L&D nurses that think its just a job....

hope3456, ASN, RN · Jan 10, 2008

I think this is an issue on many units.....not just L&D. I want to continue my education and read the nursing journals, ect but it is just hard to find the time, juggling family responsibilities, ect.

Jolie, BSN · Jan 10, 2008

I understand your frustration, and agree that OB and newborn care are areas that tend to be "ruled" at times by tradition rather than evidence-based practice. I think that this stems from the fact that most moms and babies are healthy and will do well despite our interventions, whereas sick patients on med/surg and in ICU won't improve without care based on sound principles of pathosphysiology, pharmacology, and medical and nursing care.

But, alas, it doesn't have to be this way. You have posted a couple of times venting frustration at the care provided on your unit. In my experience, the care provided in different OB settings varies widely. I started my career in a tertiary care (university-based) hospital where research was conducted and put into practice. It was a stimulating environment where academic curiousity was encouraged and evidence-based care was the expectation.

I later worked in a small community hospital that was like going back 50 years in time. Practices were based on tradition, not scientific evidence or even patient preference. I didn't last long there.

I eventually moved on to a birth center, which was a very rewarding place to work, with nurses, CNMs, and physicians committed to providing family-centered care that was safe and effective.

I guess this is my long-winded way of encouraging you to look into other facilities and options in your area. Finding a unit where patient preference and scientific-based care "rule" may not be easy, but it is not impossible, either.

MalgaBSN · Jan 10, 2008

Jolie~ Yes, thats what its probably going to come to. In school and clinical it was just expected that EBP was always your ultimate goal. Where I work now, it seems to be frowned upon. And I am in a rural hospital (I actually worked in a birth center while I was going to school and worked in homebirth before that-- so I knew it would be bad, but it gets so ridiculous).

I just feel like its so sad to just move. Many moms come through this hospital from my community (they do 1500 births a year) and the misinformation is so deep that moms don't even know how things could be more beneficial for them. Its also my first job out of school so I don't feel like I can just pick up and move yet. I'm hoping to somehow make a difference. I'm trying to work on an EBP group, so we will see how it goes.

Its just interesting to me that most of the nurses I work with spend a great deal of their time at work, but they still don't ever pick up a book about birth?!

JaneyW · Jan 11, 2008

Stay and make changes if you can. I just left a big teaching hospital that was a transport center and not very up on EBP either. I am working registry and am just really shocked at how very different practice is at different hospitals within 10 miles of each other. The really frustrating part is how they all act like I'm crazy for thinking practice could be different or better. Keep being the squeaky wheel where you are. Be a leader and agent for change. It sounds like you are happy with your community. If you are able to make changes, it will only benefit those in your community!!

txpixiedust · Jan 11, 2008

I think it's unfair to say that L&D Nurses "think it's just a job." Like Hope3456 said, it's hard for people (of any career set) to juggle their personal lives with their work life. And really, to be a well-rounded individual we should spend our "free" time doing other things that we enjoy as well.

Another thing to consider, is that many of the people you work with may be in a "slump" of sorts. Maybe they have spent much of their "free" time in the past by reading MCCN magazines, etc. and what they really need now is family time. I think as long as they are practicing good Nursing care, and actually working while they are at work, there isn't a problem. Now, if they're lazy and never assist patients, take time to verify orders, etc. then there is a BIG problem!

Life is all about priorities - and right now it seems that one of your highest priorities is work - which while admirable, should not become a standard for your co-workers. I'm fairly new to Nursing, and I enjoy reading Nursing material....but I have two priorities in my life that trump Nursing - one is God & the other is my son!

Anyhow, I totally get where you're coming from & I'm not trying to knock you. I hope that you can see your co-workers a little differently or find a place to work where you have more like-minded Nurses.

God Bless!

txpixiedust

Elvish, BSN, DNP, RN, NP · Jan 11, 2008

I understand what Malga is saying. I work with some nurses who are the same way....though they are very thankfully in the minority. Most are great, but some have lost sight of the fact that these are people's lives we're dealing with, and we're dealing with them at one of the most momentous occasions in their lives. To them, it's more like, "I come, put in my 8-12 hours, and go home and don't care." They are the ones who consistently receive more patient and staff complaints. They resist change even when there's overwhelming evidence to support the change saying, "That's the way we've always done things." We all have bad nights, but it's pretty easy to pick the ones who are there for the paycheck and not much else.

That said, I really try when I'm around one of those folks to remember what I like about my job, and remind myself that when the shift is over, I don't have to go home with anyone but myself. :)

CEG · Jan 11, 2008

I feel frustrated by the fact that most of the nurses I work with don't take their jobs very seriously. Most don't seem to think about anything past their 8 hours (like what happens to this patient when she gets home with this baby-- are they setting up follow-up when needed). I just graduated with a BSN from a very good school and I definitely consider this my career not just a job (even though for me its a step on my path to CNM). Evidence-based practice was really pushed in my school and I try to stay on top of the latest evidence and I am a member of AWHONN, I read the latest lay books coming out about birth (like Pushed; Birth-The Surprising History of how we are Born; Ina May's Guide to Childbirth etc.), I try to stay on top of anything related to my field. I swear I am the ONLY person on my unit like that which blows my mind. I am frustrated that we work in healthcare, but many of the nurses I work with don't seem to think they need to continue learning!
Almost all of the practices in my hospital are outdated. All someone would have to do is open one evidence-based practice perinatal book and see that! So I just don't get it!
Anyone else notice how OB is the least evidenced-based!?

I agree with you 100%. Nurses want to be viewed as professionals who educated with careers and have made great strides, but so many don't want to take the extra step of being knowledgeable about their career field.

