Learning to Fly

Oh, friends, I’ve been writing so many blog posts in my head, but somehow, they’re just not making it onto the [virtual] page. Lest you think I’ve been swallowed alive by clinical this summer, I’m taking a deep breath, settling in, and going to write a post about how things are going so far, because otherwise, I’m pretty sure I’ll forget what it feels like in this moment, to be on the cusp of learning how to fly more independently as a L&D/PP nursing student.

The Setting
My clinical site is a small, community hospital with about 150 beds total. 14 of those are in the Birth Place, a LDRP (Labor/Delivery/Recovery/Postpartum) unit. Some days all 14 beds are full…some days not so much. Except when I have other school stuff scheduled, I’m there when my preceptor is there, which is every Wednesday and Friday, every third weekend, and every third Monday (but the Monday’s are not the same week that we just worked a weekend, if that makes sense). My preceptor works a day shift, 7am to 7:30pm…so that’s when I’m there.

There’s anywhere from three to five nurses on any given day, sometimes more if they know procedures are scheduled. There are two scrub techs who double as HUCS, and they set up tables, do the hearing screens, help with vitals if needed…basically, know everything about the unit. There’s one OR, no NICU, and they really only take mostly low-risk patients after 36 weeks. So…lots of mostly normal birth going on here. Inductions and epidurals, to be sure…but not a lot of crazy complications or anomalies.

My Day
It’s different every day, depending on if my preceptor gets assigned a labor patient or postpartum patient. If it’s a labor patient, we’re 1:1, for postpartum 3:1. At this point, I’m starting to do more independent care…so we’ll go in together and meet patients, but unless there’s something I don’t know how to do, I’m mostly doing stuff on my own. What is that stuff, you ask?

Skillz
Well, for laboring patients, I’m helping get them admitted and settled into their rooms. I put the monitors on, take their vitals, do a physical assessment (listen to heart, lungs, check deep tendon reflexes, assess edema). I talk about what an induction will look like. I (try to) start their IV site if they need one (most patients will get one unless they specifically ask otherwise). I chart all those things in Epic. I get them water, or juice, help them order meals. I bring them birth balls, rocking chairs, or telemetry units so they can walk around the unit if they’re on monitors. I give medications, for nausea or pain, or if they have other home meds they take. I’ll hang a bag of fluid, or antibiotics if they need it. I’m in the room every half hour if they’re in active labor and getting pitocin (which I’ll also hang), monitoring their EFM strip and charting it. Oh, and you know, providing labor support as needed. Many patients on our unit end up getting epidurals, so I help with that, too–hanging a bolus of fluid, all the charting involved, regular vitals, etc.

Before the actual birth, I help the scrub techs get the birth table in the room, which has all the supplies the midwife or OB will need–cord clamps, sutures, placenta bowl, hemostats, sponges, etc. I bring in a lamp for the provider, and a mirror for the mom if she wants it, and an extra trash bag and dirty linen container. I bring in the baby warmer, turn it on, and make sure all the resuscitation equipment is ready to go, just in case (usually, babies stay skin to skin with mom, unless they need a little help with breathing). And I’m helping the mama as she’s pushing. I’m checking in with the baby nurse, giving updates about how labor’s been going. If mama hasn’t peed in a while, I might insert a Foley catheter, or straight cath her, depending on the preference of the provider.

After birth, I’m helping the provider as they wait for the placenta, handing over suture materials during any laceration repair needed. Or I’m helping do vitals and physical assessment on baby, giving vitamin K and Hep B and erythromycin (or “eyes and thighs,” as those meds are referred to, as the first two are injected in the baby’s thighs and the other in the eyes). I’m assessing mom’s bleeding, palpating the fundus to make sure the uterus is clamped down. Sometimes I’m administering more pitocin, depending on bleeding. I’ll help get her up to the bathroom for the first time, teach her perineal care if she has stitches. I’ll get more pain medication to her.

Of course, then there’s breastfeeding support. I’m getting better at finding the most succinct way to explain baby latches, and learning the gentle art of more hands-on support as they try to nurse for the first time.

Looking back on all this now, it sounds so simple and straightforward…but in all honesty, it took me the first few weeks to figure out the general rhythm, where things are, when and how to chart that she moved positions in labor, or got in the tub, or successfully latched. Plus all the little secrets: where to find the stretchy belly bands to hold the monitors, which most mamas like better than the velcro belts…or how to put a wash cloth in with the monitor to hold it in place better. It hasn’t been until the past week that I felt I could even begin to contemplate walking into a room without my preceptor and feel remotely competent.

But friends, it’s starting to happen! I imagine myself a bit like those awkward, clumsy baby robins you see in the spring. You know the ones…they’re all huddled together in the yard, flapping ridiculously, with their mama watching nearby, peeping encouragement or advice. But she knows that she can’t do it for them, so mostly stands back, even as they flap and flap and start squawking with frustration as they watch their siblings get airborne for seconds at a time.

It’s the strangest of sensations, but I’m starting to feel more like a nurse each day. Of course, there’s still so much more to learn…but those little moments in which I notice my feet aren’t on the ground and my wings are flapping just so and I’m not crashing back to the nurse’s station in search of that thing that I swear I saw in the supply room the other day…those moments are worth all the long hours of lecture and papers and reading. I know that this feeling will be short-lived, because in a few weeks, I’ll wrap up clinical and then move on to grad school, where everything will be new again…but at least for these last four weeks, I’m going to relish this feeling.

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