Happy Hour with Bundle Birth Nurses

#48 Assessments: What Are We Missing with Suzanne McMurtry Baird

October 16, 2023 Bundle Birth, A Nursing Corporation Season 3 Episode 48
Happy Hour with Bundle Birth Nurses
#48 Assessments: What Are We Missing with Suzanne McMurtry Baird
Show Notes Transcript

Explore the vital role of nursing assessment in maternal care as we dive into a candid conversation with Suzanne McMurtry Baird, a seasoned expert in obstetric nursing. Suzanne emphasizes the importance of understanding pathophysiology and the "why" behind assessments, highlighting how nurses can make a real difference in patient outcomes. Join us as we discuss the art of assessment, early warning systems, and the role of drills and other hands-on practice to prepare practically for the different situations that come up for L&D nurses. Thanks for listening and subscribing!

Helpful Links:
- Check out Clinical Concepts in Obstetrics on their Website, Instagram and Facebook
- Purchase a High-Risk Quick Reference Bundle
- Sign Up for an upcoming LIVE Online Physiologic Birth Training for L&D RN's
- Follow Bundle Birth Nurses on Instagram

Justine:
Hi, I am Justine.

Sarah Lavonne:
I'm Sarah Lavonne.

Justine:
We are so glad you're here.

Sarah Lavonne:
We believe that your life has the potential to make a deep, meaningful impact on the world around you. You as a nurse have the ability to add value to every single person and patient you touch.

Justine:
We want to inspire you with resources, education, and stories to support you to live your absolute best life, both in and outside of work.

Sarah Lavonne:
But, don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life, trying to add some happy to your hour as we all grow together.

Justine:
By nurses for nurses, this is Happy Hour with Bundle Birth Nurses.

Sarah Lavonne:
Today I am honored to introduce to you someone that I have recommended a lot on our Instagram and someone that I saw years ago,. I remember watching her speak on one of her high risk talks, like, how does someone know so much about so much? I will say, after I saw you talk, it was in Vegas, I don't know if I could do OB anymore because I was so freaked out. But, here I still am doing OB. This person that we were having on the podcast today is Suzanne McMurtry Baird. Welcome Suzanne, welcome to our podcast.

Suzanne:
Thanks so much for inviting me. I follow y'all and all the great work that you're doing, and so I'm thrilled to be here.

Sarah Lavonne:
Yay. So are we.

Justine:
We would love to have you introduce yourself, and then we're just going to dive in to some juicy topics today.

Suzanne:
Okay. Again, my name's Suzanne McMurtry Baird. I'm coming to you from the suburbs of Nashville, Tennessee where I live. I am a nurse in OB and I've been a nurse since 1984. Always in OB. Thought I wanted to work peds. Went and worked for a pediatrician, said, nope, no way, can't do that. I would've been crying every day at work. But, love my OB life and all of the amazing people that I've met over the years throughout the country. What you want to chat about?

Justine:
Well, okay, so always an ob. I wanted to know that. Can you describe, because I've seen different things online, like director, teacher, what has been your career path and what are you doing right now?

Suzanne:
Well, like many OB nurses, we've done everything. Right? We go to work and we would take care of patients, but we had also during our career, and something I've done, is gone in and out of leadership positions. I've done every job in OB from cleaning the floor, to scrubbing in the OR, to circulating, to taking care of labor patients. I've always worked at fairly high risk centers, so that has guided my path and my journey in obstetrics nursing. I currently have a consulting company that I work with. I'm the nursing director for Clinical Concepts in obstetrics. But, it's been after many years of working in OB and leading different teams. We can talk about some of that if you'd like.

Justine:
Yeah, I would love to talk about that. What do you do with that consulting company?

