Sarah Lavonne: Hi, I'm Sarah Lavonne, and I'm so glad you're here. Here at Bundle Birth, 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 person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life, both in and outside of work. 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. By nurses, for nurses, this is Happy Hour with Bundle Birth Nurses.
I am giddy inside to have this guest here. I have been watching Rose from afar. We've been in the same environments in various times in my career. This is one of the greats of our nursing, perinatal nursing, and labor and delivery. To have her here today is so exciting for me, so exciting for you. I'm going to actually read you her bio, which we get bios from everybody whenever we do podcasts with people, but I don't normally read them. I like people to introduce themselves, which I will have her do here in just a second.
I think when we think about, and we're going to talk about this, that when we think about nursing, at least this is how it was for me, I became a nurse to be a bedside nurse and help people and be a part of people's birth experiences and go to the hospital and clock in and clock out. What I learned as I have grown and gone into various roles that I never pictured myself being in is that there actually is so much more that we can do with our degrees. To have role models in our environments, in our profession, of the creative, impactful, and outside-the-box ways that we can use our degree, I think Rose is such an incredible example of that. Also, as a change agent, as a leader in our world.
I'm so excited for you to learn from her, hear her story, but I'm going to read you her bio here, and then I'll let her introduce herself. Rose Horton is the founder and CEO of NotOnMyWatch Consulting Partners, an LLC she created three years ago after coining the hashtag #NotOnMyWatch. You've probably heard of that already. I know I've seen it everywhere. In this role, she provides consulting for healthcare organizations, keynotes, and teams trainings. She created the hashtag out of frustration at the rising rate of maternal and infant morbidity and mortality.
As an executive nurse leader, she believes that nurses, as the largest healthcare employee contingent, have the power to change the trajectory of morbidity and mortality. Sound familiar? This is why she's here. The hashtag is a call to action for all nurses to use their collective voices to support, listen to, advocate for, and follow evidence-based practices in caring for all birthing people.
Now listen to this. This is so fun. Rose was inducted as a fellow of the American Academy of Nursing in October of 2022, nursing's highest honor. She serves as the 2025 President of the Association of Women's Health, Obstetrics and Neonatal Nurses, aka AWHONN, a 25,000 nurse member association that is pivotal in creating, supporting, legislating, and researching best practices and evidence-based care of women and newborns.
Rose also serves on the board of directors for Healthy Birth Day, Inc., as well as the scientific and clinical advisory board for Medela, and on the executive committee for the National Network of Perinatal Quality Collaboratives. Rose is the Executive Director of Maternal Health of Huggies International. Okay. Welcome to the pod, Rose. We're so happy to have you here. Jump on in and tell us who you really are because that is so incredibly impressive, but we want to know also, who are you?
Rose Horton: Thank you for that. Thank you so much, Sarah, for having me here. I love that question, "Who are you?" I remember being at a meeting recently, and I just didn't feel like titles are important. I said, "I am a labor and delivery nurse." I had a colleague sitting next to me who's very accomplished. He's like, "I love that. I am a lactation nurse." It's like, what's at our core of our being? At my core, the way I see myself, the way I identify, is as a labor and delivery nurse. We'll start there. Even though my most recent role in the hospital was a service line administrator over labor and delivery, mother, baby, NICU, lactation, and education, I see myself as a labor and delivery nurse.
I remember my first clinical and OB and seeing my first birth, and my eyes welling up in tears. I'm in a corner going like, "whoo". I knew right then that this is what I wanted to do for the rest of my life. The thought that I could do that and get paid, I'm like, "stop it". At my core, that's who I am. That's who I'm called to be. I'm other things, but that's who I'm called to be. That's how definitely I see myself. I've been privileged because of great relationships of people who have tapped me and said, in essence, "I see greatness in you. Consider doing this. Let me help you. Let me support you."
I've been privileged with lots of opportunities. I'm thankful for that. I try to be intentional in giving back as well and pulling others along and saying, "Hey, I have this opportunity. Let's do this together." Another thing I would say that I've done in my career that I love that's not even listed is that I was a flight nurse. People are often amazed when I say that, the eyebrows go up. I'm like, yes, it speaks to the fact that I am an adrenaline junkie at my core as well. [chuckles]
That was so much fun for four years, just being on call and never knowing where you're going to get the sickest OB patients out there. Being able to do your critical thinking skills, and do your assessments, and have an action plan as you get your patient back to the hospital. That's important to know about me also. I'm an adrenaline junkie.
Sarah Lavonne: That's the biggest thing that I miss about being at the bedside. Somebody asked me that recently, where I was like-- They were like, "Do you want to go back?" I was like, "Yes, for the emergencies." Which sounds so like-- I'm physiologic birth lady. That is so not it, but I love it too.
Rose Horton: I totally get it.
