Latest Comments by LibraSunCNM

LibraSunCNM, BSN, MSN, CNM 22,317 Views

Joined: Jan 24, '08; Posts: 927 (67% Liked) ; Likes: 3,571

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  • 0

    Midwifery Education Programs

    This is a link to the list of all of the midwifery education programs in the U.S. from ACNM's website. It gives you websites and contact info for each of the programs, which is where you'd find specifics about how many clinical hours are required by each (there is no set number that each program adheres to, as long as they meet certain guidelines they can pick and choose how many hours they require). Mine was 1100 clinical hours. It is possible to accomplish with a family, but I personally am glad I slogged through it before I had my daughter, it would have been infinitely harder for me. I had a classmate with kids and she seemed to be totally fine with it. It all depends on your program and its flexibility, your family support system, and your personality.

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    Yes, from time to time I wonder "why???" but then I realize if I gave emotional energy to every toxic family dynamic I encountered, I'd be drained of emotions real quick. I just feel sorry for them.

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    Quote from TruvyNurse
    We had a nurse who would be pacing at the door. She was ready to go at 7am. She gave the worst reports. Some of her "best" included: 1) not mentioning a gentlemen had a colostomy 2) reporting 16 count respirations on every patient. Even a dying man who was at least 32 a minute. 3) told me a patient needed prepped for surgery he was having in 2 hours but for what surgery she didn't know 4) once we did bedside report and she proceeded to pet the patient and talk to them like a baby "aw he had a big old poop last night didn't ya sweetie?" 5) not being aware that her patient was dead when we were doing bedside report 6) uncomfortably and obviously flirting with a young male patient during report (so bad I turned it in)
    Needless to say she was fired after 8 months..
    Literall crying with laughter right now at #5, I like the way you dropped it in there subtly among the list of other less-serious issues.

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    My least favorite reports, as others have echoed, are those that claim everything is fine, and then you go in the room and it looks like a bomb went off and you're catching up on stuff all shift. I am NOT someone who grills other nurses in report, truly mostly the opposite, I'm willing to let a lot of stuff slide if I know you're usually a team player, and appreciate when others give me the same grace. But those that are just lazy and you know they're lying outright or by omission in report kill me.

    We had a travel nurse on the mother/baby unit where I worked who was one of those nurses who's skillful in maintaining a super-competent facade, while actually being incompetent, if that makes sense. She gave me report on a fresh C/S mom of twins, and spent most of the time talking about how much she liked her as a person and what they had in common. I went into the room, it was as if the aforementioned bomb had gone off (not that neatness and tidiness are more important than actual nursing care, but come on...help organize tubes and lines and toss unnecessary trash when you settle a new patient), and the family was peeved at ME that her epidural PCA had run dry and she was in pain, and had no breakfast. A couple other things had been missed as well. I confronted the nurse about the issues when I gave her back that night...her excuse for the PCA was that "we do PCA checks every four hours, which I did." Yes, she did, but she spaced them out so that the last check was 3 hours prior to shift change, whereas standard practice on the unit was to do a quick check within an hour of shift change, even if it wasn't technically due, to prevent incidents like the one that actually happened, from happening. She had a glib excuse for everything. I discussed what had happened with another nurse in private to vent and get her advice on whether I was overreacting, she confirmed that the nurse sat at the desk all night talking everyone's ear off, and when she covered her for a break, she was constantly finding patients being neglected.

    I left soon after when I graduated from midwifery school and found out she had been brought on as staff and promoted to assistant nurse manager One of many reasons I was happy to leave staff nursing!

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    BCgradnurse, wondern, kbrn2002, and 4 others like this.

    Quote from NightNerd
    I LOLed at "luxurious." Can I get a definition, please?

    While I'm not one to care about having "nice" things, per se, I do like to have some quality in my life for the things that matter. As a nurse, I can repair my car when I need to, I always have a decent pair of running shoes, and I can take a nice vacation every couple years with some planning, get a massage every now and then, etc. *And* when I'm bummed that I don't have a mansion, a pony, and a private jet, I simply remember that I'm too tired to enjoy those things anyway.
    I LOL'd too, seeing the title made me think of that bizarre thread a while back where the poster urged nurses to oil their flowing locks of hair.

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    cayenne06 likes this.

    Quote from inthecosmos
    I think requiring a DNP is ridiculous, especially because jobs aren't requiring it. It's all about "status" in most organizations.
    I will go step further than you and say that I think, for the most part, the DNP degree itself is ridiculous. It's such a new thing that I think most programs are woefully lacking compared to PhD programs, and is just another example of degree inflation. JMHO!

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    cayenne06 and Ohm268 like this.

    Quote from cayenne06
    I am a CNM and I work full time in GYN/sexual health, with a very nice 40hour m-f type schedule. There is nothing a WHNP could do that I cannot in my current role. I do everything from menopause care, colpos/biopsies, word catheters, LARC placement, sonography, abortions, PreP, management of early pg complications, trans care, smoking cessation, the list goes on.



