Rhee

I'm glad to hear that this isn't the typical baby friendly experience. I think breastfeeding is wonderful and there are so many benefits to skin to skin vs. the warmer and rooming in. It seems as though my hospital has taken baby friendly to the extreme, and has interpreted it incorrectly. I just don't think it's my job to make my patients feel guilty. There's enough in life to feel guilty about without creating more, and there's more to having a child than how you feed him or her. We've just started with this waiver, and I kind of wonder what the fallout will be.

The hospital that I work at is in the process of becoming baby friendly, and I have some questions about how the baby friendly initiative is implemented in other hospitals. I want to start by saying that I think that breastfeeding is a wonderful, healthy, mutually beneficial thing, but I wonder if the experience where I work is typical. If a patient says she intends to bottle feed, or a breastfeeding mother requests a bottle, we are supposed to try to persuade her to breastfeed. We've been given a script to follow that basically seems guilt inducing to me. We are supposed to use this script on everyone from a exclusively breastfeeding first time mother to a patient who has had her sixth baby and has supplemented every single child. I've had patient's tell me that they have asked for bottles and the previous nurse acted as though she didn't hear the question and some mothers actually crying and begging for bottles. I feel that my job is to help my patients do whatever it is that they want, not to guilt people into breastfeeding. I will go over the benefits of breastfeeding, how babies need to nurse frequently, how frequent nursing will encourage milk supply, I will tell my patients who want to supplement during the first 24 hours that it is not necessary, I will talk about baby's nutritional needs and stomach capacity . . . I will give my patients all the information I can, but I try to do it in an informative way. And this isn't good enough. If a patient is still requesting bottles, I don't feel that I should tell them no, but the next day our lactation consults are telling me (and other staff, too) that we should try harder and that we must be pushing formula. I will help my patients do whatever they want to do, but I refuse to tell them that formula is basically poison, which seems to be what the hospital wants. I work at night and the other issue is the night time nursery. We are being asked to make our patients sign a waiver before their babies will be allowed in the nursery. The waiver lists an entire page of reasons why baby should room in and at the bottom it says something like "I would like my baby to be separated from me despite all of the benefits of rooming in. I give permission for my baby to go the nursery despite the fact that we will not receive the mutal benefits of rooming in." This form should only be given to parents once they've asked for their child to go to the nursery. I feel awful taking this waiver in to a sleep deprived woman with hormones surging through her body who has finally decided that it's okay to let us watch her baby between breastfeedings. There has to be a better way. We have also been told that we will not be able to give out pacifiers even if parents ask for them in the near future. Pacifiers are only to be used for comfort during circumcisions and then thrown away. For many people, they already feel guilty asking for a bottle or for the baby to go to the nursery. I don't really know what to say to parents who are literally so exhausted that they can't keep their eyes open or patients who have had the baby to breast so much that their nipples are so tender that they are crying. Since we've started going through the baby friendly process, we've had more babies dropped during the night, babies in bed with mothers--I found one baby half hanging off the bed next to it's mother's knees, and one completely covered with the blankets over its face next to its snoring mother. These situations are not typical, but we have been noticing that they are happening more and more frequently. I don't think that formula and mandatory night nursery are the answer either, I feel that my patients are adults who should have the ability to make informed decisions. I would like to know what other nurses experiences with baby friendly are. I feel like the my hospital is taking it a bit far and that breastfeeding has become more important than anything else, it's almost become as if lactation services have more power (for lack of a better word) than anyone else, and the relationship between the LC's and the nurses has become so adversarial, to the point where they are telling our management that we are collecting the babies every night and taking them to the nursery to feed them bottles. Actually, it's easier for me if the baby is in the mother's room and she and dad are caring for the baby and feeding him or her and changing the diapers . . . the nursery isn't for my convenience, and most of my coworkers have this same opinion. Anyway, I'm sorry this is so long, and I thank anyone who reads all my rambling and gives me some opinions and advice. ~Rhee

I reread my post and now I think that I sound uncaring. I really do try to treat everyone with kindness and respect and I care about my patients while I am at the hospital. I introduce myself and make small talk and listen to my patient's concerns, but at the end of the day, when I go home, it's my family that I care about. At work, I am there to do a job, not make new friends . . . I feel like I do the best that I can, so it's kind of disappointing when we hear that patients don't feel cared for.