Sarah Lavonne: This is totally off topic than what we had-- We'll get to the NotOnMyWatch because I'm so excited to talk about that. I'm thinking about our listeners and the fact that you've just done so much. It sounds like you said even flight nursing for four years, labor and delivery, and then all the leadership roles, and getting involved even in legislature in AWHONN. AWHONN is such an incredible accomplishment. How did you know that it was time for a change? To make those adjustments throughout your career.
Rose Horton: I think that's a great question. For the most part, a lot of the changes came organically. I'm a very curious person, and I get bored easily. Every three years, I need a new challenge, something to be like, "Oh, the next shiny thing," as my husband calls it. For the most part, because I remember when I went to Denver, I went to Denver from New York for a travel assignment just for the summer, because I had children and they had school in New York, just for the summer.
When I was interviewing, a flight nurse came in to talk to the nurse manager, and she's like, "Oh, I'm sorry. I didn't know there was somebody in here." The manager, Judy, she's like, "Oh, no, no, it's okay." She's like, "Wanted to tell you I'm going to Wyoming and everything's fine in the unit." Just a couple of little things she said, and she left. I was like, "You have a flight team? I've always wanted to be on a flight team, but I didn't want to go to the ICU or go to the emergency department." She's like, "Yes, we do." I'm like, "Can I join the flight team?" She was like, "You're a traveler." I'm like-- details.
I ended up loving, absolutely loving Denver, loving the hospital, the mission, and we decided to move. That opportunity presented itself organically. I remember the nurse manager saying, "Listen, Rose, it's a really rigorous process to join the flight team, it's the cream of the crop because you're on your own and you have to make all these decisions." I'm like, "I got it. I'm here for it. I can do that." A lot of things like that happen organically.
I have to say that when I joined AWHONN many moons ago as a baby nurse in 1999, I feel like that was another huge transition for me. When I joined AWHONN, I was, and I'll always remember, everybody always remembers your first AWHONN conference because you are eyes wide open, like, "Oh my God, everything is awesome. I didn't know this existed." I remember going to the exhibit hall, and I have my first-time attendee badge. I'm looking around excited with my friend. Someone came up to me. She's like, "Hi, I see you're a first-time attendee." I'm like, "I am." She's like, "Oh my gosh, what do you think?" I'm like, "Oh my gosh, everything is so great. I love it so much."
It happens that it was the CEO of AWHONN at the time, Gail Kincaide. She just engaged me in a conversation. She asked me some questions, and I told her, and then she asked me some more probing questions. I'm like, "Well, if you really want to know, I'll tell you all the things." We forged a relationship. She personally made it her mission to move me forward. Let me tell you, 1999, AWHONN wasn't very diverse. She asked me a question that I thought was interesting. I answered it one way, and she, like, "What do you really think?" I said, "Well, I haven't seen any Black people presenting." I said, "I don't see people who look like me here. They're all middle-aged." Before I was middle-aged.
She was like, "Oh my gosh, what do you think we should do about that?" I'm like first-time attendee. [laughs] She engaged me, and she really wanted to know. She would email me, and she invited me to different opportunities. She wanted me to-- She's like, "You want to present. What do you think we should do about this?" I attribute so much of who I am as an AWHONN member and the opportunities I've had because of that relationship. I didn't know it existed. I didn't have a vision of being on the board of AWHONN. I never dreamed that I would be the President of AWHONN. Organically, somebody welcomed me, saw greatness in me, gave me opportunity, and one thing led to another.
I would say that there's very few things that I passionately pursued outside of my RNC-OB certification. There's very few things that I pursued, but opportunities were presented. I was like, "That sounds cool. All right, let's do that." I feel like that's mostly my story.
Sarah Lavonne: I'm thinking about that new nurse, again, on the floor, or myself, for instance. My trajectory, it's interesting. I relate a lot to what you're saying. Some of it, I created myself, and I've gone hard after certain things, but a lot of things have just unraveled organically. I think if I were new, I would want to know, one, that that can happen, but, two, it sounds like you were in the right place at the right time as well.
That exposure outside your unit, in other environments, like an AWHONN, are there any other environments you would suggest for these new nurses if they're like, "I want to get involved, I want to know more, I want to expand my brain?" To be a part of everything happening in the world of OB in whatever way they can contribute. I think also, there's a side of me, this is my own personal journey, that I was literally just talking to my coach about this, who is now basically my therapist as well.
I was saying that I feel like in my adult life, there have been people that see greatness in me, like you said, but I also think that I have some internal messaging around, "I don't want to be a nuisance, I don't want to overstep." Yes, I'm so passionate, I have lots of ideas, and I want to help with everything all the time. I also am not one to insert myself into those environments. Even when people reach out, for instance, at Synova, which is where we officially met this last-- a couple months ago, I had somebody come up to me and talk to me about mentoring me.
