I love that I can say that I am just about halfway done with my clinical hours and number of births! I have definitely had more than 40 of the required number of labor managements, just need to get more births in too. Unfortunately, not every baby decides that it's time to arrive earthside when I am on duty with my preceptor. But that's ok -- baby comes when it's time for baby to arrive. No, I am not the "hurry up" and augment the labor type of student midwife, nor is my preceptor. We like to really let mother nature do what she does best. Such a nice breath of fresh air to have women labor and give birth on their own time schedules, not "our" time schedules.
My hands are itching to catch some more babies soon. Recently at work, I was the RN at a birth, and I really, really, really wanted to get my hands in there to help catch the baby! Do you know how hard it is to have to reign yourself in, and not reach down to help catch? Ohhh, this babycatching sure is in my blood, my heart, and my soul.
Oh! I also love it when mom reaches down to help catch her own baby at her birth. So totally awesome!!!! I haven't had a dad help catch their own baby yet in clinicals, but I'm willing to bet that my preceptor would be open to that if a dad was interested. I've been at a few births as the RN where the midwife had dad help to catch. So amazing and tear-producing to see a new dad helping to bring his newborn into the world.
Alright, I'm getting all teary eyed just thinking about how beautiful birth can be. Good night folks!
Showing posts with label labor and delivery nurse. Show all posts
Showing posts with label labor and delivery nurse. Show all posts
Wednesday, November 14, 2012
Sunday, October 21, 2012
The busy life of a student/nurse/mom
Life sure is busy as a student/nurse/mom. I have, once again, neglected my blog for the past week. Ok, so that's better than say.......several months, but I still have put this blog on the back burner while I live my very busy life.
Clinical practicum as a student nurse-midwife is going very well! As I anticipated, I absolutely LOVE catching babies. I love being able to do full scope triage as a student (as opposed to as the RN at my job, where my hands are tied as to my scope of practice). I enjoy being able to meet the woman, assess the situation, come up with a working diagnosis (or more than one diagnosis), formulate the plan of care and assist her in making decisions.
The more common things I see in triage:
Clinical practicum as a student nurse-midwife is going very well! As I anticipated, I absolutely LOVE catching babies. I love being able to do full scope triage as a student (as opposed to as the RN at my job, where my hands are tied as to my scope of practice). I enjoy being able to meet the woman, assess the situation, come up with a working diagnosis (or more than one diagnosis), formulate the plan of care and assist her in making decisions.
The more common things I see in triage:
- Urinary tract infection
- Bacterial vaginosis, yeast infections
- Round ligament pain
- Back pain related to the "sway back" of advanced pregnancy
- Muscle spasms (back, legs)
- Early labor or false labor
- Complaints of vaginal bleeding with no evidence of bleeding coming from anywhere (very frustrating for the woman!)
Don't get me wrong, I do enjoy triage. It keeps my mind thinking, especially when you discover something incidentally, and you come up with a diagnosis that has nothing to do with her presenting complaint! (For example: back pain is her chief complaint. Upon arrival, you find her blood pressure alarmingly high, and in the course of assessing her, you find that her lab work indicates she has preeclampsia. The back pain may be normal for pregnancy, but the high BP and abnormal labs sure are not! Bingo! You have just discovered something incidental to her chief complaint that needs addressed.)
On the nursing aspect of my life, I'm finding it easier and easier to handler larger patient assignments, thanks to my ability to juggle multiple patients as a student nurse-midwife. Granted, there is a larger amount of documentation required as the RN vs as the nurse-midwife, so more of my RN time is taken up with documentation. Blech. We really need to find a way to streamline the documentation aspect of nursing so we can actually do *Real Life Nursing Care* (trademark pending). I loathe nursing documentation. It is double and sometimes triple charting, repetitive, and cumbersome. We have to keep up with documentation standards put out by groups that have no clue what nursing really is like. They keep coming up with more and more documentation that we have to do, and less time to actually take care of the patient. Can I get an "Amen", my sister nurses?
I am, without a doubt, looking forward to completion of my education, and graduation as well as passing boards. I am ready to be done on this journey towards midwifery. It has been quite the long journey. I started in December 2008 as a Bridge student at Frontier, attending Frontier Bound. Then I Crossed the Bridge at Bridge Crossing in November 2009. Finally, Clinical Bound this past July 2012. Clinical practicum began two weeks after Clinical Bound.
And here I am. Mid October, full on clinical practicum.
I anticipate completion of clinicals by March 2013, I hope. Then --- practice comp exam. Must pass with an 80% or more. Then, comp exam. Again, must pass with 80% or more. That will give me my very hard earned graduation and MSN degree.