    However I will say that my clinical training was *heavily* biased towards obstetrics, and I get the sense that is representative of most students' experience. We didn't have any clinical rotations that were specifically GYN-focused. Maybe we need to draw a little from WHNP training, and provide a better balance of GYN clinical training in midwifery school.

    I LOVE LOVE LOVE my work and I want more students to see for themselves that there is so much more to midwifery than prenatal care and baby catching!!!!! I do moonlight inpatient as a triage midwife to keep my skills current, but gyn/repro is where my heart is.
    That's too bad, I felt my program was actually pretty strong in GYN. I did have a full semester of GYN clinical in a busy inner-city family planning clinic so got good experience with contraception, pelvic exams, breast exams and STI testing. I wish I'd gotten more menopause experience just because it's such a complex topic, but thus far I've never really had to care for menopausal women. Maybe someday! A lot of midwifery programs do fall really short in exposing students to the full spectrum of midwifery care, I agree for sure.

  • 4

    At this time, there is no requirement for midwives to obtain a DNP and no talk of making it a requirement.

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    Wheels28 and Jenbripsu like this.

    Quote from Jenbripsu
    And I totally understand that. I am aware that I need to work on getting thicker skin. In school we had to do personality tests to see what "color" we were. It was no surprise to me that I'm a "blue"....which are the tender hearted yet stubborn types. It's a dichotomy lol. I'll fight to the death for something I believe in....but my feelings are hurt easily. I don't have trouble with mean patients....but mean peers being mean to me would be something I would struggle with. High school PTSD maybe lol. Either way, I do recognize that I need to get some thicker skin and I appreciate all of the advice! I promise I'm working on it!

    Also, I didn't clutch my pearls over the comments - more just trying to get ready for the 'real world of nursing' and I read the situation as wildly inappropriate and I guess I was just trying to determine if I was right...or whether I needed that thicker skin I just spoke of. What I'm finding out is that the answer to both questions is YES!
    I have a similar personality, which is why I posted. I didn't mean to insinuate you were pearl-clutching over the language itself, but more over the idea that nurses could be anything but angelic martyrs to their patients. Nurses are human, just like anybody else, and that's OK. You don't need to waste energy on those lousy ones (even though I completely agree that the situation, as described, was totally inappropriate).

  • 8

    Quote from Jenbripsu
    Thank you to everyone who took the time to respond. I'm happy to know that this is not the case everywhere. As I mentioned above, when I brought this up in post conference without naming the nurse, my instructor knew immediately which nurse it was.

    I do not expect to get through my career without venting about a patient or their family. I haven't even gotten through nursing school without venting about instructors or other students. I am SO not blameless in the venting or swearing game. But I maintain, regardless of whether I'm a student or not, that the words and location were not professional. Had this been in the break room, fine. I'd have still thought it harsh perhaps, but not necessarily unprofessional.
    The words and location....right at the nurses desk in the center of the floor with patients and families walking the halls....It just didn't sit right. I am very glad to know that there are others who, even after years of experience, would still find this level of venting unacceptable at the nurses desk.

    As far as me being "just a student", I get it. I'm 45 in my classes with 20-somethings and sometimes they say something about not having time or something like that and I'm thinking "yeah, right....try having 4 kids and a husband!", but then I try to remember that we are all walking our own path so for them, the strain on their time is very real - as it is to me. I don't want to compete for misery.

    The same goes for me being a student. I was a mental health and suicide prevention instructor before this - and frankly my entire profession revolved around compassion and respect for the whole person. So I bring that perspective to nursing - that while I'm also just human - so is the patient and while it's a work day (or school day) for us, for them it might be the worst day of their life. I am not perfect by a long shot. I throw down the f bomb more than I should and I get frustrated like anyone else. But even just as a student, I hope that I can still bring compassion into my care since I can't bring a whole lot else yet! I understand that some of you are rolling your eyes at me right now and that's ok. I will return in 10 years and let you know if my ideas have changed. I hope they have not. My mom was a nurse for 50 years and after she retired she still had patients sending her Christmas cards (she worked in long term rehab with post trauma patients who spent months there) and a few even called her sometimes. While boundaries in nursing are different now and I don't expect (or want!) phone calls or cards, I do hope that I can continue my mom's legacy of being remembered as a compassionate nurse, regardless of the day. That may be naive, but it's a goal I'm working towards, even just as a student.

    Thanks all for listening and for your excellent advice.
    From your posts you sound like a very dedicated, caring student. I think you have good perspective on the kind of nurse you'd like to be, and I applaud that. I think the central thesis of most of the other posts is that you'll have to develop a thicker skin in nursing in order to accept the fact that other people aren't going to practice the same way you will. Some nurses are unprofessional, nasty people. The same goes for doctors, lawyers, teachers, bankers, farmers, and auto mechanics. That is what you need to start wrapping your brain around---you can't control how other people act, so just focus on being the best nurse YOU can be and tune out the others. Don't let them affect you to the point you're wringing your hands about it---it's that naievete that I think we're telling you to get over.

