I saw the tweet shoot across my phone during a meeting. Someone had walked into Brigham and Women’s Hospital and shot a surgeon. I did not know the story. I did not need to read the details to feel the familiar terror creep into my heart. It is not something that nurses often talk about. In the privacy of break rooms, during whispered conversations and in our own minds we admit that patients sometimes scare us.
Death, birth, illness, surgery, dementia, sleep deprivation, drug induced psychosis, and alcohol withdrawal are examples of the dangerous landscapes that healthcare workers navigate each day. I have been a nurse in many different situations and types of patients. Labor and delivery is one of the most volatile units in a hospital. Emotions run high when mothers and babies are involved. Babies do not always go home with their mothers. When child protective services is taking custody of a newborn, there is a palpable stress on the unit.
Nurses are an easy target for angry parents. Nurses are blamed, by parents, for reporting mothers who test positive for illegal drugs. Threats against nurses and doctors are common in these type of situations. Threats can lead to actual violence. I have been physically hurt by angry patients. I have seen nurses punched in the face, choked and pinned against walls. In the back of my mind I am always planning my escape route. My internal alarm goes off when I see a father stomping across the unit. It makes me uncomfortable to see the poster banning guns from the hospital grounds. Its a daily reminder that we are defenseless against a shooter that disregards that posted warning.
Hospitals practice disaster drills, one of which is an active shooter drill. We prepare for the worst. We hope we never have to face what Dr. Michael Davidson did on January 20th. The investigation in the Brigham and Women’s shooting is still ongoing. We do not know the relationship between the doctor and the shooter. Regardless of the relationship, it will not decrease the worry and fear that healthcare workers live with in order to do their work. Our mission and passion is to care for patients. Patient safety is our top concern and what we base all care around. On days like today, we are reminded that we need to also worry about our own safety.
As I was writing this post I recieved another tweet. The surgeon has died. Dr. Michael Davidson, your colleagues around the nation are thinking about you tonight and mourning your loss. Our thoughts and prayers go out to his family in this sad time.
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I have a large family, by current standards. I am the proud mother to five beautiful children. I conceived all of them easily, had uneventful pregnancies and easy vaginal deliveries. Sounds like a dream come true. Not exactly.
My husband and I always planned to have six children. We were happily pregnant, with our caboose baby, when all my good pregnancy mojo disappeared. We lost our sixth baby at 12 weeks gestation. I was devastated. After a few months I became pregnant with my Rainbow Baby. I was a few weeks pregnant with baby number 7 when my former due date arrived. I mourned the loss of my last baby again as that date passed, but I was comforted and reassured by the new baby growing inside me. My seventh pregnancy only made it to 7 weeks. A new storm overtook me. I almost lost myself. It seemed strange to many people that I was so sad. It is hard to explain how it feels. I felt selfish for being so sad, especially when I have friends that struggled to have even one child. I know that my children are a blessing and I am grateful. It was impossible to talk my heart into understanding that I should feel grateful and not miserable.
After two losses, we decided to not try for any more rainbows.
I have secondary infertility due to hormone imbalances. Although it is possible for me to become pregnant, it is difficult to sustain the pregnancy. When I learned my body was the reason my babies died it felt like my heart had been sucked from my chest. I hated myself for ignoring every physical symptom that seemed so glaringly obvious in hindsight. My mind replayed, on a loop, every possible time I could have been diagnosed prior to becoming pregnant. “If only” became my nemesis. I mourned my lost babies. I also mourned my shattered body image. I had trusted my body. I owned a strange pride in my ability to conceive and birth perfect babies. I rocked at baby making. I gave birth like a boss. I was a wizard at lactation. That sounds bizarre perhaps, but I enjoyed my fertility and all the happiness that it brought to me and my husband.
I still have days when the “if onlys” sneak into my mind. I sometimes think about what those babies would be doing now, if they had lived. Those times are getting less frequent and I am grateful. More of my minutes are spent in awe of my amazing five. More kisses, more hugs, more cuddles are given to the ones that stayed.
I did not get a rainbow after the storm.
My rainbow started with my first son and ended with my sweet baby girl.
This rainbow was made bigger and brighter with each of my five children.
It is not what I imagined it would be, but it is the most beautiful thing in my life.
Perinatal Loss Resources:
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Q. Should I have an elective induction of labor?
Q. I want to make sure that my OB is there for my delivery, should I schedule an elective induction?
Q. My mother is flying in this Saturday, can I schedule an elective induction for Friday?
Q. It is my first baby and I am already dilated to 1cm. I want to schedule an elective induction.
Q. I am 38 weeks and I am contracting 4 times an hour, I would like to schedule an elective induction.
Q. My ultrasound said that my baby was already 6 pounds at 37 weeks. Should I have an elective induction at 39 weeks?
Q. I really want my baby to be born on 1/15/15. Should I be induced electively?
Q. What about an elective primary cesarean section?
Q. If I have no medical reason to have an induction, should I let my baby choose his birthday?
I do not recommend an non-medically indicated elective induction of labor or cesarean section.
Inform yourself about the risks of inducing labor early.
