Monday, February 9, 2009

The "Perfect Nurse"

So I have LOVED reading all the comments to my post about the "perfect patient." So here's my flip side to it...for all of you mom's out there who have labored, or who will labor someday, or any of you dad's/husbands out there who have been with or will be with your wife/significant other when they give birth, what would you describe as your "perfect nurse"? 'Cuz really, that's what I want to be!


  1. well, i didn't actually labor or anything, so i don't know if my answer counts, but i was in the antepartum until for 9 days before my sons were born and then 5 days after (i got to go back to my old room). and i thought i was going to say something profound here, but 14 months later, i'm having a hard time remembering anything but the great nurses i had. they brought me sandwiches since the meals were awful. they helped with the NSTs (three babies and a toco monitor...not fun), they got me a new bed, and they were always kind and patient and nice to me. that's all i really care about - just be nice and patient.

  2. I would say that the perfect nurse takes care of the patient in a way that the patient never feels like a matter what the patient puts the nurse through....(in or out of the patient's control). In my opinion, the patient ic only there temporarily, and it's a pretty big deal no matter what the situation is, so just humor her until she leaves. In the same way that you are just looking out for the baby and the mom, that is what the mom is looking out for. I know there are exceptions, but for most of the cases, this is my opinion.

  3. I am a new subscriber to your blog and absolutely LOVE reading it! You are a great writer!

    I have had 4 children, so have become quite a pro at delivering babies. I would say there are a few do's and don'ts as a nurse.

    Do- Talk with a patient and be more friendly then clinical.

    Do- Be as gentle as possible.

    Do- Listen to the patient.

    Don't- belittle the patient. I was told, "Don't be a baby when I said ouch to the 5th try at an I.V.

    Don't- act put out if the patient requires a little extra care

    Don't- tell an anti-partum mom to "Get your own ice water." if she is admitted there for bed rest reasons.

    It sounds like you a wonderful Nurse though, so don't worry! You have my dream job! I was just about to enter the nursing program after I had finished my pre-req's and had to drop out when my son started having medical problems.

  4. Be aware of the power of your words. Be encouraging. If mom has a birth plan read it and talk to her about it and try to honor it.

  5. Let's see... the perfect nurse

    ** would be well-versed in evidence-based care and work to make this kind of care available to her patients

    ** would listen to moms and treat them individually instead of making assumptions and/or simply performing routines because "that's how it's done"

    ** would be kind and gentle, and as a pp said, not make women feel like a burden

    ** would look for ways to help make the birth experience easier and more pleasant for each particular mom, considering what she has indicated as her preferences

    ** would look for ways to strengthen the couple and/or mom/dad/baby bonds, again, considering individual situations/preferences

  6. Whoops - I forgot one: the perfect nurse would see to it that true informed consent was a priority, as much as time/circumstance allows.

  7. I really loved the one that I just had and she was just very fun and personable. She joked a lot to keep the mood light and stole the anesthesiologist away from someone else so I could get my epidural first! Or at least she said she did, which made me think the world of her, even if it wasn't totally true.

  8. I've had six births, and none with medication (not that I can be proud of this, I begged a few times). The "perfect nurse" is one in my mind who has the following qualities:
    1. A listening ear...
    2. A caring heart and touch
    3. Willing to let mom do what she wants if everyone is safe
    4. Looks mom in the eye and talks to mom even when things are routine, even when things are bad...even after the baby has come
    5. Answers mom's "can I have my baby" when baby's across the room and mom is left alone while all this is going on
    6. Assumes mom does care what is best for her baby even when mom might fight the IV or monitoring...tries to compromise if that's possible...yet does stand up when mom is being completely unreasonable
    7. If all is fine makes light conversation to keep mom calm
    8. Can leave a mom alone if mom needs it
    9. Doesn't bribe mom with one last cervical check before the shower. If all was well 15 minutes ago let mom shower
    10. If mom has to pee or poo, let her have a bed pan if you're afraid she'll push baby out in the bathroom if head's not really crowning
    11. Perfect nurse talks to dad with respect too, listens to him as he may know mom's needs, my husband has said, "I would have stuck up for you in that moment but I don't matter in that room."
    12. Finds a way to remain calm when decels happen so mom doesn't freak out
    13. Let mom drink and eat if safe
    14. Informs mom what is going in IV...or before a cervical check
    15. Asks before stretching cervix or other tissues
    16. My perfect nurses often did little intervention when not needed but could kick it in gear when needed. They kept me calm by explaining what was happening even if it was scary.

