Axe maternity, add emergency

  1. I don't know what schools required when most of you got your degrees, but it seems like most BSN programs (I think 2 yr as well) require you to take certain core classes. They reflect the information needed to pass the NCLEX. Almost every program requires: foundations, med-surg/adult health, peds, mental health, health promotion and maternity/childbearing. My question is, why are we required to take maternity when it seems like a very specific specialty? Maybe I'm biased, but why is it even on the NCLEX? Do you think it's political? It really doesn't make any sense when you look at the other classes. You will always need a basic foundation, most of the patients are adults/med surg, no matter where you work you will have patients with dual mental health problems (depression, anxiety, bi-polar ect). Peds is a little more specialized, but kids still make up a great deal of the population of patients and can be seen in every area of care.
    Why maternity?
    All the basic information a non-maternity nurse has to know about emergency care for a pregant woman/newborn, contraceptives and vaginal infections/sti's can be easily included in other classes. For the most part, if a pregant woman comes into the hospital with a problem she will be put on the maternity/special care unit. Is it really necessary that every nurse knows that the left fingernail of the fetus developes after X amount of days or that the uterus should be 2 cm below the umbilicus 24 hrs after birth?
    Wouldn't it be better to replace maternity with emergency nursing? No matter what unit you work in, who you work for, where you go in your personal life or what population of people you work with you will need to know how to handle emergencies. I used to be an EMT and find it disturbing that some nurses don't even understand the concept of in-line stabilization after a fall/accident (#1 cause of death in younger population) because they're too busy trying to decide which side is the dirty side of the placenta or how much bleeding is normal after a c-section. What do you all think about this?
  2. Visit MikeyBSN profile page

    About MikeyBSN, BSN, RN

    Joined: Dec '04; Posts: 463; Likes: 517
    ER Nurse; from US
    Specialty: 7 year(s) of experience in ED

    13 Comments

  3. by   USA987
    While you have some valid points, as an L&D nurse I wish that I didn't have to run to the ICU to do postpartum checks. Emergency medicine is also very specialized...
  4. by   Dixielee
    I agree of course, that is why I work ER!:chuckle

    Seriously though, I started nursing school in 1971, an eternity ago. We did the usual OB semester but when I had my first child, I might as well have been a non nurse. In fact I did not tell anyone I was a nurse because I did not want them to think I knew what I was doing! I don't know why OB is so scary, but it certainly is to me. I have been an ICU/ER nurse forever and can do most anything, have seen most everything, but will have an OB patient in a wheelchair and zoom her up stairs in a flash if she comes in! Obviously we have to see some OB's in the ER for various problems, but every ER nurse I know just groans when we find out she is pregnant!

    Maybe the "fear" comes from not being able to see the little critter growing inside the mother. We can visualize all of our other patients, get cues from their color, respiratory effort, obvious signs of trauma, etc., but not the invisible baby. At best in most ER's you have a good fetal doppler, generally no other monitoring devices, which is OK because I don't know how to use them or interpret the findings. That is where the specialty comes in. I don't want to make a mistake, miss something and have her lose the baby.

    So forgive us, OB nurses if we call and ask dumb questions or ask you to come check our pregnant patients if they can not get up to your department for whatever reasons. We are happy to let you be the experts. As for me, I would rather all my patients be at least 5 years old!
  5. by   KrisRNwannabe
    You know that is actually a good question, why is OB the only speciality included?? and further more how did it get included?? I personally can't wait for OB, but I am sure some won't like it. interested in seeing the responses to this.
  6. by   camay1221_RN
    I understand your point, however, nursing is about the continuum of care from the beginning of life to the end. All aspects of maternal/child nursing fall into that 'beginning of life'.

