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Private Fears of Healthcare Workers

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.

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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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A Call to Labor Nurses: Go to the Bedside

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.

 

nursing station

 

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Nurse Burnout: 12 Ways to get Your New-Grad Happy Back

Nurse burnout happens.  No nurse is immune.  If you are a nurse you are at risk for burnout.

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Remember how it felt to be a brand new nurse?

The only thing more shiny than your new stethoscope was your happy face.

happy dance

 

 

 

 

 

 

 

 

 

 

 

I diagnosed myself with nurse burnout when I started thinking that driving my car off a cliff sounded better than going to work.

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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.

Some suggestions to get you started: Mine of course!   Adventures of a Labor Nurse   The Nerdy Nurse     Nurse Together     Mighty Nurse     Scrubs     Digital Doorway

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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.

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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.

Look for your specialty on ANCC or NCC to start.  You will be recognized for your knowledge and add to your credentials.

Maintaining certification means that you will need to keep up continuing education in your speciality, which will prevent you from becoming stagnate.

victory

 

 

 

 

 

 

 

 

 

 

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.

vacation

 

 

 

 

 

 

 

 

 

 

 

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!

raise the rooof

 

 

 

 

 

 

 

 

 

 

 

 

6. Take some time for yourself.  Nurses know how important self-care is, but its difficult to find the time. Find it!

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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.

 

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8.  Be active.  Exercise can help improve mood and is a great outlet for work frustrations.

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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.

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10.  Spend some time with your work buddies away from the call lights and nurse rounds.

You know you love your team.  An out of work activity can remind you that your work pals are awesome.
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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.

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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.)

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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.

 

princess

 

 

 

 

 

 

 

 

How do you beat the nurse blues?  Leave your suggestions in comments.

 

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Birth Plan Basics: Chaperones During Sensitive Procedures

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.

 

 

Happy birthing!
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10 Things that Labor Nurses Fear

All nurses have rational and irrational fears that haunt our waking and sleeping hours.

Here are 10 of the top labor nurse fears.

 

 

Realizing at change of shift you had a patient and didn't know it.
1. Realizing at change of shift you had a patient and didn’t know it.

 

 

 

 

 

 

 

 

 

Calling the father of the baby Grandpa by mistake.
2. Calling the father of the baby Grandpa by mistake.
Monitoring Multiples.
3. Monitoring Multiples.

 

 

 

 

 

 

 

 

 

Farting in a mother's room.
4. Farting in a mother’s room.

 

 

 

 

 

 

 

 

Calling in the OB because her cervix is complete and its really 1 cm and REALLY, REALLY thin.
5. Calling in the OB because her cervix is complete.                                                                             But its only 1 cm and REALLY, REALLY thin.

 

 

 

 

 

 

 

 

Falling asleep in the mother's room, at the nursing station, in the OR, or in the bathroom.  You are soon tired!
6. Falling asleep in the mother’s room, at the nursing station, in the OR, or in the bathroom. You are so tired!

 

 

 

 

 

 

 

 

 

Catching lice, scabies or any other critter from your patient and their visitors.
7. Catching lice, scabies or any other critter from your patient and their visitors.

 

 

 

 

 

 

 

 

 

Dropping the baby.  Those little guys are slippery!
8. Dropping the baby. Those little guys are slippery!

 

 

 

 

 

 

 

 

Not being to keep your game face on when the mom who has no drug history has a positive drug,  a mom whispers for you to check if the baby looks Asian , or a mom who bragged about her pain tolerance gets an epidural at 2cm.
9. Not being to keep your game face on when the mom who has no drug history has a positive drug, a mom whispers for you to check if the baby looks Asian , or a mom who bragged about her pain tolerance gets an epidural at 2cm.

 

 

 

 

 

 

 

 

 

 

The full moon, rain, and days that the OB offices are closed.
10. The full moon, rain, and days that the OB offices are closed.  

 

 

 

 

 

 

 

 

 

 

 

 

What fears about labor and delivery keep you up at night?