I have noticed on a lot of our lovely press gainey comments that our patients say that they don't feel that we nurses care about them. This got me to wondering what exactly patients expect from a nurse. I work in postpartum, and I try really hard to make sure that my patients have a good positive experience and receive the best care that I can give. In that sense, I care about them, but on a personal level, I don't really care about them in the way that I care about my friends and family. It just seems like it would suck a person dry to be emotionally invested in every single patient. There have been several patients that have kind of stuck with me who I think about now and then, but this is definitely the exception. I don't want anything bad to happen to anyone, but I feel that way about any person that I come in contact with, be it a work, or the guy who delivers the pizza, or the mailman or whoever. I just started to wonder if I'm weird or what.

I like to read birth plans. I think that they are interesting. I work in postpartum, so I get to see how things play out after the fact. Most of the things that people request are things that are normally done anyway, and I definitely think birthplans are a good tool to communicate expections between the patients and hospital staff. It only becomes crazy when people become unreasonable. Once someone put in her birthplan that no one was to say contraction or pain, we were supposed to say "energy surge" and "discomfort." That is taking things kind of far.

It was probably a really bad idea for me to join a pregnancy bulletin board. I don't know what I was thinking. All of the crazy misinformation that people give eachother over the internet wants to make me bang my head against the wall. Between people giving advice about high "berrirubin" levels and calling their doctors and nurses idiots because they haven't heard of some experimental drug only used in Europe that a google search has determined is the best, newest treatment for whatever condition ails you, and my pregnancy hormones, I really need to vent. I am all about people being informed and playing an active role in their own healthcare, knowing how to do a google search or knowing how to navigate to WebMD does not replace a college education. I don't claim to know everything, but like to think that I know a little bit more than someone who got their health knowledge from the University of the Internet. I am truly convinced that patients and families have absolutely no idea what we do. I read a post today where the person said that the 'nurse' (i.e. the person answering the phone) needs to slapped because she was rude. And nursing is a customer service profession. Uh, yeah. If I want customer service, I will go to a store or a restaurant. If I am sick or injured enough to need someone else to monitor my health needs, I will go to hospital. Where the nurses' role is to help me get better and help me understand how to maintain my own health. I try to make sure that all of my patients have a good experience, but I am not there to play waitress or servant. I am sure that the 'person answering the phone' isn't even a nurse. But, oh well. It's just really getting my goat. All statements like, "is it the nurse's fault my doctor missed the delivery? (if your doc was there and left the hospital when you were ready to push, I would think it's his fault. Especially if he's 'been a doctor forever'.) "the stupid U/S tech told me the baby was girl and it turned out to be a boy", "don't let anyone check if you are dilated if you are GBS positive", "don't take Zofran if you are pregnant". I don't understand why people don't ask if they don't understand something. It just seems logical to ask the doctor or the nurses while you are there in the office or hospital, instead of coming home and asking random people on the internet what they think. One lady was complaining that her cervix wasn't checked often enough and that the nurses didn't know what they were doing. Someone explained to her that since her membranes were ruptured for some time before she came to the hospital, checks are limited so that there is less opportunity to introduce bacteria, etc. Then she wanted to know why no one told her that. Why didn't you ask? I like to explain things to my patients, I think it makes it easier for everyone if patients understand why we do, or don't do, certain things. I know that I'm rambling, and I truly thank anyone who's read this far. I feel much better now that all of that is off my chest! Thank goodness this baby is due in a few days. I think I'll just avoid the other BB. It's probably best for everyone.

I am feeling whiny today, and I am blaming it on the pregnancy hormones . . . I just want to know why oh why anyone would think that it is appropriate to visit a postpartum unit with your three children who all have lice . . . and tell us after you have been there for several hours. Or why you would bring your whole family who all has scabies to visit anyone anywhere. And that's not to mention the more normal stuff. I chit chat with my patients, and now that i am obviously pregnant, the topic comes up, especially working with new moms and babies. It just seems like most moms like talking about babies and pregnancy. I don't go on and on about myself, but I answer the questions like when's my due date and how am I feeling and all that general stuff. One dad recently told me that he doesn't care that I'm pregnant, which is fine, but his wife was the one making small talk and asking me questions. And one other person told me that they were worried that I care more about my baby than I do about theirs . . . which seemed weird to me. Of course I don't want anything to happen to anyone's baby, and I take the best care I can of all my patients, but don't I don't love my patients like I do my own family. Thank you for listening to me whine! I feel much better now!

