Hands-On L&D Nurses?

  1. 0 I am a doula and BSN/RN grad (in 5 weeks) and disappointed with the lack of hands on support I see at the hospital where I am doing my last clinical. I do not want to lose my doula skills plus the compassion and respect for women giving birth. I'm wondering if this is the norm... do many nurses feel that they are good nurses by keeping the monitors going and the pain meds flowing? Is there a hospital out there for me?
  2. Visit  healingheart profile page

    About healingheart

    Joined Apr '03; Posts: 10.

    15 Comments so far...

  3. Visit  SmilingBluEyes profile page
    0
    I think you won't lose your skills if you do not want to. I am a VERY good L/D nurse I think.....despite the use of epidurals and pain meds, there are many ways we can bond with our patients and support them in the choices they make regarding their birth experiences. Have you considered trying to find work in a Birth Center (run by midwives) or a unit that has lots of midwives on staff? I think you would find these venues much more to your liking. I wish you the best. Doulas are wonderful. You can bring so much to your nursing practice with the skills you already have as a doula. Good luck.
  4. Visit  BETSRN profile page
    0
    Quote from healingheart
    I am a doula and BSN/RN grad (in 5 weeks) and disappointed with the lack of hands on support I see at the hospital where I am doing my last clinical. I do not want to lose my doula skills plus the compassion and respect for women giving birth. I'm wondering if this is the norm... do many nurses feel that they are good nurses by keeping the monitors going and the pain meds flowing? Is there a hospital out there for me?
    Our hospital has hands-on nurses. However, you have to realize that as an RN, you will have an obligation to have your hands on those monitors (when they are being used) and you will be requires to chart a LOT! Tha's just the legal climate today,unfortunately.

    Your doula skills will always be very valuable You will be an example to others of how to keep touch in a labor.

    As a doula, you have most likely worked with clients who are motivated to go as med free or as intervention free as possible. Sadly, those people are pretty far and few between.

    As new grad, you will have a lot to learn about the responsibilities that go along with being a labor nurse. Doulas (as wonderful as they are) have NO responsibility to anyone but the woman and her comfort. While all this is paramount of course, as a nurse, you will have a tremendous legal responsibility. A doula is NOT liable. An RN is. Good luck. There are a LOT of mother/baby friendly hospitals out there.
  5. Visit  jennobrn01 profile page
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    I agree that legal issues have curtailed the hand's on experience ob pt.'s need and deserve. Consider looking into a birthing center, or a hospital that advertises themselves as low-intervention.
  6. Visit  JaneyW profile page
    0
    Quote from BETSRN
    Our hospital has hands-on nurses. However, you have to realize that as an RN, you will have an obligation to have your hands on those monitors (when they are being used) and you will be requires to chart a LOT! Tha's just the legal climate today,unfortunately.

    Your doula skills will always be very valuable You will be an example to others of how to keep touch in a labor.

    As a doula, you have most likely worked with clients who are motivated to go as med free or as intervention free as possible. Sadly, those people are pretty far and few between.

    As new grad, you will have a lot to learn about the responsibilities that go along with being a labor nurse. Doulas (as wonderful as they are) have NO responsibility to anyone but the woman and her comfort. While all this is paramount of course, as a nurse, you will have a tremendous legal responsibility. A doula is NOT liable. An RN is. Good luck. There are a LOT of mother/baby friendly hospitals out there.
    I consider myself a pretty hands-on L&D nurse. I like to build a relationship with patients when I can and I think it helps their laboring experience. I have been known to rub backs and stay in the room as much as I can. That being said, I think the other posters had it right on when they point out that an RN has a bigger function than that. We are responsible for the lives of mom and baby and often have more than one laboring mom to tend to. Even if we are in the room of the second patient, we are responsible for our other patient who is usually on EFM. I have been known to run out of a patient's room when my other pt is having a bad decel. I have also juggled admitting a pt with delivering another. It is often a matter of time constraint.

    Also, not all patients want me in there 'being there' for them. They have brought their own support people and agenda with them and it doesn't always include the nurse. I am responsible for their health status, but it is their birth and they are in charge of what they want to do and who they want around within reason.

    A big part of being a 'good' nurse of any kind is to know when to check your own belief system at the door and respect your patient's wishes. I'm sure you are a wonderful doula and you will definitely use those skills as an RN. But remember that not everyone wants a doula and many people are very happy with their epidural and pain med births. I know I was!
  7. Visit  SmilingBluEyes profile page
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    Yes Janey you said it! There is room for us ALL at the table. Just remember---- It's up to the LABORING FAMILY the level of involvement they expect and want of their nursing staff -----and the mechanisms they use to cope with pain. Nurses are not contracted/hired by the laboring family the way doulas are. And you must be prepared for your role to expand a LOT if you expect to practice as an RN in L and D. As a hospital employee, you will be held to the RN Nurse Practice Act by your State Board of Nursing, regardless of your doula experiences/role.

    Also, respect the individual! I have learned through the years, not ALL of my patients want me "in their space" during their labor. Some, I just cannot bond with, through no fault of my own, or theirs. That is ok, as long as they are comfortable and content with their experience-----after all, it is theirs, not MINE.

