Exhausted

I've just come off a four night run of working.... I have tonight off then have to work 2 more nights.... During this time I found out my dear friend and co-worker's baby died and I had to attend the viewing just before work last night.... To top all of that off, "Dr. Hostile" as I will now call him was on call last night....

In spite of all of us nurses who were working had just came from our co-worker's baby's viewing, we were able to bind together and make the most out of the busy night and make it through.... That is until Dr. Hostile showed up in the wee hours of the morning for an imminent delivery. He was down right rude, curt and - yes - hostile towards me.... and what had I done to him.... Unless I had accidentally ran over his pet dog on the way to work..... NOTHING!!

He treats me as if I am not good enough to assist his highness. Pheph.

Yes, he was the straw that broke my back last night. And, I'm down right tired of it. I need to find a way to calmly and directly address him about his behavior and attitude and how he can turn what would have and should have been a lovely delivery into a stressful, hostile event.

There is so much in this world that hurts and that is unfair and rightly makes you stressed out... Why make more?

Application for Graduate School

Since I've made my decision to go on to graduate school, I've been accumulating the necessary items to send in with my application....and finally, I have everything I need to send in. So, my goal for today and tomorrow is to Put everything together and Mail My Application!!

What all goes into a graduate school application:
- A Completed 12 page application packet
- Copy of my RN license
- Copy of my resume'
- Picture of myself - ACK!!! This has proved difficult to find one I want to send along...
- Three professional references - I am sending 4 for good measure...
- Official transcript from college
- Check for $100
- Answers to the following two prompts:

1- A statement about my desire to become a CNM including personal information about myself and my professional goals as a CNM.
2- A statement describing how I intend to integrate graduate school and its rigorous demands and time commitment into my current family, work and life situation.

Then, place all of this and your life goals and heart's desire into an envelope, stamp it and send it off. Then, Wait.

Good Experiences

There are many things that happen and I think, "Boy, I should write that down because I want to be able to remember that." But, rarely do I... My hubby is good... he has a journal... I don't.. I have one but it rarely gets written in and I am sparse about my posts here...

Like two weeks ago when I finally told my nursing supervisor about my plans to apply to graduate school for my masters in midwifery!! I was so nervous and felt like I would be disappointing her because of all of the training she poured into me fresh out of nursing school to become a fully functional L&D nurse... But, she was genuinely happy for me and truly excited for this opportunity! She said many wonderful things I wish I had written down... Like she said when she met me she knew I had great potential for things beyond a staff nurse... and that she was glad to have had a part of my training... And she just knew I would make a fantastic midwife! She was awesome....

My last night at work is another situation I hope I remember for a long time.... I was kind of in a slump emotionally when I got there... I hadn't slept well that day and was kind of off my A-game.. I was assigned an out-patient rule/out labor. Well, it turned out she was a keeper and was indeed in labor. My mood brightened after that because the expectant couple were super nice and the mother intended to labor actively without medications (My favorite type of patient!).

So, it was a lovely night... she progressed slow and steady... I was able to take my time and get her admission done, IV started, etc... Because she was not in a rush to get an epidural ASAP. She warned me that she "transitions and pushes quickly" so I made sure everything needed for delivery was ready by 6cm.

It was coming close to change of shift time and she was not delivered yet but was close to 8cm... Our unit was short staffed and the charge nurse was calling everyone to ask if they could come help - without any luck... So, having bonded with this lovely couple and feeling like she would deliver soon, I volunteered to stay past change of shift and finish out her labor and recovery.

That's when it got a little tricky. The lady's doctor was scheduled to do 2 back to back cesareans that morning and there I was sitting with a multip who "transitions quickly." I was a little nervous. The doctor checked in on us before and between the cesareans, but I was nervous as all heck. Not nervous particular about the possibility of attending a delivery without a doctor present but nervous about the politics of doing so.... Filling out an incident report...meeting with my supervisor... explaining why I was unable to ensure the Dr. made it in time...etc, etc... Plus, my patient was active during all of this... walking the hallways, etc... at 9cm, pausing and squatting, etc, etc... I almost felt the need to follow her around with some kellys and a cord clamp in my pocket.

I agreed to stay until a certain time and it was nearing that time and she hadn't delivered yet.... So much for "transitioning quickly".... I was then happy because she finally delivered after being stuck in transition for hours one half hour before I had to leave... It was wonderful... It was with my favorite doctor to work with and I was able to be with her from start to finish - at a natural medication free birth.... Something I usually don't get to do since giving up my doula practice to turn RN... I felt like I was in the good-old doula days again!!!

Then, after the delivery the doctor and I were talking and I confided in him that I was going to graduate school to become a CNM. He responded wonderfully as well. He said he used to work with 7 CNMs in another state years ago... and he would love to work with a CNM again but doubts that he would be able to in this area... I sadly agree.. But it was great to be able to talk about it... He said the next delivery I have with him where I've bonded with the patient and feel comfortable he wants me to gown and glove up and do the delivery with him as my guide. Pretty awesome, huh?

The right path

I'm faced with many decision now that I've decided to start graduate school next year. I've pretty much decided on which one I will go to: Frontier Midwifery School in Kentucky... They offer an all distance education program where I will do course work via computer and clinical work with a CNM in my community. Now, I am contemplating what the best course of action is as far as work. I drive an hour North for work now at a hospital that has NO CNMs and quite frankly I don't think ever will. There are other hospitals South and West of me that do have CNMs. I'm fairly certain that the hospital I currently work for will not subsidize my studies because they will not hire me after I graduate as a CNM.... But, there is a possibility of me taking a job at one of the hospitals that does employ CNMs and then they would possibly subsidize my graduate school... and the added benefit would be that I would work and train at the same hospital... If I continue to work in the "North" hospital and train as a CNM "South" or West... My travel time would be incredible.