I was just wondering what other hospitals do about this. Where I work, when the OB is ready to do the circ, that's when it happens. This morning, an OB wanted to circ a baby at five minutes to seven, and all I wanted to do was finally, finally, finally crawl home and go to bed. However, I know that it needs to get done sometime, so off we went. The same OB wanted to circ another baby who was in the special care nursery, and he got upset that the nurse was not available since she was alone with three babies in the nursery and could not leave the room. He proceeded to tell me that change of shift is ridiculous, he needs to be at his office by eight, and there should always be someone available to assist him with circs. I understand that he has to get to his office, and I know that I get frustrated when I want to do things and the timing isn't right, but I don't think it's ridiculous that I want to go home after twelve and half hours of work instead of staying late. This sort of turned into a mini-rant, but my tired, pregnant brain needed to vent. Anyways, I would like to know if other places always have a dedicated circ nurse (our night nursery nurse usually does this, but we only had a handful of pts last night, and only one baby in the nursery, so the nursery nurse got cancelled), or if circs are done at a certain time, or if there are any other solutions out there. Thanks!

When I take a bf baby to the nursery, I tell the parents something like, "Your baby breastfed at ten pm, so he will probably be back to nurse sometime around one. I will bring him back earlier if he is hungry, if he's still sleeping, he may be back a little later." That we are all on the same page. If someone tells me that she doesn't want the baby to come back until four or five, I tell them that the baby needs to eat at least every 3-4 hours at night. If they don't want the baby to come back they can either send pumped milk to the nursery or we can give the baby formula. Sometimes people will agree to supplement, sometimes they won't. The problem lies with the people who refuse to feed the baby when he/she goes out to the room, or only make a token attempt and send the baby right back. I can tell them that their child is hungry, but if they won't feed him, even if I do report them, no one will come until the morning. What to do with the baby in the meantime? I would never supplement a baby whose mother is willing to breastfeed, but to perfectly honest, I have supplemented ones whose parents won't feed them. To do otherwise just seems cruel. I do tell the parents, though, and I only do this after talking with them first. If they still won't feed their hungry child, I can't just let that baby cry until morning. If that makes me a bad nurse, so be it.

As a postpartum nurse, I do not supplement breastfed babies with formula unless the parents request for the baby to be supplemented. I kind of take offense to the above statement. We don't go around just giving formula to breastfed babies. I have given formula after a baby had extremely low blood sugars, I hope that mother didn't want to "smack" me. On the other hand, what do you do in the nursery with a breastfed baby whose mother refuses to breastfeed him or her because she wants to sleep, and doesn't want the baby to get any bottles. As an advocate for the baby, who doesn't have a voice, should I just let that baby cry? That definitely is not baby friendly. This happens rather frequently. Or a baby will go out to nurse, and come back in ten or fifteen minutes screaming. Then parents get upset if the baby is brought back out. I suppose the alternative would be to say that breastfed babies must room in, but that would upset many parents too. Our hospital is going baby friendly right now. We are supposed to try to convince bottle feeding moms to breastfeed. I know that breast is best and there are so many advantages and benefits to breastfeeding, but these moms are adults who can make their own decisions. I will discuss the advantages of breastfeeding and help and encourage my patients so that they have all the info, but the choice is theirs to make. On the whole breast/bottle/paci issue, I feel that parents have to do what is right for them and what works for their family. There's enough in this world to feel guilty about without anyone creating guilt for a new mom deciding how to feed her own child.

In every job that I have ever held, even when I worked at fast food places in high school, it was always made clear that racist comments would not be tolerated. We are all adults and we are all responsible for what comes out of our mouths. Using racist terms is not 'putting your foot in your mouth.' That CNA was obviously trying to get a reaction from the OP. I don't understand why so many people are defending the CNA. It doesn't matter why the RN had to take a break, when she took her break, the fact is that CNA refused to do her job. A previous poster said that we take written orders from physicians all the time. I've never seen please in a chart, and I've never gotten upset. It's my job to see that orders are carried out correctly. It's the CNA's job to assist the nurse in caring for the patients. I was an NA on the floor where I work before I became an RN. I know what they have to do, because I did it myself. If I ask an NA to do something for a patient, it's because I don't have time to do it myself. It takes more time to hunt someone down than it does to just go and fill the water pitcher or to help a pt to the bathroom anyway. However, the NA's I work with are wonderful, if we can't find them, it's because they are busy, not hiding. The OP didn't do anything wrong. The CNA did.