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One to One Nursing Care for Actively Laboring Mothers
Not all hospitals are able to, or choose, to staff their labor units according to AWHONN guidelines. Many hospitals recognize that one to one nursing care for actively laboring mothers is the gold standard and is safer for mom and baby. I have worked in both types of facilities. Nurses that are able to care for mothers one to one can give a great gift of time and attention to their patients. Mothers in labor do better when they have continuous support. I feel lucky to work at a hospital that strives for one to one staffing. I am making a call to labor nurses, go back to the bedside. I love working with you ladies and gents. You make me laugh. The nursing station is a fun place to joke around with people whom understand you in a way that even your family can not. I love swapping war stories and sharing photos of babies with you. As much as I love this interaction with you at the nursing station, I ask you to go back to the bedside. The mothers need us. Laboring mothers need continuous support. Remember labor sitting? We need to bring that back! With continuous support mothers are less likely to need medical interventions. You will be able to recognize subtle differences in your patient’s status. You will have more time for observation, assessment, education and supporting the mother and her family. One to one staffing is a great gift for both the nurse and the mother. Sometimes a mother will request less of your presence at the bedside. This is rare. All mothers should have continuous support during labor, even when they have has an epidural.
Quietly sitting, charting and guiding the mother is reassuring and decreases maternal stress.
It may seem awkward at first. It will become normal very quickly.
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Nurse burnout happens. No nurse is immune. If you are a nurse you are at risk for burnout.
Remember how it felt to be a brand new nurse?
The only thing more shiny than your new stethoscope was your happy face.
I diagnosed myself with nurse burnout when I started thinking that driving my car off a cliff sounded better than going to work.
I was able to get back to my nursing happy place and I am in love with nursing again.
Here are some ways to get you back to happy-dancing your way to work.
1. BLOG! I love it and I’m not the only nurse on the interwebs! If you are not a writer then read nursing blogs. There are all flavors of nursing blogs, from informative to hysterical.
2. Go back to school. Getting your BSN, MSN or DNP will make you more marketable and open up more options.
Going back to school will reenergize you about nursing.
You will read a LOT about new nursing research, which will get you out of a nursing rut.
You will be so busy making powerpoint presentations and writing discussion posts, you will have no time to think/complain about work.
3. Get certified in your specialty. If you are burned out then you probably have been a nurse more than 2 years. Congrats!
That means that you are qualified to become certified in your specialty.
There is a certification for just about everything nursing related.
Maintaining certification means that you will need to keep up continuing education in your speciality, which will prevent you from becoming stagnate.
4. Take your vacation days!! Everyone needs a break. Nursing is stressful.
If you don’t take vacation for yourself, then take it for your patients. Being a relaxed and refreshed nurse will benefit them.
5. Celebrate wins. We are always focused on what we need to improve and what we are doing wrong.
When you or your team have a win, celebrate!
6. Take some time for yourself. Nurses know how important self-care is, but its difficult to find the time. Find it!
7. Join a committee. Make changes. Give your input. Does your hospital have shared governance or unit representation to make decisions? If yes, join. If no, start it! You can change nursing practice.
8. Be active. Exercise can help improve mood and is a great outlet for work frustrations.
9. Go to a Nursing Conference.
There is nothing better than going to a conference full of nurses. People think that ComicCon is weird, but they have never been to a nursing conference! We have crazy nurse fun!
It is a great time and it is a place where you are reminded why the heck you became a nurse.
10. Spend some time with your work buddies away from the call lights and nurse rounds.
11. Attend a continuing education course or webinar about a topic that interests you.
Will you be inspired by experts talking about the topics that they love.
12. Quit. Not nursing, but quit your job. Sometimes you really don’t have nurse burnout, but job burnout.
One of the best things about being a nurse is the vast opportunities you have for employment.
If you need a change of pace, location or specialty do it. Give a proper notice and leave on good terms.
You never know when you may work with those nurses again. (It will happen.)
Nursing is a rewarding profession. If you feel yourself getting disenchanted, actively try to get the magic back.
If you are successful you will be back to the new grad feeling which is good for you and your patients.
How do you beat the nurse blues? Leave your suggestions in comments.
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The next time a mother or father asks you for something that is not a common practice, take the time to listen. Ask yourself if it is safe, or could it be safe. Check to see if her request has research to back it up. Many practices that we consider standard today were thought to be radical in the recent past. It is our ethical duty, as nurses, to advocate for our patients and support their autonomy. Work with a mother to help her make the best choices for her. Respect her choices even when you would make different ones.
I have heard many women talk about their lack of modesty in labor. The intensity of labor and birth often breaks down social and cultural norms of privacy and modesty. It is acceptable to be less modest during birth if you feel comfortable. You do not have to give up your modesty. You can work with your care providers to ensure as much privacy and modesty as you need and want.
Another thing to consider is if you would like a chaperone during sensitive examinations such as cervical exams. If your nurse or physician is male, a second care provider will commonly accompany him during the exam. This does not always occur, but you can request a second person at any time. You may request a chaperone no matter what the gender of your care provider. Routinely female nurses will not seek out a chaperone. You will need to make your wishes known. Women do not need to explain the reason they feel uncomfortable with only one provider at the exam. Empowering women to request a chaperone is supported by the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN). AWHONN’s position statement details who is an appropriate chaperone. Factors that contribute to the decision to have a chaperone are also included. It is up to you if your support people are present during these sensitive times.
My advice: Read the position statement. What are your preferences? Discuss your feelings with your support person. Include your preference in your birth plan.
Remember that you can change your mind and modify your birth plan at anytime. If you did not plan on having a chaperone and during labor discover that you would like one, speak up! If you planned on utilizing a chaperone and once you are in labor you decide that extra person is not needed, let your nurse know. Some hospitals require a second provider to attend during sensitive exams. If this is not acceptable to you then accommodations can be made. For example, ask for the second person to stand behind the curtain. Communication with your physician and nurse will be key to your experience. Speak up, ask questions and let your preferences be known.