“God, if you can’t make me drop dead gorgeous, please make me tactful”

Home. Coast to coast in my typical fashion.

I’ll be chilling in the home spot for another week and a half before I take off to visit friends (then head up to Mass). 

As you know (or maybe you don’t?), familiar doesn’t comfort me. Actually the familiar ends up chafing at my edges and I tend to thrive on a certain amount of controlled change. While it’s nice to be home, home doesn’t not mean relaxing because I still have to work.

It’s interesting how things change… Correction, it’s interesting how things remain exactly the same but you’ve changed and what you could tolerate before is intolerable now. 

Let’s have a brief discussion

LDRP, labor-delivery-recovery-postpartum, is a model designed to keep mom in the same room throughout her antepartum to postpartum experience. It’s lovely when you can keep the person you deliver throughout the entire process. But it only works to a point. If the set up is wrong, you run the serious risk of harming/neglecting your patients and putting yourself at risk as the nurse. Here’s why… 

Having worked in critical access hospitals with small census, LDRP works beautifully. You can have a labor and maybe 1 postpartum couplet, someone else can take the other couplets and maybe triage. You probably won’t see many more people through the shift so you can juggle. When your yearly deliveries gets up to 800-1000 deliveries, this is no longer possible. Let me repeat, this is no longer possible. 

It is not feasible to care for 2-3 couplets and a labor patient. I’m talking mom’s who are fresh sections and need up, babies who are getting meds for withdrawal, all the meds and complications that come with postpartum, patients needing/demanding discharge teaching right this minute, or setting up for circumcisions AND THEN dealing with whiny, demanding doctors with a labor patient, decelerations in fetal heart tones that require immediate action, or a patient writhing in bed because doctor broke their water (and wants them delivered immediately). 

You can look at the acuities or the board and say things can’t be that bad, but when I’m dancing on the edge of walking out something isn’t going well. 

I’ve learned to be cool under pressure through traveling, but I understand my limits. I’ve gone it alone in a few situations I really shouldn’t have and managed to get out okay.  I also try keeping my grumbling down because it doesn’t accomplish much. Things hit the fan? Put your head down and plow forward as safely and quickly as possible. 

That’s where it gets hairy. When does it stop being safe? When’s the point that things change? Every place has their issues with staffing and it’s amazing how we as nurses band together to get things done, but the point of change cannot come when the nurse is in litigation or has hurt herself OR hurt the patient. The change should come when the nurses say “I don’t feel safe.” With in reason, of course. We all know nurses who cry ‘overwhelmed’ when things aren’t so overwhelming…

But when steady nurses say they are at their limit? When those who can tackle everything are ready to quit? That’s when it’s time to reexamine how things are run and make them changes. 

For patient safety

For staff safety 

For sanity’s sake 

For my license(s) sake 

Stop making hospital such a business that the nurse and the patient suffers. Can I get an amen? A-men

No hospital is perfect. I won’t ever find that perfect place because it’s the nature of the beast (and I’m an antsy girl), but I can hope. I can outline my ideal hospital with hearts around it in my journal and daydream. I can continue saying what needs to be said. As tactfully as possible. What doesn’t kill me will hopefully make me stronger instead of losing my license. 

Enough of that, I’m hoping I can hang out with one or two people while I’m off. The queue forms to the right. 😊

Travel on, road warriors 

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