Friday, April 16, 2010

The Allure of Likeness

      Oh how we love to be alike. Isn't this how we connect with one another, search for the things we have in common and latch onto them like life rafts; all of us, adrift on this ocean of life; tides of fear, joy, perspective, experience, pulling us this way and that. Of course we want to find ourselves among "likeness". We recognize ourselves in others, we want them to see themselves in us. We get to know ourselves better this way.
   But..... it can be a challange to be true to ourselves. To stand out, to not only display our differences, but to champion them! Isn't our ocean littered with cast aways, wreckage, and rubbish? Who among us hasn't abandoned one ship of self for another, more acceptable, socially appropriate mode of transportation?
    Years ago I began to recognize the ways in which people connected with one another. I became distrubed when I began to understand how negative the threads of similiarity we used to sew our relationships together are. I noticed, in the groups of people I associated with, how common it is to connect through our traumas, wounds, and negative experiences. We like to share our difficulties and display them like costumes, choosing which to don by looking at those around us, comparing our scars, and grouping ourselves with those most like us.
   I bring this up, one, because I often think about it, and two, because I've been thinking about it in relation to my work environment. The allure of likeness is strong. Even though I have spent many years cultivating my awareness of negative habits of connection, I still find myself drawn into the web. Although I am often able to seperate myself from the negative comments about patients/family members/Doctors/nurses, I do slip into it now and then. Icky!
   I recognize the need to vent is strong, and often appropriate. Some situations require a release and sharing with colleagues can be healthy and help to build strong relationships. But much of what goes on is out of habit. It is just too easy to label others, to bond with one another through shared perspectives, to create a circle of "we" by creating a boundary for "them".
   I don't want to loose my perspective and become a part of the common ship of likeness, like the members of Davy Jones' crew in "Pirates of the Carribean". I want my relationships to be woven with threads of positive commonality and difference. I want to be able to use sarcasm and labels occasionaly, because I enjoy humor as a method of healing and communication, but I want to maintain my awareness of the tide that carries me. I fear, if I do not, I will look out at the horizon one day and find myself lost,  woven into the fabric of a ship I did not want to be on, traveling in a direction I never wanted to go.

Monday, April 12, 2010


      I feel comfortable at work. There are many, many things I've yet to learn, and bits of paperwork I miss every once in awhile, but I feel easeful with the work itself. My experience as a doula and familiarity with the  birthing process may have much to do with it, but somehow, I feel it is more than that.
   I think I am doing what I am meant to do. I have followed my passion and it has led me here. And as I continue to follow my passion, I continue to find myself greeted with exactly what I need. I have an openness, a willingness, a desire to meet each moment with my full attention and presence. I want to learn, I want to fullfill my potential. It is good to do what I love.
    I am learning about my own limitations, areas in which I need to pay more attention, things I need to spend more time on. I know that today I forgot to share some information in a report. I assume there are elements of the massive amounts of paperwork that I most likely failed to fill in properly. I am confidant I did the majority of the work well and correctly, but I am aware of the great possiblity for missing something, or multiple somethings as the case may be.
   I did a blood draw today. I successfully filled the tube, which ended up being the wrong tube. Thankfully I did not need to do another draw. Unfortunately the site infiltrated, which means the patient ended up with a hematoma and bruising. I felt badly for her. It will probably be pretty painful for awhile. But I was proud of myself for the successful draw! I look for successes where I can.
   I find myself comforted when experienced nurses encounter the same difficulties as I. For instance, today, for some reason, I could not get any of the thermometers to work for me. One after the other they didn't work. I've been using these same thermometers for weeks. I wasn't doing anything differently today. I couldn't figure it out. I asked my preceptor to try using them and she was having the same issue as me. It made me feel better to know it wasn't just me doing something blatently wrong with something as simple as a thermometer. Other times I can't figure something out, like how to program a pump that's different from all the other pumps on the unit and completely new to me, so I mess with it for a few minutes, then have to leave the room and ask my preceptor for help. Most of the time I handle these situations by using humor, poking fun at myself, etc. I don't worry too much about it. It doesn't bother me a lot. But I don't like to appear clueless to my patients. I want them to feel confidant in my ability to care well for them. To trust in my competence.
  So far it seems they do not mind my small blunders. I think my honesty helps to put them at ease. We shall see.

Friday, April 9, 2010

REACHE Conference.... more stirring the BirthNurse thought pot!

   Today I attended the REACHE conference. The presentations/speakers were enthusiastic, entertaining, and informative.
      I must admit I love me some research! Interestingly enough, I also enjoy data, statistics, and in particular... Evidence Based Practice (EBP). Several years ago I attended another REACHE conference where Henci Goer  (   was a presenter. She is a well known proponant of evidence and research in childbirth, but she also is very clear about how the data can be interpreted/misinterpreted and learning how to interpret research.
    Over the first few years of my doula career I picked up tidbits of research, data, EBP like I was flypaper and I became aware of the vast quantities of conflicting data and the lack of EBP in childbirthing. I began to cultivate an understanding of the ridiculousness of attempting to apply data to an individual woman. There is no real way to extract research from a particular study or even a group of studies that can be reliably applied to a particular situation and result in an expected outcome. People don't work that way, birth doesn't work that way. But many elements can be integrated into the way we approach caring for birthing women as a population, especially in the implementation of practice on a systemic level, as in hospitals, physcian/midwifery clinics/practices, etc. That is why we do these group things, form collaborations, beg for research money, because we want to change more than just one person's experience. We want the best for everyone, or as close to the best as we can get. But how do we know what's best??
   As one of the speakers at the REACHE conference alluded to today, as human beings we naturally chose things that meet our needs. With the internet at our fingertips we can easily find "research" that supports any view we may want to champion. Or even better, any practice that we want to adopt, or more likely, a practice that we are comfortable with and do not want to change!
    As I gathered more information, and attended more births, I began to change the way I talked with clients, instead of citing research that supported certain choices.. i.e. non-pharmalogical interventions, breastfeeding, etc. I began to cite research with the caviate "of course these studies don't necessarily apply to any individual, every experience is different", or something along those lines.
   As always, applying science to human behavior is a tricky business. This brings up my beef with Darwin, but I'll have to save that for later. Although birth is a physiological process, that is just one of it's many facets. Birth is also personal, emotional, familial, cultural, societal, public, private, the list goes on.
    Birth not only entails the individual experience of a woman having a baby, it also encompasses a fetus (or multiple fetuses), a family (however that may be defined), the care givers, attendents, and the combined experiences of all those involved, however indirectly. In other words we bring the entirety of ourselves into every situation we encounter, and so does everybody else! (How well we are able to seperate out the elements of ourselves we wish to display/use, and how each influences the other is a topic for another day). Not only is birth a complicated, unpredictable physical event, it is also a complicated human event, and it carries with it all the mess, misunderstanding, and uniqueness of all of our humanness.
   No Wonder we all have so much invested in Birthing. We have big feelings, big opinions, and big investments in Birth because it is a Big Deal!

