What's Up With This?

What would you think if you interviewed with a practice where you felt things went well, you liked everyone you met, discussion was smooth and comfortable, and even had a quick response to your thank you emails from the people you met with, including the director of the practice saying that they were all currently trying to come up with a plan to properly precept you....

....and they re-advertise their opening?

Man....this is a tough one. I thought I had this job in the bag but looks like they were not as into me as I thought.

Yet Another...

This one had steam coming out my ears....

Young woman, first time mother, in early labor. Well, more like prodromal labor because her cervix was not changing, or could have been false labor, but at this point we didn't know. She was just beside herself with her contractions so she stayed for some IV medication and sleep, and then was reevaluated several hours later. The resident did the exam and pronounced no change in the cervix. The woman was offered another dose of IV medication or to go home. She was undecided about what to do, so she was given some time with her husband to discuss what would be best.

I went back to her room to see what she wanted to do about 10 minutes later. She still wasn't sure, but needed to discuss the pro's and con's of both with me. As we talked the attending doctor came in and announced that she was going to reexamine her. I thought this was odd, and told the attending doctor that the resident just did an exam, that the cervix wasn't changed and the woman was discussing the options of more medication or going home.

The attending just said, "I'm still going to check her."

Attending does the exam, and while her hand was still in the woman's vagina announces that she is 5 centimeters and give her an amniohook so she can break her water. The woman was so happy to hear that she was 5cms that she was like, "Well, then, please break my water! Make this happen!"

So water now broken, woman happy but contracting more strongly almost immediately, the attending stands over the woman with her arms crossed and says, "So I'm told you are doing this natural?"

Before the woman can answer the attending makes a noise like, "Oh, please!" She then goes on to say, "Trust me, you won't be able to do it! You already needed IV medication when you weren't quite in labor yet. Don't go fooling yourself, really!"

I was shocked. Shocked.

And then the attending walks out.

The woman at this point was contracting quite frequently and much stronger. Before I could say anything, she said to me, "I don't want anything!"

And I said, "Of course. You can do what you want, and you can do it." A very simple statement compared to what was going on in my head.

The woman went on to labor without any medication. She was of course having a difficult time, particularly when she hit the transition phase of the labor, but went on to have the unmedicated birth she desired.

How To Get Out Of Bed Post Cesarean

A comment from the previous post:
Now you have my curiosity piqued, since I have two clients who may have Cesareans in the near future.
So, what ARE your tricks for the first time getting out of bed?
Thanks! Sarah

So here are my tips for getting out of bed for the first time after a Cesarean birth- this can be applied to anyone with abdominal surgery- that hopefully will make it much easier!

• No matter what- GO SLOW! Make each movement deliberate and slow and in steps.
• First, get yourself over as far to the side of the bed as possible. This can be done while laying flat or with the head of the hospital bed elevated.
• When moving in bed (as in above movement) place your feet flat on the bed, knees flexed, and lift your hips/midsection with the strength of your legs. Use the arm rails to help move your upper body.
• Once over at the side of the bed get into a sitting position, as high as you are comfortable.
• Next, start to turn your entire body as a whole to face the direction you are headed. Use the arm rail as support.
• Swing your legs down towards the floor while using the arm rail to lift your upper body straight up.
• Now, get yourself in a proper sitting position, feet flat on the floor. Keep your head up. Now just sit there. Get your bearings.
• Once you feel stable, its time to stand! You may want to scoot yourself further to the edge of the bed to get a better footing.
• To stand, pretend you are doing a reverse squat- in other words- use your legs! Stand up straight using your legs, trying not to bend at the waist.
• Do not hunch once you are standing. Stand tall!
• Just stand for several minutes, again, getting your bearings.
• When walking, keep your head forward, not focused on the floor- this can be dizzying.
• When sitting, do another squat- use your legs!
• Some like an abdominal binder or support pillow to hug across the belly.

I hope this helps!

An Improved Campaign

The other day at the gym I was pedaling my ass off on a recumbent bike listening to my iPod (I finally got up with the times) and looked up to towards the half dozen tv monitors that hang above the equipment. I could not hear them because you have to tune in to whatever radio frequency they correlate with, but one of the tvs had a new J&J nurse campaign commercial. What I was surprised about, in a good way, was that they were showing images of nurses doing more skilled nursing type activities than in their previous campaign. I didn't see any baby holding, or patronizing pats on the elderly person's shoulder. And I didn't see any bylines like "Dare To Care". I think what was shown during the small amount I caught was some nurses running a code blue and then it changed to another image that I can't remember- which means that it wasn't condescending enough to be memory worthy. At the end of the commercial several nurses stood together with their arms folded looking ready to take on the world.

Needless to say, I was pleasantly surprised. I felt like the campaign finally heard the complaints on how derogatory the first campaign, despite how well meaning, it was. I think they finally hit a little closer to conveying the right messages to the general public about nurses.

************

On the personal front, an interview may be in the works. We'll see. Posts are sparse these days because my per diem L&D nursing job has slim pickings so not much fodder to pick from or be inspired by.

On the other hand, I got to experience nursing care from the recipient's end. I had a recent (planned) hospitalization and surgery and was humbled by landing in the patient role. I was very fortunate the for the most part that all of my nursing care was fabulous and even got to experience what IV heroin users chase after over and over when one RN pushed dilaudid into my IV like a speeding bullet. (NOTE TO STUDENT NURSES: when a med book says you push an IV med over 2 minutes or 5 minutes or whatever- they mean it!)

By far the most caring person that came across my bedside was a nursing assistant who was a recent nursing school graduate. I can't remember if she told me if she was already an RN who was just searching for her first job, or if she was still needing to take her boards- thanks to that dilaudid- but it was so obvious she was ready to be a nurse. She was great.

I also was very happy to learn that the tricks that I instruct my own c-section mother's to get out of bed for the first time works! Now I can say from first hand experience that these little tricks work when you've had an abdominal incision.

My first time out of bed post-op was like an out of body experience and felt faint and sick just as I stood from the toilet. I did make it back to bed on my own two feet because there was no way I was going to be that patient who needed a wheelchair and a lot of commotion but flopped down so low in the bed that I needed to be boosted up like I was some old lady.

And it was nice to be cared for. I had no problems letting that go. But I did almost get a hand slapping when I reached up to the IV bags in the pre-op holding area to see what they were giving me. The nurse was a little put off by that, and must have went and told others in the area because shortly after my surgeon came over to me and handed me my chart and told me to keep busy reading.