 

 

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Free PDF: Caring for the Patient with an Eating Disorder

 

 

Perinatal nurses are now caring for patients that are higher acuity and with more comorbidities.  Caring for a mother with an eating disorder is rare, but does happen.  Your hospital should have policies in place for caring for these patients.  Attached is a free, one page, information sheet as a quick guide when a patient with eating disorders is admitted on your unit.  Pregnancy can be a stressful time in which old behaviors can return.  A better understanding of this disorder can help you care for mothers that are struggling with these issues.

This is general information is for all adult patients with eating disorders.  Each patient and care plan will be unique and take into the specific patient’s needs, assessment and input from the entire healthcare team.

CLICK BELOW FOR FREE PDF (with references):

Adult-Eating-Disorder-Patient-Overview-1

 

Adult-Eating-Disorder-Patient-Overview-1-page-001

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10 Nursing Actions to Bring Compassion Back to the Bedside

Even the most benevolent and happy nurse can forget that every patient is someone’s special person. Some days feel like just another ordinary day at work.  Nurses have bad days just like everyone else. The difference is that a nurse’s bad day can darken a patient and family’s already stressful stay.

When nurses begin to lose sight of the how important their role is a patient’s recovery it is important to recharge, refresh and relearn what it takes to make each day special for patients.

 

Here are 1o ways to bring compassion back to your patient’s bedside:

 

1. Identify something you like about your patient. This may be difficult with some patients, but everyone has some redeeming quality. Find it.

 

2. Smile. If you smile your patient will feel welcome and it can change your attitude as well.  Fake it till you make it.

 

3. Acknowledge and speak to all the people in your patient’s room.  The patient’s family is important and they will appreciate being recognized.  Also they can be recruited to help get ice, hold emesis bags and feed the patient.  The people in the room will be the ones that will be there to support the patient at home when he is tired and needs help. Include the whole family in patient education so that the transition back to home be will be successful.

 

4. Include the partner or loved ones in conversations with the patient. A patient’s support person needs to understand and give input on the patient’s plan of care. The decisions are the patients to make, but they often look to their partner or loved ones for guidance.

Including the partner in the conversations with patient establishes trust and is an element of family centered care.

 

5. Take lunch off the unit. This may be impossible at some hospitals.  If at all possible, leave the unit for your break. Go outside and breathe real air. Take a walk in the sunshine and absorb some vitamin D.

 

6. Use your relaxation skills to relax yourself.  You teach these techniques to patients every day, those same relaxation techniques can benefit stressed nurses!

 

7. Use your vacation days! Don’t hoard vacation days. People that take less vacation days have less job satisfaction.

 

8. Join your professional nursing organization. Keeping up to date on new research is exciting and stimulating.  Challenge yourself and continue to grow in your specialty.

 

9. Go out of your way for your patient at least once a shift. They may not thank you, but you will know that you put in extra effort to make your patient’s stay better.

 

10. When the family is visiting take a few seconds to look away from the IV pump, computer and thermometer.  Witness how the family comforts and supports each other. Watch as a daughter holds her mother’s hand for the last time. See the happiness when a husband is told he can take his wife home.  These moments are what make us human.

 

Take the time to make every day special for your patients.

For nurses it is just another day at work, but for each patient it’s a day that can change their life.

 

 

 

 

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10 Ways to Bring Back the Magic to Labor and Delivery 

All babies are special, but first babies have the unique gift of changing a woman and man into a mother and father.  There is something extra special when a family is welcoming their first child or grandchild. There is also something special about the first baby of the year. Nurses, all over the world, are betting on which mom will deliver the first baby of the new year.  Each hospital wants to be the first in the area to claim the New Years’s baby.  Newspapers will feature photos of the star newborn. The lucky first-of-the-year babies will be showered in gifts from hospitals and companies.

There is a lot of focus on the first baby of the year and nurses ensure that the birth is special and celebrated.  This is a fun tradition, but that feeling fades quickly as the never ending line of pregnant mothers stream in for delivery. Even the most benevolent and happy nurse can forget that every delivery is someone’s special day. Some days feel like just another ordinary day at work.  Nurses have bad days just like everyone else. The difference is that a labor nurse’s bad day can darken a family’s memory of their birth forever.

