Wishes Regarding Students in Birth Plans - page 2

I've been reading a lot of birth plans on the web - the one I use with my clients has been currently hijacked by my computer. I know that I include this question on my birth plan about students... Read More

  1. by   SmilingBluEyes
    Quote from MLOS
    Now that I think about the complete picture I think this was very poor of the school and of the hospital.
    I do too. Very poor.
  2. by   BabyRN2Be
    Quote from michelle126
    I wouldn't have minded students during my birth (unless it turned into a circus)..Why would a pts payor status have any significant in determining if students are aloud to observe/ learn???? Is a medicaid pt different from a private pay or insurance pay patient?
    Back in the days when all the hospitals around here had mostly semi-private rooms, they would deny private rooms to Medicaid pts even if they said they could pay. Some people in Registration were downright hostile towards Medicaid pts if they asked for a private and insisted that they could pay it. But that point is moot with all private hospital rooms for PP pts in this area.

    OK, I should have phrased my question differently. A pts wishes should not be excluded because of pay status. I guess we had a few doctors who were insistent that the Medicaid pts should not have a say in who could attend them during L&D. These doctors figured that since they "weren't spending a dime" for this delivery, that they shouldn't be able to say whether or not a med student (or student nurse, for that matter) should be excluded from their birth. I swear, the attitude was "why should they have privacy at tax payer expense?" I was really miffed when I heard this. Even though I have insurance, I have some abuse issues and I do draw the line at having more than who is absolutely needed at my birth.

    Because of this attitude, I have noticed that if a pt has other than state funded insurance, the staff doesn't ask if they can have a student (nursing or med) attend their birth. They just send them in. If a pt has private insurance, I've noticed that a nurse comes in and asks beforehand if a student can be present.

    I didn't mean to ruffle anyone's feathers here. I know that a pt's privacy should not matter regardless of pay status. As I said, I should have phrased my question differently.
  3. by   lisamc1RN
    Quote from MLOS
    When I was being admitted to the hospital to deliver my daughter, my husband & I were asked if we would accept students in the room. I was young at the time, and wasn't really thinking about the value of the experience, so I debated but finally said yes (right about the time a contraction hit me!). However, my complaint about this, especially knowing what I know now about clinicals, is that I never saw a student until I was literally within 2 minutes of delivering, then suddenly there was a whole herd of students in the room - at least 5. I didn't know these people - they weren't introduced to me. It felt very intrusive. I know my husband was uncomfortable with it. But there were other things to focus on, like the imminent arrival of our daughter.

    Now that I think about the complete picture I think this was very poor of the school and of the hospital.
    I had a similar experience during the birth of my first child. I was asked if students could attend and I agreed. During the most difficult part of the labor, students started pouring in. My husband was actually trapped in one place, it was so crowded. Not only that, but I could hear them talking. At the time, I didn't care because I was so focussed on the pain and getting my baby out, but afterwards, I wasn't too impressed. I wouldn't ever agree to it again. I hope that the hospital that I do my clinicals at won't do things that way. If they do, I hope that I will be a lot more respectful of the laboring mother and her family.
  4. by   palesarah
    Quote from BabyRN2Be
    Back in the days when all the hospitals around here had mostly semi-private rooms, they would deny private rooms to Medicaid pts even if they said they could pay. Some people in Registration were downright hostile towards Medicaid pts if they asked for a private and insisted that they could pay it. But that point is moot with all private hospital rooms for PP pts in this area.

    OK, I should have phrased my question differently. A pts wishes should not be excluded because of pay status. I guess we had a few doctors who were insistent that the Medicaid pts should not have a say in who could attend them during L&D. These doctors figured that since they "weren't spending a dime" for this delivery, that they shouldn't be able to say whether or not a med student (or student nurse, for that matter) should be excluded from their birth. I swear, the attitude was "why should they have privacy at tax payer expense?" I was really miffed when I heard this. Even though I have insurance, I have some abuse issues and I do draw the line at having more than who is absolutely needed at my birth.

    Because of this attitude, I have noticed that if a pt has other than state funded insurance, the staff doesn't ask if they can have a student (nursing or med) attend their birth. They just send them in. If a pt has private insurance, I've noticed that a nurse comes in and asks beforehand if a student can be present.

    I didn't mean to ruffle anyone's feathers here. I know that a pt's privacy should not matter regardless of pay status. As I said, I should have phrased my question differently.
    I'm absolutely appalled at that hospital's lack of respect for medicaid patients. Do you still attend births as a doula there? If you are, aren't you in a position to advocate for your client's wishes if they do not want students? Are you affiliated with the hospital (as an employee or volunteer)?