I was a NA on the same floor where I'm now an RN. I work in postpartum. I can remember thinking --she only has 3 rooms, 6 patients, and I have eight rooms, 16 people. It will be so much easier when I am a nurse. I can say now that I didn't have any idea what I was thinking. I was in nursing school at the time, too. It's impossible to know what a job entails until you've done it. So many times, our NA's and patients see us charting, or looking up info on the computer, or calling the doctor, and maybe that looks like I am not 'working', but I am. Once I heard a patient's family member say "These people don't work, they are just writing things down." These sitting down tasks are important, too. I can see how it looks from the outside, though. It's all a matter of perspective. I work with great NA's. We work as a team. I worked hard when I was an NA, but that doesn't mean that I knew what the nurse's job was then. I was treated with respect, just as I treated everyone else around me. And if I was asked to do something, it wasn't because the nurse didn't want to do it. Now that I am the RN, I try to be considerate of the NA's too. I am not above taking ppl to the bathroom or getting ice water. Honestly, it seems silly to try to find another person to do something I can do when I am right there. I do have to admit that sometimes with difficult patients, whichever NA I am working with and I will coordinate so that we either alternate trips to the patient's room or go in together so neither of us gets overwhelmed. Everyone has an important role. However, a nurse and a nursing assistant are not equal roles, though the people filling those roles are equal as human beings. Everyone deserves to be treated with simple human dignity and respect.

I work in postpartum. We do fundal checks on our C-Section patients on admission, then every four hours for the next 24 hours, then q 8 hours after that. For lady partsl deliveries, fundal checks are upon admission and then q 8 hours. Of course, that's the minimum. We can always do more if there is cause for concern. ~Rhee

You already know that you have a potential problem, and that is half of the battle already. It seems like you are concerned that you don't want to upset anyone or treat them differently, so just be aware of your words, tone of voice, and body language. You don't have to love every patient, just treat every patient with respect. You never know about any mom, you know? The teen mom might be better equipped to deal with change that the 49 year old primip. It all depends on the person, her support system, her circumstances. That's individual to everyone, no matter what her age. I was a teen mom. And eleven years later, my son is happy and healthy, and his dad and I have been married for almost twelve years. We both have college educations and great careers. It's all about each mom making the best choice for herself.

A few weeks ago I had a patient who was having a hard time breastfeeding. She told me that she wasn't how committed she was to breastfeeding, and that she just wanted to try it while she was in the hospital and help was available. We had a long conversation about breastmilk vs. formula, and pros and cons of breastfeeding and bottlefeeding. I ran into this same family a little while ago, and this mom told me that she's still trying to nurse her baby, and she pumps so that her little one gets all the advantages of breastmilk even if she isn't nursing. And the reason she is doing this instead of giving the baby formula is because I encouraged her. I really am blown away on how big of an impact I had. It just kind of warmed my heart, and I wanted to share.

I work in postpartum. I deal with lots of baby poop, but hardly any mom poo. I find baby poo less offensive somehow. I just want to add that I find nursing a very humbling profession. People with holier than thou attitudes, or who think that they are too good to do certain aspects of their job will eventually realize that they are no better (or worse!) than anyone else. I work with very talented, smart, educated nurses, none of whom refuse to help patients clean themselves up. And I do have to say that every time I might be getting a little to big for my britches, something always happens to remind me that I'm only human too, and that I am not always right. For example, a few months ago I had a patient who was not in the usual socio-economic class that comes to our hospital. She and her family were a bit odiferous, talking about smoking and drinking, and the whole family appeared a bit dirty and unwashed. I was nice to this young woman, but inside I cringed every time I went in to her room. I'm not proud of this, but I was not as attentive as I may have been to another patient. I did not neglect her, I made sure her needs were met, but I did not go the extra mile as I may have for someone else. I had the same patient the next night. I wasn't looking forward to my assignment. But something happened when I went into her room. She started asking me questions, and we talked. Instead of seeing my perception, I saw a young woman concerned for her child, doing the best she could. And it's my job to do the best I can to educate her and give her tools and resources to help her raise her child. Not my job to judge. And I knew that my attitude was wrong. Here was a person looking to me for help. So I think of her whenever I start making assumptions, because I see that I was wrong. So if someone doesn't want to clean poo, that's fine. It's not fine to refuse to clean a patient, no matter how 'politely' it is stated, or expect someone else to do the parts of our job that we don't like. No one likes poop. It doesn't make someone superior nurse to refuse to clean patients. It's just the attitude that has to change. The sarcasm and flip attitude are disrespectful to patients and coworkers. I also wonder if this person is afraid of how she will and cleaning poop, and this is how she is coping.

I just have to say that anyone who tells a patient to wait to use the bathroom or to continue to sit in because of his or her own aversions to bodily fluids or anything else should not be a nurse. Perhaps the patients doesn't say anything to you because they are embarrassed or shocked at your attitude. Caring for the patient should be the first priority. We all have issues and aversions. We all do plenty of things everyday that laypeople would find disgusting, to be blunt. I find it terrible that you would tell someone who needs to use the restroom, or who needs to be cleaned up, to wait for someone else to come along and do it because you don't like poop.