  9. Hi!
    My first delivery totally sucked. It was then I realized a nurse makes or breaks your labour and birth experience. My nurse J was terrible. She was snotty, seemed like she hated her job, that I was a burden, and annoyed with me when I was complaining that my epi didn't seem to work. She didnt believe me when I said my water broke and thought I peed myself (nice), and laughed at me when I said I couldnt do it anymore. So maybe dont so any of those things? I really needed a medical professional I could trust and feel comfortable with. Isntead I felt awkward the whole time.
    My second birth experinece was way better. I had a nurse who loved to chat, I told her about my fears, and she reminded me to trust her. I did. She was amazing through my labour, had a great sense of humour and kept me posted on everything. I liked hearing a little bit about her personal life (she mentioned she had kids) which made her seem more "human" if that makes sense. I just had such an amazing experience. She seemed happy to be doing her job and I didn't feel like a burden at all.

  10. Don't have an attitude.

    Don't tell the patient that her extra bleeding (which the doctor later says is just normal) is due to her having her babies so close together

    Don't tell your patient that it's unsafe to have more than 2 c-sections. She has an OB to give her advice on how many c-sections are safe for her paticular body and health history.

    Don't tell your patient that her body "just isn't made for having babies". This is NOT what a first time mom wants to hear after giving birth via c-section. Expecially not a mom who wants a large family.

    Do hold the patients hands if she's scared during the epidural, spinal, or c-section

    Do reassure the patient that everything that's going on is normal

    Do remember to change the patients pad if she's been sitting in it for 3 hours during heavy bleeding- even if you are busy.

    Do remember that if you are a really young nurse and are instructed to give carseat advice to a mother of 4 children that she might actually know more about the carseat installation than you do. Same goes for giving the baby a bath.

    Do remember to bring the patient plenty of snacks and sodas while she's unable to get up. Oh, and always keep the water jug full!

    Do remember to be kind- helpfull, but not in the way.

  11. The perfect nurse:

    1. Listens to her patient.
    2. Believes her patient is telling the truth.
    3. Talks to her patient even when things are falling apart around them.
    4. Answers questions honestly, and if she can't answer the question makes sure that the doctor addresses it when he / she does rounds.
    5. Remembers that while this is just another day at work for the nurse, it's a life changing event for the parents.
    6. Remembers that this is just as important to dad as it is to mom.
    7. Doesn't trivialize mom's experience. If this was a difficult delivery, a perfect nurse won't dismiss mom's feelings of anger, betrayal, disappointment, or fear. Instead she will hold her patient's hand while she cries, rages, or talks about her feelings.
    8. Never tells a new mom "all that matters is a healthy baby". It's important to send that healthy baby home with a healthy mom. Health includes emotional as well as physical well-being.

  12. I agree with all of the above and a labor nurse can make or break your labor experience! I just had the easiest birth ever, but the worst labor nurse. To the point I should have asked for another nurse! I wasn't a difficult patient and hardly bothered her. My previous history is dd 1- severe pe and emergency induction at 36 weeks (different dr and hospital), dd2 - severe pih and emergency induction at 35/5. Last baby - mild pe and scheduled controlled induction at 36 weeks w/ mature amnio. When I was admitted - great nurses. That is where it ended!

    When I was admitted, I was told I was admitted for mild pe (knew that already). Basically my uric acid was high, protein in urine was going up (wasn't high but was in the 200s and going up each time they tested), bps were way up (on two different bp meds to control it and strict bedrest), CNS involvement (headaches, vision issues, brisk reflexes), and creatine clearance was high. My peri wanted to deliver me at 34/6 and I refused. My ob agreed with me. However, at my 35 week appt, he said I could stay pregnant, get sicker, labs get worse because they were not going to get better, and have an emergency delivery and become severe again (if I did this labs and 24 hr urine every 2 days till something changed) or I could agree to an amnio in 2 days at my peri and do a controlled induction that night. It was an easy decision for the amnio.