    I'm having a hard time expressing my thoughts tonight... but I find that doulas often find themselves treading a fine line between advocating for their clients and maintaining a welcoming/respectful environment for themselves and their clients. For doulas affiliated with hospitals or OB practices this can be especially hard. Make too many waves and you can find yourself in a hostile work environment, or possibly even fired. Even as nurses we can find ourselves playing politics- having to know just the right way to address this MD and that CNM to ensure that our patients recieve not only the level of care they are entitled to (that's a given), but the level of respect they deserve. It's easy for someone with a big ego or a manipulative personality to bend a patient to do things their way if we (nurses, doulas, patients) enable that kind of environment & behavior.

    Anyway... we ALWAYS ask patients if they mind having a student. Medicaid patients are not treated any differently than privately insured patients. We stress that the students are paired with a nurse and are not there as spectators but as a part of the birth "team". Most of our patients, especially multips, are comfortable sharing their labor & birthing experience with students when the students are respectful of the mother's birth environment. I've even had postpartum patients comment that they didn't think they'd want a student at their birth but found their student nurse so friendly and helpful that they were glad they had, that they enjoyed having them as a part of their birth experience,
  5. by   DawnEyes
    I would definitely say no to having students (or any non-essential personnel) in the room. Where I work (and as was mentioned above), the students don't enter the room until delivery is imminent. When I am at my worst --and possibly in the most pain -- this hoarde of people comes rushing in. Excess chatter, laughing in the background, a crowded room -- all of this would do nothing but annoy me and my husband to the extreme, as well as make the whole birthing process a complete 3-ring circus instead of the cherished event it's supposed to be.

    As for students or even 1st years doing my delivery? Not a chance, and I will request as much. Most of the time they're clueless about what needs to be done, such as protecting the perineum during delivery, not to mention having only book knowledge about what to do in case of shoulder distocia, etc.

    My husband is in the military and the chances of me delivering in a teaching hospital are pretty much 100%. But I do not feel in any way that this does not give me the right to refuse non-essential personnel or students access to my room or my care. Just as long as I am courteous and up front with the staff concerning my wishes, there should be no problem accomadating them. So far I've only seen a handful of women request the above, but it was very easy for us to make it happen and there were no further comments.
  6. by   ayndim
    I can't belive that a hospital would allow all of these students to come rushing in at the last minute. Birth isn't a spectator sport. As I said before I had a student nurse with one of my deliveries and she was great. She said with me the whole time and wasn't intrusive at all. Plus, like I said she was a doula before that and wanted to be a CNM. But I would not allow more than one student in and they would have to be there most of the time. And I wouldn't let anyone but a midwife help me deliver.
  7. by   CSLee3
    It is sad to think that so many people would not allow a student to participate...DID WE FORGET WHERE WE CAME FROM? No one is born with RN on their cheeks and the very nurse that is caring for you may have limited exerience because no one took the time or care with him or her to make that person a better nurse. As long as they are supervised I will always allow student nurse to participate in my care. As for being a male nurse, I was discriminated against in nursing school. I was only allowed to assist in one birth after I begged the instructors, and met with the family on my own! I was told to stand in the back of the room with the other men or go hang out in the nursery for a week.

    I cherished all nursing clinicals for what they are...a learning experience. Please remember that as nurses and healthcare workers we must keep that torch going, by passing on the knowledge and helping when and where we can.
    Peace in you hood.........Chuck
  8. by   Gompers
    I don't know what other nursing students got to do during their OB clinicals, but we didn't get to do all that much. We'd do the H&P for the mom, a careplan, make a med list, etc. - but we didn't get to do anything that might endanger the mom. The RN assigned to that patient did all the IV stuff and we were only allowed to give oral meds, but only in post partum. In L&D, our main thing was to support the mom and observe the birth, be it vaginal or C/S. The moms actually loved this because they got to have a support person there with them all day long, while the RN was busy doing her other work. The unit would ask the moms if it was okay to have a student, and told them that while one student might be with them for the labor, another might join in for the actual birth. (Instructor would just grab whoever she saw first if a baby was crowning, so we could see as many births as possible.) But that was the limit - 2 students, one of whom had been with the mom all day.

    As long as there aren't tons of students at the foot of the bed talking away, or students hanging mag or pit on me, I'd be okay with their participation.
  9. by   HazeK
    [QUOTE=BabyRN2Be] "I request that no students be involved in my care." ... have you had any problems with pts refusing to have students in with them and how is this handled?"

    I don't have much of a problem with this part of a birth plan. Here's why: I get myself alone in the room with the patient and her significant other. I go over the birth plan in detail with them, using a very supportive tone and attitude. When I find "bumps in my road" like "NO students", I respectfully ask them why they included this and what did they think a nursing student in L&D's involvement would have been... THEN, I tell them that all our nursing students are allowed to do is watch ME work, ask questions, and, IF ok'd by the patient, put in a foley catheter AFTER the epidural, palpate contractions, and hold their hand!!! Almost 100% of my patients have then OK'd for my nursing student to follow me around...and often, by the time of delivery, the patient is comfortable with the student assisting with pushing positioning and pericare...and grateful for another person who cares for them!