Suzanne:
At Clinical Concepts, I have a physician partner who is a maternal fetal medicine physician, Dr. Stephanie Martin. I have a simulation director, Julie Arafeh, and she's out of California. We go into hospitals and we evaluate OB care from the time a patient would enter in the hospital until they're discharged. We look to work with teams to improve care for those patients. We really had started out thinking it would be more teams working just on high risk or critical care obstetric programs, but we've worked with all levels of maternal care units from level one to level four.
We help set up those programs or redefine them. For instance, a hospital may be wanting to go from level two care to level three care. We will then assist them with that, and then also we do a lot of education in that. A lot of quality improvement, a lot of team training. We'll simulate with teams, we'll set up simulation programs. Of course our background, all of our team's background is high risk and critical care obstetrics. We also set up OB ICUs because we have experience doing that, and do the education around that.

Justine:
That's amazing.

Sarah Lavonne:
I just think Bundle Birth is a unique scenario along the same lines, but also very different trajectory of what we've focused on. But, for somebody like you who's been a part of so many different scenarios, so many different roles, and kind of seen all different angles of the hospital system, what was the impetus for you to start your own company and go on this traveling simulation, high risk training thing? What got you into that, and why are you so passionate about it?

Suzanne:
Well, the three of us were actually working together in a hospital. I've been working with Julie Arafeh since the '90s, actually. She walked into my office at Vanderbilt and applied for a job, and I was the manager. After I quit drooling, I hired her quickly. A few years later, she moved to the maternal fetal medicine office. But anyway, we all reunited in Texas and were working together. We set up the OB critical care unit at Texas Children's. I was there setting up all their clinical programs, and Julie, we recruited her to come in to work with us in simulation and train our teams, like code teams and RRT teams and help refine that. Then Dr. Martin was already there with me, so we had the three of us.
When we left Texas Children's, we said we would love to be able to do this in other hospitals. I had already started a consulting company that I was utilizing just for my personal work with education and had this desire, maybe take what we did at Texas, because we really changed clinical practice in that area for OB nursing. Especially adding that OB critical care unit, for example, and moving into the new hospital at Texas Children's from about 250 deliveries a month to over 500 in less than a year. We were training all these nurses, training all these teams. We said let's do this on a bigger scale, so that's what we decided to do.

Sarah Lavonne:
I'm thinking about all of your background in simulation, high risk and what I know already of what you do. I think for me, I don't know that in my career simulation and drills were emphasized. It's always the lowest on the totem pole. Even our skills day, well, we can't staff the floor. I'd be a part of, I remember teaching at skills day and doing one session through one cohort of nurses, and then they were like, "Oh, sorry, there's nothing in the budget for this for the rest of the nurses," or, "Oh, it's too busy," and it's just put off constantly.
When you think about what you've seen specific to the value of sims and the value of this kind of high level training, what have you seen? Because again, I don't know from my perspective if it's that valued by the hospital system, and yet we literally just did this podcast about the Georgia case. The attorney was like, "When was your last sim on shoulder dystocia?" I'm like, I've never done an actual simulation on shoulder dystocia. I'm seeing that you fill in the gaps there, but if you were to speak to our audience and maybe managers that are listening to this, my guess is it's more floor nurses than anything. But, what do you have to tell us about sim/education/what you're doing and how it can affect us/why it's so necessary? It's kind of a loaded question.

Suzanne:
There's so many different aspects to simulation. I think that hospitals have taken it down one pathway when it could be utilized to do so much more. For example, I think nurses are used to doing simulations with nurses. They may emphasize a skill, but rarely what we find is that there is an interprofessional team that is practicing a specific scenario together. I think that that is a huge lost opportunity, and we can always tell. When we go into a hospital and we start simming with a team, everybody has something set up, most hospitals. But, it is in a site or away from the unit, and it is not incorporating their environment and it is not incorporating their entire team.
They have a lot of knowledge about the protocol. Let's say they're simulating a protocol on hemorrhage, that the nurses we find have a lot of practice together, but not with the physicians. When I say physicians, I'm talking about anesthesiology, OB, midwifery, residents. They may be simulating somewhere else or they may be performing simulations in a different setting, but rarely do we find that nurses and physicians and all care providers are practicing together. We see that gap. We see the knowledge gaps of what comes next, who is in charge, what are the roles. We can train even to where people stand around the bed. Again, some units are more advanced than others, but rarely do we see that the whole team is engaged, and that the whole team finds it valuable. That may include a hospital administration, but it may include other providers as well.