I think I at least owe it to myself to send my resume out to the other midwife friendly hospitals in my area and see what the possibilities are. I feel loyal to the hospital I am at now... they took me fresh out of nursing school and invested a lot in me already to train me as a L&D nurse... But, in reality, I have to do what is best for my future and that of my family.

Torn.

The Climb

However corny it may be... I love Miley Cirus' song, "The Climb." It is an inspiration for me to enjoy the journey...not just the destination.

Well, recently Mark and I went to Los Angeles California for a conference he had --- and some time away to ponder my next step in my journey. During my time away, I decided that I would take the next step and apply for entrance into graduate school right away with a goal of starting next August and graduating as a CNM two years from then.

I am super excited for the destination...but kind of dreading "The Climb." I know how grueling full time work and full time school is..I've been there - Done that! But it is only two years..... And, I also know how quickly two years can fly by. And, with the prospect of many, many working years ahead of me, I can see no better way to spend them than doing exactly what I KNOW I was born to do: Be a Midwife.

Another deciding factor is that it will be healthy for the children to see me accomplish such an important goal that I set for myself. Showing them that hard work and dedication can bring accomplishment.

Finally, I will be easily making two to three times the amount of money I am making as a nurse. That's just the icing on the cake!

So, Here we go.... AGAIN!!

The card

I haven't posted in a while....  But, things are still going well at work.  I love working but am glad to have a break when I'm not...  We have some really interesting antepartum patients currently that I've been learning a lot from.  One patient has a complete placenta previa.  My stress level goes up 100% when I go in and see my name next to her room number indicating that I'm her nurse for the shift.  

I've had some good births and some not so good ones...  One night in particular was a difficult one.  There were several things brewing on the floor that night...  Another nurse had a postpartum patient who had to be transferred to ICU.  At the same time my pitocin induction patient started to have late decelerations.  I felt like I was walking a tight rope all night ..  trying to up her pit so she could deliver but not up it too much so the infant wouldn't become distressed in utero.  

It was stressful to say the least and the doctor on call for the night was one who does not handle stress very well... he just makes the situation more stressful, usually, and is NOT calm under pressure.  Then there was an incident where I called the anesthesiologist to place an epidural for my patient and when he arrived I was starting an amnioinfusion, so I told him he wouldn't be able to start it until after I finished the amnioinfusion set up.... Well, that didn't go over well at all.  

By the end of that night one doctor actually yelled at me (for waking him at 2am and then not being able to start the epidual immedicately when he showed up) and the other doctor was borderline rude and short with me all night....   I did break down at one point in the break room and cry.....   But I pulled it together and made it through the rest of the night with the patient - ended in an emergency cesarean section that we all saw coming.  I think the stress got to everyone that night....   And, in the morning, one of the doctors actually apologized to me for his actions and told me I did a good job handling the difficult induction.

As nice as that apology was, is wasn't nearly as nice as the card I received about 3 weeks later.  The patient who I was caring for that long and stressful night mailed a card to the hospital's maternity unit for me.  She handwrote a lovely message telling me how much she appreciated all the efforts I made to care for her and make sure she and her son had a safe and special birth.  It meant the world to me that she would take time from being a new mother and address a thank you note to me....  After all the sweat and tears that night brought me... to know that the mother appreciated my care and that I was able to shield her for the stress of that night and make her feel safe and special.  It was a simple gesture from her...but one that really touched me.  

I do not remember my labor nurses at all.  I'm not sure why...  But, I know I will remember some of my labor patients for ever.  

Being Pulled

Since being off of orientation I've been put in the rotation of "being pulled" to other units of the hospital if we have a low census and all of the scheduled nurses on OB are not called for. I have gotten pulled twice so far.

The first time I got pulled to a medical surgical floor for a "One on One." This means I was sitting with one patient for my entire 12 hour shift because she was elderly and confused. She kept trying to get out of bed and pulled at tubes/wires, etc. So, needless to say that was a LOOONG 12 hour shift!

The second "pull" was to the Neonatal Intensive Care Unit (NICU). I enjoyed that pull. I got assigned two babies to care for... they were stable and basically needed meds given, monitored, fed and rocked every now and then. Eventually I am supposed to be cross-trained to the NICU... and I think I will enjoy this training.

Since being off orientation, I'm experiencing everything for the "first" time... For example, My first time circulating on a c-section ALONE... my first time tirating pitocin on my own.... etc. etc... Surprisingly, I get a little nervous... I know I can still ask people questions, etc... But I do love my job!

Deliveries

This past week I delivered a baby! The doctor didn't make it in time and it was up to me to handle the situation. It was only my second night off of orientation..... Mom and baby did well and I realized I was capable of more than I imagined.

It wasn't the first time I was present at a birth the doctor didn't make it to... But previously, I was on orientation and I always had a preceptor with me and I wasn't directly in charge of the safety of the mother and baby. This time was different. It was a very good experience.

It is amazingly more common than I thought that the doctors miss deliveries. In fact, the night I delivered the baby, there was another birth the same night that another doctor missed as well.

It is really a balancing act that the RN is asked to preform. She must be the eyes and ears of the doctor. Manage the labor and inform the doctor of the progress and any complications. Carry out all orders. Then, when it comes time to deliver, the RN has to get the doctor there at precisely the right time. Doctors do not like to come too soon or too late.