It was so therapeutic and healing for me to be like, "Oh my God, there is someone out there that wants me to succeed," because it can be really lonely when you're that person that cares so much. I know that so many of our nurses all over the place are those nurses who just want to do better, and they want to help, and they want to be engaged, and they want also someone to see that in them, and maybe they're not getting that in their units. Do you have any advice for those types? That was my long rant about it, but what would you say to them?
Rose Horton: I would say just to be open to opportunities and possibilities. I remember-- I've lived in seven different states, and I live in Georgia, and this is our final destination. No pun intended on those movies, but I'm staying right here. I remember when I was in Huntsville, young nurse, baby nurse. I did a presentation on-- this will tell you how early in my career, on PIH, pregnancy-induced hypertension, instead of gestational hypertension now. I remember doing this presentation, and I remember we didn't have these sophisticated AI tools in PowerPoint, but I remember that there was an ability to draw. I remember drawing on my slide with that little pen emoji. Trying to show what a vessel looks like and the vasospasms that happens in the vessels.
Anyway, I did this presentation. This is my first presentation, but I went all in. It reminds me of something I heard you say. You talked about doing maybe 150 hours of research and investigation for maybe one statement.
Sarah Lavonne: Yes, I'm crazy about that.
Rose Horton: I was fascinated with pregnancy-induced hypertension, not gestational hypertension, and preeclampsia. I did a bunch of research, and I got some great images, had this really fancy presentation that I did it for the team in Huntsville. The director-- I was hired as a perinatal clinical specialist, but not CNS, because I'm not a CNS. She wanted me just to have oversight over-- Really, it was program development for the Women and Infant Services. That's the title she wanted it to be, so I could be in that salary because she was looking out for me, and I loved it.
I remember she came to the presentation, and she's like, "Oh, my God, that was such a great presentation. You should submit an abstract to AWHONN." It was that simple. "You should submit an abstract, because I haven't seen even this caliber at some of the local AWHONN meetings." I submitted something for the local chapters. I say that to folks to be open, to be open to opportunities that come your way, and not say no. People who are close to me know that my default answer is "yes and," because I feel like if you enter life with your palms up, like my friend says, and to be open, that more opportunities will come your way. Be open to that.
If there's something that maybe you really want to do, maybe you really want to do a presentation, consider your section and your Chapter AWHONN groups to do that. If you're a neonatal nurse, maybe you're a NAN member, consider NAN as well. Synova is another really great place. I love Lori Gunther to death. I used to be on the Synova board. I know she is always looking out for new, innovative folks who have great ideas. Consider that. Then go to someone. I've had this happen. Many people have come up, "Hey, would you be willing to be my mentor?" Again, my default answer is "Yes, I am." I do that. I look for opportunities.
I had a mentee recently. I said, "Hey, let's submit an abstract for AWHONN. We'll do it together." She's like, "Oh, you would speak with me?" I'm like, "I would be honored to speak with you." Our abstract was accepted. She has been all over the nation because there is greatness in her. She was telling me recently, she was like, "I owe you so much." I'm like, "Girl, you don't owe me anything. It was my honor and privilege to do it with you. I love that people are seeing what a great researcher you are." I encourage those who have more of a platform to intentionally reach out to others and to look for that person that has greatness that reminds you of yourself or that reminds you of somebody different from yourself, but the world needs to hear their story as well and to be intentional in helping them.
I think those would be my big ones. Locally, I am very involved with community-based organizations. I feel like Healthy Mothers, Healthy Babies is an amazing organization that could benefit from more nurses being involved. March of Dimes. March of Dimes is the jam. They're really great and they're local all over the place. Look for your community-based organizations also and ask, "Are you looking for any volunteers? What can I do for you?" I think that would help and get you more exposure and help you learn more.
Sarah Lavonne: Yes. Just get you out of your environment. We all need change. I know for me, anytime I'm feeling stuck or bored, you talk about that three-year itch, mine's about a year, and then I'm like, "Oh my gosh, I need something new." To switch up your environment and just see what's out there, and it may work, it may not, but also just-- it's like, I think, we put too much pressure on ourselves, too, that it has to be this way versus like, "Let me just show up myself and really know how amazing I am and what I can offer."
The other thing I love and that I'm hearing here, is that somebody like you that I know people listening, myself included, are like, "Oh my gosh, she's amazing." There's almost this invisible barrier where you're like, "Oh, they're too great. They've done too much." Just removing that and just being like, "They're people too." This is what I saw at Synova with my future mentor, whom I'm meeting with tomorrow. I'm so excited. It was like, "We want to help." I know, even for myself, I'm like, "Yes." Nothing is a nuisance. It's like, if you have the will, if you have the heart, if you are passionate and you are looking to grow, it's like, go after it, go get it, figure out what you want, and then pursue that dream.
Rose Horton: I was thinking that while you're pursuing, also know and tell yourself you're worthy, you're enough, you will excel. The universe wants you to excel. It's natural to have that little fear and a little bit of imposter syndrome, but speak back to it and say, "I'm worthy, I'm enough, the universe wants me to succeed."
