Nursing, Parenthood, & Life

Updates and musings from one momma nurse

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Wednesday, March 25, 2015

Advice to Expectant Parents from a Postpartum Nurse

Dear expectant parents,
First of all, congratulations! You'll be bringing new life into this world soon, and that is a big freaking deal. Mostly exciting but a little bit terrifying, am I right?
Here are a couple things you need to know that will save you (and your nurses) a headache at the hospital.

1) Choose a pediatrician or family doctor. Preferably you've chosen one prior to delivery, but if not, you may be required to make your decision before you can be discharged from the hospital. If the physician does not see baby at the hospital, someone else will cover, but we need to know where to send the chart afterward!

How do you choose a doctor? Start with your insurance. Find out who is in-network. Talk to friends with kids. Do they like the doctor their kids see? Call potential physicians to find out if they are accepting new patients. Sometimes the type of insurance you have makes a difference, as some physicians can only accept a certain percentage of private insurance, Medicaid, etc. Narrowed it down to a few? Call the office to ask about sitting down with the pediatrician so you can get a feel for their personality.

This is legwork you don't want to have to do in the 48-72 hours after delivery, so use the nine months prior to get it done!

2) Purchase a new carseat. I love bargains, but carseats are not an area where you should cut corners. Garage sales, craigslist, and facebook are NOT good places to score a carseat!

Carseats have expiration dates (often 6 years after the date of manufacture, but not always). The material in the seat breaks down over time, and the manufacturers can only guarantee the seat's performance for a certain amount of time. The expiration date should be printed on the bottom of the seat.

Did you know carseats need to be replaced after an accident? Even if it was just a fender bender and there is no visible damage to the seat, it needs to be replaced. Car insurance companies should not give you hassle about replacing carseats. The seat has done its job and absorbed the impact, and cannot be relied upon to perform the same way the next time.

If you get a carseat from a garage sale, can you be certain it's never been in an accident?

Don't risk your child's safety for the sake of saving money!

Ok, so you have the (new) carseat. What next?

Read the manual. Keep it in a handy place. Play with the straps on the seat. Figure out how to loosen and tighten them. Practice strapping a doll or stuffed animal into it.

Install the base of the infant seat in the car. Be prepared to bring the seat itself into the hospital sometime before the day of discharge.

If your baby is small (less than 5lbs 8oz at our facility), has respiratory issues, or spends time in NICU, the nurses may need to do special tests to make sure baby can tolerate sitting in the seat, and you won't want to wait until the last minute to do those. Even if your baby does not need the special tests, the nurses will want to see the seat and check the fit of the straps before you get to leave. You do not need to bring the seat into the delivery room, but you will want to have it handy.

Need help installing the seat? Call your local fire station. Find out when a Certified Car Seat Technician will be available there to help you. They are not there 100% of the time, so showing up unannounced at the fire station is not recommended.

Again, during the first hours after baby arrives is not when you want to think about the carseat for the first time! About a month before the due date is generally a great time to get the seat in.

Is there more you need to know and do before baby arrives? Sure. But taking care of these two items will save you so much undue stress, and allow you to put more of your focus where it should be: getting to know this wonderful new person!

Love,
Your Postpartum Nurse

Friday, November 21, 2014

Customer Service

This is in response to some blog posts I've seen recently protesting the use of patient satisfaction surveys to determine reimbursement.

I haven't settled my opinion entirely, but here are some thoughts.

As a hospital, we ARE a customer driven organization. If we don't have patients, we don't have a hospital to run.

I absolutely think we need to focus on being the best hospital we can be, with appropriate technology, properly skilled clinicians, and safe care for all.

But isn't that just the bottom line?

Can't we do better?

We are understaffed and overworked.

We are busy saving lives.

We are balancing the needs of many, twelve hours at a time.

But above all, aren't we people taking care of people?



What do my patients want?

They want excellent care, and they want compassionate providers.

I'm busy with a critical situation in room A, and the patient in room B is asking for pain medication? Certainly my priority is to get Patient A stable, but doesn't Patient B deserve attention? Maybe I can't make it to that room immediately, but I can ask another nurse to pass that pain medication for me, or ask an aide to explain to the patient that I will get to them as soon as possible.

No matter where we work or what patient population we serve, we are a team. We have to work together to provide the best care possible for our patients. We have to look out for each other and recognize when our coworkers need a hand. We have to talk each other up instead of sniping about the shortcomings of another unit or provider. Even though I might not work directly with Dietary or Environmental Services, patients view all of us as a unit: The Hospital. If they hear me grumbling about how Pharmacy never sends my meds on time, or how ER always sends up my patients dirty, or how that night shift nurse always leaves extra work for me, it reflects poorly on ME, and on The Hospital as a whole. What's that cheesy saying? Together Everyone Achieves More.

Let's work together and achieve greatness, shall we?

