mother/babyRN

I would approach her and mention you were thinking about what she said but you are more interested in what she didn't say. You could ask for specifics and then let her know that if she has any concerns with your reports she should talk to you directly. If she approaches you again tell her thank you for her interest but you think you are doing ok....

Absolutely on point and thank you so much for a great article.....

I do talk about it all the time but do not know if people at my current facility have checked it out. I have noticed that now I have been fortunate to have had an article selected that is highlighted, that they are starting to express interest in going in and reading the articles, and by being there, checking out all the specialty forums. I didn't realize that all the talking I did with the nurses in my previous place of work encouraged at least a couple of them to join, so I try to do my part in advocating AllNurses! Martha

Awww..Thank you everyone.....I will try some of the advice and I know that at the moment, things are just due to what I mentioned, because during the time I am off or manage to catch up with sleep, it is much better. Unfortunately, I am not at a place where I can change my work circumstances, and I have an amazing husband who helps out tremendously.....But, there are those moments where we have to wonder when things are "normal" and when they are not.....That, I guess, is just the way life is......But, thank you so much for all your advice and replies...I want to have all of you as my nurses!

It can be worse because not only are you charged with caring for older people and their physical, emotional and psychological changes; you are tasked with dealing with some of the same issues WHILE caring for others. The other night I drew some blood from a patient with routine orders postpartum. I got as far as the desk and forgot the tubes were in my pocket. I forgot them (albeit briefly) because someone had the audacity to call me into an emergency situation while I was en route to the lab. Imagine that! About ten minutes later I happened upon my lab slips and WHAM, a lucid memory of having drawn the blood came rushing to the forefront of my brain. I sent the labs and they were fine. Thank goodness. Another time I was staring at the patient addressograph and couldn't remember the name of the thing. That is, of COURSE, I was aware of its presence and function; I just couldn't form the word "addressograph" in my attempt to tell another nurse where her patient stencil was. We both laughed at that and compared mutual forgetful moments, but in the back of my mind, I wondered what it must be like to have receptive or expressive aphasia following a stroke. Now that I'm older I have to think and differentiate between the "elderly" moments and real cerebral danger. How scary is that? If you have never experienced those sorts of events (either one), please be grateful. It teaches you to be even more patient than you hopefully already were. It can be humorous but also humbling. It can be a pain on so many levels. I thoroughly hate it, even when it happens only once in a while. I try to make light of it but it is a uniquely valid concern. I need to be there for my family. I need to be there for my patients. I need to be there for my co-workers. I need to be there for me... When I was a younger nurse it didn't often happen that I would lose track of my mission on the way from a patient room to the supply cart. These days, however, if I am interrupted on the way I sometimes stare at the cart for several moments before I remember what the heck I am in search of. It would be laughable if not for the fact that it occurs to me that must be what confused patients feel like. How frightening for them. It can be scary and concerning and downright inconvenient. How is it that one nurse can make an excellent cheat sheet and then lose the darn thing more than once a shift? I have to make copies just in case I lose the first one. That's a lot of work for a harried nurse. What else might I forget? Will it happen during a real emergency? Will I make a med error or put a patient in jeopardy? Yes, it is true that with age and fatigue comes forgetfulness. Marry those facts with menopause and it brings on a new appreciation for estrogen And definitely a desire for restful sleep. The other night I was in the middle of patient teaching with a first-time mom with marginal support at home. By the luck of the draw, I was also the charge nurse. That meant I was interrupted several times to intervene and investigate other matters. It was probably two hours later when I realized I had not been back to finish my teaching. I was horrified because I had told my patient I would be right back. She was very understanding but it caused me to wonder what it must feel like to patients who have to wait for long periods of time to even see a nurse due to the business or skill of the nurses working on the floors to which they are assigned. By now many of the nurses reading this have identified with the loss of thoughts that happen every once in a while and later, often. Some are smiling or even laughing. But I am not... You see, I'm afraid. I'm afraid when those moments happen because I have been a nurse forever and that is what I do. That is who I am. What happens when or if I can't be a nurse? What happens when I NEED a nurse? Those moments of forgetfulness may very well be benign side effects of aging, working twelve-hour night shifts, chronic sleep deprivation and co-existing and caring for a husband and three young children. What if it isn't? Nurses need to remember that they are people first. They (We) are not invincible. We definitely aren't perfect and we are subject to all of the fears and concerns anyone else faces. We are a single part of the "every" one who co-exists with us. Losing ourselves takes on an entirely new meaning when considering that fact. Here is what I would like should the reality of my forgetfulness become more significant than the usual things that happen post the infamous fifty-year-old hallmark. I want a nurse to care for me who sees me for who I am, even if I am confused. I want a nurse who makes me laugh by laughing at him or herself. I want a nurse who establishes a rapport with me and my family and involves them positively in my care. I want a nurse who holds my hands when she talks with me, or if I cannot reply, to me. I want a nurse who looks into my eyes and sees my pain. I want a nurse who searches for whatever sparkle I might have left and nurtures it as far as it can go. I want someone who won't laugh at my confusion, or ignore me in the hallway in the Geri chair because I am annoying him or her. I want a nurse who on the busiest of shifts tries to remember that I would not be screaming or soiling myself if I had any control over that. I want a nurse who is aware that could I do so and they were in a similar position, I would care tenderly and fiercely for them. I want a nurse who recognizes that I love hugs, and who is willing to give one. I want a nurse who tells me over and over again that I am safe and not snarl at me or resent that I am causing a scene. If I am doing that it is because I can't help it. If I am angry and not confused, or somewhat confused, I want a nurse who will limit set with me appropriately and not worry about his or her job when they do. I want someone to talk to me and not over me if I am in a comatose or vegetative state. I want a nurse who will read to me if I can't see or for any reason not be able to do so myself. I want nurses who will talk to each other while they are tending to me but say so and include me by doing so if I can't respond. I can hear you. I want a nurse who respects and works with my family and understands that I am not just a patient to them. I am (or was) their life. I am (or was) their mother or wife. I am (or was) just a person like them. I want a nurse who understands that I may be in pain even if I can't talk or ask for pain medication. I want a nurse who can see pain in my face or in my actions and doesn't leave me without pain medication because I can't ask for analgesia. I want a nurse who pays attention to subtle nuance... I want a nurse who doesn't dismiss me or my importance in the world simply because I can't talk, see, relate or care for myself. I want a nurse who will wonder and honor who I am and who I used to be. I want a nurse who will constantly search for signs that my mind is functioning even if and when my body is not. I want a nurse who will advocate for me and my family I want a nurse who is not afraid to touch me. I want a nurse who is not afraid to cry. I want a nurse who is special... In other words, I want to be cared for the way I try to care for others. There are so many other things I need. There are so many things I want. I would tell you what they are But I forget... Written by...Martha RN

