Kansas State Conference

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Click HERE to register!

 

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Infant Loss

It was a routine induction that turned into a cesarean section for failure to progress.  The fetal tracing had looked great except the last 20minutes we were having a hard time keeping the baby on the fetal monitor.  Since we were moving into the section room no one was too concerned at this point.  Nothing was out of the ordinary until the physician brought over a limp lifeless baby.  My heart sank.  We did everything we are taught in NRP.  Chest compressions, epinephrine, intubation, nothing worked, no heart rate.  What seemed like forever we worked on this baby all the while the mother  and father are there watching us.  By the time the pediatrician arrived he said we should stop it had been almost 30 minutes with no heart rate.  I didn’t want to stop I wanted to give them the little girl they were supposed to take home.  This was by far the hardest day of my nursing career.  We had a photographer come and take pictures with the family.  Tears were shed by all involved.  Nothing prepares you for a unexpected loss like this.  As a group we were lucky to have a formal debriefing.  It was difficult to watch the family go thru the emotional pain and suffering over the next few days.

Two years later I received a card from the mother and a bracelet with charms one for being an angel trying to save their baby. She remembers me not wanting to give up on their daughter and doing everything we could to try and save her.  She will never know how much this meant to me.

They went on to have other children and was honored they requested myself to be there for delivery.

 

 

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Advocacy 101: my Nurse in Washington Internship experience

Each year AWHONN awards two scholarships to the Nurse in Washington Internship program in Washington, D.C. I was thrilled and honored to be one of those recipients this year, and I’d like to share my experience with you.

The Nurse in Washington Internship (NIWI) program is held for three days each spring and is sponsored by the Nursing Organizations Alliance. It is designed to teach nurses about the legislative process and how to develop the skills necessary to be constructive and effective advocates for our profession, our patients, and ourselves.

The first two days at NIWI were focused on preparation. Prior to my arrival I had been sent multiple articles to read, websites to explore and public policy to review.  We then focused long days of training on how to identify the legislation that directly impacts healthcare, who to contact for additional information, and how to build collaborative relationships with our local, state and federal representatives.  We met with current and former lobbyists, legislative aides, and elected officials. We learned about the legislative process, how to build an effective “ask” (specific issues on which you want to influence your legislator), and tips on navigating the complicated and unfamiliar world of politics.

The final day of my NIWI experience I spent on Capitol Hill. I had appointments with Senators Pat Roberts and Jerry Moran and Congressman Kevin Yoder.  These appointments were made several weeks ahead of time to ensure that I would have a few minutes with each of my representatives.  Unfortunately, the schedule was complicated by severe weather, as a major snowstorm moved into the D.C. area the night before my appointments.  Congressman Yoder and Senator Moran were unable to fly out of Kansas City during this time, so I met with their legislative aides instead.  I was able to meet Senator Roberts very briefly, but spent most of my time with his aide as well.  Undeterred, I shared my “asks”, educated them on the specifics, and provided my contact information should they ever need more information or clarification.

I had three topics on which I provided education and requested support. The first was to request that each of my legislators join the Nursing Caucus, a bipartisan House and Senate committee designed to learn more about issues impacting our profession and how nurses are transforming healthcare in America.  Republicans are woefully underrepresented on this Caucus, and none of my representatives had joined.   I’ll be checking in with Senators Roberts and Moran and Congressman Yoder on a quarterly basis to remind them of this important opportunity.

My second request was for $244 million dollars toward the Title VIII Nursing Workforce Development Program. An investment in this program will help ensure access to care across the nation in the face of an ever-increasing nursing workforce shortage.  Title VIII provides Nursing Education Grants for thousands of entry-level and graduate nursing students and has partnered with over 4,200 clinical training sites, many of which target medically underserved communities.  This request was well-received by everyone I spoke with.  This is considered a bipartisan issue that is popular among both conservative and liberal constituents.  The public knows about the nursing shortage, and support for increasing the available workforce is widespread.

My final request was that they support continued funding of the National Institute of Health (NIH), which would provide $160 million dollars to the National Institute of Nursing Research (NINR) for Fiscal Year 2018. Though that sounds like a great deal of money (and it is), it represents a tiny fraction of the NIH budget.  I provided examples of how nursing research is transforming patient care from the bedside to the boardroom and encouraged them to remain steadfast in their support of this important foundation.  It’s important to note that shortly after my visit, President Trump’s administration rolled out a budget proposal that included $6 billion dollars in cuts to the NIH.  I will include information at the end of this blog on how to contact your legislator.  Please, please let your voice be heard.  Cuts this size will be catastrophic to the NIH, the NINR, and future growth of healthcare research, innovation and outcome improvement measures.