Sunday, April 4, 2010

A good day

     During my last shift on the L+D unit I attended the birth of a couple who chose to birth without medications. They had taken a 12 week series of childbirth classes and were working with midwives. The patient and her husband arrived early in the morning after several days of laboring at home. She was 7 centimeters. The few hours I spent with them were wonderful.
    I got to integrate my doula skills with my nursing skills and provide direct care to the patient and her husband. He was wonderful, supportive and present. The midwife was calm and unobtrusive. My preceptor and I worked well together. She allowed me to do what I could do, checked in with me periodically, and took on the roll of "baby" nurse when the baby was born.
    My patient spent some time in the birth tub during her labor. I used a doppler to listen to her baby's heart tones and used my hands to palpate her contractions. I performed a few cervical exams to check her dilation. She had the urge to push for quite awhile, while she still had a bit of cervix left. Not too long after I performed an exam my patient was saying she had to push so I asked the midwife to come in and check her, with the patients consent of course. The midwife examined her and and her exam was the same as mine. This was very validating for me!
    You may or may not know that cervical exams are very subjective. Women's cervixes do not dilate in perfectly concentric circles, care providers and nurses have different sized hands, perform exams differently, and have different interpretations of 0-10cm. Baby's do not apply the same kind of pressure, in the same spots, and cervix's can feel different from exam to exam, actually when a woman is in labor you hope that they feel different, change is good, but it can be tricky when you have multiple examiners. (The topic of the necessity, or not, of cervical exams is for another day!)
  That being said, as a new nurse, and a new cervical "examiner" it is helpful for me to know my exams are "accurate", although accurate may not be the right word. So the few times I have had providers do a check after me I have been glad to know they come up with the same results as me.
    It was a great birth, a great way to start the day. Things went well for the patient, her baby, and her husband. They were happy, glowing, and exhausted. They kept telling me what a wonderful nurse I was!
   So wonderful! How gratifying and validating. I made a difference for them. They had the birth experience they wanted, in fact, at one point, she told me her experience in the hospital was better than she had hoped for! How amazing is that!
    It was a good day!


           After three twelve hour shifts in a row last week I found myself pretty dehydrated. It's one of the unfortunate results of being watched by the Joint Commision/JHACO, we are not allowed to have personal drinks at the nurses stations. We can have them in the break room and/or in the charge nurse's office. It takes some coordination, and time to get to a drink of water. Plus, I happen to like coffee, so I drink that during my breaks as well, and end up becoming even more deyhdrated because of it.
           My astute husband has suggested I try bringing electrolyte drinks with me to work and sipping on those throughout the day, when I get a chance. So I am going to try that this week and see if it makes a difference. I am also going to remind myself to get as many sips of water in during my shifts as I can. Every little bit has to help. Right?

Wednesday, March 24, 2010


     So many things happen in a day. Two shifts since my last blog and I am already loosing details that I'd wanted to share. Hopefully they will come to me as I sift through my short term memory.
         I've worked with a couple of patients that have been considered challenging by those who worked with them before me. I am considering more and more the effect of how a report is given, the words, tone of voice, emotions used, on the person receiving the report and their subsequent care of the patient. It has to have some effect.
    How much of our own prejudices are we passing on? Do we consider this before we spread it around? What are we projecting onto those we are caring for? Are we aware of it? Are we honest with ourselves?
     These are the kinds of questions and topics I'm considering, although I have not had a lot of time to put into their consideration. I would love to think more about it. It's a topic that really interests me and I think a lot can be learned from looking into it further.
       I find, when I interact with people directly, meeting them where they are at, offering them my time, my presence, and my attention, it goes a long way toward gaining their trust and respect. Although I have my own thoughts and feelings about the choices people make, and sometimes my empathy for them causes me to feel some grief, I do not feel burdened by judgement of their actions, choices, etc. I feel as though those type of things become suspended, somewhere away from my interactions with individuals, and I am able to truly be with them as they are, and show up as my best self. I am really grateful for this.
      I try to listen to what others say about others and allow my experiences with them as individuals and as a unit (nurse/patient, Dr/patient, etc.) to filter out what is needed and what is not. I find much of it is not. How much do I really need to know about someone before I can walk into their space and provide the best care for them? Good question. Like everything else it probably depends on the particulars of the moment.