Please don't refuse the next sexual assault case, if asked. You feel badly but she feels worse and this is how we learn lessons (I'm talking about us nurses here). If you refuse something or someone because of your discomfort level, think of how it would be if everyone felt that way. Now you know some important things to do with a collection and because some of those things weren't done by the book means that they are things you won't ever forget to do OR teach someone else. Besides, even on the very basic level YOU were a patient advocate. Remember, "she" was just a little girl....Please re evaluate your decision because the patients (we) need you and each other. It is only a mistake if you continue to repeat it..Other than that, Its a lesson. Nursing is all about brushing yourself off and getting back in the trenches even when it hurts your mind, soul and heart. As a former rape "victim" and the author of "She", please at least re think you gut reaction to avoid being there or collecting evidence....WE need you....Thanks, Martha

I would get frustrated that my kids couldn't dress themselves and discover that I had tried to put trousers on the baby and not be able to figure out how to do it...Putting both lets into one leg etc. This is also the time my husband chooses to ask me questions or have talks with me so later when I can;t recall he says, "We discussed this," and I, of course, don;t remember,,,Once I made a pot of tea for me and my daughter (so they tell me) and I don't remember doing it,,

I'm sorry that you had such a rough night. You should submit your post as an article on what maternity nurses actually have to deal with vs the perception most people (and other nurses) have,

Just an amazing rendition of the way all new grads feel. I loved it. You go girl! GREAT job and well written. I felt like I was going through the transition with you....Kind of like I felt when something happened on the unit when I was a new grad and I ran down the hall to get the nurse and then realized, oh crap, I WA the nurse.....This is beautiful and welcome to REALNURSEWORLD!