My experience in Washington as a legislative Nurse Intern was remarkable. It was humbling and overwhelming to see firsthand the democratic process at work, and I am inspired to continue my efforts to advocate and influence public policy for the betterment of our patients.  Friends, don’t be afraid to use your informed and educated voices.  Your elected officials on every level need to hear from you.  And they want to hear what you have to say.  I was repeatedly told how much they love nurses.  We have been America’s most trusted profession for years.  Legislators regard us with respect and believe that our voice is one of bipartisan credibility.   Please, use the links below to find out who your elected officials are and then take a moment to introduce yourself to them.  Let them know that you’re available for questions.  Tell them how you feel about healthcare reform, funding, and growth.  Advocacy isn’t just meeting senators in Washington, D.C.  Advocacy is calling legislators’ offices to share your opinion, signing letters that represent your profession’s viewpoints, attending town hall meetings, or joining political action organizations that share your beliefs.  And never forget that the most important way of all to advocate is also one of the most simple:  Vote.  In any election-local, state, national:  let your voice be heard.

State legislators: https://openstates.org/find_your_legislator/

U.S. House of Representatives: http://www.house.gov/representatives/find/

U.S. Senate: https://www.senate.gov/?State=PA

Voting registration: https://www.usa.gov/register-to-vote

 

 

Heather Scruton, MBA, MSN, RNC-OB, CEFM

 

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On being certified

I remember the first time I ever heard of a RN being certified – I would love to say it was before I became a RN (and maybe it actually was). The first time I REMEMBER hearing about it, I was working as a RN on a busy, urban, L&D unit. I met this incredible clinical nurse specialist named Carol Burke. Carol had a passion for placentas that was admirable – I wanted to be like Carol when I grew up. When Carol offered a free certification review for staff RNs in OB/PP, I started thinking more about this certification thing . . .

The prep, the reading, the practice questions – don’t get me wrong, they were all worthy parts of the process. But it was not until after I achieved certification, years later really, that I understood the value.

At the time, as a RN in Illinois, there were not State requirements for continuing education. Although I have always loved learning, time has a way of escaping you. You realize the last conference you attended was 18 months (5 years, whatever) ago. While there was not a mechanism in place to require CE for my licensure, certification changed this.

All certifying bodies have requirements. My nursing certifications are through the National Certification Corporation (NCC). NCC is the primary certifying body for RNs in OB/NICU nursing and Advanced Practice Nursing. Although their process has changed quite a bit over the years, the message stays the same: certified RNs need to stay current and evidence-based. Check out the one minute public awareness campaign called “Just Ask” from NCC: http://www.nccwebsite.org/justask.aspx.

The q three year assessment I take for my certifications pushes me to seek education in areas I may not choose on my own. It highlights areas for improvement and then, well, makes you address it! The first time NCC rolled out their “assessments” and subsequent assigned CE based on scoring – I was embarrassed! I knew what my areas of weakness opportunities for learning were, but to have them in writing felt so vulnerable. Since NCC has adopted the assessment process, I have come to love being certified. The assessments are not intimidating anymore – I look forward to seeing how I have improved in areas, and where I can turn my attention for further growth. Being certified has helped me become a more well-rounded RN within my specialties, and has provided some framework with where to go. Nursing is life long learning and growth – certification can guide the way.

 

-Kim

 

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The DNP Degree

Image result for doctor of nursing practice

The Doctor of Nursing Practice (DNP) degree is similar to the PhD in that it is the highest level of education available for nurses. The DNP places an emphasis on clinical practice and leadership training while the PhD focuses on scholarly research and inquiry (All Nursing Schools). In other words, the DNP nurse implements evidence-based, best practices that is generated from the PhD nurse.

Many issues have driven this change in nursing education at the graduate level including increased complexity of patient care, nursing personnel shortages, lack of doctorally-prepared nursing faculty, and increasing educational expectations from other members of the healthcare team (American Association of Colleges of Nursing (AACN), 2016). Nursing is following the course of these health professions in transitioning to a doctoral degree for entry-level practice. Examples from our interprofessional team members include Audiology (AudD), Dentistry (DDS), Medicine (MD), Pharmacy (PharmD), Physical Therapy (DPT), and Psycology (PsyD).

The DNP is a degree (not a role). Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse-Midwives, and Certified Nurse Anesthetists are all eligible to pursue a DNP. There are currently 289 DNP programs in existence and are located in 48 states plus the District of Columbia (AACN, 2016). Nurses who currently hold an MSN are grandfathered into practice and are not expected to return to school to obtain a DNP.

There are many reasons nurses opt to earn a Doctor of Nursing Practice (DNP) degree: a desire to learn more, career advancement, job requirement, entry-level into practice, or bucket list item. A practice doctorate ensures nursing is on par with other members of the healthcare team (Michigan Center for Nursing, 2016). Although my current role did not require me to pursue my DNP, my choice was motivated by several factors. I wanted to show my kids that learning should never end, have the preparation to lead teams effectively in my facility, and check this off my bucket list :-).

Here is an additional resource for those considering advancing their knowledge. It is a post containing additional information about why another NP chose to pursue her DNP degree: http://www.melissadecapua.com/blog/category/doctor-of-nursing-practice.