    Anyway, the next morning, my labor nurse was mad that my ob had the cervadil pulled at 10 hours instead of 12. Then she was mad when I requested the iv in my left hand (she put it in the right). She checked me and said no where ready. My ob came in right after and checked me and said I was 3 cms. I requested my epidural at that point (because I have really fast labors and got it too late last time) and my ob gave it to me. She had an issue with me getting it early. My ob and I had discussed in the office about preventing infection (both previous deliveries had uterine infections and with laps too. My ob said he would do iv antibiotics to prevent it). I mentioned it to her and she said what do you want an epidural or antibiotics? Then she told me that I knew too much about my meds. She told me we don't pretreat infections around here. Never bothered to talk with my ob. I am sure he had forgotten as he has had me on antibiotics before. I had a d&c from a loss at 13 1//2 weeks in February. I was terrified of infection again with a d&c. He gave me antibiotics before and during surgery to prevent it. Then she told me she had PERSONALLY reviewed my file and labs and I was not preeclamptic (funny my peri - 29 years experience and ob - 13 years experience, both said I was. If your labs are bad, you are not in a good situation. Diagnostic criteria is 300 mg protein in urine, bp 140/90 twice in 6 hours or 30/15 baseline, and or CNS involvement). Even if she felt I was not preeclamptic, I was at the very least PIH with pressures of 160/110. When I saw a pressure of 160/112. I commented to my dh that it was still pretty high. She told me then don't look at it and shut the monitor off. My ob had ordered fiorinal for my horrible headache (had that headache for 2 weeks, one of the reasons they delivered, and took fiorinal before admission). She would not bring it to me. I literally had to tell her I had an order in my chart. It had been 6 hours and I wanted it. If she didn't bring it then have someone else do it. She was only nice when my ob was in the room. She only brought the fiorinal when the baby nurse (same one for my last delivery) remembered me right off the bat, made a beeline for my room so she can do this baby and she remarked on how sick I had been and the headaches with the last baby. That she had wanted to cry with me when I had them with my last baby. Then she brought me the meds.

    I had a very easy controlled delivery. No tears. No pain cause of the epi early. Loved it. My ob rocked, love him.

    However, this nurse ruined the day with her attitude. We never used the call button except when I was close and could feel pressure. She made me feel like I was an idiot, my drs didn't know what they were doing, and that I was a burden. She acted like she hated her job. I was so sick of the nurses by the next day that I requested to leave. They told me they would never let a barely 36 week baby leave at 24 hours old and for that matter, they wouldn't let me leave either because I needed to be under observation for the pe.

    Oh and the antibiotics issue - kidney infection at 5 days pp. I was PISSED. Ended up seeing my pcp for that as my ob was out of the office.

    I have my pp appt next week and I intend to discuss what happened with my ob about the nurses. The worst part is I am mad at myself for letting her treat me that way. I should have immediately requested another nurse as soon as she gave her opinion on whether I was preeclamptic or not. The point was my drs felt that the baby had been under enough stress (as my peri put it) and she needed to come out. It was not in her scope of duties or anything to sit there and comment on my drs professional opinions.

    So I guess that's my rant on everything a nurse shouldn't do. I wish I had the nice caring nurses that were there when we lost our baby at 13 1/2 weeks that let me cry on her shoulder for a long time. I guess weekend shift is different than the shifts during the week. I was very disappointed with my care this time. I will say that the baby nurses ROCKED. They were awesome. My nurses - blech.

  13. Okay, I enjoy reading your blog, and if you know of any mother/baby or well baby nursery blog writers I would love to read those, too (as that is where my bad experience with delivery happened).

    I liked my L&D nurse, although I was in for a c-section, scheduled at the last minute (baby was breech, went it to meet with perinatologist to have an u/s to see about a version, baby measured 9.5lbs, decided c/s was the way to go!)

    I wish she would have told me to watch for a UTI when I got my catheter removed. I am sure that is the next nurses job (mother/baby unit?) but better to be told twice than never. I was in so much pain all over that I didn't realize it was a UTI for FOUR DAYS (I figured it out when my upper back started killing me after I'd left the hospital, but I remember burning pain when I went to the bathroom the first time). I should have known, but I was out of it and no one mentioned it so I didn't even think of it.

    Don't act annoyed or like you have better things to do. My nurses acted like I was a burden. That didn't make me want to ask them questions or talk to them about my concerns/pain, etc. They were cold.

    Warn c/s patients to get up as soon as possible. Again, this is probably the next nurses job, but my nurses NEVER got me up. After I got shoulder pain it took my nurse 5 hours to figure out what was wrong. I threatened walking myself to the ER at 3am because I was in so much pain. She finally got her charge nurse and the charge nurse knew what it was immediately once I told her I was a c/s patient. I was up walking the halls at 4:00am to get rid of shoulder strap pain. Again, I know that happens from surgery, but I was so tired and felt crappy that I didn't even think about it until it was too late.

    I know each unit probably has specific things they are supposed to go over, but I don't think duplicate information ever hurts. My L&D nurse was SO nice and I know I would have listened if she had given me some post-delivery/recovery advice. My mother/baby nurses were cold, distant, and honestly, horrible. But I didn't realize how bad it was until I got home and thought about how THEY SHOULD HAVE told me those things. I felt stupid and guilty for not thinking about the UTI & walking ASAP, but then I realized they should have been helping me with that stuff... THEY'RE the nurses!

