I’m ready to start at the new place, which means I made it safely to Massachusetts after a few minor mishaps. One of which included losing my wallet at the welcome center clear on the other side of Connecticut. But prayer is a pretty miraculous thing because not long after my fruitless searching, someone called saying they found it and would mail it home. Yay!
Starting at the new place also means it’s orientation time again. Seriously, after 3 years, I’ve sat through so many orientations I could run them myself. I stand by my theory that every orientation is the same. “We’re a great hospital, you should feel privileged to work here, listen to all the important people talk”, times two days. I’m just hoping I get a free voucher for the cafeteria. I’m also hoping for no surprise tests and coworkers who treat me well. Fingers crossed.
With the start of orientation, I always think about floor set up. What’s my ideal hospital? Aside from one that treats nurses like they are the backbone of the system and includes them in decisions? Well, when I inherit a windfall of money, purchase an LDRP floor, have it dedicated to me, and design it how I see fit, this is what I’m imagining. Picture it!
The Canea C Famil Birth Center or the CCFBC for short.
My ideal floor would be situated so the nurses can actually navigate the floor and not run down multiple corridors in the event of a staff emergencies. I already walk 5 miles at work, there ain’t no need to add 5 more miles to that because the floors are the length of a football field.
Pods would be acceptable with desks at each one, but i require a better central monitoring system so everyone can see on large screen when patients are having decels. And on the topic of monitoring systems, I need one that’s actually user friendly. What’s that mean? Stop with multiple tabs, charting in a bazillion places, and clicking around forever to find the box or test I need. Lab results should be easy to locate and print. Everything should flow over. Labs, vitals, doctors notes. I shouldn’t have to hunt for that consult. In other words, I need to you actually consult the nurses who work the floor on how to set up the computer system and I shouldn’t have to retype vitals signs so many darn places
I want tub rooms and a home like set up for those who want a natural birthing experience, with the ability to quickly transfer patients to traditional hospital set ups if necessary. I want in house doulas who understand how the hospital works and behaves accordingly. Lobby for your client but meet halfway on how things should go.
What about staffing, acuities, and set up? I don’t think the floor should be split, because patients have the right to remain in the room they’ve delivered on. I believe the staff should be split and rotate. Labor and postpartum. Minimum staffing is 3. Someone to triage/charge, a labor nurse, and a postpartum nurse. Four would be ideal, but I know that’s not feasible in non-ratio mandated states. You staff up as the number of labors increase. You can run two labors if they are early or do two inductions at nights. One becomes active so you hand it to the free nurse, labor/deliver/recover that more active patient, transfer her care to the postpartum nurse, and then take your previous labor back over or open yourself up to assist with triage/take a new patient. The free labor nurse can triage (if needed to help charge), assist with breaks, take postpartum patients. So if you have a scheduled section, an active labor, 2-3 couplets you’d staff 1 for charge, 3 to do labor, 1 to do postpartum = 4. Your section has a buddy in the free nurse, you can have charge be present for immediately after the vaginal delivery (until baby is out and okay) or have your PP nurse second the vaginal if the charge is busy. Everyone gets a turn as postpartum or labor, and you don’t get out of helping!
This means, no gyno patients. It also means you’d increase staffing for the number of labors/couplets. 6 couples is two for postpartum, 3 couplets a piece with them free to take a 4th each. 3 labors is 4 nurses for labor. You’re always one labor nurse over to buddy or take a patient. Anyone in early labor can be doubled if you’re busy and staffing is short.
I want CRNA’s on the floor, rounding for epidurals. They are sooo much easier to work with than regular anesthesiologist. I also want all doctors (OBs and anesthesia, also surgery in some form) present in the morning and at night for board report. So you know who’s a possible c/s, epidural, rapid progresser. Everyone is in the loop.
I want a modified bedside report. Report the brunt at the desk and then go together to greet the patient and examine lines. Off going nurse writes names on the board.
I’d love a better reward system for nurses who excel. Something that really breeds ownership. Meetings that are convenient for all the staff. An opportunity to grow with mentorship programs. New staff orienting to all aspects of obstetrics. Start by making them the second nurse for deliveries so they are more comfortable handling neonates at delivery, progress to monitor reading and caring for laboring patients, then recovery period, lastly postpartum. Then training sessions/ didactic that fills in the learning gaps. Learning PPH, Mag administration, preterm labor, etc.
I also believe that sending staff to training outside the hospital is imperative. AWHONN conferences, Lactation consultant seminars, or whatever educational things would enhance both the nurse and the floor.
And no more than 2-3 groups of doctors with 3 doctors in each group. I don’t have time to figure out who is on and when. Keep that mess simple. Also, more midwives! Good ones who understand practice and their limits. I’d love for there to be a midwife in triage or a OB hospitalist. They’ll be in house at night, available for precipitous deliveries, and just to make it so I don’t have to wake up that doc I dislike talking to all the time. Can I have an in house pedi to attend deliveries when needed??! Yes, I can have that.
Whoa! This got long, didn’t it? But seriously, I could go on and on. And on and on. This is just my quick ruminations of what it would be like if I was ever in charge of anything other than myself. A girl can dream, can’t she?
Here’s to a world where i dream big and get what I want.
Travel on, road warriors