Sarah Lavonne: It's conspiring for you.
Rose Horton: Exactly.
Sarah Lavonne: Along with pursuing your dreams, you have started a movement, and we'd love to hear about it. Can you tell us about NotOnMyWatch and how that came to be and what it's become?
Rose Horton: I would love to. I was taking some notes so that I can remember all of the things because this is not what I envisioned in 2017. I think in 2015, I left my OB position. My itch again. I was like, "I don't want to do this anymore." My CNO, she was newly promoted to CNO. We had been directors together. She came to me. She's like, "Rose, please don't leave. I don't want you to leave. I want you to stay and help me be successful in my role." I'm like, "I just don't want to do this anymore." She's like, "What do you want to do?" I'm like, "Well--" [chuckles] I put it out there. I told her. I said, "This is what I want to do."
I didn't quite get what I wanted to do. I knew that I didn't want any direct reports. I just needed a break. I said, "I don't want any direct reports. I don't want my salary to change. I want to do something innovative to help move the needle forward." We co-created a job description for me. I did that for almost three years. Then I left that job in Pennsylvania for what I thought was going to be my dream job. It was a startup. Again, this is Rose. Startup. That was 2016.
Startups were not like an everyday thing. When I saw what they wanted to do, it felt really aligned with my mission and who I am. I'm like, "I'm out of here. I'm going to join the startup, move to North Carolina." The startup was not for me, not at all for me. I was like, "Okay, I'm just going to leave."
Sarah Lavonne: How did you know it wasn't for you?
Rose Horton: Ooh.
Sarah Lavonne: You don't have to tell us who it is. Just like [crosstalk].
Rose Horton: Oh, no, no. No, I wouldn't. I knew it wasn't for me because I started having pains in my stomach whenever I would see a call. It was just a couple of us. It was the CEO, the CFO, the founder, and myself. We had an HR person, but we were building and growing rapidly. The startup life, and I believe this is the startup life, there's no boundaries. There's no boundaries. You get calls all throughout the day. I remember the day that the CEO called me at nine o'clock. I thought it was like a butt dial. I answered it. I'm like, "Hello?" It's like, "Rose, I was thinking--" I'm like, "Are you thinking at nine o'clock? What is happening here?"
Sarah Lavonne: I really knew that.
[laughter]
Sarah Lavonne: So rough.
Rose Horton: Besides that, there was some infighting, and there was a lack of focus, and the mission that I thought we had shifted. Yes, it was a lot. I said, "I don't want to do this." I quit my job. That made it four years. Four years that I was out of OB. Then a colleague reached out to me, and she's like, "Hey, I saw your post. I know you're between jobs. Do you want to come to Atlanta and do an interim job?" I was like, "That could be fun. I was a travel nurse. An interim leader would be fun." She's like, "Yes, come be the interim nurse manager."
I'm like, "Nurse manager? Wait a minute." [laughs] "Wait a minute," because I pay homage to all the nurse managers who are listening, because that is absolutely the hardest job ever. I had been a director. She's like, "Yes, come do this." I'm like, "Okay." She's like, "You need money, right?" I'm like, "Facts. I need money. I'll come."
Sarah Lavonne: We all need money all the time.
Rose Horton: [laughs] "I'll come." I went. I accepted the assignment, and that's how I got to Atlanta. I remember I was in the role for maybe 30 days. The organization had a Leadership Development Institute, LDI, meeting on a quarterly basis. I was asked to present at the LDI meeting. Usually, about 250 leaders would show up for this event. I'm like, "Okay." She's like, "You have like 12 minutes." She said the wrong thing to me. She's like, "Think about it as your TED Talk." I'm like, "Say less. Say less."
I said, if all of these people are going to be in the room, let me talk about OB. Because most hospital leaders don't know what happens in our service line. I started Googling. This would have been December of 2016. I'm doing some Googling about OB. I'm like, "What's new? I haven't been here for a while. Let me see what's going on." I saw a story about the death of Kira Johnson. Then I saw a story about the death of Lauren Bloomstein, a NICU nurse. I saw about the death of Shalon Irving. I remember being in my hotel room and just bawling my eyes out. I'm like, "Oh my gosh, what has happened? What has happened in our profession?"
I saw the work of ProPublica and the Lost Mothers. I was devastated. I remember thinking, "Oh my gosh, what can I do? What can I do to be part of the solution?" The thought came "Not on my watch." "Okay, not on my watch within my area of control and purview and oversight, authority, leadership," whatever word you want to use. I was committed to saying, "We're not going to have any preventable infant and maternal morbidity and mortality on my watch." I remember typing #NotOnMyWatch, because hashtags were pretty new back then. It was on my slide. I talked about what was happening in OB.