I have totally seen nurses who don't consider the impact of their practice. I overhead a nurse in a c/s recovery telling a mom "just give the baby a bottle until you feel better. It won't affect your ability to breastfeed, I have never seen it affect anyone." Well Duh of course she hadn't since the mom and baby go to postpartum two hours after birth and she probably never even sees another feeding.

I have two children, go to school full time, work full time, and yet I still have time to read a journal here and there. What we do has such an effect on people- and once one person has an experience they share that with others and the effect just keeps on going. If I can clear up a misconception for one woman I may affect every woman she knows.

Imagine what a difference it would make on the floor if 90% of the nurses were up on the latest evidence-based practices. If nearly every nurse was pushing for change and had science to back it up, I could see not only a change in how we practice, but also an increase in the credibility of nurses and more power for the nurses in the hospital environment.

bagladyrn, RN · Jan 11, 2008

I feel frustrated by the fact that most of the nurses I work with don't take their jobs very seriously. Most don't seem to think about anything past their 8 hours (like what happens to this patient when she gets home with this baby-- are they setting up follow-up when needed). I just graduated with a BSN from a very good school and I definitely consider this my career not just a job (even though for me its a step on my path to CNM). Evidence-based practice was really pushed in my school and I try to stay on top of the latest evidence and I am a member of AWHONN, I read the latest lay books coming out about birth (like Pushed; Birth-The Surprising History of how we are Born; Ina May's Guide to Childbirth etc.), I try to stay on top of anything related to my field. I swear I am the ONLY person on my unit like that which blows my mind. I am frustrated that we work in healthcare, but many of the nurses I work with don't seem to think they need to continue learning!
Almost all of the practices in my hospital are outdated. All someone would have to do is open one evidence-based practice perinatal book and see that! So I just don't get it!
Anyone else notice how OB is the least evidenced-based!?

Malga - You sound as though you have some great ideas and dedication for your new career. I'd like to throw in a word of caution though. As you are a new grad and obviously the "new kid" on this unit, be careful not to come across as feeling yourself to be "superior" to your coworkers. Referencing your "BSN from a very good school" and stating that you are "the only person on my unit" who tries to stay on top of things will only alienate your coworkers (who may have learned some very valuable skills from their experience) and prevent them from being receptive to the very good ideas you may have. Keep in mind that you really don't know what reading and research they do or have done and that you don't yet have the depth of experience to judge their skills and or caring. Don't disdain their years of experience. Try asking them for advice or opinions on areas in which you see they excel (not in a way which looks as though you are trying to show them up). Take your time and you may be able to institute changes that you see are needed with the cooperation of your coworkers.

My perspective in telling you this is both as one of the "old OB nurses" and as a travel nurse who is always the "new kid" who has learned to tread lightly.

babyktchr, BSN, RN · Jan 11, 2008

I have many thoughts on this post, but will limit it to agreeing totally with the above poster. I know I was a bit flustered with your "BSN from a very good school" statement, I can only imagine what that comes across to your co-workers as. You seem to have the "take on the world" attitude as you start your nursing career ( I am only assuming you have just started) and that is wonderful. There are ways to empower and motivate change. EBP is a great thing, and I am a proponent of it. It takes time to change what has been, and resistance will be part of change. If you do it right, it can be done and done well. Don't forget though, that there is experience out there that NO BOOK can offer you.

Learn much...learn often. It can never hurt you to do that. It is what you do with your knowledge that is key.

MalgaBSN · Jan 11, 2008

babyktchr & bagladyrn~ I'm sorry, but you read that statement completely different from the point I was trying to get a across. I wasn't bragging by any means. What I was trying to say is that I didn't just work my a$$ off day and night for 4.5 years to just accept the old school way things are done and stop learning. I am fresh out of nursing school, but not new to birth work or healthcare. And I work with other newbies that don't question their own practice or things they have learned at all. I don't come across this strong on my unit-- this is a website that I often use for venting. I get along very well with my nursing colleagues.

there is experience out there that NO BOOK can offer you.

I agree with that statement to a certain extent; but many things in OB are done a certain way because thats how they have always been done. Here is a EBP example:

"Although it is generally thought that practioners with more experience have accumulated more knowledge and clinical skills and, therefore, provide hight quality care, researchers recently found the opposite to be true. Physicians with more experience have less factual knowledge, are less likely to practice based on current science and standards from their professional associations, and are more likely to have a poor patient outcome when compared to physicians with fewer years of experience. Although this study was about physicians, likely the same implications apply to nursing." (Creehan & Simpson Perinatal Nursing 2008).

JaneyW · Jan 11, 2008

I say go Malga! I have been a nurse for 5 1/2 years out of a not so prestigious ADN program, but I joined AWHONN and have expanded my knowledge base with classes and journal reading. I am also currently getting my MSN to teach future OB nurses. I can't tell you how many times I have been in struggles with other nurses over EBP v. How it has always been done. Baby's cold? Put it skin to skin with mom, not in the warmer (research-based practice plus an AWHONN standard of care!). Baby to nursery within 1 hour of birth for meds and bath?? Baby needs to stay with mom to breast and bond--meds can be given skin to skin. Bath can wait a bit. Keeping baby and mom together after birth is even EBP for pediatricians, yet it is not the practice of teaching hospitals in a lot of areas.

I am 40 and have three kids and a house and everything else vying for my time. It is no excuse. In CA, we have to have 30 hours of continuing education every two years. I try to take that time to learn new things in my area. My AWHONN membership sends the journals right to my home. I can read them when I am waiting for my kids at various functions. I agree with a previous poster. If we want to be treated as professionals with a true knowledge base and be compensated for such---we need to keep up.