The optimal time for a doctor to enter the room is sometime between +3 or +4 and crowning.

One tip I'll pass along to L&D nurses in training: DO NOT break down the bed until the doctor has committed to being in the room. If the birth does happen without the Dr, at least you have the bed there for the baby to slide out onto. It helped a lot not to have to worry about holding onto a slippery wet squirming newborn as I was worried about checking for a nuchal cord and delivering the shoulders, etc.

Night of Competencies

I had an unbelievable night a few weeks ago.... I did nearly every job to do on the floor - in ONE night.... I could have had almost all of my yearly competencies signed off in that one night!

I started out with 2 outpatients, which I evaluated and subsequently sent home.

Then, there was a birth where I was assigned to "catch the baby." After the baby was stabilized, I accepted the mom and baby as a post-partum couplet and cared for them for about 3 hours or so.

Then, a cesarean section was called, and I was asked to be the scrub nurse for it, which I did.

After that, I said to one of the nurses, mistakenly, "About the only thing I haven't done tonight is labor."

Yep, you guessed it. In walked a mom in active labor, 8cm dilated at around 5 am. Do I need to say who was assigned to take this labor patient?

She had a very quick labor, as she was a gravida 6.... And she ended up having an "unattended" childbirth - which means her labor nurse - me - delivered her baby.

Well, that, thankfully, was the end of my 12 hour shift.

Unbelievable!!!!!

Some Disney Pictures

Sorry for the absence.... Had to think about what direction I was going with this blog...

Anyway, some vacation pics:

Disney World was Awesome!

Wonderful is right ON

We've just returned home from the WONDERFUL world of Disney! Disney world in orlando, Florida, to be exact. I was totally impressed with the whole resort and all of the parks!!!

We had an awesome time. There were tons of rides and attractions that were age-appropriate for our kids that they loved. And, there were pleasant surprises around nearly every corner. One day we were walking around the magic kingdom and out of no where a show with mickey, minnie and all of the main disney princesses started....we watched that - it was awesome - then a few blocks later, a parade started up main street.... So fun!!!

I'll post pictures later...

I need to seriously adjust to real life after a week there... Everything you could ever want was there!!! We had the "deluxe" meal plan... and we got 3 full sit down meals a day plus two snacks and a refillable drink mug.... The meals were outstanding!!!! Complete with appetizers, main course, dessert and a drink.... It was all included.... And, I never had the willpower to say no to a dessert.... I was SOOO bad... Cheesecake galore!

Real world hit when on the way home we stopped for lunch and we couldn't just pull out our Disney "Key to the World" card and say, we have the deluxe plan. :)

We did a lot of swimming, went to a water park and hit all of the disney parks...doing as much as we possibly could.... Collapsing at the end of the days after parades and fireworks, etc... It was so fun...but tiring.... We tried to fit in as much as we could possibly fit in because who knows if we will ever be able to get our kids back down there...

One of my highlights was going out on the lake in "captian hooks" pirate ship to watch the "wishes" fireworks over the castle at the magic kingdom. It was so beautiful. I love fireworks. We also got to spend some time with family members who went along, too.

Lance got a "pleuto" hat and got all the characters he saw to autograph it. He got about 20 total autographs and then pictures with them too... Let's see who I can remember: Mickey, Minnie, Donald, Pleuto, Goofy, Pooh, Eeyore, Tigger, Meeko, Stitch, Chip, Dale, Rafiki, Brer Rabbit, Woody, Buzz Lightyear, Flik, Jiminy Cricket, Peter Pan, Smee, Captain Hook, and a couple more I can't remember right now. The other kids were not into the pictures with the characters or the character signing...but Lance loved it!!!

I could go on and on... It was truly a magical place for the kids...and adults....

Superstitions

Nurses are superstitous creatures. If you doubt it, just walk onto a calm nursing floor and utter the words: "It's quiet today."

Yes, in the world of nursing if you say it, it's bound to happen.....

If you are having a good streak on IV starts, you don't dare mention it out loud or the next vein you puncture will blow and you'll be off of your streak.... Or, if you order chinese food; the unit is bound to explode into unforeseen craziness, the likes of which will leave even the seasoned nurse bewildered.

Thus far, I've had a hard time accepting these "myths" as I don't tend to buy into such beliefs. However, I've received an initiation of sorts into the eerie world of nursing superstitions recently on the floor.

Two events happened that now have me wondering if I shouldn't just hold my tongue when certain thoughts enter my head afterall.

A couple days in a row we would reach the "nearly over" point on the floor at about 5:30 or 6:00 am where we would start to make our patient rounds one last time, tying up our loose ends and preparing for the fresh infusion of day shifters to descend upon us.... Then, just as we were finally reaching the end of our "to do" list, a "Rule Out Labor" outpatient would arrive. "Darn it"... we would think, "Why couldn't her husband have drove just a little slower and arrived at 7:30 instead???"

So, after a few days of this happening consistently.... We got to that point again one morning and I said, "Isn't it about time for our 6 AM "Rule Out Labor" outpatient to get here?"

The glares I got from my lovely and normally very friendly co-workers were just plain evil. OOPS... sorry guys... It remained quite.... The doctor who was there to witness my mishap of words had left to go to her office... It was still calm..... Then, the phone rang and the secretary took down some information and hung up. She then announced to me, "Dr. So-and-So wanted to tell you that your "Rule Out Labor" patient is on her way over." Yes... You guessed it.... That day I was the overworked, overtired nurse that morning who got the bumm assignment of evaluating the outpatient who strolled through the door at change of shift. :)

Then, a few days later it was a particularly long and arduous night made even more difficult when things stalled to a motionless halt around 3 AM... I fought to keep my eye lids from closing from exhaustion... When things get quiet on night shift, the most effective way for me to stay awake is to keep busy.... with anything... clean, stock rooms, organize, anything.......