Sarah Lavonne:
Would it be appropriate for me to ask you what is the best unit you've ever seen? Like, any hospital was going to model after this one, this is the unit. They've got it down. Because when you say to train to even where to stand around the bed, that's amazing, and I can't imagine units doing that. Is there any unit that comes to mind?

Justine:
What did they do? What were the characteristics?

Suzanne:
The units that we trained, that's what we do, we train them to zones. We train them to know even before they come into the room what their role will be for the day. They may have a beeper or a phone. They may be assigned at shift change to say you're going to be the recorder if there's an emergency, or you're going to be medications, you're going to be in zone two. Those zones have certain roles that you know automatically you would go to. For example, if you had a code on your unit, which we're seeing more and more CPR required in pregnancy, if I knew I was going to be in zone two, I would automatically know that my roles would be chest compressions or giving medications or assisting with something in that area depending upon what the emergency is.
You can use that for shoulder dystocia too. When you have a shoulder dystocia, there are distinct roles that nurses fill and there are distinct roles that physicians fill. If you don't practice those, then you turn out to have a scenario where you might not know, do I need other help at the bedside? Do I have the adequate resources that I need to fulfill my role? In that scenario, in this shoulder dystocia, of course nursing has limited roles. Although I've seen nurses try to take on roles they might not should have, one of those being documentation of internal maneuvers, for instance. But, there's lots of ways to train and there's lots of ways to use simulation. You can even use simulation to determine if a protocol is going to function for your unit before the unit rolls it out and finds out, hey, this doesn't even work at our hospital.

Sarah Lavonne:
That makes way too much sense. Why would you do it?

Suzanne:
Right? I went into a hospital one time that we were looking at their policies, which is another thing that we do, and they had copied the CMQCC protocol for something algorithm, and they had put it just literally cut and pasted it into their policies. It said call the MFM, and I said, "But you don't have an MFM that works."

Sarah Lavonne:
Oh, no.

Suzanne:
They were like, yeah. I said, no. These kinds of tools that are already out there can just be adapted into what your resources are and what you can do at your hospital.

Justine:
People talk about simulation, but no one's actually, I don't think, doing it well that I've heard of. That's why they have to hire a company like you to come in and run the drill and get people ready. How else do you know this stuff? You can know in your head. We're not saving lives by our heads, we're saving lives by our hands and applying our brains to our bodies to respond and critically think in this scenario. I think we can do better. That's really what you do, is critical thinking in nursing and applying high risk concepts to practice in a practical way.

Suzanne:
Right, and whatever way that is has to work for your team and based upon your resources. It needs to be easy. That means our healthcare systems are so complex now that we need to make it easy. I remember that commercial that had the easy button that they would smack, and that's the way I feel when we come to healthcare, we've made it so complex.

Sarah Lavonne:
Well, you've had the opportunity to see so many nurses practice in different ways, different units. I will say, you say a phrase often that I've heard you say a few times, vital signs are vital, and that we miss a lot of things and we normalize the abnormal a lot of times. I was even sharing this with my husband last night, talking to him about this episode today. I was like, "We see 115 heart rate, and we're like, ah, she's in labor, she's in pain." He was like, "You guys just don't respond to tachycardia?" Because he's an ER nurse. I was like, "Well, but no." I would love to talk a little more about how you've seen the nursing assessment, especially in labor and delivery, diminish over the years. If you were in charge of training our assessment skills for every single nurse, every time they first see a patient, what would be your steps to be like, these are what you never forget, this is what you do. Maybe not the why, but how would you start it?