    Yes, of course: Labor/birth can be healthy and natural experiences. However I strongly caution the OP: PLEASE do NOT prejudice yourself against those who choose to cope using pain meds or anesthesia versus doulas, Bradley method and natural birth. Some are just NOT interested. It is their call. To hold any prejudice or disdain for this choice would be a grave disservice to those you say you want to help as an RN as well as doula. Good luck.
    Last edit by SmilingBluEyes on Mar 30, '05
  8. Visit  BETSRN profile page
    0
    Quote from jennobrn01
    I agree that legal issues have curtailed the hand's on experience ob pt.'s need and deserve. Consider looking into a birthing center, or a hospital that advertises themselves as low-intervention.
    I think it is only fair to add the "low intervention" hospitals STILL have to monitor, chart and keep themselves out of the legal arena if at all possible.
    I consider myself a low intervention nurse. However, I have had to accept the fact that not every birth is meant to be intervention free and that labors change course like the wind.


    When an emergency happens, all games are off in the doula arena. You have to be alble to change your role instantaneously!

    Those doula skills are going to help you a lot, but you CANNOT forget the legal liability that will come with the RN in back of your name.
  9. Visit  SmilingBluEyes profile page
    0
    Quote from BETSRN
    I think it is only fair to add the "low intervention" hospitals STILL have to monitor, chart and keep themselves out of the legal arena if at all possible.
    I consider myself a low intervention nurse. However, I have had to accept the fact that not every birth is meant to be intervention free and that labors change course like the wind.


    When an emergency happens, all games are off in the doula arena. You have to be alble to change your role instantaneously!

    Those doula skills are going to help you a lot, but you CANNOT forget the legal liability that will come with the RN in back of your name.
    I agree 100%
  10. Visit  webbiedebbie profile page
    0
    I was trained as a L&D new grad. I feel I received excellent instruction. It was a small hospital with 4 LDR's. I spent a lot of time with my patients during labor if they wanted me there. (Most did).

    When I moved to another state and secured a position at a big teaching hospital, I was mortified when I was called to the manager's office and she told me that I was spending too much time with my patients! She wanted me sitting at the nurse's station with everyone else watching the monitors.

    In all my years of nursing, I have learned that ALL hospitals are different. We sit for a national exam, but each hospital and staff have their own way of doing things. It is an adjustment. Some things may seem petty to some (for instance, one hospital required that we check Homan's and document it, and another says they don't bother with it). As for me, I check Homan's with every assessment and I do DVT instruction for ALL my patients and I document that!

    The extra skills that you have acquired (doula) will blend in with your nursing skills. Concentrate on those nursing skills, and your doula skills will fall naturally in place. In other words, your doula skills will enhance the nursing care you give your patients.

    I wish you the best in your nursing career!
    Last edit by webbiedebbie on Mar 31, '05
  11. Visit  Harlean profile page
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    As an L&D charge nurse on a unit that does over 400 deliveries per month I have to say like many others that the clinical climate today does not leave a lot of room for spending qualilty time with patients. Here in California we were hopeful when the ratios were approved that this would mean a patient load that allows for more of the social/emotional/supportive care that most nurses love to give. Unfortunately this has not been the case.

    I think the original intention of advanced technology was to free up more time for the basic care laboring patients need. Unfortunately it has simply made their care more labor intensive (pardon the pun).

    All I know is that I make every effort I can to communicate my care and concern for my patients as much as possible in the time I have. It's all any of us can do. The family is important but that only works when they are supportive and/or present.
  12. Visit  Spidey's mom profile page
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    All great comments - not much to add. The role of RN can incorporate some of the doula experience you have gotten but our role is much different too.

    We have to be RN first.

    And hospitals are different. Choose wisely.

    steph
  13. Visit  SheaTab profile page
    0
    We are a large L&D unit (40+ LDRPs) and we have a policy of staying at the bedside when you are taking care of a labor patient. We even have central monitoring but my facility believes that you are better able to deal with issues at the bedside and that it enhances patient perception of their experience. There have been times when mom and dad are sleeping after the epidural that I nearly fall asleep in my chair and I usually freeze but for the most part I really believe that it is an absolute plus. I've never perceived that I was unwanted at the bedside and I believe that I bond more with my patients than I did before we implemented the policy. We are strictly 1:1 when in labor. I can't imagine trying to deliver one patient while admitting another as one of the previous posters indicated! YIKES!
  14. Visit  FrumDoula profile page
    0
    Quote from Harlean

    I think the original intention of advanced technology was to free up more time for the basic care laboring patients need. Unfortunately it has simply made their care more labor intensive (pardon the pun).
    My understanding was that the technology was offered not to help with basic care of laboring patients, but to increase "safety". It has done neither, and has, if anything, reduced the amount of hands on nursing that laboring mothers so desperately need. The technology that many low risk laboring women are subjected to not only do not increase safety, but increase risk, unfortunately.

    I would like to correct the misconception among some nurses that doulas only work with women who desire natural birth, and that we see natural birth as the only viable option. This is incorrect. Doulas attend a wide variety of births, from planned c-sections to home births and everything in between. I've had plenty of clients who chose medication. As long as there is informed consent, along with good labor support, we're there to simply help the mother and her family in the birth process.

    Now, having read research study after research study, it is not difficult to understand why so many doulas prefer low-intervention births for the low-risk mother. It's simply SAFER not to have unnecessary interventions such as mandatory IV's with no thought to patient hydration levels, continuous fetal monitoring, etc etc. Birth can be notoriously unpredictable, yes. But you can also stack the odds against a woman having a safe birth if you load her up with every intervention in the name of "safety" and prevention.

    And I want to mention something else about doulas and epidurals. Penny Simkin, a very famous doula and physical therapist, has often argued that a woman who has an epidural needs MORE doula care, not less, simply because she needs to be reminded to connect emotionally and physically with her labor. She has written some very interesting articles on that subject.

    Cheers,
    Alison


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