So, after doing the dishes in the break room and sitting down the exhaustion began overcoming me.... I said to my co-worker, "I wish I had an outpatient to get me over this hump this morning."

WOW.... Did I live to regret that request.....and all of my co-workers reminded me that the mess that was to follow was "MY FAULT."

Within 45 minutes of me uttering that dreadful sentence, the unit was in mass confusion.....

First a lovely "Rule Out Labor" outpatient arrived and I gleefully accepted this assignment. I went into her room to do my initial evaluation and assessment..... But, when I walked out of the room a mere 20 minutes later the scene at the nursing station was vastly different from when I entered. The secretary was fervently pulling papers, filling charts and faxing orders.... The charge nurse was on the phone calling in all possible helpers.... There was a crew of NICU nurses assembled outside of a LDRP room complete with a warmer, neonatal crash cart and the neonatologist. And, there were all of my innocent coworkers in room 422 trying to manage the now emergent 25 week abruption patient who walked through our doors just seconds before her amniotic sack ruptured.

Yes, mass confusion ensued. Every available hand was preparing for a crash cesarean.... and I found myself standing in the nursing station with 6 babies (who I knew nothing about because I wasn't their nurse) and a labor patient to admit (because my lovely "rule out labor" was indeed IN labor).

Yes, there was no way I was falling asleep at this point. That worry was far from my mind.

So, you can see a littel glimpse into what makes us nurses believe that superstitions are alive and well...... With good reason.

High Risk Weekend

Last week while working there was a slow period one night, so I got out my notebook (I keep a notebook at work with helpful reminders, policies, etc for easy reference)... I was making a "wish list" of sorts of things I wanted to get more experience with and reviewing them for when the time came. I decided that I wanted to care for a pre-ecclamptic mom and I wanted to be in on an emergency cesarean for the experience of having to work quickly and to sharpen my skills.

Well, not more than a few days later, both of those "requests" were fulfilled. I had a weekend that could own no other name than "My High Risk Weekend" because of the high-risk patients I was fortunate enough to care for.

Friday night I arrived and was assigned to an outpatient who just arrived from the Dr.'s Office with uncontrolled pressures. So, she was fresh...nothing done yet... a great starting point. It turned out her pressures spiked super high and we had to admit her and start her on Mag. !!!! I WAS THRILLED!!! Not, of course, because she had to have Mag, but that I was the nurse assigned to her and I was going to start and run the Mag... What a great experience!! I had run Mag before, but it was already started then and the woman was half way delivered before I took her over.

So, having just reviewed the protocol and mathematical equations needed to run Mag for the loading dose, maintaince dose, etc... I was READY!! I even surprised myself at how quickly I figured out the correct flow rate, etc... Anyway, then we had to induce her as well... So all night long I ran the mag, monitored her response to it and managed her induction hand in hand.

She didn't end up delivering on my shift, but I didn't feel slighted at all.... I was simply grateful for the high risk experience I was able to gain. Then the next night I was assigned to her again...she was postpartum now but still on Mag.... So, I cared for her and her "mag baby" - both who were tired and "mag'ed out" - another good experience.

Then, as if it could get any better, My last night of the weekend, Sunday, I was happily caring for a SROM mom who was in labor...Lovely couple. She was progressing beautifully, then we got word on our unit from the EMS that they were bringing a 30 week mom in with massive vaginal bleeding. I would never normally do this, but I actually chose and was allowed to give up my lovely labor patient for this potential abruption.

And, it WAS a massive placental abruption!!!! I've only read about them... But I actually was able to be involved in caring for her during diagnosis and during her emergency cesarean section.

It was a physically and mentally challenging and draining weekend. It was awesome.

Getting Away From My Roots

I had lunch today with a doula friend of mine.. We had maybe only had lunch together once since I became a practicing RN. We were catching up on each other's lives... telling stories, etc... She called me out, and rightfully so, when I was telling her about being called in to work yesterday for two sections.... "Sections?" As a doula, I would never call a woman's birth a "section." Sections are pieces of grapefruit... Not a childbirth experience.

I realized, yes... I had used to be more careful about my terminology... The little things like that really mattered to me as a doula... and as a mother... What has happened during the past year that I didn't even blink an eye when referring to "2 sections."

I excuse a lot of my lack of "doula care" during deliveries now due to the fact that I am still learning and perfecting the role of the nurse at a birth... and I am so focused on doing all of the procedures correctly, and documenting properly and communicating with the doctors responsibly... That I don't focus so much on the things I did as a doula... giving a back rub and a quick pointer on positioning & movement to a mom and dad going through transition... etc. etc...

I have said (and truly believe) that when I get the "nurse stuff" under my belt and am able to preform my RN functions automatically without much purposeful thinking going into it, then I will be able to more actively incorporate my doula training and experience into my nursing practice... I do think that this will happen... But, now I wonder by that time how many other little things like calling a birth a "section" will I have let creep into my practice and view as normal?

Will try to be more conscience..... Yes, I want to train to be a good OB nurse, But I don't want to lose my convictions along the way.... afterall, those are the things that led me to become a RN in the first place.