Suzanne:
I think you have to start at the why. I think that we've missed the why. I think that we've missed the understanding of pathophysiology. I think that you have to start there, because if you don't understand that a heart rate of 115, number one is tachycardia, number two is abnormal, then you tend to normalize it and you go toward those things that you feel comfortable with. What I find in nurses is they want to know the why. That's the way we were all trained. We were trained with care plans. Right? We were trained by faculty members in our school of nursing that said, "When you do an intervention, you need to know why."
But, if any of you have ever been in the hospital lately, you may have a plan of care. I know everybody has a whiteboard, but that whiteboard should be used to address, what are your goals? My goals in assessment is to provide a thorough assessment. I think that I've got to understand the why's as to why something might be abnormal. Or again, we resort back to those, I feel more comfortable with the patient being in pain. I feel more comfortable that she's anxious, that she's in the hospital having a baby, and we don't know how that's going to progress. We normalize that abnormal parameter. What I find, just that we don't understand the assessments that we're seeing, we don't understand the pathophysiology of some of the disease processes as well, and so we back and normalize our abnormals.
I think that we've also been required with our assessments to spread out those assessments that are most important. For example, I think many nurses come into the hospital and think I need to do a head to toe once a shift. That may be 12 hours. But, what we need to do is come into our shift and say this is my patient. These are the anticipatory, again, the possibilities of her care that I should anticipate ahead of time, and my assessment should be based upon that specific patient. She's high risk, she's low risk.
If she's low risk, certainly a once a shift listening to breath sounds would be fine. But, a patient who is high risk has to have more frequent assessments based upon her potential possibilities of what pathways she may go down. Hypertension, cardiac, sepsis, even if it's chorioamnioitis, we all know that you take temperatures more frequently. Right? But, that patient now is also a potential to have sepsis. I think that that is where I would start to say don't get tied down to a protocol that says I have to do breath sounds once a shift, and adapt your plan based upon the patient's needs.

Justine:
Well, this goes into what I found through teaching over the last however many years, is that I feel like I find myself saying constantly that our job is to assess. That is our primary responsibility as a nurse. I feel like that's sort of a novel concept. We all know, but that to me, everything outflows in our nursing practice from our assessment. I walk in the room, I want to lay eyes, that's an assessment. Something's off about this, that's an assessment. Then there is the head to toe. There is the vital signs. I'm at the bedside now. I have the luxury of watching other nurses practice when I'm with clients, and it is fascinating, let me tell you, the variation of nursing skill. I have never heard someone, or seen someone not heard, seen someone listen to breath sounds at the bedside during their assessment. I've done hundreds of births that way.
Now, until I had a pulmonary edema case that she had shortness of breath and everybody else is coming in with their stethoscopes. But, something like breath sounds, something like vital signs where I'm like, it's been four hours. I know she's here for induction, but she does have risk factors. I'm thinking in my mind, trying not to overstep even though I am a nurse and I am assessing constantly what's going on, those little pieces along the way, I don't know, and I would love your opinion on this, of where have we gone in terms of claiming our assessment and really owning our assessment skills, even, that I am really paying attention and my job is to assess. Instead, it's my job is to chart, or my job is to get the baby out. In our case, we hear a lot of my job is to advocate for the patient. Of course, yes. But, where's the assessment piece?

Suzanne:
You can do all of those at the same time. Right? First off, you have to go to the bedside. You cannot assess from the desk. When I walk on a unit and I see the nurse's station packed, you can't assess mom or the fetus from the desk. You have to go to the bedside. I think secondly is having some parameters around how frequent that is for all patients with specific diagnoses. For example, preeclamptic patient. If a patient is preeclamptic, she's high risk. If a patient has severe features of her preeclampsia, she is very high risk. One of those risks is developing pulmonary edema. Every two hours, that patient has breath sounds. I'm not talking about listening to the anterior upper quadrants of the lungs. I call those breast sounds. You need to sit the patient up or roll the patient onto her side, listen posteriorly throughout the lungs.
As somebody who teaches nurses, as somebody who may be a preceptor for new nurses, we have a lot of new nurses, and hallelujah for that. But, we need to train that that's what we do in our skills assessments every year. Maybe we have a virtual station where we're just listening to breath sounds and the appropriate way to do it. Same thing with heart sounds. I may not be an expert on every type of heart sound, but we have to hear them and learn them to be able to recognize when something's abnormal.
I think practicing that, having these parameters in place, that these are your expectations, that assessment is the lane of the nurse, that you are the eyes and the ears at the bedside when others may not be. Lawyers love that saying, by the way, eyes and ears of the physician or the midwife. But, that's where our nursing process starts. Remember? Assessment, noticing if there's anything abnormal in that assessment, communicating that, developing the plan of care. What do you come back to? Assessment again. It's a cycle, and that's the way it should be all shift.

