Setting a bad example?

mcl4 · Jan 3, 2002

You are the one who brought up the notion that teaching in the middle of the night was somehow odd and that instead we should be promoting sleep. Maybe on surgical units that may be true, however, even having NOT floated to another unit I am quite aware that things may be different. I am shocked that you even floated to post-partum, because it is more than bringing in babies and checking bands. I have gotten most of my teaching done during breastfeeding interactions - and it's more than how to latch on - but about adequate nutrition for the mom which translates into adequate nutrition for the infant. Moms have to increase their caloric intake by 500kcals/day while breastfeeding, also need to increase fluid intake. Also smoking is extremely discouraged while breastfeeding. Post-partum moms need to exercise if they want to retain their shape prior to delivery, but need to know when they've had enough in relation to increase bleeding. There are a whole host of things that need to be taught to moms in the short 24 hour period. I would be doing them a disservice if I didn't teach them. And videos don't always cut it.

No, I don't go in a 2am and click on the lights and begin lecturing. When I bring babies in for beastfeeding, or when it's time for their assessments, or for god's sake, some mom's deliver at 11pm and are still in recovery at 2am. Teaching is done THEN. So no, sleep is not primary right after birth and during breastfeeding (sorry, that's life) - if anything, sleep can be done during the day depending on what time the patient delivered.

This is the impression you've given me is that you go in, light up the room and lecture moms for a significant period of time at 2 a.m. I float to the nursery and each of the mothers on the floor also have another nurses assigned to them that does their assessment. I've been in the rooms at the times of assessments and while they will answer questions and help the moms, they do not go into lengthy conversations about their diet and exercise since it done during waking hours unless asked. If you know anything about sleep, our bodies are programmed to sleep during the night. Teaching can be done during the day since patients are more awake and there is more staff to do so. In addition, my impression is most moms, like myself, are very tired during transition and after delivery. I'm not seeing this as an opportune time for teaching other then pertinent information needed at that time. Perhaps for some moms, but I'm guessing many are exhausted especially if they had a lengthy labor. I also believe moms know smoking isn't good for themselves as well as the dangers of smoking around babies and nutrition is important PP.

You also must remember that moms are able to call their physicians office or the floor when they get home if any problem arises that they have questions. Mothers are not left out there by themselves after they go home and this is part of discharge instructions. If there are problems breastfeeding, lactation nurses are available now at many hospitals and they too will follow up with the progress of the moms at home. My point is that teaching is done well passed discharge by clinic nurses and physicians.

mcl4 · Jan 3, 2002

Originally posted by Susy K
No, I haven't floated to any other unit - because I am a Labor and Delivery nurse. I would be useless to an ICU, just as an ICU nurse would be useless to Labor and Delivery.

Nurses, including labor and delivery nurses, float throughout the hospital at some facilities. They are not assigned ICU patients, but they are expected to be able to care for a patient on a telemetry, surgical, medical or pediatric floor. These nurses do great both in labor and delivery as well as being on other stations. After all, they didn't just go to nursing school to be a L&D nurses and it is a good way to keep up the other skills that they learnt in nursing.

mcl4 · Jan 3, 2002

Think of this: People will joke about getting marriage or sexual advice from a Catholic priest, saying, "Well, how would he know what he's talking about?" I have a feeling that some patients might feel the same way about getting health information from an overweight, or smoking, nurse. [/b]

Priest are asked about the moral issues with sexual advice and just because a priest has never married, does not mean they can not help a couple through a difficult time in a marriage. I'm fairly sure they have an educational background in counseling.

SHANA BANANNA · Jan 3, 2002

I completely agree with this one. let's be realistic.............how many fat DR's have i had tell me to eat well and exercise........lots.......how many who were skinny as a rail, lived on tuna and plain lettuce have told me the same thing? Lots also. I have my own brain, I figure it out for myself. and lets not leave chemical dependency out of the picture..........and we all know you cannot see that on the outside. sooooo for me? I'd rather eat an oreo now and again and be content..........I give my pts 110% no matter how I look..that's the bottom line.......besides. I HATE TUNA! )

Originally posted by fergus51
I think we tend to forget that weight does not equal health. The least healthy nurse on our unit is as skinny as can be, but outeats her husband at MacDonalds and smokes like a chimney and drinks like a fish. I could care less if a nurse is overweight or smokes as long as she does her job. If anything I would think a patient is better able to relate to a nurse with some faults rather than a superhuman

mcl4 · Jan 3, 2002

Finally, my co-workers do know my position on this topic. We frequently have conversations about how to better influence our patients. Actually, our conversations are much more constructive than this one is turning out to be. [/b]

Perhaps one of the overweight, out of shape, smoking nurses at North can post these constructive conversations on this board Matt. Perhaps you can add the nurses who have an associate degree in nursing give their thoughts on how you've judged their level of education.

Q. · Jan 3, 2002

OneChattyNurse:

I really liked your post. I did. But I do want to point out the parallel you made r/t health, and a well-groomed, professional nurse. Did you intend to make them related? Because they aren't.

The question was about health, not attractiveness. They are not one in the same.

mcl4 · Jan 3, 2002

That's why, thanks for your input. And you too VAC. Awesome comment about how birth and breastfeeding ARE major lifestyle changes.