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    Ohm268 likes this.

    Yes, that basically goes along with the minimal reasoning I've heard for it---it lowers your malpractice costs or facilitates credentialing in some facilities if you're not doing births. I think now, though, it's just less necessary as more and more state affiliates are getting pro-midwife laws passed that involve better recognition of CNMs/CMs and what our training and scope of practice entails. Not saying there aren't states where the WHNP might be useful if you're also a CNM, but for me it's never been remotely necessary.

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    mdcRN2011 likes this.

    Quote from Ohm268
    I will ask for some clarification about why this is the case for this one specific hospital. The only other thing I'm unclear about is why if CNM covers everything a WHNP does, why then do some schools still offer dual specialty CNM/WHNP when it might make more sense to completely switch to CNM/FNP like Vanderbilt or CNM/PNP like UofM where the dual specialty helps to expand your scope of practice? Is it just for the sake of profit and further monetarization of nursing education or is there another reason?

    Would it be difficult to change the dual specialty curriculum to CNM/FNP or CNM/PNP since FNP and PNP are normally offered already as specialties along side CNM in most APRN programs?
    I've wondered all that myself, and I really have no idea. My program didn't offer a WHNP track so I've never heard first-hand the academic justification for it.

  • 9
    cleback, nursej22, Here.I.Stand, and 6 others like this.

    Quote from Dakeirus
    Sure, I am all for that. But there's a difference between someone calling me from the OR saying "Just an FYI, the patient who's about to come out is HIV+" and "You absolutely need to wear gloves. This patient has HIV." Ermagard, let's wear hazmat suits!! The sad part is they say it out loud in front of the patients like they're, as you put it, some sort of leper.

    I've had a nurse question me on why I was touching an HIV+ patient without gloves when I was merely talking to her and only touched her shoulder once. Seriously? And when she wanted to shake my hand and thank me for taking care of her before sending her off from the PACU, was I supposed to say, "Hold on, let me wear some gloves first. OK, now you can shake my hand."

    Honestly, I'm more worried about bringing home Cdiff whenever I work in the MICU.
    I agree with everything you just said PLUS I now love you because you said "Ermagerd." Favorite meme ever.

  • 8
    LoveMyRNlife, Kayauhs, opalbee, and 5 others like this.

    Quote from TriciaJ
    In an ideal world, people just wouldn't think to behave this way. In a slightly less ideal world, management would have the backs of their employees. ("What hospital would you like to be transferred to?" I absolutely LOVED this.) In OP's world, not remotely ideal, there is a dirtbag patient and a cowardly management.

    Of course it SHOULDN'T be this way. But it is. I think it would really help OP and all the other staff in that facility to remember that this person has no real power. He/she is just spewing vitriol. It is very unpleasant, just like a patient with c-diff. (Although it's a lot easier to feel compassion for the person with c-diff, still makes for unpleasant working conditions.) Ever see Monty Python's The Holy Grail? When the knight has his arms and legs cut off and yells "Come back and fight, you cowards!" It's funny in a movie and it really helps to learn to laugh at it in real life. I don't mean laugh openly at the patient, but try to see the ridiculousness of a powerless patient threatening to send someone to a concentration camp.

    I don't know if this person actually has borderline personality disorder as some have suggested. But here's a clue: if you find yourself feeling someone's ugliness on a visceral level, that is a trademark of a borderline. They're good at making someone feel the way they usually do. I hope, with or without management's help, OP and crew can present a united front to deal with this person. Life is too short to be stuck with someone's ugliness.
    I agree completely with everything you say. I just don't think it's realistic for someone to be able to brush something like that off as soon as it's spewed at them. If you're able to do that, truly my hat is off to you, I wish I could be that way. And as I said, she definitely needs to make him think that she can just brush it off. But I personally would be affected by that comment, and I don't think it makes me unique, so I wanted to give the OP some reassurance if she was finding herself in the same boat.

  • 0

    Quote from Ohm268
    This is a question that I have asked before as I researched CNM programs so thank you to everyone that has provided answers.

    I know that the thread is old but I wanted to add that in CA where I am from some hospitals won't hire you as a midwife unless you have both the CNM and WHNP. Part of the reason might be cost of insurance (as stated previously) another might be (whether rightly or wrongly) you put on your CNM hat for inpatient hospital births and your WHNP hat when you are in an outpatient provider setting in a clinic.

    I do plan on being dual certified even though as many people have told me, a midwife's scope of practice does encompass everything a WHNP does. The only exception that I can possibly see is if you want to see the women's gero population after menopause. Then you might need the WHNP since this sub group of women might be outside a midwife's scope of practice.

    Feel free to correct me if anything I have posted is incorrect. I learn a little more about my future profession everyday.
    Yeah I'm a little confused by what you consider a "CNM hat" vs. a "WHNP hat" and how they're different. I know nothing about California so you may be absolutely right about hospitals wanting both credentials, although it seems odd. As I said before it only really makes sense if you're only doing outpatient.


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