Thursday, March 18, 2010

feeling like a "real" nurse

        Yesterday, during my fourth shift on the mother baby unit, I began to feel like a real nurse. I started the day by assuming care of two mother/baby couplets (that means two moms and two babies in two seperate rooms). I knew where to go to listen to report. I knew to start off by looking through their charts, signing everything that needs to be signed, beginning to plan my day. I wrote myself notes: when each patient had their last medications and when they needed their next ones, which forms I needed to go over with them and have them sign, what things needed to be taken care of before they could be discharged, etc.
        I felt at ease. I asked questions of my coworkers and received friendly responses. Everyone seems to be helpful, willing to take a bit of time out of their busy schedules to assist one another. It's wonderful!
My preceptor checked in with me regularly but, mostly, I sailed through my day on my self made raft of competence! What a great feeling. I felt like a "real" nurse, managing multiple tasks at a time, working with CNA's, volunteers, doctors, midwives, RN's, social workers, unit secretaries, as part of the "health care" team. I answered the unit phone and called my patients' care providers to make requests, using SBAR of course!
     During one of my breaks, sittiing with CNA's and RN's around a lounge room table, we talked about our families, food, caring for patients, etc. It feeds me to be around people, to talk with them, to listen to them, to laugh with them! I am so blessed to be in this place, at this time, at this point in my life. Thank you, thank you, thank you!
    One of the highlights of my day came when one of my patient's was preparing to have their son circumcised. (don't freak out yet!) Circumcisions are hardly ever performed where I work. There is one doctor that does them every once in awhile. My preceptor said she thinks she's only participated in one since she's been working there. Another RN took a call from my patient's pediatrician. He had called to say he was coming in 10 minutes to perform the circumcision and wanted lidocaine cream placed on the baby's penis.
    Finding the cream was quite a tadoo. There was discussion amongst the nurses about how long the cream should remain on the penis before the cut was made? How long would it take the pharmacy to send the cream up to our unit? Did the nursery have the cream on hand? (No, they didn't). The nurse who took the call from the doctor scanned a STAT order to pharmacy and suggested I call pharmacy to let them know we needed it ASAP. I did call, that's when I found out from the other nurse that she had scanned it as a STAT order, and I was firmly told by the pharmacy tech that "You do not need to call if the order is STAT, this phone call is unnecessary". I thanked her very much and went about pulling together the circumcision supplies and paperwork with my preceptor.
    A few minutes later the doctor arrived. Another RN, who had done a circumcision with him a few weeks earlier and run into the same problem with not having enough time for the cream to properly numb the baby's penis, spoke to the doctor at the nurses stattion. She suggested, in the future, he write orders for the cream in the patient's chart the day before the procedure so that we could have time to procur and place it. He was receptive to the idea. It was a good exchange for me to witness.
    The DR then went into the patient's room to go over and sign the informed consent for the circumcision. I came in a few minutes later, with the cream, to apply it. The doctor was finishing up an examination of the baby and was still chatting with the parents about the procedure. He asked me where we would be performing the procedure. I responded that we were preparing to do it in the patient's room, unless he would rather do it somewhere else. The DR then asked the parents what they thought. The mom said she was fine with being in the room but that the dad did not want to see it. So it was decided that dad would step out and the circumcision would be done in the room. The DR left the room then, saying he would be back in about 15 min.
   After placing the cream on the baby and bundling him back up I asked the parents if one of them wanted to  hold him.  I went over some of the paperwork with them, aftercare, etc. Dad was looking anxious and asked me,
      "So how much do you know about this procedure? I know it was started as a religious thing, but what are the benefits of doing it?"
     Thus began a lengthy discussion about informed choice. I encouraged them to take the time to gather more information if they felt they needed it. I told them there is a lot of information about circumcision available, that from what I know, there is not a lot of evidence supporting the physiologic need to remove the foreskin. That in America it seems to be mostly a cultural and religious choice. I also said that they did not have to do the procedure today. That they could take more time to think about it and do it at another time if the chose. Just as we were finishing our discussion, and Dad seemed to have decided he wanted more information, DR came in.
      I said something to the effect of "perfect timing, we were just discussing their desire for more information", as I was leaving I heard Dad say, "I think we've decided not to do it today...."
    Several minutes later the DR came out of the room and stated they had decided not to have the circumcision done today. He did not seem at all put out by it. I was relieved. While he was in the room, after I had left, I wondered if he was giving them contradictory information to what I had. I wondered if he would think I had fed them false information or tried to pursuade them one way or another. He made no indications that any of that was the case. That was also a good experience for me!
    I went back into the patient's room, to remove the cream from baby's penis, remove the circumcision supplies, and check in with the parents. Dad said they had had a good talk with the DR. That DR had told them he couldn't give them any really good reasons to circumcise their son. That the only issues he really sees in practice have to do with hygiene. (Which was something I had also mentioned to them).
    The whole experience had the staff and nurses talking. Some had very strong opinions about it, some were for it, some were against it, some were undecided. For the most part I kept my personal opinion out of it. Even when chatting with my coworkers. Although I did mention feeling happy for my patient, the baby, that he gets to keep his penis intact, at least for a little while longer. I left feeling like I had saved a penis! My good deed for the day!
   But what was even better was encouraging the parents to take the time they needed, to gather as much information as they needed, to make an informed choice, that they would feel good about. My being there for that, listening to their concerns, offering evidenced based information, supporting their unveiling of their own power as parents, was another precious moment that I am so glad I was present for!!!

Monday, March 15, 2010

Keeping myself up at night

    Last night I had a difficult time getting to sleep, visions of patients flowing through my mind, stress hormones circulating through my blood stream. I kept running over my day:
                               *Did I forget to chart her edema?
                              *What if I misinterpreted her bleeding and she hemorhaged after I left?
                               *That blood pressure cuff and machine didn't appear to be working correctly....
                               I was going to get another machine and come back to retake her BP, but the end of
                               my shift got busy and I forgot... what is she develops Eclampsia? More women develop
                               it after birth than before!!!!!
                              *Why didn't I go into that patient's room more often?
                              * There really are people who won't feed their baby unless you remind them?
                              *What if that baby goes home and gets even more dehydrated? There's nothing I can do
                              about that, is there?

         Yesterday I began to get a real felt sense for the importance of having a routine. There are so many details to keep track of when things follow an expected course. When they deviate from that course there are even more details to be aware of, to be responsible for! I will have to work at developing my own routine, integrating elements from those I've observed, those I work with, to provide the best, most coherent care for the patients I work with.
        I am going to forget things. I will most likely make many mistakes. If I am diligent they may not cause any gross damage to those I am caring for. I need to remember I am not doing it alone. I have a host of team members available to assist me. It doens't help to think that if I make a mistake when I'm in the orienting phase my poor preceptor will be responsible too! Even when I am the responsible party I can still stop, take the time to ensure I am making the best choice for my patient and for my self. Otherwise I will not be getting any sleep. Then I won't be any good to anyone!   

Friday, March 12, 2010

2nd Shift

    Obviously if I am going to blog about the details of my residency experience I am going to have to do it more immediately following an experience. It's too easy to forget the juicy details if I put it off for a few days.
        This past Saturday I did my second shift on the postpartum unit and had a great day! It was a 12 hour day shift. It started out nicely, several patients (mother-baby couplets) to work with. I chose one couplet to work with more on my own. My preceptor observed me doing some of the tasks, pointed me in the right direction, helped me get my charting in the right place, helped me get into the medication system, etc. I did quite a bit on my own and felt good about it.
     Working with the patients is the best part, it comes pretty naturally for me. When I don't know something, fumble while removing sticky tape from an IV site, or drop something on the floor, I often make light of it, smiling, bringing appropriate humor into the situation. I think my air of easefullness helps patients feel comfortable with me, even though they know I am new and don't know everything!
     My third shift on the unit is this Sunday. I will be working with a different preceptor and am interested to see how her approach differs from those I've worked with so far. I look forward to the opportunity to gain new perspectives, insights, and learning new ways of doing things.