Justine:
I'd be curious for you to just lay it out. Say I'm a new nurse and I'm coming onto the floor and you're training me. I'm walking in. What would be your summary of the expectation of your initial assessment? What are the things that, baseline, should be done on initial assessment?

Suzanne:
Well, I start with my vital signs are vital, and understanding if there's anything that is abnormal. A heart rate over 100, for instance, is abnormal, and we have normalized that quite a bit in OB. Then I would go through my vital signs and then I would go through talking to the patient. I would go through palpating the patient's pulses. One of my favorite things in my assessment is palpating the pulse quality. Is it weak and thready that may indicate that the patient needs more fluid bolusing? Or is it bounding and strong, which is what we would expect in a pregnant patient? Again, palpating the pulse, not just relying on the monitors.
I would palpate the abdomen, make sure it's not tender. I would palpate fetal position. I would palpate the strength of the contractions, the resting tone. Just teaching a new nurse or a student how to do that. I think sometimes they're afraid as much to touch somebody. I see a lot of gloves touching, too. You can touch somebody's abdomen without gloves on. You can palpate a pulse without gloves on. You can listen to breath sounds without gloves on. We're the personal touch. I think palpating for edema, I mean, you can't just look at somebody's lower extremities to see if they have edema. You have to palpate.
Those types of things, I would just walk through a head to toe through my systems, listening to their breath sounds, heart sounds. You'll never get good at listening to breath sounds or heart sounds unless you do it and practice. Then I would teach them, don't get so hung up on the skin. Don't get so hung up on your fall risk. Don't get so hung up on assessment of, how do you feel about your body image while you're in labor? That is seriously one of the things that I've been reviewing on charts. I've never met a pregnant woman who felt really great about their body image at the time, labor and birth. But, that is seriously in the charts these days.

Sarah Lavonne:
Wow.

Suzanne:
The skin assessment is important. But again, I've never seen a labor patient, a high risk or a critical care OB patient with an decubitus ulcer, not yet. But, assessment of that once a shift is adequate unless you're using some device that may cause erosion of the skin. But, I may see that every three, four hours, and then nothing about breast sounds in a patient who has preeclampsia.

Justine:
Well, my guess is that that's like an automatic, they just click "do the skin assessment" and the breath sounds aren't automatic. That would be my guess. I think what you said about listening and practicing will make you better is so important. I've been trying to teach some of the new grads, like, yeah, we don't all listen to lung sounds all the time, and we need to be and just start listening to them because the more you hear and see the normal, you'll cue into the abnormal. That's really important to listeners. I hope you all dust off your stethoscopes and bring them to your next shift, because it is important and we need to be using them.

Suzanne:
I think it goes back again to understanding the pathophysiology. Anybody that's heard me lecture, I love urine too, and I do love urine. Urine can tell you so much. Not just output, but what color is it? How does that relate to a patient who has preeclampsia with severe features, and she has dark, concentrated urine? Maybe you start noticing her pulse quality is much more weak, and maybe you start noticing that her pulse pressure is more narrowed. You start seeing her heart rate go up and you start seeing her respiratory rate go up. What does that all tell you?
Those are the types of things that we need to tie together and critically think about why you might have some abnormal assessments based upon whatever that patient. Well, because all of these assessments and the information that you're learning about when you do them can be applied to low risk or high risk, every patient. I've seen definitely low risk patients turn into high risk.

Justine:
Totally.

Suzanne:
Want to make sure that you're good if that occurs, right? But, you want to apply it to all your patients.