I'm so sorry for your loss, but your tribute to your aunt and the subject of elderly suicide was a poignant, personal and sentimental look at the subject through not only your eyes, but the eyes of your aunt, and I was in tears at the last sentence. Truly, I believe her husband caught her on the way down and she was lifted back up. What a lovely blend of fact and family...Thank you so much for sharing.

Let me just say that in maternity, where sometimes the vision is totally obscurred by edema, these tips are great...Thank you

I hate you, heart attack. You robbed us of our lives together without warning or reason. Like a ferocious storm overtaking a dead calm sea, you snuck in and overwhelmed everything in your path, including the life we had before you. I hate you heart attack... You took the man I used to know when you catapulted into our lives like some treacherous blight that couldn't be quelled. You changed every one and every thing in your path. You trampled all within your boundaries... Why? Why him and please God, why now? This morning he saw his baby girl smile for the first time. I remember thinking at that moment that all was supremely well with the world; with us. I came home that afternoon to an answering machine message instructing me to call the hospital. "Ma'am, we regretfully inform you that your husband is having a heart attack." "You need to get here as soon as possible." I didn't believe it. I thought I must be dreaming. I dropped the phone. The baby was in my other arm. I watched the phone tumble slowly to the floor and all its guts fall out, along with my own. Or so it seemed. I called my dad. I wanted mom and dad to somehow make things right. All I could do was cry. Heart wrenching wails that poured from the inside out. I don't remember the ride to my parent's house. I do recall making the call to my husbands parents. Somehow I managed not to cry. But, I did not feel strong. Later my brother would tell me that he never wanted to hear me cry that way again. He had heard me over the phone. Somehow I managed the long ride to the hospital, Clasping my sister in laws hand all the way, I silently prayed. We had just buried her husband. How could we possibly bury her brother too? My strong vital husband in the ICU seemed suddenly so small. I beg the nurse to bring the baby in. She says no and then mercifully changes her mind. I was going in anyway. The ships Captain is there and most of the crew. This is not good... Their eyes face the floor. They see me and there are countless hugs around. They are trying to be strong for me. I know I have to be strong for them but I am not feeling strong. I am just so scared. A nurse comes in and doesn't explain anything but she does say, "Well, I don't have to explain what's going on since you're a nurse." I surprise myself by gathering enough strength to say loudly and passionately enough so everyone knows, "I am SO not a nurse today!" The explain everything they do after that. My husband tells me not to cry. I can't help it. I bring our baby in for him to see. I make him touch her. She smiles her second smile for daddy. I want him to be strong for her. I want him to be there for her. I want him to be there for me. Please God, don't let him die! I can't do this all alone. I HATE you heart attack! Later, after the hospital, we can't figure out what to say to each other. We don't know how to act. I am afraid to leave the baby with him in case it happens again. We are so confused that I finally break down and yell, "I don't know how I am supposed to be!" I hate you heart attack. You are worse than a thief. You raped our lives together. I know I should be grateful but all I am is mad. You left someone who used to rush home to pick me up to go see magnificent sunsets. Now we don't rush anywhere... He is winded. He is scared. So am I. He doesn't say it but I know he is afraid. I feel as though we are adrift in a stormy sea with no lifeboats. We have to ride the storm, or perish. How could you do such a vicious thing? And why? We're drifting dangerously apart and I don't know what to do about it. Sometimes I feel as though we'll never get back. This man no longer wants me or talks with me and I can't fix it. Ironic, since I am the nurse who elicits conversation from everyone. I'm so very sad. Sometimes I feel defeated. But, I won't let YOU win, heart attack. I won't. I won't let you take me too, because I love him more than I hate you. I miss my husband, my sweet, creative, proud, funny, sexy loving husband. The one who sent me flowers for no reason and for every reason, who made me feel beautiful, wrote me love letters and touched me passionately and often. I'm searching on the surface of a selfish thought but I can't help it because we had our baby and then we had you and now, I'M the one with the broken heart. As a nurse I thought I could handle just about anything. There is that involved but detached manner in which we learn to handle sad or traumatic news delivered to our patients, their families and even our colleagues. Nothing prepared me for the absolute fear and grief I faced when my husband was unexpectedly felled with an MI. While in the ICU it both floored and fractured me that his nurse just assumed that because I was also a nurse, I would know what was going on or wouldn't need an explanation. All these years later I realize her discomfort level probably rested on an attempt to establish a rapport or dialogue with me to ease my pain. Although I always make an effort (or so I thought at the time) to treat everyone as equally as possible, this incident with my husbands illness forced me to see that I too on some level assumed that because a patient or family member was in the medical profession, they somehow could be spared the bulk of the information because they were already aware. That, I determined, is a gigantic myth. The nurse I personally chastised by insisting I was not a nurse that day was immediately apologetic and I am certain, as all we nurses do, learned a similar lesson that day. Now when I have a doctor, nurse or medical employee as a patient or the family member of one, I am up front about informing them that I intend to explain procedures, teaching and anything we will do along the way. I also acknowledge that I respect their experience and expertise but that intense experiences, such as labor and delivery in my case, can certainly be distracting. Usually I notice a sense of relief when I make that statement. That doesn't surprise me because I know how I felt when my husband was facing life and death issues and the staff concluded that I knew what was going on because in my distant past I was an ICU nurse. If I could pass that important tip along to nurses experiencing the other side of the spectrum either as patients or loved ones of same ,that would be my number one not so obvious tidbit of wisdom.:heartbeat Written by....Martha, RN