Final step: pass boards. I'm aiming for April 2013.
Ready, set, let's GO!!!
Friday, September 21, 2012
Continuity of care
Finally! I'm starting to see several patients for several of their prenatal visits -- and even seeing them at both their birth and their postpartum check up too! This -- the continuity of care -- is what I have been looking forward to as a midwife.
You see, as the labor and delivery nurse, I do get to care for some women repeatedly during their pregnancy, but it's usually because they are either hospitalized with complications, or are in and out for multiple outpatient visits. Although I do love that part of my job as a nurse, it is definitely not the same as seeing women over the course of their pregnancy, birth and postpartum period as the midwife. Plus, as the midwife, I take a more important role, because I am actually doing education and teaching, as well as offering treatment options to women and their families.
It's just ...... different. But a good different! I like it!
The other thing that's different as the midwife is that I am the one making management decisions/offering options (if there are multiple options). Instead of just gathering assessment (subjective and objective data - what I do as a nurse), I am gathering the data, formulating the diagnosis, making management decisions and providing comprehensive education.
I freaking LOVE IT!
*****************************************
I still have moments where, when I am working on L&D as the nurse, I start wanting to make the decisions on the plan of care. I have to be careful not to overstep my boundaries, especially when it comes to the minutiae of explaining options and risks vs benefits. For example, even though I want to tell a woman that it is her right to decide if she would like to VBAC or have an elective repeated c-section, my mouth is often taped shut because the MD doesn't bother to offer it (VBAC) as an option. This all truly depends on which MD is on call that day, and what type of mood they're in. This is what happens when one works as a nurse in a very VBAC-unfriendly hospital environment. (Which is so different where I am doing my midwifery clinicals!)
Other things as a nurse: I technically cannot tell an outpatient client that she has a urinary tract infection, based upon the urinalysis results. As the RN, that's out of my scope to make a medical diagnosis and tell the patient. I can skirt around it though, by telling her that it looks like she *might* have a bladder infection, but I'm going to run your results by your doctor/midwife, and he/she will be in to talk to you. Sounds crazy, right? But it's a matter of sticking to my scope as the RN. It's frustrating.
However, there are providers (mainly, the midwives, but also some of the docs) that I work with that totally trust me on my ability to make a medical diagnosis. They trust my assessment of the patient, my thoughts on the possible treatment options, and take that into consideration in their management. I really respect that they trust me like that. Then again, I'm about 90% of the way towards becoming their peer as a very-near-in-the-future CNM.
***************************************************
I love it when a laboring woman arrives back on L&D after I have seen her as an outpatient evaluation several hours before, and I have that gut feeling when they left earlier that they will be back in active labor ----- and they come back in active labor! I call it my "Spidey Sense". Sometimes, I seem to have this knack for being able to just observe someone and know what's going on with them. Kind of like when I can see a pregnant woman and know that she has preeclampsia: she just has this "look" about her. Hard to explain! Maybe it's the generalized facial edema, or the under eye circles, or just that they look "sick". I know that other nurses have this ability to just "see" when someone is sick. Please tell me I'm not alone!
**************************************************
Anyway, hoping for some more births this weekend. I am ready to add some more to my birth log!
You see, as the labor and delivery nurse, I do get to care for some women repeatedly during their pregnancy, but it's usually because they are either hospitalized with complications, or are in and out for multiple outpatient visits. Although I do love that part of my job as a nurse, it is definitely not the same as seeing women over the course of their pregnancy, birth and postpartum period as the midwife. Plus, as the midwife, I take a more important role, because I am actually doing education and teaching, as well as offering treatment options to women and their families.
It's just ...... different. But a good different! I like it!
The other thing that's different as the midwife is that I am the one making management decisions/offering options (if there are multiple options). Instead of just gathering assessment (subjective and objective data - what I do as a nurse), I am gathering the data, formulating the diagnosis, making management decisions and providing comprehensive education.
I freaking LOVE IT!
*****************************************
I still have moments where, when I am working on L&D as the nurse, I start wanting to make the decisions on the plan of care. I have to be careful not to overstep my boundaries, especially when it comes to the minutiae of explaining options and risks vs benefits. For example, even though I want to tell a woman that it is her right to decide if she would like to VBAC or have an elective repeated c-section, my mouth is often taped shut because the MD doesn't bother to offer it (VBAC) as an option. This all truly depends on which MD is on call that day, and what type of mood they're in. This is what happens when one works as a nurse in a very VBAC-unfriendly hospital environment. (Which is so different where I am doing my midwifery clinicals!)