OB Education Day

Today at work we had a whole day of simulations, drills and re-certifications. It was one more thing on my plate to study for and prepare for, so I'm glad it is over. But, it was actually a great day as far as learning opportunities go.

To begin we went in and took our NRP neonatal resuscitation examination right off the bat. Can we say stressful?!?! I felt very good about most of the questions until I got to the sections that covered the skills I don't routinely use because we have a NICU that responds to our intubation and prematurity needs. So, I was sweating it a little bit towards the end, and was glad to have that certification out of the way for 2 more years!

Then we rotated through various workshop/stations throughout the remainder of the day.
First I went to a respiratory class/workshop. We reviewed the basic lung sounds heard and the characteristic and causes of each. Mainly focusing on coarse and fine crackles as they are what we are continually assessing for as a sign of pulmonary edema in the women receiving fluid boluses, mag & pitocin.

Then, I went to a postpartum hemorrhage class. This was one of my favorites. We had a simulation where each of us had to be in charge and SBARR our help who arrived and organized the whole effort. We reviewed causes including uterine atony, retained placental fragments, trauma like lacerations, etc, and thrombine disorders. We went through all of the interventions we should be prepared to carry out like 2 large bore IVs, O2 via non-rebreather mask, Labs (PT, aPTT, INR, Fibrinogen, type & cross for 2 units), and medications/dosages (methergine, hemabate, pitocin & cytotec).

Next was lunch...we all went to subway.

Then I attended a session on CPR/CPR on the pregnant woman, including perimortem cesarean sections, which I pray I never, ever have to be a part of. According to recommendations, a cesarean section should be preformed within 4-5 minutes of a woman coding - right there in the room. Scary stuff.

Finally, I went to the neonatal resuscitation session where we did our mega codes. We each took a turn being in charge of the code and walked right through various scenarios including PPV, chest compressions, intubation and umbilical venous catheters for pushing volume expanders and meds. It was good to get my hands into the crash cart and locate all of the supplies, etc as it is not done unless needed usually.

So, overall, I truly enjoyed the day of practice and review. I feel fortunate to have a position at this hospital. They are organized and value important things like the education and continued training of the nursing staff. It was a good (yet long) day.

Education Overload

I've been studying a lot lately. My nursing research class has taken a lot out of me. I ended up with a 20 page integrative research review (IRR) with the title: " A Systematic Review of the Literature About the Incidence of Screening for Intimate Partner Violence in the Maternity Patient."

To summarize my 20 pg paper in one paragraph: Intimate partner violence (IPV) can have serious sequelae including premature birth and infant death; and, IPV is more prevalent than both PIH & Gestational Diabetes. However, the screening for IPV in pregnancy by healthcare workers is sporadic and inconsistent at best. Despite screening tools being available to healthcare workers, most institutions simply do not integrate them into their practice. Additionally, more research is needed to determine the most effective screening tools and interventions.

In addition to finishing up my nursing research class (WHEW!!!), I just finished up my health assessment class today. I can now assess you head to toe in 30 minutes flat! Good to know, I suppose. I also finished a 1 credit kinesiology class as well last month.

On top of all of the school work, my work has been crazy busy - and I'm in the middle of recertification and special trainings there, too.

Tomorrow I get recertified in neonatal resuscitation, so I've been trying to re-read the neonatal resuscitation text book and review materials for that. And, our hospital is super focused on continuing education. They design special educational days where you have to go and participate in mock drills and take tests on certain situations/skills like postpartum hemorrhage and shoulder dystocia, etc. So, I've been in the middle of that this month as well.

Overall, I'll be ready for a break from all of this studying soon!! I'm super glad I'll be done with school in August!! Then, I can just focus on getting obstetrical experience and continuing education for my RN license.

Life as a Med-Surg Nurse

So, this blog is supposed to be thoughts from an OB Nurse.... But recently, I've been feeling a little like a Med-Surg Nurse..... You see, when the census is low in OB, we take post-op Gyne patients... Sometimes it will be a hysterectomy or my all time favorite to say in report the "Salpingoophorectomy" AKA removal of an ovary and its fallopian tube...

Anyway, the last few days we've had a low census, so we had about half of our patients being Gyne patients. I was kinda disappointed at first when I saw my assignment...afterall, the whole reason I suffered through four near tortourous years of nursing school (and am still going) is so that I can care for women who are giving birth.... Not women who are loosing their reporductive organs... But, like other things in the past (scrubbing, to name only one), I was pleasantly surprised at how much I didnt' actually mind my post-op gyne assignments.

I've found out that I'm glad I have this aspect to my job as well. I have the opportunity to keep my general nursing skills fresh and sharp with the occassional med-surg assignment...and, I can appreciate more the whole circle of a woman's reproductive life.... Helping women to celebrate pregnancy and birth; then, encouraging them to embrace and accept menopause, whether natural or surgical...it is a new stage for them to acclamate to, one that they may not be prepared for.

I've found that allowing them to talk to you about their feelings in a general way is healing for them... For example allowing the woman to say to me, "I've always loved being a mother" without them having to verbalize, "I'm sad I'm losing my uterus." Listening and understanding is what they remember about you as their nurse, not that you kept their JP drain empty or their SCDs on or their IV going... You know?

I'm still in the honeymoon phase, I suppose. But, I still love my job - nearly every aspect of it - and think every single minute of nursing school was worth it!

In My Opinion

If you haven't seen the ABC News segment with Selma Hayek in Sierra Leone, then follow THIS LINK and watch the video clip then come back here to read on.