    Trust me, I wasn't real keen on working with elderly pts when I was in nursing school, as I knew I wanted to do OB, but I did my time, and I am where I want to be, in L&D.
  7. by   twinmommy+2
    I think they use OB to make use of some widely used skills while in a speciallty setting. Like assessments, IV medications (we started them in OB), problems with bleeding like DIC and shock. Personally, I would also like to see the ER in a rotation but I also liked OB.
  8. by   Antikigirl
    I think the OB rotation was an example of the varing degrees of nursing to give you a look into how vast nursing can really be! I enjoyed my OB rotation...but was going ER (which was like pulling teeth to get into since they didn't have much in the way of clinical rotations in it!!! Finally had to give up after nursing school, a pitty...I want back into it!).

    Neat thing was that I was chosen for any/all emergency probelms during my rotation! Talk about learning about having to handle family dynamics! WHEW!~ No better way to learn about family dynamics than OB (and ER..but OB was so much more dynamic because all family members were usually cramped into the room vs only a few folks allowed into the ER at one time!). Good to learn the dynamics and how to overcome probelms..and boy..I take my hat off to OB nurses...I would go bonzo with all the freaked out folks! LOL!!!!!!

    IT was also awesome to really get the hands on knowledge of the differences between a ped, infant, adult, geri! They really are so different, especially with meds! I sware you have to be a math genius to deal with infant meds!!!!! LOL! Very good experience!

    If you are interested in ER...may I suggest what really thrilled me to no end!? Ride along with paramedics! Best exprience I have ever had and I do it yearly now! I LOVE IT!!!!!!! I learned more in 5 minutes than I did in 2 years of school! Awesome opportunity if you can get it...and usually they will only let a NURSING STUDENT do it (something about liablity and a nurse doing nursing stuff instead of being a silent watcher...).
  9. by   humglum
    Quote from KrisRNwannabe
    You know that is actually a good question, why is OB the only speciality included?? and further more how did it get included?? I personally can't wait for OB, but I am sure some won't like it. interested in seeing the responses to this.
    I don't know what your programs are like, but in mine, OB was far from the only specialty included. We had didactic lectures on OB, pediatrics, psych... the list goes on. We had clinicals in all these areas... AS WELL AS ER, OR, and some more esoteric specialty areas like home health, hospice, etc. When I was in school we were taught time and time again how to respond to emergencies, how to recognize emergencies in patients across the continuum of care.

    Whether it probable that you'll ever need to know how to palpate a fundus or not, its still a valuable portion of a well rounded nursing education, in my opinion. If you're a medic or a nurse in the ER, you need to know how to handle a patient crowning in your parking lot. I will personally never take care of an elderly trached and PEG'd patient, but it was an important part of my education.
  10. by   mariedoreen
    AWESOME QUESTION! Because really you're right. Obviously emergency care is a specialty but as the OP was pointing out, it can also be encountered on ANY unit. Any patient can go south in a heartbeat (or lack thereof) and wouldn't it make more sense to spend more time on emergent care than on an area that is almost always specific to its given unit? I agree it should be touched on but I would also agree that it appears to make more sense to develop an emergency care unit and scale down the OB unit. Opinions of nursing instructors?
  11. by   humglum
    I think nursing education is scattered enough these days without eliminating an entire unit of didactic and clinical study because it is too 'specialized'. In a good nursing program, you should be learning about emergency care, and if you're that interested, you could do your senior internship/preceptorship/capstone/whatever they call it at your school in an ED.
  12. by   RN4NICU
    Since I work in the NICU, 99.5% of nursing school was irrelevant to my current practice - babies are altogether different, even from kids. Premature babies are even altogether different from term babies. That is why all new grads need extensive orientations, because school teaches you the basics of a lot of things, but you learn what you really need to know once you begin working - just like any other major. I have never met a college grad that was truly prepared to function in their position without a pretty sizable learning curve. That is why internships (or externships) exist.
  13. by   SmilingBluEyes
    Quote from CharmCityRN
    I don't know what your programs are like, but in mine, OB was far from the only specialty included. We had didactic lectures on OB, pediatrics, psych... the list goes on. We had clinicals in all these areas... AS WELL AS ER, OR, and some more esoteric specialty areas like home health, hospice, etc. When I was in school we were taught time and time again how to respond to emergencies, how to recognize emergencies in patients across the continuum of care. If you want to be a paramedic, be one. If you want to be a nurse, expect to learn more than "in line stabilization" and trauma care. WE do a lot more than that.