When labor nurses begin to lose sight of the magic of birth it is important to recharge, refresh and relearn what makes each birth special.

 

Here are 1o ways to bring magic back to labor and delivery:

 

1. Identify something you like about your patient. This may be difficult with some patients, but everyone has some redeeming quality. Find it.

shock

2. Smile. If you smile your patient will feel welcome and it can change your attitude as well.  Fake it till you make it.

 

funny ctm

 

3. Acknowledge and speak to all the people in your patient’s room. The mama is not the only one welcoming a baby into the world.  The patient’s family is important and they will appreciate being recognized.  Also they can be recruited to help get ice, hold legs and fan the patient.  The people in the room will be the ones that will be there to support the mom at home when she is tired and needs help. Include the whole family in patient education so that they can help mom and baby transition successfully.

 

CALL THE MIDWIFE - SERIES 3 - EPISODE 8

 

4. Include the partner or coach in conversations with the patient. A mother’s support person needs to understand and give input on the patient’s plan of care. The decisions are the patients to make, but they often look to their partner or labor coach for guidance.

Including the partner in the conversations with the patient establishes trust and is an element of family centered care.

 

lunch

 

5. Take lunch off the unit. This may be impossible at some hospitals.  If at all possible, leave the unit for your break. Go outside and breathe real air. Take a walk in the sunshine and absorb some vitamin D.

 

6. Use your relaxation skills to relax yourself.  You teach these techniques to patients every day, those same relaxation techniques can benefit stressed nurses!

 

7. Use your vacation days. Don’t hoard vacation days. People that take less vacation days have less job satisfaction.

 

vaca

 

8. Join your professional nursing organization. Keeping up to date on new research is exciting and stimulating. Challenge yourself and continue to grow in your specialty.

 

Call the Midwife - Ep 4

 

9. Go out of your way for your patient at least once a shift. They may not thank you, but you will know that you put in extra effort to make your patient’s stay better.

 

lice

 

10. When the baby is born take a few seconds to look away from the IV pump, computer and delivery instruments. Witness a new person take his first breath. Watch as a mother holds her baby’s for the first time. Look at a father’s complete reverence and amazement at the miracle that has just occurred.

 

Doris Aston CTM

 

My New Year’s wish is for all nurses to be reenergized in 2015.

Take the time to make every delivery special for your patients.

For nurses it is just another day at work, but for each mother it’s a day that she will always remember.

 

 

 

 

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Nurses are on the Nice List

I love the Nativity story. Regardless if you believe the baby in the story is the son of God or not, the story resonates. Picture a young, pregnant Mary searching with Joseph for a place to stay . To complicate matters, Mary’s birth time was near and she surely wanted to get off that donkey and put her feet up. Although there is no mention of Mary’s birth attendants, I’m sure she did not give birth alone. The local midwife, perhaps the lady of the too full inn, would have been called to Mary’s side. In the warmth of the manger the work of labor would be accomplished by a young mother, far from her own mother and sisters. The women around her would act as surrogate mothers, sisters and friends. In this sacred space a baby was born.

Over 2000 years later we continue to celebrate the humble birth. Much like the unnamed birth attendants that witnessed the first Christmas, nurses all over the world are welcoming babies into the world today. Even today there are times that there is not room at the inn. When labor rooms are full mothers are not turned away. Triage and PACU become makeshift labor rooms and when those are full, out come the partitions to provide privacy in the hallways. Nurses know that you can never “max” out on patients in labor and delivery. No matter how many women show up in labor they will be taken care of by the nursing team. Most days there are enough rooms and enough nurses, but even when it gets crazy, nurses meet the challenge and take care of the mothers and their babies.

Santa will make early and late deliveries to many homes. Special people are waiting, in hospitals all over the world, for each Christmas miracle that will be born today. Christmas babies will be greeted by smiling nurses and doctors that are missing their own little ones in order to care for others.

Thank you to all the first responders and healthcare workers that are working today to care for other people’s families. We are thinking about you while we enjoy our time off.

imageDon’t worry….Its your turn to be off next year!

Merry Christmas!

 

 

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