Are you man-nurse enough?

The Oregon Center for Nursing has a picture that about sums it up:



Okay, so I don't snowboard to work every day, or fight kung fu villians while I'm there, but I do have an old band t-shirt that has flames on the sleeves.

Mom's still waiting.

Today I had the same patient as yesterday. You know, the one who asked "When do I get to go home?" five hours after popping a baby out. She was so bored and annoyed, and to boot her partner was there, also bored and annoyed. They were not very receptive to me, the nursing student, who was also bored and annoyed but kept having to come back to their room on odd errands like giving the mom consent forms to sign.

Not only is she still there today, but the pediatrician thought she heard a heart murmur and wants an echocardiogram. Heart murmurs are normal for newborns but she wants the echo because this mom lost another baby to SIDS. And the baby needs a hearing screen. So they'll still be there tomorrow. Bored. And annoyed.

But not annoyed at nursing students, because this student is done with maternity.

Note: I'm not dissing the echo. But she still might've been discharged yesterday and had this murmur discovered and worked up by the pediatrician on an outpatient basis, right?

Trapping moms in the hospital for no reason

Not that OB rotations are supposed to be exciting, but today was particularly boring. I had a 20-something mother who gave birth vaginally without complication at 2 o'clock this morning. Baby is breastfeeding great. He latched good, stayed on forever, and kept falling asleep (so did mom). She wanted no pain medicine after the birth. She was very independent and acted surprised that we thought she needed anything. When I got there at 7:30 am, she asked me when she gets to go home.

The nurse handed me some pills to give her - a stool softener (protocol for all postpartum women at this particular hospital) and a Motrin. The patient looked at me funny about the Motrin because she wasn't asking for it, and looked at me funny about the stool softener because, well—wouldn't you? I told her she didn't have to take either of them, but she did anyway. When I had to chart how she rated her pain, I didn't know what to write! The nurse told me to just write abdominal aches.

I asked if I could assess her baby, and she's like "What?" Assess your baby. "You want to do what to my baby?" Check it. "For what?" I don't know! Hydrocephalus. Congenital heart defects. Stuff your baby obviously doesn't have. Why am I even here?

As for going home, I told her that since she's in the hospital, they'll probably want to do tests 24 hours after the birth: PKU, hearing test, bilirubin, etc; but honestly I can't see any reason to keep her. Not that it was up to me.

Also: a couple of nurses freaked out because a woman was walking down the hall holding her baby. "Doesn't she know she's not allowed to do that?" "Well," the other nurse says, "we're not like other hospitals that have nice clear signs in the room saying they're not supposed to walk with their babies." I don't get it. You can't be an independent adult in a mother/baby unit. If you drop your baby, obviously you can sue the hospital for letting you even hold your baby!

All in all, it was an exercise in futility. The only thing I saw today was that obstetricians and hospitals have to keep perfectly healthy women locked up after their births in order to avoid lawsuits.

Shortage of Nursing Instructors = Nursing Shortage

I think I figured out one tiny component of the nursing shortage in the US: all instructors in a college program of nursing must have their Master's of Science in Nursing. And there are a surprising number of MSNs required to teach the average program. You need multiple lecturers because of the sheer amount of content you must cover in each 8 or 10 week class. And you need enough clinical instructors to handle the student load - each clinical instructor typically takes only eight students, because they must accompany each student when they pass meds or do anything else that legally requires an RN.

For instance, my medical-surgical class last semester required three lecturers for the Didactic portion, and two additional MSNs for clinical rotations. Five master's degrees to handle 37 students!

Now, take a field where you only need an Associate's degree to practice (or a hospital diploma, if you got your license in the 1980's or before--which don't count toward college credit hours), and where a person with an Associate's degree can make upwards of $75-90k (so I hear) if they specialize in a high-skills role or work agency. In an industry like that, you're going to mandate that all nurses who want to teach at the local community college must get through another four or five years of college on top of what they've already been through to get their RN—and then pay them $45-50k? It's not going to happen very often. One ICU nurse told me that she loved teaching, but she can make the same amount of money working two days a week. She said she might teach when she retires.

(Which is probably why so many teachers are just retired nurses, who become the bane of students' existences and grow increasingly out of touch with reality. On the other hand, many of the teachers are people who could be making mad cash but just genuinely love to teach, which I think is the case with most of the teachers at my program.)

I can understand requiring a Master's in Nursing to teach the theory portion of the program. Or at least to be Lead Instructor. But it doesn't take a master's to lead a gaggle of lost students around a med/surg or OB floor, or to pass meds with a student, or to tell them how to operate in the real clinical world. If we didn't require one master's for every eight nursing students, we might not have a shortage.

By way of introduction.

I'm a nursing student and a nurse's aide who works in an intensive care unit. I'm also a father of four children who were all born at home with midwives.

I'm starting this blog to write a little more officially and academically than I have elsewhere on what I think about birth and death, or rather, midwifery care, obstetric practice, care of the critically ill, and care of the dying. I also have many thoughts I want to hash out about the US healthcare system, hospitals and nursing homes, and the general practices of nursing and medicine.

As of this writing, my four kids are under the age of five. So if something I write doesn't make sense, it probably means I have a kid in my lap who's hitting the keyboard, eating my arm, or needing raspberries blown on their cheeks to keep them quiet.