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Men Need Not Apply

 

what now

 

If we, as women, want equality in the workplace, why are we sabotaging our fellow nurses? Why do we call males in the nursing profession “male nurses”? Using this phrase insinuates that nursing is a female profession. It is true that in recent history nursing has been dominated by females. Currently about 10% of nurses are male, but that number is growing. Women have fought for status among our male physician colleagues. We wanted to be respected for our knowledge, training and experience. Our sisters, daughters and friends became medical doctors by an increasing number. Gender stereotypes in medicine have been torn to bits. We do not refer to women MDs as “female doctors”.  Yet we cling to our gender biases in the nursing field. This bias is clearly evident in the obstetrical field. In the land of labor and delivery, female nurses continue to dominantly out number male nurses. This may be more design than accident or patient preference.

It starts in nursing school.

Beginning in nursing school, men are cautioned to be respectful of mother’s wishes to be cared for by women only. This warning is appropriate and justified as some cultures and religions forbid men from caring for women. Other women may have experienced sexual violence or simply prefer women only care givers. Outside of these exceptions, it should be presumed that the gender of the nurse does not matter. The hypocritical bias against men in labor and delivery is especially apparent during nursing school.  It is common for a male student to be shooed out of a patient’s room that not only has been to a male doctor, but has male residents rounding on her. The message that we are giving our fellow nurses is clear.  Male doctors are respectful and take care of patients appropriately, but a male labor nurse is, for lack of a clinical term, creepy.

I have heard the argument that men don’t understand what women need in labor, because they can’t have babies. This is a belittling and backwards notion.  If that concept is extrapolated out to other fields of nursing, then only cancer survivors can work oncology, the mentally ill can only work psych and diabetics only can teach about diabetes. There are many women that have never, and will never, have babies that are wonderful labor nurses. I have met many of these ladies and I am proud to call them friends and colleagues.

As a clinical instructor, I spoke to a patient and asked permission for a male student to take care for her during her delivery. This is not an action that I wanted to take, but what was required of me by the unit. The sweet lady agreed graciously. Her labor nurse went right in after me and sabotaged the whole plan by “clarifying” that this was a MALE nurse and he would be there for the delivery and was she SURE that she wanted a MAN in her room. When the question is posed in that way, patients may begin to feel embarrassed and feel like they should say no. Her doctor was male, which made the situation more preposterous. The student was gracious about the situation, but his learning suffered because of a nurse that felt justified in blocking him from the experience.

Is our culture biased against male nurses?

There is a cultural bias against males in OB nursing.  It begins in nursing school and is reinforced in the hospital setting. I have had multiple conversations with floor nurses, hiring managers and physicians regarding hiring males into labor and delivery. The push back is quick and strong. We don’t need men here, we don’t want men here and our patients shouldn’t have to have men in their deliveries. A survey was conducted to gauge perceptions of males in obstetrical nursing revealed that this is not what patients, nurses or men prefer (McRae, 2003). According to the study most pregnant women would accept a male OB nurse. Up to three quarters of the labor nurses surveyed had positive attitudes toward male labor nurses. Few men had worked in obstetrics, 6.8% and most said they would not want to work in OB. Male nurses did site nursing school as the reason they were not interested in OB. These results can be viewed as a tremendous positive for men who would like to pursue obstetric nursing. With very little representation in the specialty, men enjoy a favorable opinion from both mothers and current labor nurses.

Social Media weighs in on the topic.

I quick polled two of my online social groups. One is a mothers group and one is for labor nurses. The majority of the mothers reported that they would be comfortable with a male labor nurse. The ones that stated that they would  uncomfortable explained that they were exceptions. They agreed that males should be free to be OB nurses and probably would be good at the job.

Brittany Renee Dunevant summed up her feelings this way, “Women have a male doctor (OBGYN), so what is the difference? If he knows what he is doing, then he is the same as a female nurse to me.”

The labor nurse group had similar feelings. All respondents agreed that males should be OB nurses. About 46% of the nurses had worked with male OB nurses. Half of the nurses said that although there was no official ban on male nurses, it was an unspoken rule in their labor unit.