I remember saying to the group, I'm like, "Listen, this hashtag is going to go viral." They laughed, and I absolutely laughed because I thought it was funny. I said, "Even if it means we're going to go viral within the walls of this hospital, it's going to go viral." I was unprepared for the emotional response that my presentation garnered. People were like, "Oh my gosh, how do I get behind NotOnMyWatch?" "I don't understand. What do you mean 'get behind?'" [laughs] It's just my hashtag. It's not a program. It's not a movement.
That's how it started. Clearly, it resonated with so many people. I loved it. I'm like, "Okay, well, we can't have a hashtag without a logo." [crosstalk] I reached out to some friends, close friends. I'm like, "Y'all, I need a logo for NotOnMyWatch." I had told my leaders about this plan, and many of them were at that meeting anyway. One of the charge nurses, her daughter, she's like, "I'm going to ask Gia to create something," because it was a challenge. I'm like, "The best one, I'm going to give you a $50 gift card." It was very, very hard.
Sarah Lavonne: Cute. That's so fun. I'd be all over that. I do all the graphics for our business. [crosstalk] I'd be like, "I'm going to win."
Rose Horton: [laughs] Gia ended up winning. I have to tell you, Gia is not your average. She was a senior that year. Ended up going to do full scholarship and did an internship at Google, first job at Google. That's who created the hashtag. I made some T-shirts. I reached out to some friends. I'm like, "Listen, I think this hashtag has the potential to really change the trajectory of morbidity and mortality." That's how it started. Then, believe me, everything else has been pretty organic after that. People just saying, "Come to our hospital, talk to us about NotOnMyWatch." Then we developed the tenets of NotOnMyWatch.
It is somewhat of a movement. In 2026-- Again, created it late 2016. It's been fully 10 years. We're going to formalize what it means to join the movement. It took a minute because I didn't know. I've never created a movement before. That wasn't the intention. The intention was just to say, "What can I do? What will my team rally around?" It was a term that I would hear the nurses say all the time, "Mm-mm, not on my watch." I'm like, "Yes, yes." Here we are.
Sarah Lavonne: What do you think resonated about-- I'm going to say specifically that presentation, your TED Talk, that you did. What do you think resonated with the audience the most? Right now, I don't know about you, but I talk about morbidity and mortality when I open the physiologic birth class, and I'm like, "We have to talk about the issue. These are the numbers, like, hello, wakey, wakey." You almost get immune to it because you're like, "Yes, it's an issue, and it's everybody else's issue. We have a global problem." What I love about that is that agency that you place in the individual, too, and we talk a lot about owning your care and saying, "This is what I can control."
It's like we have a similar pause at the door that came from a podcast episode, actually, that came out while I was just ranting about something. I was like, "What if we just paused before we walk in the door and said, I am committed, I am actively here to listen to my patient, to connect with them, to give them my absolute best, to believe them in this moment." That's it. Just at this door, that's all. The issue feels so huge. It's like, "What can we do about it?" Nothing. We get immune to that. What do you feel resonates to this day when you talk about it?
Rose Horton: For the TED Talk, I remember driving-- [laughs] It's so funny I refer to it as a TED Talk. Anyway, you know what I mean.
Sarah Lavonne: [unintelligible 00:31:29] I get it.
[laughter]
Rose Horton: I remember driving there-- My youngest daughter, we chat almost every morning. I said, "My presentation's today," and I was telling her how I was going to start. I was going to start with a couple of-- I was going to start with Wonder Woman and with-- I think it was Wonder Woman, Superman, and someone else. I was talking to her about, let's say, DC Comics. I remember a clue. She's like, "That's not--" whoever it was. She's like, "That's not--" Marvel versus DC. She's like, "That's not Marvel. That's DC. I want you to represent appropriately, Mom." I'm like, "Yes, thank you. I'm so glad I talked to you." I even wove that into my opening because I usually like to start with something funny.
I remember telling her, I said, "I want them to laugh." I love it when people like-- that laugh out loud, that chuckle. I love it. I said, "I want them to laugh. I want them to cry. I want a standing ovation." Again, my trusted source-- I would never say this in public, even though now you're going to share it with the whole world. She's like, "Yes, Mommy, we're going to manifest that. Yes." That absolutely happened. We started with the laughter about the Comics. I tied that all in.
Then I talked about those three cases. Because it was so, so fresh for me, it was very emotional. I was trying not to cry. That emotion resonated with them. I think the storytelling aspect is really powerful. Then I ended with a call to action in light of everything else. I think that was the bow. It's like, "Okay, you told us what the problem is." 600 at the time, 600 women die. At that time, I remember that 60% of maternal mortality is preventable. Now it's 87%. All of that really resonated because they hadn't heard it before.
I remember after the presentation, there was a line of people wanting to chat with me. Some telling me about their horrible birth stories. "Thank you for highlighting this and what they've experienced." There was one person-- These are all our employees, right? There was one person that said, "I have a T-shirt shop. Once you get your logo, I'd be happy to print T-shirts for you for free, because I love this." It's the power, again, of storytelling and the power of being your authentic self and speaking your passion. I think that was my first indicator, like, "Oh, okay, this could potentially be a thing throughout our hospital." That made me use the word earlier that I love. I don't hear a lot of people use it, but that made me giddy.