I'm a relatively new postpartum nurse, and I've experienced this situation a few times over the past several months. A few weeks ago, I had a patient that really made me think. Ethically, if a mom says she wants to breastfeed exclusively, should I suggest bottle feeding if the nursing isn't going well? This situation was rather extreme. I don't want to undermine anyone's breastfeeding, but I also want to make sure that the baby is getting adequate nutrition. My pt, a first time mom, wanted to breastfeed her baby. (I personally don't care if a mom wants to breast or bottle, after all the baby is hers. I just care that the baby is being fed an appropriate amount of an appropriate substance.) I was trying helping her position the baby and get her latched on. Although she said that she wanted to breastfeed and stated that she wanted no bottles for any reason, when it actually came to feeding the baby, the problems began. She sat in the bed with her arms at her sides with the baby on the boppy in front of her. I positioned the baby in her arms, and when I told her to hold her breast and rub her nipple across the baby's lips, she sort of leaned forward and shrugged her shoulder. I tried and tried to work with this new mother, I talked with her about the baby's nutritional needs, but ultimately, I can't hold her baby and her breast, and breastfeed for her. I tried very hard to be patient and understanding, but I still found the situation frustrating. Every nursing session was like this. Each time, the mother would sit with her arms at her sides. I tried to find a nice way to tell her that she need to participate; the baby can't do this by herself. I hope that I succeeded in being nice, I had the baby's best interest at heart. It was especially important to me that this little girl eat because the mother was GDM. Over four days, lactation saw her twice, and once the baby's lost 10% of birthweight, the peds ordered the parents to supplement. I just wonder if I should have encouraged supplementing sooner. How do you handle this type of situation? If a mom wants to breastfeed, I want to do all I can to help be successful, but in situations like the one above, I also want to make sure the baby is getting enough calories. I also feel that it's part of my job teach parents the basics so they know how to take care of the baby once they get home (and when to ask for help.) Sorry this is so long, and thanks for any advice. Rhee

Hello, I'm in my last semester of nursing school, and I'm doing my last clinical in the cardiac progressive care unit with a preceptor. I'm wondering if there are any specific things that I should brush up on before going back. My first day there was kind of overwhelming and I don't want to be a useless lump on the floor. Any suggestions would really be helpful. Thanks! ~rhee

What about an infant stethoscope if she's planning on staying in L&D?

Does anyone know of an actual store to buy scrubs at anywhere around in Warren, Madison Heights, Sterling Heights, or Troy? I know there's a life uniform nearby, but they seem rather expensive to me. I've decided that I need to try things on before I buy them. I ordered scrubs from allheart.com and I look like a child dressed in my father's clothes. I really don't want to start my first job tripping over my pants that pool around my feet . . . Thanks! Rhee

I'm a student at Baker . . . each clinical starts with an orientation, it's usually a half of a day, about four hours, but it can be a full day depending on the clinical instructor. Fundamentals clinicals are one day a week, Med-Surg I clinicals are two days per week, OB and Peds are once per week apiece, Psych and Elderly are one day per week apiece, and the last semester you follow your preceptors schedule. Clinicals are eight hours long and are usually 7-3:30 or 3-11:30. There were a few people who got 11 am-7:30 pm clinicals in fundamentals. It's up to the instructor, though. I've had some clinicals that started at 6:30 in the morning, but we did get to leave early. Some instructors have a full day at the start of the rotation and a half of a day at the end.

Nursing school is tough because we will be responsible for people's lives. And you can't be a nurse if you don't pass the NCLEX anyway, so how would making school any easier help? It's hard, there's no way around it. I do think that it would be possible to pass the NCLEX by self-study, but I don't think that anyone who did that would have the depth of knowledge or "why" behind the anwers to the questions. My med-surg I class was basically self study. The instructor didn't lecture, we had no handouts, our classroom time was spent doing group projects (which isn't a necessarily a bad thing, but in this case it was the blind leading the blind). Most people didn't study to comprehend the material because it's kind of hard to teach med-surg to yourself, but just studied to know the answers to test questions. I think I could have gotten much more out of the class if I'd learned to understand concepts rather than just answer questions correctly. I think that's what nursing school is supposed to teach.

Okay, this is what my book says.... "Other enema solutions, such as milk and molasses, vegetable oils, hydrogen peroxide, and champagne are reported in literature. However, these types are rarely used." I've heard of milk and molasses, and I can understand vegetable oil and hydrogen peroxide, but a champagne enema just seems like a waste of champagne..... My instructor didn't know why anyone would use champagne for an enema, either.

My textbook mentioned champagne enemas, but it didn't anything else about them. This seems really weird to me, I can't figure out why anyone would use champagne for an enema. It must be something to do with the bubbles.... Does anyone know? I'm curious.