Wishes Regarding Students in Birth Plans

CSLee3, ASN, BSN, LVN, EMT-P · Jul 5, 2004

It is sad to think that so many people would not allow a student to participate...DID WE FORGET WHERE WE CAME FROM? No one is born with RN on their cheeks and the very nurse that is caring for you may have limited exerience because no one took the time or care with him or her to make that person a better nurse. As long as they are supervised I will always allow student nurse to participate in my care. As for being a male nurse, I was discriminated against in nursing school. I was only allowed to assist in one birth after I begged the instructors, and met with the family on my own! I was told to stand in the back of the room with the other men or go hang out in the nursery for a week.

I cherished all nursing clinicals for what they are...a learning experience. Please remember that as nurses and healthcare workers we must keep that torch going, by passing on the knowledge and helping when and where we can.

Peace in you hood.........Chuck

Gompers, BSN, RN · Jul 5, 2004

I don't know what other nursing students got to do during their OB clinicals, but we didn't get to do all that much. We'd do the H&P for the mom, a careplan, make a med list, etc. - but we didn't get to do anything that might endanger the mom. The RN assigned to that patient did all the IV stuff and we were only allowed to give oral meds, but only in post partum. In L&D, our main thing was to support the mom and observe the birth, be it lady partsl or C/S. The moms actually loved this because they got to have a support person there with them all day long, while the RN was busy doing her other work. The unit would ask the moms if it was okay to have a student, and told them that while one student might be with them for the labor, another might join in for the actual birth. (Instructor would just grab whoever she saw first if a baby was crowning, so we could see as many births as possible.) But that was the limit - 2 students, one of whom had been with the mom all day.

As long as there aren't tons of students at the foot of the bed talking away, or students hanging mag or pit on me, I'd be okay with their participation.

HazeK · Jul 6, 2004

"I request that no students be involved in my care." ... have you had any problems with pts refusing to have students in with them and how is this handled?"
I don't have much of a problem with this part of a birth plan. Here's why: I get myself alone in the room with the patient and her significant other. I go over the birth plan in detail with them, using a very supportive tone and attitude. When I find "bumps in my road" like "NO students", I respectfully ask them why they included this and what did they think a nursing student in L&D's involvement would have been... THEN, I tell them that all our nursing students are allowed to do is watch ME work, ask questions, and, IF ok'd by the patient, put in a foley catheter AFTER the epidural, palpate contractions, and hold their hand!!! Almost 100% of my patients have then OK'd for my nursing student to follow me around...and often, by the time of delivery, the patient is comfortable with the student assisting with pushing positioning and pericare...and grateful for another person who cares for them!
OF course, I do NOT allow HERDS of students at the bedside of these "nervous Nellies"...THAT would be pushing it!
I hope this helps.

BabyRN2Be · Jul 6, 2004

I'm absolutely appalled at that hospital's lack of respect for medicaid patients. Do you still attend births as a doula there? If you are, aren't you in a position to advocate for your client's wishes if they do not want students? Are you affiliated with the hospital (as an employee or volunteer)?

Yes, I am in a position to say something, only IF I'm working on a private birth. Most of the time I come on, the mom has been in the hospital for a few hours already and they already have students assigned to them. I do trend a fine line in working as an advocate for the parents. We absolutely can not wear out our welcome as it affects the whole doula program. When I'm working at the hospital, I can't make waves. It's a different type of doula'ing. We are there to help pts who need extra help - those who might be taking too much of the nurse's time, etc. Since we haven't met these pts beforehand, I don't know what their wishes might be. If one has said that they don't like all the people who come into their rooms because of a history of rape or abuse, there's not much I can do about it other than tell the staff. After that, it's out of my hands.

If it's a private doula patient, I can be more active as an advocate. When I'm working at for the hospital, I have less say.

Jolie, BSN · Jul 7, 2004

When I delivered my second baby, I was pleased to be asked by the nursing instructor if I would allow a student to care for me on post-partum. When half the shift had gone by without seeing a student, I assumed that they had enough other patients, and didn't need to assign a student to me.

At 7pm, right at the beginning of visiting hours, the student barged into my room and insisted that my hubby, daughter and mom leave, as she NEEDED to assess me and do my teaching. She had no answer when I inquired as to where she had been for the last 4 hours. I told her I would allow 15 minutes, as our family time was at least as important as her assessment. She couldn't figure out how to apply the blood pressure cuff, didn't know how to find a fundus, inquired about my RhoGam (I am Rh positive), and scolded me for choosing to bottle feed (I was exclusively nursing my baby). I asked her to call her instructor into the room to assist her with her care. The instructor had the nerve to scold me for making the student nervous and failing to cooperate with their care. I don't know if it was the hormones or the lack of sleep, but I really gave it to the instructor. The student was a second semester junior caring for one stable PP patient, and still couldn't get anything right, and the idiot instructor was defending her!