Erin L. Hollen is a perinatal nurse, certified childbirth educator and  breastfeeding counselor.  Erin discovered that she had some hidden biases that the survey brought to light. Upon reflection she observed that a male nurse may have a positive affect on fathers. Speaking of fathers Erin shares “…if they see that you can still be supportive of a woman in this situation and still be ‘masculine’ maybe they will participate more.”

Is labor and delivery a secret, girls only club?

In many hospitals the answer is yes. The new question is: How will we break down the gender bias that we are perpetuating with each new class of nursing students.

Answer: Let male nurses into OB. No questions asked.

 

McRae, M. (2003). Men in Obstetrical Nursing: Perceptions of the Role. MCN, The American Journal of Maternal/Child Nursing, 28(3), 167-173. Retrieved November 22, 2014.

 

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Being a New Nurse aka The Hunger Games

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All nursing students have heard the saying, “Nurses eat their young.” Being a new nurse is scary.        Your first nursing job may feel  like the Hunger Games.

 

 

 

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You think you nailed the interview when the manager loves your nursing school story about the geriatric patient with the smelly feet.

 

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After your third panel interview in a week, all you can manage is to say thank you and hope that you get a job offer.

 

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This is you nailing your first nursing  job.

 

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This is the firs time you sign your name with RN

 

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The opening ceremony is how you look in your starched uniform and perfect bun.

 

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This is how you look after you’ve been a nurse for 6 months.

 

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Finding a computer to chart is like fighting your way to the cornucopia.

 

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You have never heard so many machines beep at one time.

 

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The reaction you get when you ask for help from the nurse that no one warned you about.

 

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The pep talk your preceptor gives you about caring for the 90 year old, 90 lb woman with dementia who you are just a tad afraid will hurt you, again.

 

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The last 7 minutes of your shift, while you are waiting to clock out.

 

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The minute you finish your shift assessment your charge nurse floats you to another unit.

 

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You and your buddy decide to complain to your manager about your 4 on, 1 off, 4 on night shift schedule. They won’t fire both of you…right?

 

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Haymitch is your veteran nurse friend that gives you advice and is always dragging you out for bloody Mary’s after your night shift

 

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When the doctor belittles you in front of the patient.

 

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This is the key to getting nursing awards.

 

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Losing a patient is difficult, but you have to finish your shift.

 

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This every shift that is short staffed, which seems like every shift.

 

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Getting to know the other staff is not as easy as you think.

 

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Learning how to prioritize patient needs and requests can be overwhelming.

 

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Your family and friends don’t know what you are going through, but they are your biggest supporters.

 

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How you feel when the charge nurse asks you take your 3rd admit of the day.

 

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How you justify playing Candy Crush after you offer to help out your unit.

 

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When you find out your work spouse accepted at another hospital.

 

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Keep smiling! Your bonus is based on the patient satisfaction scores.


 

 

 

 

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This is you realizing you are not a brand new nurse anymore. You actually know what you are doing!  You rock!  Now its your turn to be a mentor to a new nurse.

 

 

 

 

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STAT ibuprofen and an Ice Pack (For the Nurse)

belly kissI am extremely sore today!  I am not in pain from working out at the gym, playing soccer with my kids or golfing. I am sore because I labored two unmedicated births yesterday. Tired feet and sore backs are standard fare for a hospital nurse. Swollen legs are also common, due to long hours standing in an operating room or by a critical patient’s bedside. It may be surprising that laboring a mom, that wants a natural delivery,  is a full body work out. My shoulders are stiff, my arms are aching and my thighs are sore.

Birth is magical regardless of the mode of delivery or the use of pain medications. That being said, I love unmedicated births. I love helping a mother work through the process of labor and accomplish her goals. I love the moment that the baby is born and is placed on mom’s chest as she sighs with relief. I love all of it, but it can be intense for the nurse.