    Whether it probable that you'll ever need to know how to palpate a fundus or not, its still a valuable portion of a well rounded nursing education, in my opinion. If you're a medic or a nurse in the ER, you need to know how to handle a patient crowning in your parking lot. I will personally never take care of an elderly trached and PEG'd patient, but it was an important part of my education.
    Exactly. I don't see the issue the OP has. Our program had us all over that hospital. Ob included. We were in ED, ICU/CCU, Med-surg, ortho and yes, peds and psych. We also had to do a day with hospice and home health RNs each. A well rounded program is what you need and I don't think "axing OB" is necessary.

    If you want to be a paramedic, please do so. I respect them so much. But if you want to be a NURSE, plan to learn more than trauma care. We a do a lot more than inline stabilization and trauma care in the nursing world. Expect to have to learn about the majority of things nurses DO when you are in nursing school. That many of us don't know trauma care does not mean we are not good nurses. Nursing is a big field, much more so than EMT/Paramedic.
    Last edit by SmilingBluEyes on Mar 31, '05
  14. by   NurseFirst
    adrenalin junkie, eh?

    i am an emt-b, former paramedic (when johnny & roy were on tv, the first time) and second year nursing student.

    nursing is related to hospitalization. to compare, for instance, medical assistants do not do bedside nursing. emergency care (i.e., inline stabilization) is done outside the hospital, in general. just because neck injuries are the number one cause of death in young people doesn't mean they are the number one cause of death in young people who are hospitalized, eh? maternity is something that happens inside the hospital. yes, emergencies occur on all units. that's why healthcare workers have to learn cpr at the healthprovider level; you make an interesting point, though: maybe inline stabilization should be covered in cpr classes--not just jaw-thrust (though it is certainly strongly suggested). however, the particular kinds of emergencies are, generally, unique to those units, eh? and, at least in my training, that's where they are covered in our theory classes. i will tell you this: there are certain kinds of emergencies i learned about in nursing i never learned in either my emt or my paramedic classes--in particular, i'm thinking of autonomic dysreflexia.

    i'm also thinking--since i am considering doing a preceptorship in a rural area--that in rural areas you don't have so much specialization. ob would be one of the situations that a nurse "generalist" can be expected to know how to handle.

    just my


    nursefirst

    Quote from mikeybsn
    i don't know what schools required when most of you got your degrees, but it seems like most bsn programs (i think 2 yr as well) require you to take certain core classes. they reflect the information needed to pass the nclex. almost every program requires: foundations, med-surg/adult health, peds, mental health, health promotion and maternity/childbearing. my question is, why are we required to take maternity when it seems like a very specific specialty? maybe i'm biased, but why is it even on the nclex? do you think it's political? it really doesn't make any sense when you look at the other classes. you will always need a basic foundation, most of the patients are adults/med surg, no matter where you work you will have patients with dual mental health problems (depression, anxiety, bi-polar ect). peds is a little more specialized, but kids still make up a great deal of the population of patients and can be seen in every area of care.
    why maternity?
    all the basic information a non-maternity nurse has to know about emergency care for a pregant woman/newborn, contraceptives and vaginal infections/sti's can be easily included in other classes. for the most part, if a pregant woman comes into the hospital with a problem she will be put on the maternity/special care unit. is it really necessary that every nurse knows that the left fingernail of the fetus developes after x amount of days or that the uterus should be 2 cm below the umbilicus 24 hrs after birth?
    wouldn't it be better to replace maternity with emergency nursing? no matter what unit you work in, who you work for, where you go in your personal life or what population of people you work with you will need to know how to handle emergencies. i used to be an emt and find it disturbing that some nurses don't even understand the concept of in-line stabilization after a fall/accident (#1 cause of death in younger population) because they're too busy trying to decide which side is the dirty side of the placenta or how much bleeding is normal after a c-section. what do you all think about this?
    Last edit by NurseFirst on Mar 31, '05

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