One in which nurses in L&D or PP plays a small role in. Teaching goes well beyond the hospital stay which will influence parents through the next eighteen years and beyond. I

think you have a minimal role over a patient in the hospital for six hours, a day or two and in reality health professionals in a clinic setting will have far more reaching influences

in teaching them about health issues in their families lives. I would change this opinion if a child was in NICU where these nurses do impact these families with the length of the

babies stay.

A baby at two months, mothers are not going to call their L&D nurse with questions, they call their clinics and talk to these nurses. Mothers tend to develop relationships and receive much of their teaching from a clinic nurses or their family physician especially if they have chronically ill children. A peds nurse might also develop a relationship/influence on a family if there child is in the hospital often. That is why many families invest time in searching for a ped/family physician since this relationship is so important with this major life change when a child is born.

Q. · Jan 3, 2002

mcl4:

I think you are arguing now just to argue.

If I carried the attitude that my impact on my patients is minimal, then I would not being doing my job to the fullest.

We all need to work together and not rely on the clinic RNs (which by the way, I work in a clinic also the RNs don't have any patient care, only the MAs do - and they don't do teaching) to educate these patients who may no-show for their appts.

Also, my unit has received breastfeeding calls from moms with babies up to 2 years old, as well as voiding/stooling concerns.

fergus51 · Jan 3, 2002

Originally posted by mcl4
One in which nurses in L&D or PP plays a small role in. Teaching goes well beyond the hospital stay which will influence parents through the next eighteen years and beyond. I
think you have a minimal role over a patient in the hospital for six hours, a day or two and in reality health professionals in a clinic setting will have far more reaching influences
in teaching them about health issues in their families lives..

How is this any different from any other floor? In our hospital people don't stay any longer than is absolutely necessary on med surg or ICU floor either. I should add that some mothers stay longer when they need more teaching, and unfortunately I disagree with the idea that most women seek out information when they are pregnant. I get a LOT of mothers with no prenatal teaching, spotty medical care and no experience with babies. I had a 34 year old first time mother who thought it was acceptable to only breastfeed every eight hours. Moms like this need a lot of teaching and I have to grab every available moment. I am not going to send her home when I know her baby will starve.

Oh, and our moms and babies room together. The nursery is strictly for babies with health problems. That may be why you got the impression we all go in at 2 am wake up a sleeping mom and start lecturing. In actuality most teaching at night is done with feeds when the moms are awake anyways. Teaching can not always be done during the day because moms usually sleep when baby does and I wouldn't wake a mom up at 2 pm either.

bonde0613 · Jan 3, 2002

"I can't imagine that this makes a good impression on patients when these nurses sit down for teaching about risk factors, or to the general public when they come to visit. "

I have read this post each day and finally I feel a need to defend the original post....as this seems to be a big game of "Telephone" similar to what I used to play in 5th grade: The original message has totally been lost.

Matt never once said what his impressions were. He simply asked about the patients' and general public's perceptions were. He wanted to get a discussion going on how other nurses felt about this issue. And, my goodness - a discussion certainly followed!

I speak with very personal knowledge when I say that Matt is anything but judgemental towards people who struggle with weight and other addictions. Matt loves the nurses he works with, and frequently talks about what wonderful nurses they truly are. HE does not need to defend HIS views because that was not the original point at all. He simply was questioning the affect this had on patients' and the general public! Geesh!

mattcastens · Jan 5, 2002

The following arrived in my private messages from nocnurse, and is posted here with her permission:

Matt, I agree with you. As an ex-smoker, it hurts me to see nurses doing the very things you mentioned. I have always felt that if I could quit, everybody could. But I understand how hard it is, too. the other thing that I hate seeing as a morbidly obese nurse doing bedside nursing. We had a nurse like that years ago who huffed and puffed just getting out of her chair and walking down the hall to a patient's room. Can't imagine how a patient could feel like they are getting good, competant care from someone in worse shape that they are (I was working a CABG stepdown surg floor at the time)! Yes, it concerns me. I am waiting for a non-smoking pt. to tell a smoker nurse who just came in from her "break" to "get your nasty breathe out of my face!" LOL But, they don't, and I don't understand it. The other thing I take exception to with the smoker nurses is that they get their "smoke breaks" no matter what now days. I remember back in the "old days" that we didn't get those "smoke breaks" unless our work was done. Now you are not only super-busy with your own pts., but having to cover for their pts. when they go out. and it isn't a matter of them asking you to cover for them. They just leave, saying "I'm taking a break!" and off they go. Then when their pts. lights go off and they need something that you can do - guess who's doing it! I think I am going to start taking "non-smoke breaks" and leaving the floor. But have you noticed that if a non-smoker says anything about going off the floor - WOW, the looks you get! It's as if they are expected to go smoke, but you aren't even allowed to take a break. Like something must be wrong with YOU if you even think about it! Getting old fast. Don't have an answer, except that I am now over 50, and have decided it is time to start taking care of myself. It's hard, though, cause I come from a work-ethic that says "the pt. always comes first" and there is no such thing as "your pts., my pts. and noever the twain shall meet". Guess I'm just getting old. But I love nursing and will probably drop dead going down a hall to a code when I'm in my 70s! LOL Good luck to you and Happy New Year to your and yours. Would have answered you on the forum, but can't figure out how to post on it yet. Sue