Wednesday, March 10, 2010

First 12 hour shift on the unit part 2

     During my first shift I had the opportunity to add some information and offer education to a few patients here and there. One of the most rewarding elements of my day involved aiding a new family in breastfeeding. The patient was interested in breast and bottle feeding. The newborn baby had received formula in a bottle after birth, before coming to the postpartum floor.
     When my preceptor and I were first in the room the patient indicated a desire to breast feed for the "first week or so". After listening to her for a minute or too I began to feel as if she could use some more in depth education about infant feeding. We offered her a bit of information before moving on to the next task.
      A bit later, at the nurses station, we had the opportunity to chat with the Lactation Consultant  (LC) on the unit that day and asked her if she would be willing to offer some education/support to our patient. She was able to chat with our patient and later told us that she seemed interested in trying to breastfeed and the LC thought the patient would ask for help if/when she needed it.
    Later I was in the patients room and was able to support her in latching the baby onto her breast, support them both, and offer a ton of information/education at the same time, but one of the best things I was able to do, the thing that appeared to have an impact on my patient, was the way in which I spoke to her about her baby, her breasts, and her ability to feed/provide for her newborn.
   I said things like:
    "Look at your colostorum, you have so much of it!"
   " He knows just what to do, what an intelligent baby"
   "See how his lips are flared out, that's just right!"
    "Hear that puff of air sound? That means he is swallowing, getting just what he needs"
   "Isn't it amazing how your body just knows how to provide this food that is just right for your baby?"
    "You are both doing it. Look at what you're doing? You are both so amazing!"

      It may sound over the top, but I assure you I was sincere, and my patient appeared to appreciate it. Every time I was with her throughout the course of the afternoon I offered her tidbits of information about caring for her baby, feeding her baby, her baby's amazing talents, relexes, and needs. I shared with her the wonders of colostorum and never even mentioned formula. ( I would have if she had asked/brought it up, but she didn't). I didn't say anything about bottle feeding. I focused on the moment, on what was happening right then, between that mother and that baby! I encouraged her to ask for help, even if it was for every time she wanted to latch her baby on, to use the resources available to her in the hospital, to ask questions, etc.
    And you know what, she did! Once, I was at the nursing station, and she came out of her room ,walked up to me, and asked me if I could help her latch her baby on! It was so awesome! I did help her and the next time she asked me to come into her room to help her, I talked her through it and she was able to get that baby on effectively all by herself!
   Watching her face, seeing the pride and awe eminating from her was magic!
   From the first time my preceptor and I spoke to her about infant feeding until my shift was over, her demeanor and attitude regarding feeding her baby seemed to change completely. From my perspective, she went from vaccillating and unsure, to confidant and committed!
   I can't explain to you how much this experience filled me. Even thought I've helped many, many women to feed their newborns,  I walked around full and satisfied that evening. I came home walking on clouds. I had truly made a difference in the life of my patient, her baby, and her partner. Whether or not she chooses to continue breastfeeding, switches to formula, or does some of both, those moments she had with her baby, the opportunity she had to successfully feed him from her own body, with a supportive woman by her side, will always be with her. I have no doubt she will view herself and her baby differently from now on, consciously or unconsciously, in a big or in a small way...
  It doesnt' matter to me. I know my being there changed something in her, uncovered something in her that she may never have known, or maybe had forgotten, and that is a miracle to me!!!

Friday, March 5, 2010

First twelve hour shift on the unit Part 1

       This past Tuesday I did my first shift on the unit.
        I arrived about 15 minutes prior to the beginning of my shift. I had no idea where to go to meet my preceptor. I went to the staff lounge, waited for a bit, didn't see her come in, then walked around the unit. I asked a few people if they knew where she was, nobody did. A few said she hadn't come in yet.
So I went back to the lounge and asked a few more people. Someone finally suggested I go to the Charge Nurse office upstairs and ask.
       By this time it was a minute past the beginning of my start time so I decided to clock in on my own. I had never used  the clock in system before, but I figured I could do it by myself. What I wasn't sure of was the protcol about clock in time, which machine to use, etc.
       Then I went upstairs, went to the door of the Charge Nurse office, and found 4 nurses sitting around a desk, giving/taking report. They all looked up at me, and despite my desire not to interrupt, I told them I was supposed to be orienting with &* today and asked if  they knew where she was. The Charge Nurse replied, "And she's not here today." She looked at a sheet of paper and said a name, which I only caught the last name of, and told me to go back downstairs to B Quad to find her.
       So I went back down stairs and asked if anyone knew where &* was. Someone directed me to the Unit Secretary's office. I went into the office and stood against the wall, listening to three people getting report from a tape recorder. Then another nurse came in and gave report directly. It turned out one of the people was a nursing student from PLU, I think there were about 6 of them on the floor that morning.
After report I asked one of the nurses if she her last name was &*. It was, so I introduced myself and told her I had been assigned to follow her around for the day.  I think I said something to the effect of "I've been pinned on you for the day".
        &* was very gracious. As she prepared herself to go out onto the unit ,she asked me if it was my first shift on the unit. I said that it was, and she said it would probably be a "follow her around and observe" type of day. I told her that was fine with me and I followed her out onto B Quad where she had been assigned.

Report and Patient Assignment:
    It appears that report is given via tape recorder. The out going nurses on a particular quad take turns going into a private room, an empty patient room, or an open office, and record report for each of their patients onto a tape recorder. Then the oncoming staff go into the room and listen to the report via tape recorder. Then the oncoming nurses choose which patients they want to work with and receive "live" patient updates from the outgoing nurse of that particular patient.
  I'd never encountered report given this way before. I will have to experience it some more before I have a sense of how it really works.

