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!!!