I was like, "Oh my gosh, people can stand behind this." I had the leader of infection control, saying, "Do you care if I use this? Because NotOnMyWatch could be a great campaign for us in the infection control." I'm like, "Please." Whoever. Security came to me. They're like, "We want to use NotOnMyWatch in security." I'm like, "Yes."
Sarah Lavonne: Ooh, so cool.
Rose Horton: I know.
Sarah Lavonne: That's so cool.
Rose Horton: I do think storytelling is a great piece because I went into a little bit of detail, especially about Lauren Bloomstein's story, because she's a nurse. She's a NICU nurse. She went to the hospital where she worked. Nobody would have expected her to die. I'm not saying there's ever intentionality, but there was no intentionality. We failed to recognize that her hypertension was worsening, and she was going in to help, and sharing that story and sharing some of the graphic. Her husband was a fellow, I believe, at the time. There was a picture that I saw online of him and the baby. The baby's in the seat. The seat's on the floor, and they're in their house. He looked so forlorn because he's not supposed to be going home without his wife, without her mom.
I do think storytelling helps. Sometimes when you feel-- because I've had this experience, I've been talking about this since 2016, sometimes when you feel like, "I'm just going through the motions. This is not resonating with people." It's always two or three people who come up to you afterward and say, "Oh my gosh, that was so great. I am so motivated." I'm sure this been your experience to be part of that. Sometimes just that one or two, that's enough. It's like, "Yay, yay, we can do this."
Sarah Lavonne: For somebody where you've owned your leadership in this charge, that can feel very lonely. Sometimes you can feel like, "I'm doing all this work, and I'm doing all this stuff behind the scenes. I've got the logo, and now we've got the T-shirt or whatever, but where are they? Where are they? Anybody out there?" For me, it's also been so pivotal. I've had even just one person where they write in with their whole long narrative story of how-- What's fun for me always is the patients. I had a Bundle Birth nurse, and she was trained in the moment I saw her pin or whatever. That keeps you going.
Rose Horton: Absolutely.
Sarah Lavonne: When you think about the problem of morbidity and mortality, this being your thing, what agency do you think we do have? When you say that-- You said 87% of deaths are considered preventable, and who are the ones preventing them? The ones assessing all the time, which is our job. What is within our control? I hear that, and I'm like, "Oh, geez," I feel responsibility. Also, I would love to hear your practical take on what that looks like for nursing care.
Rose Horton: A lot of it is within our control, but I want to say it's a shared responsibility. It has to be the work that we do as clinicians. It has to be the work that the providers do with-- Don't even get me started with inductions because I feel like inductions are such a problem for us right now. It's the providers. Then it's the hospital and our willingness not to follow evidence-based care, but to lean into what the providers want because we equate providers with patients, with money, with sustainability. Then there's systems, and then there's policies. It's multi-layered, and everybody has skin in the game.
I always start with that. Everybody has skin in the game. Given that everybody has skin in the game, what can I do? It's not about it uniquely being my responsibility, but it is where can I take ownership to make a difference? I own the 6, 8, 12 hours that I am responsible for that patient. I own that. I love the whole teen birth movement. I'm sure you're familiar with that. It's a simple concept. The simple concept is that we have communication about the patient, in front of the patient, and with the patient. That's it. It's not--
Sarah Lavonne: That was SBAR 15 years ago, 20 years ago.
Rose Horton: Exactly. What do I own within my time? The five tenets of NotOnMyWatch, I really feel like it is the solution. I was on a podcast recently with Dr. Jen Link, and I love her so, so very much. I said, if I had a million-dollar chip, I'm not a gambling person, but if I went to Las Vegas and I had a $1 million chip, and they said, "Rose, where do you want to place this chip in an effort to mitigate maternal and infant morbidity and mortality?" I love all of the innovation that has sprung in our field. I love decision support. I love AI. I love all of those things. However, I would put all of it on the five tenets, all of it, because it doesn't require any money for us to do these five things.
Number one, we treat everybody with dignity and respect. Doesn't cost any money. Number two, we listen to and believe women. There's a viral video that was going around a few weeks ago of somebody obviously in active labor sitting on one cheek in the wheelchair while the nurse is doing this. Her inability to see humanity in that person, not to listen and believe when she's like, "What's your due date?" She's like, "No." Not to believe that something's about to come out of her vagina, aka your baby. Listen to and believe women.
Number three, shared decision-making. We need to dismantle the hierarchies that we've created in healthcare that the person on top, which is usually the provider, gets to make all of the decisions. Decisions need to be centered around the patient's voice and their choice. Shared decision-making. Number four, evidence-based care. I feel like if we could truly, truly, truly standardize our care based on really good data, that will remove any variability. We won't say, "Well, for this patient, we're going to start the Pitocin at 3 millunits, but this doctor would start at 6 and double it and triple it." No, no. No, no. We're going to standardize our care--
Sarah Lavonne: We're going to go off when we need to go off on Pit. Not get yelled at for that.