Some facts from the story include Selma's humanitarian trip to Sierra Leone with a push towards erradicating neonatal tetanus, which is often transmitted via an infected umbilical cord stump. Protection from neonatal tetanus can come by sterile birth practices or via a maternal tetanus toxoid immunization during pregnancy. This latter method is what is being focused on here and by Unicef and Pampers. The two organizations have joined together to make tetanus vaccines available to women in need in developing countries.

Some points of controversy with the story:

During the nightline video, an infant is shown taking its last breath, dying from tetanus. The actual death is shown. Secondly, Selma, who is still lactating, breastfeeds a hungry african infant on camera.

Some of my admittedly random thoughts on the story.

It is enlightening to those of us in the developed world to hear of such easily preventable tragedies. Never would we think of packing an umbilical cord with manure or mud....as is done in Africa and other such developing countries, contributing to this horrible death for the infants. Yes, a simple, cheap vaccine can potentially save many babies from needless death. And, think what could be accomplished with the education of those women, teaching the importance of a clean environment for childbirth. It does inspire us to give to help reach the helpless babies in time.

However, I'm not so thrilled with the idea of pamper's "help" being tied to America's commercialism. "If you buy 1 pack of pampers; we will deliver 1 tetanus vaccine." Hmmm, not so heart felt, it would seem.

Secondly, I take offense to the airing of the infant's death on national media. Was consent to air the child's dying breath given by the baby's mother? If so, did she truly understand that it would be plastered across the internet and aired nationally on Nightline? Even if she did consent, is it humane? Is it necessary to make the point? Are we sensationalized enough to expect to see a dying baby in a journalism piece on dying babies in Africa? In my opinion, it was senseless, needless and in poor taste.

Lastly, I have issues with Selma's breastfeeding the infant who was not hers. I am not disputing the fact that breastmilk is superior food for all babies, especially babies living in such plain disadvantage as those on the piece in Sierra Leone. I am just .... shall we say concerned about the details of the act. Was the mother of the infant alive? Did she give consent for the infant to breastfeed? Was Selma medically screened at all? In light of the subject matter, compared to dying of tetanus, contracting an illness from Selma's milk is probably a mute point. However, breastmilk has been shown to transmit such diseases as HIV and Hepatitis.

And, there are established human milk banks designed to do just such screening on donor human milk, which is then made available to those in need. This program is small and in need of promotion and expansion, for sure. Perhaps selma could put her celebrity power behind this established method for the safe distribution of breastmilk instead of randomly picking up a hungry infant and so genersously allowing it to suckle, as was portrayed in this piece.

Again, my thoughts are random. What are your thoughts? I do think that the issue is important.

Should Americans help with the shortage of funds available to vaccinate pregnant women in Sierra Leone? Yes.

Should we go a step further and strive to improve the unsanitary conditions newborns are exposed to? Certainly.

Would it be beneficial for all babies - everywhere - to breastfeed? Absolutely.

Does this journalism piece do justice to any of these issues? In my opinion, No.

The State of the OB Floor

So, What's been up on the childbirth front?

My sleeping after night shifts is getting considerably better. I used to have an awful time of sleeping the day after.... Waking up frequently, not getting to sleep easily... Well, that all seems to be changing. My last 3 day stretch of nights went great! I fell right to sleep and slept for hours before waking. In fact, the last night I worked, I went to bed at 9am when I got home and slept until after 4pm that evening before waking up even once! Sleep makes everything better.

I have scrubbed in on c-sections with every doctor with practicing privileges now. So, I'm scrubbing independently now. I still really like scrubbing... It is a surprise to me, but I don't mind it at all.

I am trying to make some positive headway with the one doctor who has been giving me grief. Out of all of the doctors there, every single one of them have gone to my nurse manager telling her what a great job I'm doing and how quickly I learn - every one of them EXCEPT this one particular doctor. I think I've written about him before.... Well, he's still on my case. The other nurses tell me he does the same thing to every new nurse and it is sort of like a right of passage or some such nonsense. Anyway, I think the ground is just starting to thaw, and hopefully his obsession with making my shift miserable will pass soon enough.

I've gotten a string of high risk patients recently, which is really what I need experience with. I've managed several PPROM patients (pre-term, premature rupture of membranes). I've had a stillbirth induction unfortunately, and I attended a birth where the doctor didn't make it....I nearly didn't either as the head was already out when I went in and I caught the baby, literally...clamping and cutting the cord and all.

Things stay pretty busy on night shift for us. The vice president of the hospital came around the other night to talk to us and reassure us that the hospital is still strong in light of the current economic condition. Hospitals all around are laying off and cutting back. Apparently our hospital is still making money and is not in trouble, but the struggling economy is having a trickling down effect -- People are cancelling elective surgeries because they lost their insurance coverage when they lost their jobs, etc... So, the VP informed us that they are putting a freeze on hiring right now. But they do not expect that any layoffs are in the future.

The good thing with a nursing degree, I believe, is that I will almost always be able to find work with it. It may not be in the department I want it to be or during the hours I would like... But, work as a nurse will nearly always be available. Luckily, the VP informed us, that we OB nurses picked one of the safest specialties to practice nursing in, as far as job security goes.

Still Smiling, somehow

This picture can be our starting point in our Pictorial journey to the orthodontist this year.

If you look closely (or click on the picture to enlarge it), you can see the space between little Lance's front teeth. Then, on either side of the front teeth you'll see spaces again. Those spaces are where the incisors are supposed to be. They are in his gums, but there is not enough room for them to come down. So, we've begun the journey to hopefully allow them to come down.