Confession time, patients with epidurals are generally less work for nurses.  Plain and simple, an epidural and a urinary catheter make my job a lot easier. Monitoring the baby is easier, since mom is generally resting and immobile. There are no hasty trips to the bathroom between contractions, because the catheter is draining to gravity on the bed frame. I can relax at the nursing station, charting comfortably while watching my electronic fetal monitoring strips. I am reassured that my patient resting comfortably, with the her call light within reach. Transition consists of some rectal pressure or napping, occasionally vomiting and shaking.

Moms that go natural need their labor nurses more. Transition is different without an epidural. Mom’s have looked me in the face and begged me to cut their babies out during contractions. Then, in between contractions, insist that they don’t need pain medication. I have learned to go with what my patients tell me when they are not contracting. I know my patient, with an epidural, is complete by watching the early decelerations on the monitor or because she suddenly says she needs to poop. I can tell when my natural mom is completely dilated by the involuntary pushing she starts to do at the peak of her contraction and the change in her demeanor from desperation to intense focus.

I have been in that patient keeping her nurse busy. During my first unmedicated birth, I begged my nurse to help me during transition. She thought I meant medication, but I wanted her presence. I knew I could have the baby without drugs, but I did not want to do it alone. I needed her there, to silently bear witness of my labor and remind me that it would not last forever. She ended up catching my baby during change of shift. The doctor was trying to gown up for the delivery. He had one glove on when the baby shot out. It made me secretly happy that my attentive nurse had been the one to catch my baby.

Now its my turn to catch precipitous deliveries and bear witness to women as they labor. When I am lucky enough to care for two moms in one day that are skipping pain medication I am elated. I am also worn out!

 

 

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Please Don’t Hit Me

stressI have been hit, kicked, punched, slapped, had my hair pulled, scratched, spit on, cursed at, had things thrown at me and bitten. Am I in an abusive relationship? Are those memories of an abusive childhood? Am I a street fighting ninja? No. I am a nurse.

Nurses experience abuse from patients. Patients can be impaired by disease processes, medication, and stress which causes them to strike out against the hand that cares. Multiple studies have shown that workplace violence against nurses is mostly due to patients hurting nurses. Nurses have an almost universal reaction to this violence. They keep coming back to work to risk being hurt again.

Patients who lash out

Helping a person through the detoxification process is exhausting and can be dangerous for the patient and the nurse. Alcohol is the legal, easily accessible drug of choice for some adults. When a person realizes that they have a drinking problem detoxing in a medical setting is the safest way to do it. Alcohol and drugs have powerful affects on the body which are not always understood by the abuser. Cleansing the body of the substance can be difficult to endure. It is possible to die from detoxification that is not medically managed. Young male adults are particularly terrifying for me to care for while they are detoxing. A 6 foot 2 inch, 200 pound, 25 year old man having hallucinations is no match for a woman who can barely reach the pedals in a pick up truck. Thanks to physical restraints and adequate doses of lorazapam I have avoided serious injury from this type of patient.

One group of patients that I have not escaped injury from is the laboring and postpartum mother. I have had my arm pinched, squeezed and scratched countless times from doing post delivery fundal checks. I routinely preamble the fundal check my asking my patient to “Not hurt your friendly nurse.” They look at me smiling, not quite understanding what I am about to do and why I am warning them that it will be uncomfortable. As soon as I’m pressing the top of their uterus, to assess for firmness, the claws come out. My arm is the closest target. I am actually more gentle than a lot of my counterparts, but there are times that being gentle is not in the patient’s best interest. Postpartum hemorrhage is the number one reason for maternal death. A mother can exsanguinate (bleed to death) in just 10 minutes. Although I have literally had my hand slapped, I will keep putting myself at risk for the safety of my patients.

Why is the violence tolerated?

The patients are why nurses keep coming back to face the possibility of injury. We forgive and move on to the next patient. We try to make the workplace safer, but accept that due to the nature of our work we are vulnerable to abuse. We hope that when we are ill, injured, confused and angry there will be a nurse to help and forgive us.

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Nurses Lie

Nurses have been voted by the public as one of the most trusted professions year after year.

Let me share a secret with you, nurses lie. Of course all nurses are not saints. It is possible to run across a Nurse Ratched or Nurse Jackie from time to time. That is not what I mean. All GOOD nurses lie. Nurses may pride themselves on being honest and having integrity in their personal lives, but they can not stop lying at work.