    So, double up on the information. It never hurts.

    Keep the stories coming. I love them.

  14. I've been thinking about this a lot as I think back to my son's birth 4 years ago (10th). I had GREAT nurses each time - and one that wasn't so hot each time. The great ones didn't treat me like a freak for having a birth plan (maybe because I had a respected doc who signed it?). If they had concerns about anything, it was a conversation - not an order - about changing it. Since they were willing to be flexible, so was I. They didn't insist on making me talk through contractions but instead respected out space and need for quiet during them (I was laboring without medication). They asked my husband some of the routine questions that he could answer to involve him in the whole process. They basically treated us like we were excited new parents who knew what we were talking about rather than John and Jane Dipstick that knew nothing and they knew better.

    The bad ones are the ones that stick out. The second time it was the nurse who did things like insist on checking my cervix during a contraction - then saying, "I need to get X to do it - I have such short fingers and can never find the cervix when it's up that high... are you sure you're not here too early?" Then when I WAS admitted, she knocked my gown off the hook while I was in the tub, stepped on it, and then hung it back up... three times... and was put out when I asked her for a new one.

    But the worst was with my son. All had gone really well and I was so excited to bring him home. A nurse I had never seen came in, took him from my arms, and said this was her favorite part - she got to bring him to the front door of the hospital to go home. They insisted I be in a wheelchair, I could have carried my own son out - but she wouldn't let me... took it as her shining moment... and that was the one act that launched me into PPD.

  15. I'm a mom of five. I've had just about every type of delivery available and have had really BAD nurses and ones that I would love to put a cape and a crown on, making him or her queen or king for the day! I've given birth in three countries and have had 3 C's, 2 V's, with a variety of complications.

    The best I've had have listened, been clear in what they needed to do, been honest with me, answered questions, when they didn't have an answer - found someone to answer, didn't treat me or dh like an idiot, and although it was clear they were stressed with the "rush hours" of patients didn't apply the frustration back to the patient. I've been blessed to have at least one of these with each delivery. My last, there were three of them, two of them men! And I still see one of them periodically and we recognize each other to say hello!

    The worst, well, let's say that they chose the wrong profession.

  16. A few off the top of my head:

    - Speaks directly to the patient, and never discusses the patient as if she's not in the room (even if the patient does not speak English - she still knows that you're talking about her)

    - Is positive and friendly. Just a happy attitude can make such a difference if people are nervous or upset!

    - Along the same lines, encourages the mom that she can do it! And doesn't undermine the mom's birth plan by pushing things that aren't part of it, if they aren't necessary.

    - Is honest without being scary, and treats the family as an intelligent partner.

    - Is nice to doulas! I know some nurses have had negative experience with doulas, but I've had negative experience with nurses, yet I always bring an open mind to each new nurse and hope they do the same for me. Doulas can be a great part of the team, and it's nice to have someone expect the best of you.

    - Is on the patient's side...the best is when nurses go out of their way to honor a patient's wishes. If the nurse knows the patient wants intermittent monitoring, she pops her off the monitor the second she's allowed to. If she sees a dark and quiet room, she whispers and moves softly. Those are the nurses I always remember and that the women I work with always say they loved!

  17. Ok, I'm way late to comment on this but I just found your blog today. I've had 2 babies. One with an epidural and one water birth. I had great birth experiences both times. Only "negatives" that had anything to do with the nurses were 5 sticks and 3 nurses to get one IV placed (I warned them I was a hard one to place an IV), my cath never got placed correctly and didn't work (thank goodness I didn't feel like I had to pee), and neither time did my nurses have a sense of humor. My husband and I cracked jokes during both labors and the nurses looked at us like we had third arms. We deal with stress by goofing off. Maybe joking while pushing w/o meds threw them off a bit :)

    Of the two births, the natural one was 'best'. 3.5 hours from AROM to birth and we only saw medical personnel when admitted and when pushing. We were left on our own the rest of the time and we liked that (not that it was long. maybe 2 hours alone?). Oh, I take that back, there might have been one time they came in to put me on the monitors part way through. It was brief and to the point though.

    I liked L&D nurses both times, it was post delivery that I requested a new nurse with my second. If a women has a baby, isn't wearing a wedding ring (swollen hands), a FOB isn't in sight (he was home taking care of our other baby), and mom looks young...don't assume she doesn't know what she's doing and start lecturing/taking over her baby. Shesh, just don't make assumptions at all, ask questions instead. Nurse I had with baby #2 was RUDE beyond belief!