First off, I'd like to say that I know nursing school is not nearly as fascinating to everyone else as it is to me. ;) I feel that this blog is a good forum for me to record my experiences for posterity and that 10 years from now I can look back on these things and re-live what I will most likely have completely forgotten by then (knowing my pitiful long term memory).
I had my very first Labor and Deliver clinical on Tuesday. It was AMAZING! First off, I was assigned to do clinicals at Trident hospital, which is my #1 choice for where I would like to work in Labor and Delivery when I graduate in December. They are the most progressive of all the area hospitals. Jobs have been extremely hard to come by for the classes that graduated from MUSC in the last year because of the economy, so I have eagerly anticipated spending this summer getting to learn on the very floor I want to get a job, letting the nurses and nursing supervisor see me in action and (hopefully!) make them fall in love with me and want to hire me when I graduate. For that reason, every clinical I do there this semester is practically a job interview, and there is a lot riding on what happens there.
I started the morning off at Trident hospital introducing myself to my two patients, one of whom was a hispanic woman who obviously did not speak any English and was writhing flat on her back in her hospital bed (gasp!) in heavy labor, while her husband sat reclining in a chair texting and nodding his head as if he could understand what I was saying. Awkward! But having been on that floor, let alone that hospital, for all of 30 minutes my main goal was to stay out of the way and fly under the radar, so I backed out of the room. Within minutes, staff went pouring into her room because she was ready to push. I stood in the background and listened to the doctor try unsuccessfully to communicate with her. The only word of Spanish anyone in that room could speak was "puja" for push, so they just kept saying that over and over. Then I was told to grab one of the laboring woman's legs and hold it for her as she pushed, which is something I have thankfully done many times before. At one point the woman was not working with her contractions and pushing, and all the doctors and nurses were yelling "empuja!!!" but it just wasn't getting through to her. In the heat of the moment my shyness and reluctance to get in the way was overcome by the excitement in the air as I saw the baby's head starting to show, and I said to the woman, "empuja otra vez!" which means "push again." All activity in the room literally came to a crashing silent standstill, the mom almost jumped out of her skin and looked at her husband in shock, and my assigned nurse said, "you can speak Spanish?! For God's sake jump in there!" I spluttered and tried to explain to the staff that I really don't speak Spanish anymore and just know a little bit, but the energy in the room was as if I had saved the day and everybody was positively giddy. Just then the baby's head crowned and I told the woman in Spanish that I could see the baby's head. After her baby was born, the doctors were asking me to try to tell her all sorts of things and I did my best but it was just humiliating how little I remember. One of the nurses said, "You're hired!" You can imagine how great those words were to hear! When most of the staff had left, I stayed to help the mom get comfortable, put her bed back together, and help her get the baby latched on. The nurse who said I was hired was still in the room, and I said to her, "I'm going to take you up on this whole hiring me thing, this is where I want to work." She said to tell the boss that Tammi wants me, and that I speak Spanish. Come to find out, she was actually the charge nurse on the floor! Whoa! Needless to say, I will be brushing up on my Spanish before December.
Then I got to witness a medically necessary c-section and take care of the mom in recovery after her surgery. Something I thought was very interesting is that Trident has paid attention to the natural birthing practices that go on at the birthing center, and have changed a lot of their policies because of the great outcomes they've seen. One such change is that they now leave the c-section babies in the OR with mom until she comes out to recovery, where they bathe the baby in front of mom and dad and then put the baby naked and skin-to-skin on mom and encourage them to breastfeed just minutes out of surgery. I remarked to my nurse how great that is, and that my sister-in-law had a c-section there a year ago and her baby was taken to the nursery. This is when she told me that they implemented this new policy not even a year ago "after they got their heads on straight." That is why I want to work at Trident, they are paying attention to stuff and willing to change and not just do things the same because they've always been done that way.
Probably my favorite experience that day, though, was when I was helping that same mom after her c-section. She had breastfed her first child, but said she'd had a very difficult time getting it started. One of the nurses helped her roll onto her side and get the very eager baby to latch on and start nursing. When the nurse walked away, I asked the mom if she felt like the baby had enough of the nipple in her mouth, and she asked if I could help her check. The nurse, hearing us, came back and took a look and found out the the baby did not have nearly enough so repositioned them and tried again. She worked with them for a minute or so, and eventually walked away saying that the baby still didn't have enough in her mouth, but it was ok and that mom would just be a bit sore afterward. As a lowly nursing student who has had no classroom education on such things, normally I would not have intervened, but I am a mom, I have breastfed, and I would never let one of my friends do it badly in front of me without helping. Without even considering my place, I asked the mom if she wanted me to help her get a proper latch and I told her that that's where I went wrong with my child, getting blisters from his first nursing due to a bad latch. She was very appreciative and after about 30 seconds I had that baby latched on beautifully just as the nurse, who just so happened to be that same charge nurse, returned and saw this crazy nursing student manhandling her patient's breast looking to the world like she might actually know what she was doing. There were some raised eyebrows, but results do not lie.
By the end of the day I was walking on cloud nine. It was so fantastic to feel that I was finally doing something I am good at, interested in, but the best part was I walked away from that experience feeling that I really brought something to the table as a person. Usually in the hospital setting, us students are unsure, confused, and scared to death most of the time. But as a labor and delivery student nurse, I am already an expert at helping women in labor, I knew how to calm their fears, and I could help them breastfeed, and I walked in there like I had been there for years and did what I love to do most. This was my first time since starting school that I felt like I was MADE to be doing nursing! I guess it just took finally being give the chance to do the type of nursing I want to do.
I have discovered recently that I will need at least a year of labor and delivery nursing before I can apply to grad school for midwifery. At first this was devastating, because I did not particularly want to be a nurse and already feel that I've wasted nearly 30 years of my life not being a midwife already. But after talking to some midwives, I agree with them that one must master all the basics, especially the medical-type interventions such as fetal monitoring and cervical assessment before training as a midwife where these interventions are purposefully minimally done. Up until Tuesday, I had believed that I could only be happy working in a birthing center assisting with natural childbirth, and that seeing all the unnecessary interventions done to women on a routine basis in the hospital would suck my soul out. Interventions are wonderful, even life saving in certain situations, but certainly should not be done on everybody who walks through the door. But now I realize that while I'm spending this year learning the ropes, there is a lot of good I can do as a nurse working somewhere where high interventions are the norm. For example, none of my patients will be left to labor alone, flat on their back in a hospital bed which is the most painful position for a woman in labor. I will be that nurse telling them to get up, walk around, lay on their side, teaching dad how be helpful, putting the head of their bed up when they push, spending the extra time it takes to help them be successful at breastfeeding, whatever it takes to give them the best mother-baby outcome possible in their given situation. It seems like these are small things, but I think these are the type of things that a lot of nurses most likely do not take the time or initiative to do, and its what can make a painful and difficult process just a little bit better and give mom back some of the power that is taken from her on the hospital floor. I want to be known as the "super nurse" on the floor who's moms have the best support, most attention, and high success rates. At this point in my life, I cannot think of a better way to change the world than that.
