary evil.), but for example, when a baby is delivering vaginally and the shoulder becomes stuck under the pelvic arch - aka shoulder dystocia - one of our first interventions is suprapubic pressure. To a well-meaning family member, suprapubic pressure only looks like I've got my entire body weight on top of a belly, which is completely necessary to try and free that shoulder and deliver the body! I say all that just to drive home the point that situations can be scary when the nurses are moving quickly, but we work better when everything and everyone is out of the way, and can answer questions after the situation is resolved.

I guess I kinda got on a soap box there. Check back again soon for the next installment!

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