    OF course, I do NOT allow HERDS of students at the bedside of these "nervous Nellies"...THAT would be pushing it!

    I hope this helps.
  10. by   BabyRN2Be
    Quote from palesarah
    I'm absolutely appalled at that hospital's lack of respect for medicaid patients. Do you still attend births as a doula there? If you are, aren't you in a position to advocate for your client's wishes if they do not want students? Are you affiliated with the hospital (as an employee or volunteer)?
    Yes, I am in a position to say something, only IF I'm working on a private birth. Most of the time I come on, the mom has been in the hospital for a few hours already and they already have students assigned to them. I do trend a fine line in working as an advocate for the parents. We absolutely can not wear out our welcome as it affects the whole doula program. When I'm working at the hospital, I can't make waves. It's a different type of doula'ing. We are there to help pts who need extra help - those who might be taking too much of the nurse's time, etc. Since we haven't met these pts beforehand, I don't know what their wishes might be. If one has said that they don't like all the people who come into their rooms because of a history of rape or abuse, there's not much I can do about it other than tell the staff. After that, it's out of my hands.

    If it's a private doula patient, I can be more active as an advocate. When I'm working at for the hospital, I have less say.
  11. by   Jolie
    When I delivered my second baby, I was pleased to be asked by the nursing instructor if I would allow a student to care for me on post-partum. When half the shift had gone by without seeing a student, I assumed that they had enough other patients, and didn't need to assign a student to me.

    At 7pm, right at the beginning of visiting hours, the student barged into my room and insisted that my hubby, daughter and mom leave, as she NEEDED to assess me and do my teaching. She had no answer when I inquired as to where she had been for the last 4 hours. I told her I would allow 15 minutes, as our family time was at least as important as her assessment. She couldn't figure out how to apply the blood pressure cuff, didn't know how to find a fundus, inquired about my RhoGam (I am Rh positive), and scolded me for choosing to bottle feed (I was exclusively nursing my baby). I asked her to call her instructor into the room to assist her with her care. The instructor had the nerve to scold me for making the student nervous and failing to cooperate with their care. I don't know if it was the hormones or the lack of sleep, but I really gave it to the instructor. The student was a second semester junior caring for one stable PP patient, and still couldn't get anything right, and the idiot instructor was defending her!

    The staff nurse later thanked me for "letting it fly". Apparently they had been having trouble for quite some time with poor quality students and instructors, and management was not doing anything about it. I was asked to relate my experience to the head nurse the next morning. I doubt that it did any good, but it sure made me feel better!
  12. by   Zhlake
    On my birth preferences sheet I requested no students as well. It wasn't that I was afriad of them doing something to me--I wanted to be as comfortable as possible while in labor and felt that the presence of students might hinder me from fully relaxing.
  13. by   SmilingBluEyes
    Quote from Jolie
    When I delivered my second baby, I was pleased to be asked by the nursing instructor if I would allow a student to care for me on post-partum. When half the shift had gone by without seeing a student, I assumed that they had enough other patients, and didn't need to assign a student to me.

    At 7pm, right at the beginning of visiting hours, the student barged into my room and insisted that my hubby, daughter and mom leave, as she NEEDED to assess me and do my teaching. She had no answer when I inquired as to where she had been for the last 4 hours. I told her I would allow 15 minutes, as our family time was at least as important as her assessment. She couldn't figure out how to apply the blood pressure cuff, didn't know how to find a fundus, inquired about my RhoGam (I am Rh positive), and scolded me for choosing to bottle feed (I was exclusively nursing my baby). I asked her to call her instructor into the room to assist her with her care. The instructor had the nerve to scold me for making the student nervous and failing to cooperate with their care. I don't know if it was the hormones or the lack of sleep, but I really gave it to the instructor. The student was a second semester junior caring for one stable PP patient, and still couldn't get anything right, and the idiot instructor was defending her!

    The staff nurse later thanked me for "letting it fly". Apparently they had been having trouble for quite some time with poor quality students and instructors, and management was not doing anything about it. I was asked to relate my experience to the head nurse the next morning. I doubt that it did any good, but it sure made me feel better!
    THAT my friend is SCARY. Our rights to have or not to have "outsiders" in our delivery experiences MUST be preserved. And socioeconomic status should never come into play as to whose preferences are either ignored or respected. I would not work in a place where people's rights to self-determine their care were in jeopardy, soley due to their medicaid or self-pay status. People have the right NOT to experience things like this.

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