(And in the meantime, lowering nurse to patient ratios sure wouldn't be a bad thing! Ahem, administrators. Each patient is not my only patient, but they deserve to feel like they are!)

Wednesday, November 5, 2014

Expecting the Norm

On the type of units where I work, healthy is the norm. My patients may have pre-existing conditions (such as diabetes or high blood pressure), but most of them choose to be in the hospital. Perhaps it is for an elective procedure, or perhaps it is to deliver a child.

When I take care of my patients, I have certain expectations about their course of treatment.

Sometimes, though, complications develop, and it is my job to be aware and proactive.

I have found that my tendency is to assume that everything will be normal, and to shrug off aberrations as just slight deviations from the norm that will resolve themselves.

I have to make a conscious effort to pay close attention to each detail of each assessment, and to give serious weight to any concerns raised by patients or their loved ones, so that the proper steps can be taken to optimize their health.

I recently had a mother tearfully thanking me for being in tune with her child's condition as it developed, and getting him the interventions he needed.

THAT is why I am a nurse.

To provide for my patients' needs, whether they are physical, emotional, or spiritual.

To provide a listening ear and a sympathetic heart.

To answer questions.

To teach.

To enable.

And if necessary, to delegate to someone with a higher level of expertise, so that all needs can still be met.

Sunday, June 1, 2014

Teaching an Old(ish) Nurse New Tricks

Over the last few years, I've developed my beginning-of-shift routine. I generally look at my charts first, then go to each room one by one to medicate and assess simultaneously. The drawback to this is that sometimes I don't make it to my last room before 9am, and that's longer than I'd like to go without seeing my patients! This week, I decided to try something new for me. As soon as bedside report was completed (so I had a basic knowledge of what each patient was there for, but hadn't looked up specific orders), I went to each of my rooms and did an assessment. By doing that, I was able to see everyone before 8am, so I knew what their baseline was in case they might have a status change mid-shift. Once the assessments were completed, I looked in the charts to fill in details, then began coming around with the morning medications. I didn't get to start charting any sooner than I would have, but I felt a lot more prepared for the day, and I felt like it went much more efficiently than usual. So, who says you can't teach an old nurse new tricks?

Tuesday, May 27, 2014

Miscommunication

How's your pain now? Can you rate it on a scale from 0 to 10? "Well, it was at about a 9, but I repositioned my leg better, so now I'm at a 10." ...Wait a minute. Does that mean you have no pain? "Yes, no pain. It's at 10." This is the point where I re-explained the pain scale we use, where 0 is no pain and 10 is the worst possible. (The patient explained that she and her husband used to joke around and rate each other. i.e. You are all dressed up, you're a 10 today! or You've been out working in the yard, you're a 2! In her mind, 10 = good!) Come to think of it, she did look very relaxed when her pain was a "9"!

Saturday, October 19, 2013

Perspective

My patient unexpectedly developed a serious issue and was rushed off to emergency surgery. Just before he was wheeled off my unit, I caught the eye of two nursing students, who had been watching with awe as the situation developed and was handled.

"So exciting!" one gushed.

Those two words hit me like a punch in the stomach.

Exciting? I could think of many words to describe the situation, but exciting wasn't the first to come to mind.

Terrifying.

Frustrating.

Nervewracking.

Uncertain.

Unifying.

Motivating.

Four years ago, however, I probably would have reacted the same way they did. Here's a chance to see something new! I can totally write about this in my clinical reflection! When else am I going to experience this particular type of case, unless I work in a particular field of nursing? Can't wait to tell my classmates and instructors about this one! Maybe he'll develop some sort of complication to make it even more interesting!

Amazing what a few years in the field can do to your perspective.

Tuesday, March 19, 2013

We recently dipped a proverbial toe into the waters of pageantry, and have easily come to the decision to pull that toe back out.

Sweet Pea was asking for several months about being in a pageant. I basically ignored the request initially, since many of her passions are fleeting at this age (5). She persisted, so I did some research.

I found a local pageant that seemed to be less cray-cray than the ones you might see on cable television (no spray tans allowed, makeup/outfits are to be age appropriate, all participants get a crown, etc), so I signed her up.


Sweet Pea was stoked. She strutted around the living room blowing kisses and twirling. She talked nonstop about the pageant. She was disappointed when I told her she wouldn't be on tv.

Checking herself out pre-pageant.
And then we got there.

Sweet Pea got overwhelmed.

She was shy.

She kept her fingers in her mouth for about half of her time on stage, and bawled on the way home about not getting a trophy (despite the new tiara on her head).


Little miss apprehensive

Needless to say, we are going to stick to pursuing alternate interests, such as gymnastics and soccer. Enjoyment and aptitude go a long way!


Lined up for their first turn on stage. Spot Sweet Pea!

You can take the cray-cray out of the pageant rules, but you can't take the cray-cray out of the parents. These two were more entertaining than their toddler.