         Apparently it had been a "crazy" night shift. Nurses were behind on charting, patients needed lots of things done, and everyone seemed pretty frazzled and overwhelmed, understandably. I pretty much hung out to the side of things, listening and observing. A nursing student was assigned to one of my preceptor's patients, whom my preceptor had worked with the day before, and she had three other patients as well.
       We spent much of the morning preparing two patients for discharge. There was some teaching to do, some paperwork to fill out, but much of it had been done by the night shift. As I mentioned before documentation is all done via paper charting, and all doctor's orders are via paper charting as well. It is an interesting excersise to read various forms of handwritting, some of it requires a great deal of "interpretation", which I am not exactly comfortable with. It seems as if the nurses become familiar with doctors' handwriting and establish some degree of exerptise in interpreting their orders, but the room for error is still unnerving for me. We shall see how/if this changes for me over time.
That's it for now. More on my first 12 hour shift on the unit to come.......

Tuesday, March 2, 2010

12 Hour Shift Brain Drain

Today I worked my first 12 hour shift on the Mother Baby Unit. I basically followed a preceptor around and contributed here and there. It was a great day and I have so much I want to share here on the blog, but right now my brain is completely drained. My eyes are heavy and I can barely put two words together effectively. So, the detailed blogging will have to wait.
I have education classes to attend tomorrow and thursday so it may take awhile to get to it. But I'm planning on sharing!

Sunday, February 28, 2010

New Nurse Education

This past week I attended several education classes for my new job.
Two were designed to familiarize me with a couple of the computer systems used throughout the hospital.
I have to say, the hospital I will be working at is not techonoligcally advanced in the least, as far as computer tech goes anyway.
There are several computer systems, with many over lapping elements, and the charting is pretty all over the place. The majority of charting is still "paper" charting, with a goal of moving to fully computerized charting within the next several years. But there are several elements that need to be charted via the computer and in the paper chart. Plus, all prescription orders are still done via paper, which leaves a huge margin for error. And guess whose responsible for clarifying the order, making sure it's appropriate for the patient, asking the Dr. to change it if necessary, administering it to the patient (or not), and being responsible for it all????
   No, not the Dr.... The Nurse of course!!!
 This is one of the most anxiety provoking elements of nursing for me, the drug administration. The chances of harming a patient are so large. Medication errors happen all of the time, especially when hand written orders are used! I am confidant I can be a safe clinician, and I know my heightened awareness will benefit me, but I am also not naive enough to believe I will never make a mistake, and that scares the beejeebees out of me!

Anyway, the other two days of my week were spent in Perinatal Nursing classes. Much of the information was familiar to me, thanks to my doula background and my lust for learning.
What interested me the most were the attitudes and perspectives of the other nurses taking the classes and the presenters themselves.These classes are designed for nurses who are new to labor and delivery/OB. Many of my classmates have been nurses in other areas, only a couple of us are new, new nurses.
The presenters are all experienced OB nurses. One of them especially peaked my interest. She is especially interested in High Risk Labor and Delivery and started her lecture the first day by saying something to the effect of,
                         "Now I know you'll all hear that birth is a normal, natural thing, and it is, but I'm here to tell 
                          you that at any moment anything can go wrong!"

Now remember, most of those taking the classes do not have much, if any, experience with birth or laboring women... way to scare everybody! And what a bias to place on birth.
  So I listened to the rest of her lecture that day understanding she may be coming from a particulary biased perspective.
  Then, on the second day, she lectured on intrapartum nursing, and demonstrated ways to support women through labor. She advocated for keeping women out of the bed as much as possible, suggesting admitting laboring women "into the rocking chair, rather than into the bed".  She discussed the importance of staying with the laboring woman rather than watching the monitors from the nursing station.   What an interesting combination of perspectives this woman is turning out to have!
I have several more classes to attend with her and am interested to see what and how she presents next. I am beginning to admire and respect her and believe she will be a great assest to me as I move forward in my nursing career.

Thursday, February 18, 2010

Working Woman

      I started my job yesterday. Arriving at the hospital in the morning I began the day by filling out paperwork and providing documentation to HR. One of the employee health nurses went over my vaccination records and I ended up needing to have a rubella titer drawn. I'll also have to undergo two TB tests over the next four weeks. No big deal.
      Next I went up to the Family Birth Center and met with the unit educator. She provided me with a ton of paperwork, to be filled out throughout my residency period, which will be about 12 weeks, as well as a book on Intrapartum Nursing, We went over my schedule, including several days of classes, hospital orientation, and unit orientation with preceptors. I will spend about six weeks working on the mother/baby unit, with postpartum moms and newborn babies, then I will move on to the labor and delivery unit!
     After meeting with the educator, I spent the next few hours reading through self learning modules and filling out written "tests". There were topics such as Infant Abduction, Magnesium Sulfate, Pitocin, Breastfeeding, etc. All things I am familiar with and excited to learn more about!
    I feel so lucky to be paid to do what I love. To start out attending classes, learning more, reading about topics I'm interested in. I am a blessed woman! I am a woman with a job, a paid job! It's been a long time coming. I can hardly believe I've reached this point in my life, that all I've done so far has led me to this point. That myself and my family made it through the trials and tribulations of my education and insanity to this place of my getting to do more of what I love!
   There is  more to come of course. I still plan on obtaining my Masters degree and becoming a midwife, but for now nursing is where it's at, is where I'm at, and I am so EXCITED!!!