Seven lies that nurses tell:jurse jackie

1. It’s just allergies.

Nurses are constantly exposed to illness. They work long hours with little time for resting, eating, drinking or potty breaks. Many nurses work the nightshift which further weakens their immune systems. The nature of their work leaves nurses vulnerable to illness. It is not possible to stay home every time a nurse is sick. Patients need cared for 24 hours a day. Bills still need to be paid. Hospitals fire nurses when they take too many sick days. All these factors create tremendous pressure to take an over-the-counter cocktail of medications and head on in to work.

2. You are dilated to 9cm.

This may be true. Maybe not. It depends if your doctor is impatient with moms while pushing. Three hours of pushing is normal for first time moms, but not all doctors will wait that long. Your nurse may be buying you time to avoid a cesarean section. She may see that you really need to rest before you start pushing. Maybe you are waiting on a family member to arrive and she is trying to buy you time. Maybe she needs to eat a snack before she passes out and she knows you want to start pushing right at 10 cm.

3. Don’t worry, it happens all the time. It’s not a problem.

Chances are it doesn’t happen all the time, but your nurse wants you to feel comfortable and not embarrassed. Even if it is a common occurrence it probably is still a problem. A patient passing gas while a nurse is inserting an urinary catheter does NOT happen all the time and it IS a problem. Nurses will lie through their teeth while they try to not inhale and also try to not break sterile technique.

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If I can’t have Dilaudid can I have my IV Phenergan? Don’t forget to push it fast!

4. You can’t have any more Dilaudid.

Chances are you technically could have more. When a patient is asking for more narcotics in between snoring sessions and they can’t tell the nurse from the IV pole, they are not getting any more Dilaudid!

5. I have time for you.

Nurses wish that statement was always true. It is often a lie. Heavy patient loads and mountains of charting take time away from the time at the bedside. In a rare moment when a nurse is caught up with his shift work he still has hospital, unit, certification and licensure education requirements to complete. Nurses will stay at the beside and make the time for you that is needed. Then they will stay late to chart and come in on their days off to complete their continuing education requirements.

 

6. I need to go check on a lab result. (or any excuse to get out of a room)

Sometimes this is nurse code for “If I don’t go to the bathroom right now I am going to have to call a code brown on my self.”

 

7. I don’t smell anything. Yes they do! They smell it. They are just being nice. If it is within the nurses power to fix the problem then they will bathe, deodorize or bandage up the offending odor. When there is nothing to be done about the smell, they will lie to preserve the dignity of their patient.

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Nurses lie. Should a nurse share her battle with irritable bowel syndrome and explain how it will affect her time management of her patient care? Sometimes ignorance is bliss. Despite a history of lies, nurses deserve to be the most trusted profession.

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If Your Hospital was Divergent

“We believe in ordinary acts of bravery, in the courage that drives one person to stand up for another.”
― Veronica Roth, Divergent

If nurses are anything, they are Dauntless.  What if your hospital was Divergent?

 

 

This is your first day off orientation.
This is your first day off orientation.

 

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This is how you fixed your hair in nursing school.

 

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Abnegation is the type of nurse you want to be when you start nursing.

 

Dauntless
Dauntless is the type of nurse you become after a few years.

 

Scoring the best assignment is like winning capture the flag.
Scoring the best assignment is like winning capture the flag.

 

This is how you feel when you realize your great assignment is not as great as you thought.

 

This is the point you decide to call the charge nurse for help.
This is the point you decide to call the charge nurse for help.

 

There is always at least one RN buddy that you can depend on when it counts.
There is always at least one RN buddy that you can depend on when it counts.

 

Charting gets a lot harder after 3 A.M.
Charting gets a lot harder after 3 A.M.

 

This is how you decide who gets the last kolache in the break room.
This is how you decide who gets the last kolache in the break room.

 

Sometimes patients just need a hand to hold.
Sometimes patients just need a hand to hold.

 

When your manager comes in early to talk with you.
When your manager comes in early to talk with you.