George and MarthaNight time briskness slapped me in the face as I climbed in to my car for the familiar trek to work. It was my third scheduled night shift but only the first I had felt half way healthy enough to attend. I had called ahead to prepare myself for the pace of the unit, and was already exhausted at the prospect of a wild night. The evening nurse had sounded breathless and added that she had not yet had one free moment to eat or go to the bathroom. "That's just wonderful," I mused, as I negotiated the ten miles of rural darkness to the hospital. Busy nights on the maternity unit were not always the happy, baby rocking times that the general public and most other nurses believed. They could be brutal and exhausting. Sometimes they could even be tragic and an inner voice nagged I should probably expect nothing less. As I drove into the parking lot past several ambulances in the emergency bay, I steadied myself for whatever chaos loomed ahead, keeping in mind that however short staffed the evening shift was, our shift would be even more compromised. Such is the stuff of the night shift. It took a concerted effort simply to walk up the hill and into the hospital. It hadn't escaped my notice that the Emergency room was packed or that there was a blazing harvest moon; two sure hints that my night was going to be crazy. I chuckled at the thought that scientists had actually funded a study to determine that there was no truth to the notion that a full moon impacted upon patient behavior or events. Obviously they weren't out in the trenches with us. My husband had provided me with some soup so I wouldn't be hungry overnight. I just couldn't to tell him that if by some miracle I was able to arrive at a point that eating became likely, simply eyeballing the mixture sent my poor tummy into a tailspin. I attempted in vain to ignore the aroma. I wasn't surprised upon arrival. Full moons generally don't lie. At least one night nurse had been called in early to help the evening staff, and looked as though she had put in a full shift. She seemed so pooped that I wondered how she would get through the remainder of the night. Not five minutes into report I was informed that because three night nurses had called in the night before, two evening nurses had been mandated to stay, and were not there for the current shift. All eyes were focused directly on me. I was still ill enough that I didn't care, but didn't tell them that. Nurses are expected to be invincible and available whatever their condition. I apologized on behalf of everyone. Perusing the patient board, it became readily apparent that it was not going to be the quiet night I had hoped for. Several people were in labor and there were patients in pre term labor as well. I prayed no one would have to be transferred to a specialty facility because there were no nurses to be spared for the ride. Another nurse took me aside and whispered she had a patient she thought I should take. Apparently my "emotional support" skills were legendary and definitely required in this case, which was an eighteen week fetal demise. The alternative was a drug seeking, needy, fresh c/section patient currently lobbying the staff to take her outside for a smoke. For the first time in quite awhile I wished for a labor to immerse myself. That said, I informed the charge nurse I would do whatever she wanted. The expression of relief in her fatigued eyes made me glad I had given her the option. I took a deep breath, said a quick prayer, and prepared for battle. Dragging myself out of the chair, I prepared to meet the unfortunate couple, who were in shock. They had gone to their regular office visit and discovered that there was no heart beat. There had been some spotting previous to their visit but the patient hadn't thought much about it because it was sporifice and had occurred with each of her other two pregnancies. She didn't want to talk. That was ok by me. She had recently been medicated for the pain. Her husband was snoring on the couch and I noticed both she and I were annoyed by that. I introduced myself and informed her I was to be her nurse for the night. She grunted something in reply and faced away from me. Her evening nurse had mentioned that this couple didn't want to deal with the staff. They were in a room at the end of the hall to minimize interaction with babies, but we could both hear the cries of the infant in the room next door, and she gave me a penetrating stare that signaled I close the door and get out. I did. Ten minutes later I spied the husband walk down the hall to the kitchen. A tall grizzly bear type, he breezed past me as though I didn't exist. I was not surprised or offended and quietly introduced myself adding that while I had every intention of respecting their privacy I would be looking in on them from time to time. He nodded, shook my hand and wordlessly, turned back toward their