Friday, February 12, 2010


     Okay, so I know not everyone is interested in evidence based practice. I also know that most people aren't aware of all of the "evidence" that is out there. Who has time to look it all up? Do all the research? And then integrate the information into how we live our lives?
     Evidence based practice is a whole string of blogs yet to be tackled, for now I am thinking about the evidence our children are presenting to us everyday.
     ADHD, ADD, food allergies, obesity, behavioral issues, mental health diagnoses', children commiting violent acts, suicidal two year olds... I hate to state the obvious but....
     Something is wrong here!!!!
    There are many many issues at play here. A million and one theories, tons of therapies, medications, treatments.
   I have a question. What would the world be like if we paid attention to our children from the beginning, from conception, from preconception?
   For those who look to science for proof, etc. there is a growing body of "evidence" indicating that what happens to babys in the womb effects them throughout there lives, even that what their moms experience prior to their conception effects them.
   For me it seems obvious. Duh!
   We know emotions have chemical and physical manifestations. We know mom's hormones mix with baby's, they share the same blood!
     Everything that "happens" in the womb effects the baby, that's where they are formed! Where their brains, hearts, and integrated systems are created! The chemical structure of their nervous systems founded. Of course their environments have an effect!!  And why wouldn't this effect them for the rest of their lives, it's their body after all, that stays with them!
  People are amazing, bodies are amazing. People are adaptable, maleable, their capacity to withstand trauma, to grow, to flourish, to live thru incredible experiences despite incredible defecits is hardly believable. We are truly miracles, each and every one of us.
   Yet I can't help but imagine the possibilities. If every baby was wanted, loved, adored, and respected prior to conception....
              There is a tribe in Africa where the birth date of a child is counted not from when they've been born,  
              nor  from when they are conceived but from the day that the child was a thought in its mother's mind.
             And when a woman decides that she will have a child, she goes off and sits under a tree, by herself,   
             and she listens until she can hear the song of the child that wants to come. And after she's heard the  
             song of this child, she comes back to the man who will be the child's father, and teaches it to him. And
             then, when they make love to physically conceive the child, some of that time they sing the song of the
             child, as a way to invite it.
             And then, when the mother is pregnant, the mother teaches that child's song to the midwives and the
            old  women of the village, so that when the child is born, the old women and the people around her
              sing  the child's song to welcome it. And then, as the child grows up, the other villagers are taught the 
             child's song. If the child falls, or hurts its knee, someone picks it up and sings its song to it. Or perhaps
             the child does something wonderful, or goes through the rites of puberty, then as a way of honoring this
             person, the people of the village sing his or her song.
            And it goes this way through their life. In marriage, the songs are sung, together. And finally, when this  
            child is lying in bed, ready to die, all the villagers know his or her song, and they sing--for the last time--
            the song to that person.

   "You may say I'm a dreamer, but I'm not the only one. I hope some day you'll join us, and the world will be as one" - John Lennon "Imagine"


Monday, February 8, 2010

Consider this......

You are about to have sex with your partner...

You have to choose someone to watch...

Who will it be?

Birthing a baby is one of the most intimate experiences of your life, much like having sex.

Who will you allow to share this intimate experience with you?

Think about it!

2010 REACHE conference

The topic for this years REACHE conference is:
"Changing Birth Practices: From the Inside Out and the Outside In"
Several speakers will present topics such as:
  • Tools for changing standards of practice
  • using social media to present evidence based information
  • synthesizing conference information and bringing to your work
  • and a panel of Nurse Managers discussing changing practice on the labor and delivery floor
For more info visit:

Thursday, February 4, 2010

In The Beginning... Continued....

    I was closely monitored during my first pregnancy. I had frequent appointments with my OB, the diabetes educator, and later, when I developed hypertension, I became part of a study, which increased the number of visits I had, as well as the number of caregivers and number of lab draws, diagnostic testing, and worries.
    Honestly, I think my naivete reduced my worry. I don't even remember if N and I attended childbirth classes. I do remember that I knew very little about pregnancy and birth, and that I did not know enough to question many of the "routine" tests, etc. that I was subjected to. I did know that I wanted to be as healthy as I could for my baby, and I did a better job of managing my diabetes during my pregnancies than I have at any other time in my life so far!
    I wanted to have a natural childbirth. I did not want to subject my baby to unnecessary interventions or drugs. I wanted to breastfeed, to care for my baby on my own terms, but I did not have as many tools then as I do now. I was young, underprivaleged, and treated as though I didn't know anything, and mostly as if I was not to be trusted with my own body.
    At my 37 week appointment, on Friday, April 14, 1995, I was diagnosed with preeclampia ( I don't recall how my doctor explained it to me, whether or not I was offered any "choices" regarding how to proceed, but I do remember the interventions started with an amniocentesis to determine if my baby's lungs were mature. (
     The test came back, determining my baby would likely be able to breathe on her own, so my doctor proceded with an "emergency" induction. I was in a tiny room by myself, lying in bed, bored out of my mind, anxious, scared, and stunned, like a deer caught in the headlights. N made it as soon as he could, and I remember my friend and her husband stopping by to visit. It was a very long process. I was given a cervical ripening agent, though I don't recall which one. (  (
    Late Friday evening I was started on a pitocin drip, (, ), and on Magnesium sulfate (, ).
 I don't recall either of these drugs being thouroughly presented to me, in terms of indications, possible side effects, or even what they were intended to do. Nevertheless I received them.
   I do not recall when my contractions began. I do remember I maintained a sense of humor and the ability to communicate with those around me for hours. I also remember wishing I could sleep before active labor began, but being distrubed by the nurses every hour for vital signs checks, blood sugar checks, etc. To this day I believe my labor would have progressed differently if I had been allowed to sleep that night, but that's not the way it happened.
   I  continued to labor without pain medications, despite the pitocin, mag. sulfate, and immobility ( I was not allowed to get out of bed. I had an IV in each wrist, a baby monitor, and a contraction monitor attached to me). Sometime on Saturday my labor had progressed to a point that my doctors wanted to break my water to help "speed things along". I was at a teaching hospital so I had several residents, interns, fellows, and other types of doctors visiting me and directing my care throughout the day. I only saw my OB for a few moments on Saturday morning.
    As soon as my water was broken my pain increased beyond my ability to tolerate it. I requested an epidural block be placed. ( I was given a very strong epidural, so that I could not move my legs on my own and I felt very little pressure with the contractions.
      Sometime around noon it was time for me to push. I only knew this becuase I had been told by the doctor who had examined my cervix and found it to be completely dilated. So I began pushing. I was already exhausted from getting no sleep, the anxiety of an unexpected induction, laboring for hours and hours, and not having any significant calorie intake in over 24 hours. I was put on oxygen as I, and my baby, became more and more tired.
   So I pushed, and pushed, and pushed. Not very effectively if the comments I received from the careproviders were any indication. (Of course I couldn't push effectively when I was exhausted and couldn't feel anything!!) One resident in particular was very aggressive in the way she spoke to me, basically threatening me with a cesarean  (,%20   if I didn't get to work and push more effectively.
   I know now I was lucky in having a vaginal birth. It was a very different birth culture when my daughter was born. If the same situation were to happen today I'm confidant I would have had a cesarean for her birth.
   After nearly four hours of pushing (unheard of today), I was exhausted (of course), my baby was showing increasing signs of  distress and exhaustion, and it was decided that I needed help getting the baby out. I was given an episitomy ( and forceps ( were used to pull my baby down, through my bony pelvis, through my vagina, and out into the world. As her head emerged, my episotomy tore, leaving me with a fourth degree pelvic floor injury. (, ). There were no less than 15 people in the small hospital room when my daughter was born. Students, interns, residents, fellows, maybe on offical OB, nurses, and some friends and family. Like I mentioned before, it was a teaching hospital, and what an interesting "case" I was!
   N, was horrified when our daughter emerged. He remembers her being blue, almost purple, and floppy. She did not cry for a few minutes and he believed her to be dead. I was so exhausted and overwhelmed I don't remember feeling anything for several minutes after her birth.
   My pelvic floor repair was performed by an intern, who did not know what he was doing, and I suffered from the effects until just this year when I had a pelvic floor repair surgery performed. The repair took nearly two hours, during which time my baby was taken from me, given oxygen, suctioned repeatedly, scrubbed and rubbed with roughness and force. And worse of all, for me, she was given a bottle of sugar water when I specifically told the nurse I did not want her to have a bottle. I wanted to breastfeed her.
  This was particulary disturbing to me, and still is, because it was one of the few times, if not the only time, during that birth experience, when I spoke up for myself and my baby. And I was ignored. How infuriating!
    I don't remember how long it took for me to have my baby placed in my arms, but it felt like an eternity. She was red and her face was bruised. When she cried she turned almost purple. My mom said she looked like a "beefsteak tomato".    N and I stared at her with awe and such incredible joy and love. Truly amazing!
     She and I had a difficult time establishing breastfeeding. I could not even see her clearly for the first 24 hours of her life due to the side effect of blurry vision that magnesium sulfate had so generously provided. It took months for my pelvic floor to heal, though as I mentioned above, it never did heal properly.
  So that was my first birth experience, in a, not so small, nutshell. I experienced many interventions, many medications, many side effects, and what I consider to be traumas, and I have taken those experiences and applied them to my second birth and to my work as a birth doula, lactation educator, prenatal yoga instructor, and I will bring them to my work as a birth nurse, and, in the future, as a midwife.
   Thankfully my daughter recovered from her birth, though I know she carries the traumas she suffered deep inside her and they are unexplainable with words. But she and I have talked about it. She has watched her birth video, and I have held her, apologized to her, and rocked her while we both cried.