Sarah Lavonne:
Well, and I think about the morbidity mortality crisis in the US. I mean, the CDC says more than half of all maternal deaths are preventable. I say this in our physiologic birth class that, who's preventing those deaths? Hello? That's where I really think that if our assessment skills were honed, if we took charge of our assessment and said I am going to be at bedside, looking at the patient, feeling the pulses, listening to the lungs, watching and taking the vital signs regularly and taking them serious to try to piece it together, we say change the game. I'm like, it's a game. It should be a game, and it can be fun to try to figure it out. We're not celebrating when people decompensate, but also we're recognizing it. If we pick up on it early, we can prevent bad outcomes.
To me, it all comes back to our assessment. That's why what you do, what we're talking about today is so vital, vital signs being vital, to help truly, this is how we save lives. It's like when you have a bad outcome, I would think back to any bad outcome that any of us have had, and not out of blame, not out of shame, but out of learning to say, what did I miss? What could I have done better? We all should be doing that whenever there's anything that goes wrong. More often than not, could we be more on top of seeing our patients? Yeah, I think we could. Taking them seriously and piecing all the pieces together like the medical professionals that we are.

Suzanne:
Correct. I call that the art of assessment. It really goes back to even the art of nursing. That, when you practice it and you get into these routines and you understand what you're seeing is abnormal, I think nurses need some bumper lanes on our bowling lane. That is to have structure in place to have a process in which we communicate that, but that we have an expectation that the physician or midwife will then come to the bedside if we have consistently abnormal assessment in a reasonable timeframe. They do the diagnosing. Nurses do not diagnose, but the physician or midwife would diagnose, and then we would develop that plan of care.
That is called an early warning sign system. It's recommended by all of the organizations, AWHONN, ACOG, SMFM, ACNM, The Joint Commission. Actually, The Joint Commission came out with the first statement in 2010, because I was doing my doctoral work then, and I celebrated something that The Joint Commission said. That was every unit needs to have early warning triggers, and there needs to be a process by which a provider then comes to the bedside to do an assessment, to make a diagnosis, and develop the plan of care. That was actually my doctoral work that I did, implementing that at a large community hospital. That is going to change outcomes. That right there, because it's not just the assessment, we have to have response to that assessment.

Justine:
Yep.

Sarah Lavonne:
I think nurses also may feel responsible for the response, which what I would say to that is that we're responsible for getting the team responding, but we're not responsible for the whole thing. It's a team effort. I think that can feel like a lot of pressure otherwise. But, I think we're responsible for assessing, seeing what's going on, and then alerting the team and assuring that the team is responding.

Suzanne:
Yes, an expectation of the team. It's not just the expectation of the nurse, it's the expectation of administration, the physicians, of the midwives. They want to know when their patient has changed status. That's our job, to notify them. Right? I have a heart rate of 120. I am not going to try to explain it away. It has been climbing up and now we're at 120. You need to come to the bedside and assess the patient to determine, why is this patient's heart rate at 120? I'm not going to call with just one value. I'm going to tell them blood pressure, heart rate, respiratory rate, pulse oximetry, other assessments. What is the fetus doing? I've taken her temperature. I haven't given her any meds to make her heart rate go up. I need you to come and assess the patient and make a diagnosis as to why this patient's heart rate is 120, because that is abnormal.

Sarah Lavonne:
Well, but this patient, I know her from the office and she's super anxious. I'm sure it's just anxiety.

Suzanne:
Yeah, that is one of the last things I usually see in a chart that, when I turn the page, the patient decompensates and codes. One of the typical OB normalization of abnormal is in heart rate. We say the patient's in pain or she's anxious. Those should be off your list until you've ruled out every other reason, because hypoxia, infection, sepsis, all of these can cause a tachycardia. If you know that you haven't had, I don't care if she has been running a heart rate of 120. If she's been running a heart rate of 120 in your office and you didn't do any cardiac assessment, then that is a violation in standard of care.

Sarah Lavonne:
I'm a nurse and I'm listening to all of this, and my response to you is, I have two patients. There's not enough staff. This all takes so much time, and it's the hospital's fault that they don't staff us well. I really can't do that thorough of an assessment because I'm just too busy. I'm just too run down.