Rose Horton: Yes. If you get yelled at-- I think we need to have this conversation in front of my nurse leader right now. Let's go to that office, and I'd love to have that conversation with my nurse leader right now. Ooh, that's a whole [unintelligible 00:42:14].
Sarah Lavonne: That's a good one. I know. We'll have you back for that.
Rose Horton: [laughs]
Sarah Lavonne: Yikes.
Rose Horton: Shared decision-making. Then last but not least, that we advocate. We advocate for all women and birthing people. When I say to my patients-- I remember saying to my patients, "I'm your person. I'm here for you. I got you." You know how affirming it is for somebody to say that to you?
Sarah Lavonne: So true.
Rose Horton: "I got you." I feel like if we would do those five things, I will put my million dollars right there. Everything else that happens with innovation and with all of these amazing solutions-- I talked to you about a hackathon. I'm very much in favor of hacks. That is layered on. That improves efficiency. It makes our work a little bit easier. It decreases our burden. It maybe tightens the safety net, but we start with us doing these five things. That's what I believe.
Sarah Lavonne: I'm like, "Sign me up. How do I join?" I mean it.
Rose Horton: I'll tell you in 2026 [laughs] when we're official. You can join.
Sarah Lavonne: Which is perfect because that's a month away. Less than a month. I'm here for it.
Rose Horton: Totally.
Sarah Lavonne: When you put those five things that simply into five to-dos or five, like, "These are the things," I could not agree with you more. I feel like, "Yes, amen." Those to me are all things that require some internal work on behalf of the nurse. I was at a birth two days ago with a client who it's her third baby. I've done the other two with her now in the last six years or so. She was talking about-- She's a very spiritual person. She's very well-known. She is known for her art and the feels and the flow and the Maya Angelous of the world. She said to me, she's like, "I think it's fascinating when people say to me that I want the hospital birth."
This lady came in for an elective induction in the hospital with a doctor that's very medical, as medical as it gets. Has her routine of like, "You'll be delivered in this many hours if it's up to me," and blah, blah. Got her epidural before she had painful contractions. The most medicalized birth ever. She had, by the way, a 9-hour induction from 140 minus 3 to baby in 9 hours. It went so fast, mind you. I will say that we did a lot of physiologic birth things, so that helped. She was so detached from the outcomes. Detached, not in a way that she wasn't present in her body. She was very present in her body.
She walked in with-- and she just said, "I have the mindset that I trust my team. I've surrounded myself with the best people who really care for me." Even her medicalized doctor, that doctor's a very good physician. In the case of an emergency, she's in the best hands possible. I believe that, too. She has the support she needs, and she has the education, and she's made informed choices. She said, "I just have my hands open, and I'm just allowing my body to do what it knows to do because I can release into the hands of the people around me while also being actively present in my body."
Again, this lady's a poet. It was very spiritual and beautiful. She said, "Most people would think I would want a home birth." That makes sense with her archetype, but she did not. When I think about-- I'm picturing her. What I said to her was, "That is what is missing in most patients, the ability to trust your body, to trust your team, to allow for labor to unfold while also maintaining control of what you can maintain control of and understanding the process as it goes, and having those conversations." This physician might be very medical, but very shared decision-making. She tells you what she wants very clearly. Also, if you give her pushback, she's like, "Oh, well, sure. Yes, let's do it," because she's all about customer service.
I think about it even through that lens. I think when we're talking about morbidity, mortality, and complications, this was an uncomplicated, beautiful, easy induction that she had an amazing experience that was very medicalized. What she experienced was even to the point where she said, "Even my nurse, the energy in the room was so good. The nurse was calm. She had a bunch of D-cells." I'm looking at the tracing going like, "Oh, my gosh, how are we going to get her to complete?" Luckily, she was, which, of course, made all the sense in the world.
She's like, "Even in the emergencies--" and she called them emergencies. They were not, but that's what she felt. She's like, "I just felt so safe. I felt so heard. I felt so included." Obviously, it turned out good. I think about the fact that we don't realize when we own that agency over those five things listed that it does rely on us being able to enter a room. It's like all those soft skills. It's not like, "I can start an IV, or I adjusted the monitor, or I kept the baby on all night." There's so many mechanical, or "I charted everything that I needed to chart." We get so caught up. The robotic must do my job.
When we're talking about changing outcomes, to me, this is why I'm here for it, because I'm like, "Yes, this is what we're talking about," is all those soft skills and all the internal work to show up to the bedside, one, activated to look you in the eye and say, "My hands are open. I'm ready to listen." I'm pausing enough. I might hear the monitor because we know we can't turn that off. I'm like, "I'm present, and I'm watching, and I'm seeing those subtle changes. I'm noticing a little inflection in your voice that might change. I'm going to pursue curiosity in that. I'm also not judging you for wanting certain things and taking on too much."