 

Thank goodness for nursing mentors.
Thank goodness for nursing mentors.

 

Don't worry.  We will go get  a drink after the staff meeting.
Don’t worry. We will go get a drink after the staff meeting.

 

Oh Crap!  This means paper work.
Oh Crap! This means paper work.

 

Overtime?  Yes, of course I will stay, if you are Four.
Overtime? Yes, of course I will stay, if you are Four.

 

This is you trying to beat the lunch crowd.
This is you trying to beat the lunch crowd.

 

Joint Commission is here.  Act right people.
Joint Commission is here. Act right people.

 

This is how you feel when you lose a patient.
This is how you feel when you lose a patient.

 

 

This is how you feel when you save a patient.
This is how you feel when you save a patient.

 

This is how you feel to go home!
This is how you feel when you get to go home!
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Birth Plan Basics: What Should I Wear in the Hospital?

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I am frequently asked about the patient gowns that women are given to wear in labor.  Mothers want to know if they should and/or have to use them.

Comfort is important.

Many moms worry more about how their feet will look or shaving their legs before labor begins than what they will wear in labor.  It is good to feel comfortable in labor.  If getting a pedicure before delivery puts a mother at ease, then she should get one! The clothes a laboring woman is wears during the hours of labor and birth may have a bigger impact on her comfort than the color of her toenails.

What are you allowed to wear in the hospital?

You do have a choice!  I have labored mothers in everything from being absolutely naked. to being covered hear to toe. You are not required to wear a hospital gown.  You can wear whatever makes you feel comfortable.  There are some restrictions in the operating room.  If you are having a scheduled cesarean section or end up there after laboring, you will need to wear the hospital gown.  Hospital gowns are preferred in these situations due to infection risks and the types of monitoring equipment used in the surgery.  If you still would like to wear something else to surgery discuss your options with your nurse or doctor.

Pros and Cons of the hospital gown

Pros:

There is a fresh one waiting whenever needed.

You don’t have to worry about getting blood, poop or vomit out of it later.

Some are designed for breastfeeding or monitoring ease.

Cons:

They are made to accommodate a large variety of sizes and usually do not fit well.

Modesty can be an issue, especially while walking in the halls.

Hospital gowns can make you feel like a sick patient and less empowered.

What are my clothing options?

Occasionally I have labored a mother whom was only comfortable completely naked.  These were all patients that were laboring unmedicated. I provided modesty when she requested it with sheets. Tank tops or breastfeeding tanks are popular.  Sweat pants, shorts or yoga pants are easy to slip off for cervical checks and are comfortable for labor.  Skirts are comfortable, modest and do not need to be taken off for pushing.  There are specialty lines for labor clothes for example: http://www.prettypushers.comThe specialty clothing is designed to accommodate monitoring equipment and maximize utility and comfort.  If you do not want to pay the specialty price, there are plenty of other options.  In my most comfortable delivery I wore a breastfeeding tank and a maxi skirt with a wide, elastic waist band.  The ultrasound and toco monitors fit in the band so that I did not need to wear the monitor belts.  I moved around very comfortably and always felt modest.  When it was time to push it was easy to pull the skirt up and out of the way of the delivery.  I did not plan on wearing the skirt again, but I was happy to find that the evidence of delivery washed out easily.  I wore that skirt multiple times in my postpartum months.

Postpartum Tips

If you choose to wear the hospital gown for labor and delivery you can still wear your own clothes after delivery.  It is good idea to bring 2-3 pairs of comfortable, stretchy clothes with you for your postpartum stay and the drive home.  The hospital’s maternity underwear are disposable and great for giant pads.  Some moms prefer to bring in their own underwear or brief type panties.  Hospitals will often provide slip resistant socks for their patients.  You can bring in your own socks or slippers if you wish.  Breastfeeding moms will spend a lot of time with the baby skin to skin during the first few days.  Nursing bras are not vital for the hospital unless you feel uncomfortable without a bra.  You may want to wait to buy nursing bras until after your first week at home since your bra size will likely change.

 

The bottom line.  

Its your bottom and you can cover it however you wish!

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