Suzanne:
It really doesn't take that long to do a full assessment. If for some reason you cannot meet the assessment that a patient needs, then it's your responsibility as a nurse to go to the charge nurse, or the manager or whoever it is on that shift, whatever your structure is, to say I need some time with this patient until I can get this figured out. There's always going to be resources and ways in which we can flex during a shift and to help each other out. I've worked on many different units and I've worked with many different levels of staffing over my career, and you can always flex. We do the best we can, but that patient who is decompensating is the priority. That may mean that elective inductions are called off until staffing can become adequate to take care of the needs of the patients on your unit at that time.

Sarah Lavonne:
Well, and I want to remind people, this came to me as I was a manager, because you start to see things a little bit different. Normally as a staff nurse, you're kind of like, well, I don't have time, and they don't know, and blah, blah, blah. I remember thinking, I wonder if the cultural issue here is the fact that we think we're entitled to sit at the nurse's station and to chat with our friends all night, and how that quickly becomes an excuse for we don't have time. Really, I am trying to prioritize hanging out at the nurse's station and getting out of the room, instead of prioritizing the needs of the patient.
I want to remind people too, this just makes me think your job is to the patient. If you don't talk to your coworkers all night, you're not there to talk to your coworkers, go to brunch after your night shift and have a mimosa and debrief the shift together. Get your time outside of there. You are being paid to assess and watch this patient and make sure that they're safe. If we're missing it, that's on us. Yeah, I just think we need to remember that while staffing might be challenging, that our job is to be at the bedside.

Suzanne:
I know staffing is challenging all over the country. Again, if we go back to the art of assessment though, and we think about what is absolutely necessary to do for these patients, then maybe if we could skinny that down and get rid of a lot of the charting that is not necessary. This is where your nursing administrators need to come in and say that Braden skin score, I know you want it done, but in OB, we're going to do that once a shift and that'll be our head to toe. But, we really don't need to do that every four hours, or whatever parameters that have been set up, because that's not our patient population. It's not a neonate with oxygen prongs on. It's not an elderly woman who's 86 years old.
We've got to get back to what's important, and that is paying attention and doing the assessments that we need to do based upon that specific patient. Then, yeah, it's always a drag if, it always seems like I would get the highest patient acuity assignment the night we would have potluck or something, or I'd have to go and do this in the OR whole time. I'd be like, well, y'all enjoy because I'm not eating tonight. I understand all of that. You got to have fun at work and you've got to enjoy your coworkers and everything. But when patient needs, with our maternal morbidity and mortality rising, we've got to flex to whatever the patient needs.

Justine:
I love that.

Sarah Lavonne:
Well, thank you for hanging out with us, Suzanne. If you have any last minute words of encouragement for these nurses about to change their practice and become the best little assessors ever, what would you say?

Suzanne:
Go in the room. I love being in the room and talking to my patients and getting to know them, their family members, their support members. I do all my charting in the room instead of bringing out my strip to the desk or going back and scrolling back to do my assessments. I sit there, I talk to them. I get to know them. I'm there to do my hands-on assessments. If you have two patients, then I go back and forth and I spend time. Not every patient is constantly have driving needs for you to do something around the clock. Some may and some may not, but usually those are at least one-on-one. Hopefully more and more units will have one-on-one staffing for active labor patients at least, or especially if they're being induced. But if not, then you do the best you can. But, assessment trumps everything else. Laying your hands on the patient and getting to know your patient and having them trust you is, to me, the most important role you can play as a nurse.

Sarah Lavonne:
Suzanne, if they wanted to find you, where could they go? If a hospital's listening or somebody with hospital decision-making power is listening, where can they go to follow and maybe potentially even bring you to their units?

Suzanne:
You can find me online at our website, www.clinicalconceptsinob.com, and/or social media. We are on all social media platforms and you can send us a message on any of those, as well as on our website. Hope to see some of y'all around the country, and come up and say hello, because I want to talk to you and see what's new on your unit and see what's going on.

Justine:
Great. Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram.

Sarah Lavonne:
Now it's your turn to go and assess your patients. Get really good at those skills. Get used to laying your hands, without gloves, and obviously charting in the background. But, the priority becomes getting to know your patient and watching for signs that things are changing. We'll see you next time.