All of this is, to me, this is, yes, NotOnMyWatch for morbidity and mortality, but healthcare. The culture of OB, of we need these things just in general, and then the trickle down is we're saving lives. How good does that feel? That's what we all got into nursing for.
Rose Horton: Exactly. I love that. That was absolutely beautiful. It sounds like such a great experience. I remember when we put several things in place at my last organization here in Atlanta, part of the Emory system. We were intentional in putting a lot of things in place because we wanted to have more equitable outcomes, because our outcomes were better for some people, but not for others. We wanted to change that. I remember getting our Press Ganey patient satisfaction scores, reading things, and crying my eyes out because it was women saying all the things you just said. These are Black women, 67% of our patients at my former organization look like me. I felt seen. I felt heard. I felt safe.
In a time when Black women are not seen, not heard, don't feel safe. Scared for their lives. Scared to let their bodies do, because you know cortisol is coursing through our bodies, adrenaline is coursing because we're fearful. We're afraid of dying and childbirth. Our bodies can't do what it should do because of that. We were able to create a culture that allowed women to just be in their own experience and trust us, knowing that we got them. I can't think of--
Sarah Lavonne: What culture is that? How did you do it? I know we're going on another tangent, but I think it's so important.
Rose Horton: Yes, we just don't have enough time.
Sarah Lavonne: We want to come back because that's the conversation we need to have next, because there's big picture morbidity, mortality, but then there's microcosm of particularly our Black and brown moms.
Rose Horton: Yes, that's definitely another conversation that I'd be happy to have. Really, it's the reason why I'm self-employed because it worked so beautifully and we had such great results. I'm like, "I can be part of a bigger change. I can make myself available, and I can partner with other nurse leaders who want to go on this equity journey, who want to improve outcomes, who want to mitigate morbidity and mortality." That's the whole reason. I wanted to work for myself anyway because I really like me, but I wanted to make myself available to share my learnings because if you want to go far, go with others, right?
Sarah Lavonne: Yes.
Rose Horton: If you want to go fast, go alone. That was the impetus for me. Next time, I got you. I'll tell you all the dets.
Sarah Lavonne: We got it. We're putting it on the docket, everyone. We're going to leave you with this cliffhanger. Any other words of wisdom you want to leave this audience with?
Rose Horton: You said something that reminded me, and I would say this to my teams. For us to remember our why, it doesn't take much for me to remember that first birth that I saw in nursing school. Just to remind people of what a privilege. We, in the perinatal and neonatal space, we're so privileged to see and experience a life-changing event that families remember forever. We get to be part of that. I know that it's chaotic, it's crazy, it's busy. Sometimes it feels like a dumpster fire, but can we do that pause? Can we, before we go into a patient's room, just take a deep breath and say, "I'm entering into a sacred space," and just change everything in our brain and go be 100% there?
I feel like we can. I remember during the pandemic, because of turnover, things were crazy. I put scrubs, and I did patient care. I remember taking care of this patient. English was not her first language. She was Somalian. She wanted an unmedicated birth. Even though it was one o'clock in the morning, and I had worked all day because that's when I work, night shift was dying. I needed to come in because I need to be there for my team. I said-- they know what I love. They're like, "There's a patient who wants an unmedicated birth." I'm like, "That's me. That's my girl."
I remember just being so joyful throughout that whole process, being there to support her and watch her and her partner and welcome that baby. She asked my advice about names she was choosing for her sweet baby. I was like, "Oh my gosh." It reminded me of the privilege that we have. I just want to remind everyone, we're incredibly fortunate and privileged, again, to share something really intimate in labor and delivery, in mother-baby, in the NICU. Don't forget that. Take a moment and pause. Take a deep breath. Be part of the change.
Sarah Lavonne: If people wanted to find you, where could they find you and know more, and join the movement?
Rose Horton: Yes. They can go to my website, www.notonmywatchconsulting. I'm also on Instagram. I think I'm most active on Instagram, NotOnMyWatch, or NotOnMyWatchCo is our handle. I'm also on LinkedIn, and it's my name. It's Rose Horton on LinkedIn. LinkedIn is my jam, and Instagram is my marketing manager's jam. Between those two jams, we be jamming. [laughs]
Sarah Lavonne: Thank you so much for being here, for sharing your passion with this audience, and for all the work that you do for all of us and for the world of birth.
Rose Horton: Thank you.
Sarah Lavonne: 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, subscribe to our email list, or follow us on social media. Now it's your turn to take what you learned today, apply it to your life, and remember why you got into this work in the first place. Having your hands open to listen, to see the patients in front of you, and say to yourself with every single patient, "NotOnMyWatch." We'll see you next time.