room. The room light went on signaling a need for my presence. She wanted something else for pain because her cramps were becoming intense. I immediately called the doctor, an old fashioned elderly practitioner who just could not understand why I would bother him barely two hours after her last dose. He refused my suggestion of an epidural and was not impressed with my opinion that the patient should receive more pain medication. Even my argument that people in labor expecting a healthy baby generally receive multiple doses of analgesia at frequent intervals didn't faze him. Eventually he allowed me to offer the patient a sedative but emphatically insisted that she not be given more pain medication until four hours had elapsed from the first dose. No amount of cajoling would sway him, and I did not want to antagonize the doctor in the event I needed him later on. It was my belief that since we were not protecting a live baby and losing her child was already mind numbing, we should medicate the poor woman to the hilt. Every night I realize a moment when I become a patient advocate. This was it. She wasn't happy with me. Anger blazed across her tear stained face. I told her it was perfectly acceptable to unleash her anger on me. I even encouraged it. Her features softened and she eyed me silently. I promised to bring the pain medication the moment it was due, giving her the option of accepting a heated body massage. I added in the event she chose the massage, I would not expect her to talk to me. To my great surprise and relief, she consented. Ten minutes into the back massage her first words were directed to me in a t, vulnerable voice. "I just don't want to leave without a baby." Then, "this is the most horrible thing that could ever happen to anyone and I just never imagined it would happen to us." She continued to alternately talk and cry as I wordlessly massaged her back, legs, feet and hands. As she relaxed her wall came down and the tears flowed. Mine joined them. I could tell her husband was no longer sleeping, so made a point to mention that often husbands feel left out or helpless since they can't fix things. Sometimes it can seem that they don't care when I reality they care quite a bit. I noticed that he came over and sat by his wife's bedside as she cried. I finished the massage and encouraged them both to rest, noting that they embraced and there were shared tears between them. I promised I would be close by and readily available, taking time to make sure that the call light was within reach. Two am was the appointed time for pain medication and I gave it as promised. Not ten minutes later she rang for more and it crushed me not to be able to accommodate her. I sat with her while she cried, screamed and swore. I said nothing but stroked her cheek as she let out some of the pain we couldn't touch with any medicine, all the while thanking God for my four children. She reached out and grabbed my hand as her poor husband sat helplessly by, pale and silently suffering. I reached over and grasped his hand with mine and with a silent glance that spoke louder than any words I might have said, he acknowledged his gratitude. We three sat there for some time like that, as one. The older doctor had forbidden the patient to get out of bed and wanted her to use a bedpan. Something about dislodging the medication he had administered to promote cervical dilation and the eventual expulsion of the dead fetus. This was another tidbit left over from the dark ages I would have to figure out how to discuss with him. When the patient begged to get up to use the bathroom, I told her I certainly wouldn't refuse but stayed close by due to my suspicion that delivery was imminent. I had been told she was five centimeters with bulging membranes just moments before she had received her pain medication. The fetus was small and it would not require much room to be passed. I asked if she felt lady partsl pressure and she angrily yelled that she wasn't sure. She refused to allow me to check her underwear. I think I knew what might happen so parked myself just outside the bathroom door. "OH MY GOD!"OH MY GOD!" "OH MY GOD!" I heard not three minutes later. I helped her to bed and summoned the troops. I needn't have since, having heard her screams, they quickly assembled. My heart sank as I peered into the toilet because I knew what I would find; what I would have to retrieve. Suddenly the soup that made my stomach jump seemed totally benign. I inhaled slowly and reached in to gently bring the baby back home, all the while trying to put the heart wrenching wails of grief coming from the bed, out of my mind. The fetus was intact, enclosed in the amniotic sac with an intact placenta. He was perfectly formed and seemingly suspended in space within the sac. I wrapped the fetus in a towel, and called the doctor to tell him we had a delivery. He didn't want me to rupture