Other things as a nurse: I technically cannot tell an outpatient client that she has a urinary tract infection, based upon the urinalysis results. As the RN, that's out of my scope to make a medical diagnosis and tell the patient. I can skirt around it though, by telling her that it looks like she *might* have a bladder infection, but I'm going to run your results by your doctor/midwife, and he/she will be in to talk to you. Sounds crazy, right? But it's a matter of sticking to my scope as the RN. It's frustrating.
However, there are providers (mainly, the midwives, but also some of the docs) that I work with that totally trust me on my ability to make a medical diagnosis. They trust my assessment of the patient, my thoughts on the possible treatment options, and take that into consideration in their management. I really respect that they trust me like that. Then again, I'm about 90% of the way towards becoming their peer as a very-near-in-the-future CNM.
***************************************************
I love it when a laboring woman arrives back on L&D after I have seen her as an outpatient evaluation several hours before, and I have that gut feeling when they left earlier that they will be back in active labor ----- and they come back in active labor! I call it my "Spidey Sense". Sometimes, I seem to have this knack for being able to just observe someone and know what's going on with them. Kind of like when I can see a pregnant woman and know that she has preeclampsia: she just has this "look" about her. Hard to explain! Maybe it's the generalized facial edema, or the under eye circles, or just that they look "sick". I know that other nurses have this ability to just "see" when someone is sick. Please tell me I'm not alone!
**************************************************
Anyway, hoping for some more births this weekend. I am ready to add some more to my birth log!
Friday, May 20, 2011
I know I'm at work too much when....
--I hear call bells go off in my sleep.
--I answer the phone at home "Labor and Delivery, how can I help you?"
--I measure things with my fingers, in centimeters. Random things. And I'm accurate down to about 0.5 cm. No need for rulers in this house! (Seriously, I did this to help my daughter with one her homework papers, where she was measuring small lines. Here, momma will just measure with her fingers....don't need no silly ruler!)
--I sign checks, credit card slips, permission slips, and absence excuses with an RN at the end. Oops.
--I keep birth/labor management pocket books in my purse. For casual reading.
--I had a dream of a difficult birth. The doctor is trying to deliver the baby after the head and shoulders are out. He's pulling and pulling, the mom is pushing and pushing. Still won't come out. I flip her over into all fours (Gaskin maneuver), and the doc reaches in to pull out............another baby attached to the first. Siamese twins! Connected at the lower half of the body. He hands me the babies, I take them to the warmer, call NICU to come. NICU gets there, and I have no clue how to handle siamese twins. I end up calling other nurses to come see this rare sight that we will probably never see again. (Note: I have never been witness to siamese twins, personally.)
--Come to think of it, almost all of my dreams involve birth. I recall another dream where I gave birth to triplets. In my bed, at home. They all weighed about a pound each.
--True story here. I'm taking care of a woman in labor. I look around and see familiar faces among her family/support people. Then I realize: I've taken care of two other couples that are present during their births. Like, less then 6 months ago for all of them. Talk about deja vu! They all recognized me too. (Not a bad thing - they're all really great couples.) Turns out they're all friends! Small world.
--I answer the phone at home "Labor and Delivery, how can I help you?"
--I measure things with my fingers, in centimeters. Random things. And I'm accurate down to about 0.5 cm. No need for rulers in this house! (Seriously, I did this to help my daughter with one her homework papers, where she was measuring small lines. Here, momma will just measure with her fingers....don't need no silly ruler!)
--I sign checks, credit card slips, permission slips, and absence excuses with an RN at the end. Oops.
--I keep birth/labor management pocket books in my purse. For casual reading.
--I had a dream of a difficult birth. The doctor is trying to deliver the baby after the head and shoulders are out. He's pulling and pulling, the mom is pushing and pushing. Still won't come out. I flip her over into all fours (Gaskin maneuver), and the doc reaches in to pull out............another baby attached to the first. Siamese twins! Connected at the lower half of the body. He hands me the babies, I take them to the warmer, call NICU to come. NICU gets there, and I have no clue how to handle siamese twins. I end up calling other nurses to come see this rare sight that we will probably never see again. (Note: I have never been witness to siamese twins, personally.)
--Come to think of it, almost all of my dreams involve birth. I recall another dream where I gave birth to triplets. In my bed, at home. They all weighed about a pound each.
--True story here. I'm taking care of a woman in labor. I look around and see familiar faces among her family/support people. Then I realize: I've taken care of two other couples that are present during their births. Like, less then 6 months ago for all of them. Talk about deja vu! They all recognized me too. (Not a bad thing - they're all really great couples.) Turns out they're all friends! Small world.
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