   My second birth was very different from my first... but I'll save that for another time.

"The Baby Whisperer" A midwife's Blog

I just discovered "The Baby Whisperer" blog this morning. From what I've read so far I am a fan!
Wanted to pass it along, share the wealth, so to speak!

Monday, February 1, 2010


       It seems as if my job search may be at an end. Nothing is set in stone of course, but today I had a a wonderful interview with the hiring manager for a Family Birth Center at a Tacoma Hospital that will be a wonderful fit for me. After two hours of talking, and meeting with two other staff members, one of whom said she was happy to meet me in person because she'd heard of me, I indicated I would love to have the job and that manager told me she would like to offer me the job.
     So from here she contacts the nursing recruiter who will contact me to provide me with an official preliminary offer, contigent upon my passing a urine drug screen, background check, and reference check. I won't receive the preliminary offer until next Tuesday when the position is officially posted, but I've been assured I will be getting the call.
      Then I will be an employed RN! Working in Mother Baby and in Labor and Delivery. My dream job for this point on my path. I feel so blessed. I can hardly wait to begin working, to begin learning, and to share what I know!

Sunday, January 31, 2010


Have you considered the use of  the word "deliver" in relationship to birth attendants assisting a woman during her birth?

    I love words. I respect them. I appreciate knowing their roots, understanding their meaning(s), and applying them appropriately. I often make mistakes in my word choice/usage. We live in a culture that throws words around, often without thinking about them, their meaning, or their consequences.
   I'm sure those of you who are familiar with, and/or work, in the birth world have heard and/or participated in discussions about the use  of "deliver" under birthing circumstances.

What does the word deliver mean? Where does it come from?

  Our language has been updated to include "to give birth" and "to assist at the birth of", but that's not how it started.  The origin of deliver comes from latin : dēlīberāre to set free, equiv. to dē- de- + līberāre to liberate.

  Is that what doctors and midwives are doing? Are they setting the baby free from the womb or liberating the mother from her pregnancy? Are the mothers passive in this act? Do doctors and midwives want to be seen as saviors? As liberators?
    I realize many women may seem as if they want to be "saved" from their births... saved from pain, saved from fear. I also realize many birth attendants may desire to be seen as saviors. I could come up with many theories as to "why" this may be the case, but for now I'd like just to bring up the choice to use "deliver" in respect to assisting at a birth.

    Words are powerful.  I've never found the age old "sticks and stones" adage to be true. Words often hurt me. I've often hurt others with the words I've spoken. Words often stick with us. Women remember what was said to them during thier pregnancies and during their births.
Check out for more information about what women think, feel, and remember about their birthing experiences.

Words matter. Should we not consider carefully which we choose to use? Especially in regards to our future and to the futures of those we love?


