Changes-for better or worse?

Specialties Ob/Gyn

Published

Hello everyone-I am new to your forum and have found some very interesting reading here. I have been a nurse for 30 yrs. next yr. (OMG!) and with the exception of 2 1/2 yrs. spent in a NICU, my work has been with L & D, postpartum and nursery. As you can well imagine, I have seen a lot of changes come down the pike and am wondering if there are those of you out there having experienced the same are feeling as frustrated as I am regarding some of these changes? What am I speaking of in particular? Let me tell you...

Breast feeding-does anyone else feel that we have totally "clinicalized" (not really a word, I know) it? With "nipple confusion" and SNS supplementation and checking baby's sodium levels, etc. it really seems a miracle the human race is still around-we didn't worry about these things yrs. ago and I can't believe we sent all our nursing babies home on the verge of dehydration or unable to suck on anything but the real thing!

The routine use of internal leads, the impatience of doctors managing the process on THEIR time schedules, insurance companies dictating how we practice (specifically-doing away with VBACs), injecting infants less than an hour of age with vaccines and on and on.... These things bother me immensely and I am constantly met with the opinion that "there's really nothing we can do about it" so just shut up and do what you're told. The hospital I presently work at bases how well we are doing on how high our Press-Ganey scores are-which can go from 80 to 90% one quarter to 30 to 40% the next and so the nurses are alternatively congratulated or told we must try harder when we know that our care doesn't deviate as much as the scores might suggest. We follow ridiculous rules and regulations handed down to us from JACHO that have nothing at all to do with our maternity patients-requiring more and more documentation which takes us increasingly away from the bedside.

Maybe I am just needing a place to vent my frustrations, but are there others of you out there that feel the same? And just what can a person to do to get back to doing what we went into this career for in the first place-helping to make the birthing experience a positive experience? Any ideas?

Connie

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Yes, things are worse overall. My two L&D friends have done it for many years. They tell me that they do see worse changes in OB but that if they were doing adult care (M/S, ICU, etc.) that they would not be able to keep working because it is much worse than OB.

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We're about the same age - and I could not agree more.

I think the underlying question is: "What is a nurse?" At the end of the day, the basics are: "The nurse is the patient's advocate."

HOWEVER -:uhoh3:My dilemma: When the needs and advocacy for my patient is in (increasingly) direct conflict with the source of my paycheck - what am I supposed to do?

What are we all supposed to do?

I think that is the core issue affecting ALL nurses right now.

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I am a very new nurse and I am within a few inches of hating my job because of everything you just mentioned. Explaining to a patient why I need to check her cervix again or start pitocin or the baby has to sit in the warmer or whatever makes me hate myself. I am in school to be a CNM and I will be waving a goodbye to L & D nursing ASAP.

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Specializes in Telemetry, M/B.

I'm an old timer too (40 years) and dittos to all of what you said. I have wondered myself how the human race has managed to survive. My 35+ children were breast fed (and bottle fed) we didn't have all the fancy pumps ect back then. At the age of 2 weeks they were started on cereal and fruit. That's how it was done then and they turned out just fine. They are smart too!! IMO it's all about the bottom line. Pumps, SNS, special bottles, lactation specialists ect.. I could go on and on. It is very frustrating for the new mom's too and lot of them give up on breastfeeding because it's become so complicated (and clinicalized) then the guilt sets in because they're programmed to believe breastfeeding is the only way to insure a normal healthy child that will be intellegent. Looking forward to retiring in a couple of years.

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I, too, wish I could retire-or at least do something else-archaeology in Egypt or something!

This is one of the things that gets me also... Medicine has become so specialized, but now it seems, at least in the clinical setting, they are lumping us all together-answer stroke questions on my pts., geesh, what a bunch of busy work! Wonder what it is gonna be like in 10 yrs.? Joint commission, it seems to me, was out of rules that made sense yrs. ago and now the stuff they come up with is just insane! They want us to label the lidocaine cup on our delivery tables! It's the only dang medicine on the table and we are suppose to label it.....Well, I guess there is the pan of H2O, but come on! At our hospital if joint mandates it, then we do it twice what they recommend. If everyone else's normal is say 40, ours is 35. Drives me nuts, but then I guess I've been that way for yrs.!