The first visit was last week when he had spacers put in. It wasn't that bad, actually. Then today he had bands put on and an impression made for the expander. Well, today's visit was very uncomfortable for little Lance. And, to make it worse, they didn't want me to come back. They said kids do better if their parents wait for them. Lance seemed ok with it, so I (foolishly) agreed to wait in the waiting room. I'm a nurse for goodness sake, I should have known better!! Poor Lance came out almost crying. I said right then to them that I would be coming back from now on.

Anyway, after some motrin and milkshake, he is doing much better.

This will be a long year, for sure. I just hate that he has to have this done!!!

Sometimes You Just Have to Laugh

It has been since before new years that I scrubbed in on a section; so, I went in this morning to scrub for 2 c-sections. I was worried about going over a month and forgetting everything I had learned.

It was a good thing for me to do... I remembered most everything, but was a little rusty in the beginning.

I had the same doctor for both. During the first section, after delivery of the baby, I un-capped the TB syringe and handed it to the Dr. to draw up cord blood. I then set the cap down in the placenta pan. He ever so gently and correctly instructs me to simply toss it off the field so there is no chance of it coming out of the pan and being lost in the patient....as the cap is not a part of our count. I say, "Oh, Ok. That's a good point." So, I hand him the second syringe and appropriately toss the cap off the field towards the garbage. The rest of the surgery moves along fine...

Next surgery: Remembering the teaching from the first section, after the delivery of the baby, I pulled off the cap of the cord blood syringe (or what I thought was the cap) and tossed it off the field. I hand the Dr. the syringe and look down at it. I had pulled off the entire needle with the cap and promptly tossed the needle off of the field!! He looked straight in my eyes and just laughed. I chuckled too... and just said, "I tossed the needle off of the field."

The circulating nurse quickly supplied us with a new syringe WITH needle attached.

But, seriously, a dozen different doctors would have handled that a dozen different ways. I was incredibly lucky that today this particular dr. just decided to laugh.

Counting my blessings today..... Afterall, it was funny.

Tag: You're IT

I was "tagged" on my facebook page.... And, I succumbed to the pressure and participated. The following is my post of:
"25 Random Things About Me."

1. I crack my knuckles, habitually.
2. I use the free return address labels that various charities send to me in the mail - without donating money to them.
3. I do not balance my checkbook.
4. I have practically no sense of humor; I hate comedies.
5. My favorite actor: Richard Gere; especially his role in "Sommersby" - an oldie but a goodie!
6. I cry EVERY time I watch the movie "Sommersby."
7. I met my husband "on-line."
8. Correct spelling and the appropriate placement of commas STRESS ME OUT!
9. Someday I will get my masters degree.
10. Nearly every wall in my house is painted brown. I love the color brown.
11. I only shave about 1/2 of the year. My vote is for hair vs. bare.
12. I don't like to sleep on the side of the bed nearest the door (because then I would be the first one the serial killer kills).
13. I wear slippers 365 days a year, continuously while in my house (and sometimes if I know I'm going to be at someone's house for an extended period of time, I'll take my slippers with me then, too).
14. I'm going to Disney in the Spring.
15. I once auditioned for a part in a local college production of "The Vagina Monologues." I didn't get cast.
16. I always wished that I could play the piano.
17. My favorite ice cream is Butter Pecan - Put a scoop atop a belgium waffle and you have heaven!
18. I am really good at doing vag exams.
19. I love to bake.
20. I hate to exercise.
21. I am technologically retarded - from cell phones to laptops, I am seriously dumb.
22. I was bit by a german shepherd as a child and am still deathly afraid of dogs (big & little).
23. Shows I record on my DVR: The Young & The Restless, House, and Top Chef.
24. I can't dance or sing.
25. I wish I were a vampire (ultimate twilight fan).

Ok, now it's your turn. I am tagging you!
If you succumb as well, let me know, I'ld love to read yours. :)

Adoration

"Our Baby" Berkeley is growing.... Sad but true... Bitter sweet... But these are two of my favorite recent pictures of baby Berks

This one is of her and her dad... Such a sweet, simple look of adoration.















And look at this one of Berkeley looking out at her two older sisters!!! How sweet... Personally, I think Caressa should just push her down!!! She shouldn't be able to look that grown up!!! Ahhh... No, seriously, this is one to frame for the later years.

New Starts

Today I'm starting my Spring Semester of courses. With only one semester after this one, I'm pretty excited to get started and get done.

And

Yesterday we found out we are starting down the "orthodontic's road of no return." Little Lance needs orthodontic work. His two incisors are impacted necessitating early orthodontic intervention in order to avoid surgery (the incisors are the teeth on either side of the 2 front teeth - his are not coming down). So, we'll start with the expander - which sounds absolutely BARBARIC to me... They put this metal contraption on his upper back teeth and each night Mark or I (READ: MARK) will have to crank it further apart to literally stretch his upper palate wider... Amazingly enough, though, his palate actually splits cells and new cells are made and new bone grows to fill in the stretched space.... Pretty gruesome... if you ask me... Gruesome but interesting - if it weren't my little 8 year old going through it!
Then we'll go to temporary braces, then a full set.

The whole process time wise will be a few years..... Price wise: you don't even want to know!! But, we're getting his teeth ready for the most important picture of his life: his wedding picture.. That's our inspiration... A long road but worth it in the end.

Interestingly, studies show that breastfed babies' palates are more perfectly formed because of the breastfeeding's natural physiological spreading of the palate by the breast tissue..... And, Lance was my longest breastfeeder at 1 and a half years.... I wonder if it would have been worse had he not breastfed?

