Wishes Regarding Students in Birth Plans

  1. 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 (nursing and residents) in the room during L&D. Usually it states, "I request that no students be involved in my care." I've found that in my private doula practice I haven't run into anyone having problems regarding this preference. In the hospital, since most of the pts are Medicaid, usually they don't get a choice.

    I'm just wondering, if you are in a teaching hospital, have you had any problems with pts refusing to have students in with them and how is this handled? I know that if I had private insurance, I probably would not want to have students. Yes, I know they need to learn somehow but with this issue I need to draw a line. Now, if I was a Medicaid pt, I don't think I'd have a choice and wouldn't question the issue.

    How is this handled?
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  2. 42 Comments

  3. by   CoffeeRTC
    Quote from BabyRN2Be
    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 (nursing and residents) in the room during L&D. Usually it states, "I request that no students be involved in my care." I've found that in my private doula practice I haven't run into anyone having problems regarding this preference. In the hospital, since most of the pts are Medicaid, usually they don't get a choice.

    I'm just wondering, if you are in a teaching hospital, have you had any problems with pts refusing to have students in with them and how is this handled? I know that if I had private insurance, I probably would not want to have students. Yes, I know they need to learn somehow but with this issue I need to draw a line. Now, if I was a Medicaid pt, I don't think I'd have a choice and wouldn't question the issue.

    How is this handled?
    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?
  4. by   ayndim
    Quote from BabyRN2Be
    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 (nursing and residents) in the room during L&D. Usually it states, "I request that no students be involved in my care." I've found that in my private doula practice I haven't run into anyone having problems regarding this preference. In the hospital, since most of the pts are Medicaid, usually they don't get a choice.

    I'm just wondering, if you are in a teaching hospital, have you had any problems with pts refusing to have students in with them and how is this handled? I know that if I had private insurance, I probably would not want to have students. Yes, I know they need to learn somehow but with this issue I need to draw a line. Now, if I was a Medicaid pt, I don't think I'd have a choice and wouldn't question the issue.

    How is this handled?
    I don't think a hospital can discrimnate that way. You don't lose your rights because you have medicaid. A woman can still refuse anyone they want. Of course, if they have no dr they may get a resident. The hospital isn't footing the bill in exchange for allowing students.

    I personally don't mind students as long as they are female. I had a student nurse with #2. She was great. She was also a doula before she was a student nurse. :wink2:
  5. by   Energizer Bunny
    I wouldn't mind students no matter what sex. And I don't even think I would mind if there were a few of them as long as they weren't crowding out mine or my husband's view of what was going on.

    I also don't think that a hospital can discriminate that way. EVERY patient has rights.
  6. by   NewEnglandRN
    With my first child, I would not have been comfortable with students observing the birth. However, after having three babies, I would welcome the opportunity for a student to share in such an incredible experience!

    It's a very individual decision.

    Michelle
  7. by   SmilingBluEyes
    EVERYONE, including medicaid and self-pay patients, is ENTITLED to refuse student participation in her birth experience. ALL NON-essential people can be refused by anyone at any time of a patient's choosing. I always ask permission for allowing students in any birth situation. In the event a family refuses, then no students are allowed in, no questions asked.

    That said, for my planned csection of my dd, (she was breech), I had a student doing her OB case study report on me from my alma mater and a room full of students of all sorts, medical, nursing and laboratory. NO problem letting them in; we all need that chance as students to have that experience. My case was an "open book" as it were, to anyone willing to come in. One DID faint, unfortunately----- and all laughed when the doctor opened me up and my daughter's butt popped out first; I said, yep that is my girl, ALLLLL attitude. And so it is how she is!!!
    Last edit by SmilingBluEyes on Jul 1, '04
  8. by   hmccartn
    i think its important to point out though, that most students arent left alone to manage a patient. not when i was a labour and delivery student last year anyways... we were teamed with a buddy nurse and they would double check our findings when reading the tracings or what not... during our whole summer rotation there was only one patient who didnt want students.. but she was also giving the doc intructions about where she wanted her c section incision so she could still wear a bikini, so i dont think she is representative of the whole..hahaha...
  9. by   camay1221_RN
    I used to work PP at a teaching hospital, that also happened to be the one I had my children.
    With my 1st child, I was just out of school, so I didn't know who was who in my room. However, I did have a wonderful med student, Mike, who helped me with counting and holding one of my legs, while pushing. Husband on the other leg. I even threw up on the guy and he took it all in stride! He was great.

    My 2nd, I was working there, and during my pregancy, I took care of a pt who requested no one in her room before 7am. She was two days PP, so she had already had her PP labs done the morning before, so her request was appropriate. With that, I hung a sign on her door with her request. This particular time, I was doubling back, and worked the day shift, so I had her the next morning. During report, one of the male med students came in and asked who was taking care of the pt in E338. I told him I was. He asked, "What does this mean?" as he held up the sign that was posted on her door. I told him, "Well, I think it means what it says, no one in the room before 7am," Now mind you, it was already 6:45, so you think this doofus could have gone and done some charting or seen anther pt in that time. But no, against my instructions and the pts wishes, he went in anyway! As a result of this, when I delivered my 2nd child, I told the students they were more than welcome to be in the delivery room with me, however, if at any time they did not respect my wishes, they were gone! Also, because I worked there, I requested no 1st year residents, because we had a real winner of a group that time, and I didn't want any of them near me! I delivered my 2nd fast, my OB hardly made it in time, so seeking out the student was not a conideration.
    With my 3rd, I also told the med students my requests, and one of them, female, said to me, "Well, there are somethings we have to do because we have to report to the residents." I told her she didn't need to bother doing the H&P because my priority was my delivery and my baby, not what she had to do for the residents!

    Sorry, that was long! You have the right to say no! Don't hesitate to do it!
  10. by   julieK
    My feeling is that if you go to a teaching hospital as a patient, you are receiving the benefit of going to a superior institution, and part of that includes the acceptance of students' participating in your care.

    -Julie
  11. by   SmilingBluEyes
    Quote from julieK
    My feeling is that if you go to a teaching hospital as a patient, you are receiving the benefit of going to a superior institution, and part of that includes the acceptance of students' participating in your care.

    -Julie
    Ah but teaching hospitals are not always superior, in my experience, and I maintain my right to refuse the participation of anyone not directly involved in my care. As an aside, I have been a patient at a teaching hospital and had less than a stellar experience with it. JMO....as a nurse who works in a community hospital, anyhow.
  12. by   fergus51
    We always ask patients if students can be involved in their care and I have never seen a case where a request was not honored. That said, residents are not considered students and they are the first line (residents, then fellows, then staff docs). A parent or patient can't insist on only dealing with "the real doctor" (staff).
  13. by   julieK
    Quote from SmilingBluEyes
    Ah but teaching hospitals are not always superior, in my experience, and I maintain my right to refuse the participation of anyone not directly involved in my care. As an aside, I have been a patient at a teaching hospital and had less than a stellar experience with it. JMO....as a nurse who works in a community hospital, anyhow.

    I am talking about in general. Of course any patient can refuse anything in the hospital. Heck, you can refuse to be treated and they can't kick you out. Who's to say that the student wouldn't be directly involved in your care? I just feel that a teaching hospital is just that and the patient should recognize that it isn't fair to interfere with that process.
  14. by   Altra
    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.

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