RN Update

     I recently obtained my RN. I am now a registered nurse. For the past few months I have been looking for work and having a terrible time of it.
    Believe it or not, despite the "Nursing Shortage" we all have heard so much about, new grad's are having a hard time finding work. The lack of work is being blammed on the recent "economic downturn". Experienced RN's, who had not been working in the field, are returning to RN work for the money and new nurses are very expensive to train.
    It appears as if things are beginning to turn around. More residency positions are popping up all the time. But none in the area I want to be working in. I want to work in  Maternal- Infant health. Ideally I will work with birthing women, babies, and families. But, residencies in labor and delivery, antepartum, and mother-baby are notoriously difficult to come by!
   So once I realized I "wasn't" going to waltz into a hospital position that I really wanted I began applying to anything and everything I thought I might qualify for, which really wasn't much. Over the last month every response I received indicated I was not being considered for the postion. I was even being turned down for residency positions. The rejection began to take it's toll and as of last Tuesday I was convinced I had wasted my time in nursing school, that there was something fundamentally wrong with me, and that I wouldn't get hired for any position, let alone something I would enjoy doing.
   Then, just after an hour or so of crying my eyes out, I received a call from a  ND/LM who wanted to interview me for a part time, clinic position. After scheduling that interview I realized I had been spending all of my time and energy pursuing something I thought I should do rather than what I wanted to do.
  Now, you should know I am generally the type of person who belives in "creating your own reality". I believe the energy you project into the universe determines what you get back. But for some reason I had lost my faith in what I "knew". I had convinced myself that I "had" to get a residency position in a hospital, whether or not it was doing something I am interested in. And the universe was not supporting me in that!
   No sooner had this all dawned on me then I received two more calls that day. By late evening I was laughing at myself. Of course I wasn't getting interviews for jobs I didn't realy want. Why would I? I have a passion, I have a goal, and all I need is faith that I will attain it, that I will be supported along the way in getting what I need to follow the path of my passion. That's why I'm here after all!
    I interviewd with Planned Parenthood on Friday afternoon. It went very well. Both the Planned Parenthood job and the Wellness clinic job would be work I would enjoy doing, work I could contribute to and learn from.
    I have another interview scheduled for Monday afternoon. This is the job I really want. Although the others would be great fits as well, this is the one! That being said I am leaving room for other options, but my vision leads me here... To working in a hospital that supports women having choices in childbirth, more than most area hospitals. A hospital that has midwives, family practice doctors, and OB's attending women. A labor and deliver/ mother-baby unit that has a woman like the one I spoke to on the phone Tuesday evening hiring it's staff!
     We had an amazing conversation. We spoke for an hour and half, almost as peers, although she has been working in the field for over thirty years.Early on in the conversation she asked "what would you say if I say the name Penny Simkin?". What would I say? Penny Simkin in the mother of doulas as a profession in the greater Seattle area. She is a pioneer in choices for women in modern childbirth. Did I already say it was a great conversation?
      I am so looking forward to meeting with the OB hiring manager in person on Monday. She spoke as if she really wanted to get me into a postion. She suggested she was working on finding a way to accomodate for my experiences as a doula and accelerate my residency with mother-baby in order to get me into labor and delivery sooner.
    It feels so good to be wanted, to be interacting with people who also have a passion for health, for women and babies, for birth, for choice! It feels good to be following my passion again, and to have faith that I will be where I need to be, to remember that I am where I need to be!!
  Watch out world... here I come!

In The Beginning.....

         Almost fifeteen years ago I birthed my first child. My first pregnancy was an incredible journey, the beginning of an incredible journey that would alter the course of my life in more ways than one.
         I was twenty years old when my daughter was conceived. My boyfriend, N,  and I were recently  engaged and had been living together for awhile. We were both attending college, he was a year ahead of me, and were pretty happy with our lives. Our plan was to be married in June of 1995.
         Sometime in 1994 we attended a music festival at the Gorge Amphitheater, along with my sister and her boyfriend at the time. We were camping out in tents, enjoying our youth and freedom. I felt tired and semi -nauseous. I remember clearly, lying next to my sweetie in our tent, I believe it was early morning, and saying to him, "Either I have the flu or I'm pregnant." I was  irritable and grumpy. I remember throwing a fit during the afternoon, demanding that we leave early. Poor boy, he tried so hard to be understanding and still plead his case for wanting to stay. (I was great at throwing fits in those days!)
        I don't recall how much time passed between the music festival and the night I took a pregnancy test. I do remember being at my friends apartment. We were having a girls night while N and his friend were out for a guys night. I was feeling jealous and resentful of N spending time with his other friends and I think we had some kind of arguement early that day. (We argued often when we were younger). I was pretty sure something was off with my body. I suspected pregnancy and had purchased several pregnancy tests. I don't remember how many I took, but I know it was more than one. They were all positive. What an amzing rush of emotions... awe, fear, apprehension, elation... I called N and told him over the phone. Looking back on it that probably wasn't the best way to break the news, but I was so overwhelmed, I remember wanting to share it with him right away, so that I wouldn't feel so alone.
         N handled the news well. He has always been a calm and steady person, one of the many (foreign at the time), qualities that attracted me to him, (and still do). In truth I have a terrible memory. I have forgotten so many of the details of so many events in my life, but I know N and I were commited to having our baby and to sticking together to do it.
        Thus began my first journey into pregancy and what a rollercoaster ride it was. Only three years earlier, when I was seventeen years old, I was diagnosed with Type 1 Diabetes (Insulin Dependent). I'm not sure how I got hooked up with my OB. I know I was on the state's Basic Health Plan, so I had to go through the whole rigamarole of getting set up with DSHS medical coupons. What a difficult and depressing journey that was.
        Being on state assistance is so much work. If you do not have compassion for those who need it then you should at least have respect for them. Jumping through all the hurdles, filling out all the paperwork (this was before the internet made online forms easily accessible, to those of us luck enough to have access to computers), traveling to all of the different sites, putting up with all of the people, keepingtrack of all of the people, making infinite #'s of phone calls, being pushed from one person to another, being treated like a second class, or no class citizen, all of this requires an incredible amount of determination, patience, and willingess to be treated as less than to have your needs met!!! And while running that rat race and jumping through all of those hurdles I was a full time college student, new diabetic, a newly pregnant young woman, and I had it so much easier than so many.
        I liked my doctor. A rare and blessed gift for me because I struggle with issues of trust in authority figures, especially when it comes to my own health and well being. He was a diabtetic himself and one of those rare human beings who listens well, communicates well, and offers information as if one had a choice. Ahhhh.....
       The first time I showed up for an appointment I discovered  I had my dates mixed up. They had me scheduled for a different day. I felt like such a failure. I cried. I don't recall if I had to reschedule or if they were able to get me in that day, but I do remember thinking it was a terrible way to start a relationship with a doctor. (Feelings of shame and worthlessness plagued me in my youth. I still struggle with them, although less and less). But we were able to develop a positive relationship. I learned a lot from him and from a nurse who worked with him. She was also diabetic. I think she was a diabetes educator but I can't be sure. She was able to spend quite a bit of time with me. Helping me learn about nutrition, managing blood sugars, and she helped me learn how to use my insulin pump.
         I was able to get an insulin pump early in my pregancy. My grandfather, a wealthy doctor himself, bought my first insulin pump for me. At the time I belive it cost nearly $4000.00,  none of it  covered by insurance. Insulin pumps were still fairly new on the scene at that time. The pump made a huge difference for me. I was better able to manage my blood sugars and maintained my A1C in a fairly healthy range throughout my pregnancy.

To Be Continued.......