Past Time

There are only a few hours before my 8 day off jaunt is over and I'm back to the Vampire Shift aka Night Shift... working at night, sleeping during the day......

So, what have I discovered as favorite past times during my mini-vacation?

I loved going snow-tubing at Tussey Mountain with my family and my sister's family... It was a blast....

I am beginning to crochet a baby blanket for my brother - who is expecting a baby!! I'm using this pattern... It's called "Tiramisu Blanket"... Very pretty cream color with a rich chocolate colored accent ribbon. I'm using the suggested alpaca yarn... I'm hoping it turns out at nice as the picture.

And, finally, I'm nearly addicted to the novels of the Twilight series - Thanks Caressa!! My sister took me to the movie, Twilight, over Christmas. I went grudgingly... with the comment something like, "Really, Caressa, a movie about a vampire??" But, believe me by the end of it, I was wishing I were a vampire.... almost... So, I am now almost finished with the first novel in the series and just bought volume II, New Moon, today so I won't have to wait a single minute to start on the second book when I close the cover on the first. I haven't smiled, laughed out loud and cried while reading a book in a long time.... But this series is a true pager turner. Lovin' it!

But, all good things must come to an end. I also bought my text books for my semester of classes ahead of me today, which start on Tuesday.

Back to the grind... Work, sleep, study. Onward and upward, hopefully.

Some Things to Check Out

Click here for a yummy recipe for Chocolate Chip Pumpkin Bread.

Click here to read a Great article online from the Los Angeles Times on Midwifery care in America. It sums up the state of birth in the US quite well, highlighting the disparity between the amount of money being spent on obstetrical care in the US and the sad results seen in our rank of 41st among industrialized countries.

Click here to read about President Bush's "Healthcare Conscience Rule." This is a sticky subject. One that I'm not totally set on my stance about. I do think direct care providers like physicians should have the ability to decide for themselves and their practice what services they will perform. However, where do you draw the line? What services and what providers does this cover? Only abortions? Only for religious reasons? The wording of this rule seems to allow for any procedure, any service worker, and because of any "moral" persuasion.

What would the repercussions be if a secretary refused to bill for a patient's IUD placement? What about when the person who cleans instruments refuses to clean circumcision trays and instruments? Do you see how this can snowball into one huge, subjective license to refuse services?

And, if a provider can refuse to perform services, can they also refuse to offer them and refuse to provide full informed consent to their patients... Can they refuse to tell the potential patient all of their choices - whether or not they would personally choose them - Can they refuse to tell them the risks, benefits and alternatives of all possible procedures applicable.

As a healthcare provider, myself, there are certainly parts of my job I would love to refuse to participate in. But, is that my choice? I am employed by the hospital I work at. I agreed to provide the services of a registered nurse on a maternity floor. So, that entails many things I would not personally choose for myself, but that others do choose for themselves (elective cesarean sections to name only one).

I am ok with that as long as there is full informed consent. Who am I to make decisions for others? Who am I to say that I know what is better for them? And who am I to practice selective nursing. If I agree with your choices, I will provide you care? No. That is not what I signed up for. I agreed to help those in need of medical services, no matter why - no matter if their "Good" or "Bad" choices put them in need of this medical care.

There just seems to be a whiff of judgementalism to this "healthcare conscience rule." A wiff that makes my stomach turn. I've lived through my share of legalism and judgementalism... People thinking they had superiority over me and authority to judge me because of what they would label as "wrong" or "bad" choices.

Unless you are walking in someone's shoes, you cannot know all of their reasons for their choices.... There is a lifetime of history behind each person's current situation. You must meet them where they are... accept them as they are... and help them no matter why they need your help.

Rant over. Off my soap box. "I'm just saying (As sis would say)."

Update on Scrubbing

My crash course in becoming a scrub nurse is over. And, like a few other things I've encountered, it wasn't nearly as bad as I had made it out to be in my head.

I dreaded learning this last role of the L&D nurse..... But, it turned out to actually be something I kinda enjoyed. I think it may be my perfectionistic nature.... But, I liked the exactness and precision that was called for. I kept the surgery field and my mayo stand (the tray the instruments lay on during surgery) meticulously in order... It felt good to arrange the instruments around the mayo stand in a precise order... then as an instrument was discarded by the physician, I lined it back up in its proper place.... I found it natural to keep right up with the suctioning and "blotting" as they call it....in order to keep a clean surgical site....

The thing the doctors desire the most out of their scurb nurses is for the nurse to "Anticipate." No, it's not enough to know your instruments and hand them to the Dr. quickly when asked for... You must learn to "Anticipate" what instrument the doctor wants so they don't have to burden themselves by asking for the instrument... They can simply put their hand out.... HA!!! (sorry, that made me laugh)... It's true, though

Anyway, by the last section I did, I actually "anticipated" correctly at one point. The doctor was doing a tubal at the end of the section... So, I watched carefully and purposefully remembered the order of the instruments he needed while doing the right fallopian tube, so when he got to the left fallopian tube he simply held out his hand (WHEW, I was glad that I had paid close attention on the right side!) and I correctly gave him the right instruments in the correct order throughout the rest of the tubal..... A Small Victory.... But it felt good.

It was not bad at all.... In the second week of training, I did 5 sections independently.... I feel ready to go with this part of it now, too. Although, all of the sections I scrubbed in on were scheduled... I would like to do one soon that is an emergency... Just for the experience of needing to do all of it in a rush.... Not that I wish anybody an emergency situation... I just want to be experienced and prepared for such a situation, you know.