The staff nurse later thanked me for "letting it fly". Apparently they had been having trouble for quite some time with poor quality students and instructors, and management was not doing anything about it. I was asked to relate my experience to the head nurse the next morning. I doubt that it did any good, but it sure made me feel better!

Zhlake · Jul 7, 2004

On my birth preferences sheet I requested no students as well. It wasn't that I was afriad of them doing something to me--I wanted to be as comfortable as possible while in labor and felt that the presence of students might hinder me from fully relaxing.

SmilingBluEyes · Jul 7, 2004

When I delivered my second baby, I was pleased to be asked by the nursing instructor if I would allow a student to care for me on post-partum. When half the shift had gone by without seeing a student, I assumed that they had enough other patients, and didn't need to assign a student to me.
At 7pm, right at the beginning of visiting hours, the student barged into my room and insisted that my hubby, daughter and mom leave, as she NEEDED to assess me and do my teaching. She had no answer when I inquired as to where she had been for the last 4 hours. I told her I would allow 15 minutes, as our family time was at least as important as her assessment. She couldn't figure out how to apply the blood pressure cuff, didn't know how to find a fundus, inquired about my RhoGam (I am Rh positive), and scolded me for choosing to bottle feed (I was exclusively nursing my baby). I asked her to call her instructor into the room to assist her with her care. The instructor had the nerve to scold me for making the student nervous and failing to cooperate with their care. I don't know if it was the hormones or the lack of sleep, but I really gave it to the instructor. The student was a second semester junior caring for one stable PP patient, and still couldn't get anything right, and the idiot instructor was defending her!
The staff nurse later thanked me for "letting it fly". Apparently they had been having trouble for quite some time with poor quality students and instructors, and management was not doing anything about it. I was asked to relate my experience to the head nurse the next morning. I doubt that it did any good, but it sure made me feel better!

THAT my friend is SCARY. Our rights to have or not to have "outsiders" in our delivery experiences MUST be preserved. And socioeconomic status should never come into play as to whose preferences are either ignored or respected. I would not work in a place where people's rights to self-determine their care were in jeopardy, soley due to their medicaid or self-pay status. People have the right NOT to experience things like this.

palesarah · Jul 7, 2004

Yes, I am in a position to say something, only IF I'm working on a private birth. Most of the time I come on, the mom has been in the hospital for a few hours already and they already have students assigned to them. I do trend a fine line in working as an advocate for the parents. We absolutely can not wear out our welcome as it affects the whole doula program. When I'm working at the hospital, I can't make waves. It's a different type of doula'ing. We are there to help pts who need extra help - those who might be taking too much of the nurse's time, etc. Since we haven't met these pts beforehand, I don't know what their wishes might be. If one has said that they don't like all the people who come into their rooms because of a history of rape or abuse, there's not much I can do about it other than tell the staff. After that, it's out of my hands.
If it's a private doula patient, I can be more active as an advocate. When I'm working at for the hospital, I have less say.

I hear ya... a very fine line. When I trained as a doula, that issue came up many times.

You are doing such a wonderful thing for your patients!

tuppence · Jul 7, 2004

put in a foley catheter AFTER the epidural

Gosh, when I had my son a couple of years ago, I let a student nurse insert my foley catheter BEFORE I got my spinal. It took her four tries -- ouch!

Oh, well, I'm having another baby any day now (due today) and I'll still let students practice on me. I'll be starting my nursing classes in a year, and I'll be practicing on people too... turnabout is fair play. :)

fergus51 · Jul 7, 2004

I would hope most nurses would allow well behaved students to participate in their care. None of us come out of the womb as RNs, so we all had to do it at some point!

SmilingBluEyes · Jul 7, 2004

Best wishes for a safe, happy delivery Tuppance. And VERY nice of you to let students learn in your case. I think that is most gracious of you. But yes, have them wait til AFTER your epidural/spinal. I would never think of placing a catheter PRIOR, unless in dire emergency. It can always wait til patient is anethesized, first, unless it's for an emergent case.

tuppence · Jul 7, 2004

Thank you.

I had originally asked that the catheter be placed after I got the spinal, but the nurse came back later and said that the doctor wanted it done beforehand because he wanted things to go as quickly as possible once I was ready for the cesarean. I don't know how usual that is, but I agreed to it. I had severe pre-eclampsia at 32 weeks and once the perinatologist checked us out, he seemed to want to do the cesarean ASAP, though we waited a few hours because I had had some toast that morning at the hospital I was transferred from. I gather it was a fairly serious situation. I was a little confused from the mag and everything, but low fluid, the placenta not looking good, and the baby's heart rate not going up were mentioned. Anyway, the discomfort of having a student insert a foley was the least of my worries, really, though it makes for a good "war story."

(The 32-weeker is 2 1/2 now and doing just fine.)