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Specializes in L&D.

I've seen a lot of good changes over the last 40 years. When I started L&D all labor patients got a soap suds enema and a full shave. Everyone got an episiotomy, and most had forceps. Everyone delivered in the delivery room, legs in stirrups and leather restraints on their wrists. Breast fed babies were only allowed to nurse for 3 min per side the first time, 4 min the second time and so on. Bottle fed babies were NPO for the first 8 hours. We didn't have fetal monitors, but labor patients were pretty much confined to bed anyway. Pit was used frequently even then--start at 5 gtt/min and increase by 5 gtt/min q15min. We didn't have IV pumps or flow controllers.

I get frustrated at all the busy work we have to do, but it's always been there. It's not a new phenonomon. I have not found patient advocacy to be in conflict with the source of my paycheck.

There are ways around having to do things you feel are unnecessary. Tell your patient that you are supposed to check her at certain intervals (if that's what CEG meant in her post), but that she has the right to refuse an exam if she doesn't want one. She can refuse Pit. She can refuse to let you put the baby in the warmer. If she doesn't know that she has the right to refuse things, tell her so. You can even guide her in her refusal. When we used to give all PP patients po Methergine routinely, I'd tell her it was time for the pink pill that gives her the really bad cramps, she didn't want to take it again, did she?

It saddens me to read of so many people feeling so frustrated and powerless in their life's work. I hope it's just a need to vent and not a true representation of how nurses are feeling about thier jobs.

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Specializes in Community, OB, Nursery.

I completely agree about the breastfeeding bit.

We (meaning the fields of medicine & nursing, plus all the books written) have made it sound so difficult that lots of women come to the hospital terrified of breastfeeding and unable to do it unless the lactation consultant is there for every feed! That is not right! I'm grateful for the LCs we have, don't get me wrong, but breastfeeding is how babies have eaten for millenia, and now all of a sudden it's gotten so hard???

That's my little soapbox. Guess we all have one.:)

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Nora-I didn't mean to sound as if all the changes in OB have been for the better-we have come a long way in quite a few areas. I too remember the soap suds enemas and shave and strapping women down to the delivery table. I remember when we cleaned our own delivery rooms and had only one FHM on the unit (we are still using it, I believe!). I think with more women becoming obstetricians, the field has become more sympathetic toward our pts. It's mostly the paperwork and now it's the computer charting-don't get me wrong-I love the TraceVue program for labor, but I think Meditech sucks and that's what we use otherwise. And I am all for being my pt's advocate, but I have been called on the carpet for it a few times. There are a lot of other, what I feel are unnecessary procedures done to my pts that I would like to see them object to, but most of them do whatever the doc wants and don't blink an eye. We have one doc that routinely puts internals in each and every pt.-doesn't consider asking the pts permission or if I would like it done. Time for me to make a change I think.

Connie

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Specializes in OB, CASE MANAGEMENT.

19 years later all of you are right somethings have changed for the better but some have been for the worse, what happened to letting laboring women labor , why do they have to be augmented. and when did the standard 40 weeks get dropped to 36-37 weeks being term. these patient apparently do not care enough about their own bodies to attend childbirth classes to be educated to know what is going on and the difference between a good doctor and a doctor that wants to go home at 5pm

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RNHeart,

Sadly I would guestimate around 80% or the patients I encounter could care less what is happening to their bodies during the pregnancy, much less take the time to participate in any kind of classes to prepare them for delivery! So the sooner they are UNpregnant the better because they always "know so and so who had their baby early and did ok" and so they jump at the chance to be induced if that is what the doc suggests! I will never be able to understand their way of thinking-maybe becos it is not thinking at all!

Connie

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Specializes in OB, CASE MANAGEMENT.

I agree totally Maybe is just part of the breakdown of our society that people just dont care about anything anymore . :banghead: this is definitely me

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