Susan Thrasher, DNPc, FNP-BC

References

All Nursing Schools. (ND). Reach the top with a DNP. Retrieved from http://www.allnursingschools.com/dnp/

American Association of Colleges of Nursing. (2016). DNP fact sheet. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/dnp

Michigan Center for Nursing. (2016). What does a “Doctor of Nursing Practice” mean to you? Retrieved from https://www.michigancenterfornursing.org/news/news-reports-and-data/what-does-%E2%80%9Cdoctor-nursing-practice%E2%80%9D-mean-you

 

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What we don’t know about mother’s milk

“Breast milk grows babies’ bodies, fuels neurodevelopment, provides essential immunofactors and safeguards against famine and disease — why, then, does science know more about tomatoes than mother’s milk? Katie Hinde shares insights into this complex, life-giving substance and discusses the major gaps scientific research still needs to fill so we can better understand it.”

My personal experience as a breastfeeding mom is extensive. I nursed my first baby for 11 months. She self weaned. But that was 24 years ago and I started giving her cereal and juice at 6 weeks of age, per my pediatrician’s recommendation. Wow, how things have changed!! I nursed 6 more babies after her, including a set of twins, and even tandem nursed a toddler and a newborn for a brief period of time. The American culture is not very friendly to what I have come to learn is “ecological breastfeeding” which follows more closely to what the rest of the world does and what the World Health Organization recommends.

The more we learn about the magic juice that is breast milk, the more apparent it becomes that we know almost nothing.

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Spinning Babies

Recently I was blessed enough to have the amazing opportunity to attend a Spinning Babies workshop.

I have been a labor and delivery nurse for almost 6 years. In that time I have learned a lot of tricks from veteran nurses on what to do to help a laboring women who has gotten “stuck”.  About 2 years ago a couple of my colleagues attended a meeting where they saw a small look into Spinning Babies. They returned very excited and wanting to implement these great tricks they had learned. Slowly we started using a couple of the moves, specifically sidelying release . We even had some doctors request we do “that side thing” to help their patient progress and avoid a cesarean section. So when a full Spinning Babies class was offered in our city a group of 10 nurses from my unit jumped at the chance.

We learned about a lot of techniques. Not just how to do them but when to use them and why they work. We gained knowledge to use not only during active labor but latent labor and even how to get baby and mom in the right position for everyday life and future labor. We now have the quick reference guide on our unit for all nurses to access and use in practice. We often have nurses who were not able to attend the class find a nurse that was and ask advice on what to do for the patient. We have already been able to see spinning babies techniques work tremendously on our unit.

There was another amazing unexpected benefit from this class; collaboration of the birth workers in our community. I believe this class helped the doulas and nurses understand our different roles for our patients and understand that all we want is for our patients to have the birth they want. I have seen the nurses and doulas on social media exchanging ideas on how to help patients in labor.

If you ever have to opportunity to attend a Spinning Babies Workshop I highly encourage you to attend. It was beyond worth it. Check out their website for information on techniques and to find a workshop near you!

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Birth Trauma

As simple as holding their hand…

https://awhonnconnections.org/2017/03/16/lessening-the-risk-of-birth-trauma/

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Evidence into Practice, Cord Clamping

In January of 2017, the American College of Obstetricians and Gynecologists (ACOG) released Committee Opinion #684 Delayed Umbilical Cord Clamping after Birth.

ACOG provides the following recommendations regarding the timing of umbilical cord clamping after birth:

  • In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
  • Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage

In doing some research into cord clamping and where AWHONN stands I found a press release from 2015: Many Infants Show Health Benefits from Delayed Umbilical Cord Clamping.

The release stated “In many birth settings, it is standard practice to clamp and cut the umbilical cord immediately after birth. Early cord clamping is deeply embedded in maternity care as part of the routine of labor and birth. In fact, this practice was once believed to prevent potential harms such as jaundice from “too much blood.” However, no published, randomized controlled trial research since 1980 supports this concern. Additionally, no maternal health outcomes have been shown to be negatively affected by delayed clamping, including postpartum hemorrhage rates.”

Even with the ACOG Committee Opinion and AWHONN statement above: Is delayed cord clamping occurring in practice?

Moving research findings into sustainable improvements in patient outcomes remains an obstacle to improving the quality of care. In fact, up to two decades may pass before the findings of original research become part of routine clinical practice.

TWO DECADES!! As nurses we need to advocate for our patients and help move evidence into practice at the bedside. So I urge you to question hospital policies, have those tough conversations with physicians, participate in shared governance, speak to administration or leadership but we can’t allow two decades to pass before utilizing evidence based practice!

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ACA Replacement

From the American Nurses Association:

Congress: Hold public hearings on the healthcare bill!

 

The Republican Party’s health care legislation has just been introduced – but some in Congress are trying to rush the process by denying any public hearings to review the legislation.

This bill is too important to rush through without ANY input from the public. Tell your representative to commit to having a fair hearing on healthcare that includes the voices of nurses and patients!

Click here to quickly and easily message your Congressman and Senator to let them know how you feel on this issue!

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