membranes so I motioned him aside and told him as a mom I would want to hold my baby and looking at him through amniotic fluid would not be the way I would want to remember things. Crusty, old fashioned with a reputation for eating nurses for lunch, he softened and asked simply that I note the fetus was intact and I was the one to break the water. He walked down the hall a few feet, turned and gestured that I approach. "You are a good nurse and this lady is lucky to have you." Momentarily floored, I no longer felt poorly. She didn't want to see the baby at first so I quietly suggested she hold him while I stood behind the curtain close by in case she couldn't do it. After several minutes she agreed and as all moms will do, unfolded the blanket and checked to see if he had all his fingers and toes. Behind the drape, my tears flowed as she said to her husband, "look at his long fingers" I wondered if she would take my suggestion that he be named but she refused. As I was preparing to leave that morning she was already dressed. I gave her a memory box with the tiny footprints I had taken, along with a poem I had composed just for her. Silently she undid the ribbon and more tears flowed between us. No words were needed. She reached up and gave me a long hug. "Thank you for being my nurse." In all the years I have been in nursing these are the words that keep me going back. I learned early on that palliative care is really all one can do in tragic times, and often it surpasses the importance that clinical intervention provides. Really, it is a marriage of the two that provides optimal support for the patient. In the case of a fetal demise a good OB nurse will learn that while the bond between him or her and a patient is understandably strong, the patient customarily wants to get as far away from the situation as is humanly possible. One of the reminders of her loss is the nurse who cared for her. An OB nurse has to come to understand and not take it personally if the patient does not want her to attend subsequent labors. Taking cues from the patient and family will always lead the nurse into providing the best of physical, psychological and emotional care. I learned a lesson from a patient early in my career who said simply, "you can't save everyone." Well, at least I can try. My patient walked by the desk and stood there without speaking until I noticed, and looked up. "George Alexander," she whispered with a hint of a smile, "after my father." "That will be his name." "Do you think they will find each other in Heaven?" "It's a strong name," I countered, meeting her sad green eyes. "I am absolutely certain they are together." I asked her to wait while I made a card with his name, and watched as she placed it in the memory box, along with some pictures I had taken of George. She was gone before my final paperwork was done. Next week I may not even remember her name. Next year I hope if she remembers me it will be because she is back in labor on or near her due date listening to a healthy heart rate on the monitor. If I am lucky, she will request me for her nurse but I will fully understand if she does not. Until then, she now has an angel in Heaven and however sad I am, I am also grateful and graced that I was appointed to share this experience with them. As I exit the unit, I have to smile as I note that "George" and "Martha" will be irrevocably entwined, always. Written by: Martha, R.N.

Hi there, I just posted a thread, which has since been closed, on my narrow angle glaucoma. I was not asking for medical advice as I have researched it thoroughly and am already scheduled for surgery, I was merely wondering if anyone has received the same diagnosis and curious as to outcomes and experiences. I am possibly more learned than most in my own diagnosis, but only the second person I have personally known with the malady. Sorry about the miscommunication and the incorrect assumption that I was soliciting advice, especially, as it was so democratically and emphatically put, I am well aware medical advice disemination is no longer policy here,...Thanks Martha:heartbeat

Hi everyone, First let me say hi to all. I haven't been here in quite some time and miss everyone. My question is whether anyone has experience with the treatment of narrow angle glaucoma. I know it is laser treatment, but just found out through a routine eye exam and subsequent visit to a specialist , that this is what I have and that it needs to be treated asap...If any of you has had this form, has it now or knows of anyone in whom it progressed to the acute stage, please comment and feel free to give me feedback. I was fearful at first but feel so blessed that it was discovered...Especially since, as a night nurse, headaches and nausea (some of the symptoms of progression to the acute phase), bother me anyway and I may not have even suspected something was so seriously wrong...Thanks...