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. 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. Bye nurses for nurses. This is Happy Hour with Bundle Nurses.

Being a labor and delivery nurse is so amazing. It is. We always talk about like we're part of the miracle. We're part of the magic. We get to shape the future. And there's also this layer that we have to manage of the stressful part of our job on top of just the stressful part of the safety things that we see and the complications and the emergencies and the bereavement cases etc etc. And then you layer the legal on top of that which adds this it feels like a dark cloud at times. I know as I went through nursing school and as I especially early on in my practice it was this constant like well but my license well but my license and I don't want to lose my license and this license and legal being thrown around left and right. And then when we look at the medical system and we talk about why people are making the decisions that they are and why we have the current state of obstetrics that we do, there's always this layer of well, we're trying to avoid liability that comes up. And so today I am thrilled to finally, it's about time invite Pam here. Pam Hetrick is here to discuss all the legal things and answer some of our questions and hopefully sort of just like settle our nervous systems because if you don't know already um you may and some of you may recognize her voice because Pam partnered with us with our mentorship program. So, we have a 12-month mentorship program and in that we brought in Pam to discuss the legal side specifically of fetal monitoring and she has a deposition and trial class on our site that when we brought her in for mentorship, we were like, can you please just help us because we're all afraid of getting sued and if you are deposed, I didn't know of anywhere to go that would help me really prepare in a safe environment of my home, know what to say, what not to say for that deposition. and or if you're worried about it, just know that class is there. It's available and Pam teaches it. So, it has been years since we met. I don't know. I don't even remember how we met. It was maybe social media, which is usually how it happens. It was. And so, now she's finally here for the pod to discuss all of the legal things. So, Pam, why don't you give us just a little introduction about who you are, what you do, what your current role is, past role, where you've been, and then why you're equipped to talk about this legal stuff. Okay. So I, as you said, Sarah, thank you so much for inviting me here. I am Pam Hetrick. I am a certified nurse midwife and I have been in abstetrics for a crazy 30 years. and I started out as a labor and delivery nurse um in a unit that was fairly new that took a hodgepodge of all people in the city of Cleveland um to form and it was such an amazing group but looking back it was a really high liability and look we're all here still with our nursing license and then I uh then I became a uh a nurse at another institution really found a passion of midwiffery with being able to have the relationships with patients for years and years and years and so I became a midwife in 2003 so it's 23 years ago and since then I have practice full scope midwiffrey I am a nursing or I should say I'm a midwiffrey and advanced practice leader at my organization now so I have about 70 advanced practice providers and drum roll in 20 days I will have my DNP and that feels yeah 20 days I get my no I get my DMP in 20 days and I'm really excited about that and so how did I get into this whole thing of expert witnessing so I didn't bring that whole thing up so when I was a baby midwife and I was you very wellkilled as a nurse. I worked with a midwife who had a pretty prolific um expert witnessing business and she had just finished doing labor and delivery and she really did not want to you lose this lawyer and so she said to me, "Hey, I've got this RN case and it's pretty much a slam dunk. I can't take it, but will you take it and I'll walk beside you on how to be an expert witness?" and I said,"I have no clue what I'm doing, but I will follow your lead." And so, the birth of Hetra Consulting LLC started in 2004, and I have been actively reviewing lawsuits primarily now. I, you know, I have some uh attorneys that have had me for a long time, and so they'll call me even for a nursing case, just to say, "Take a look at this. Let me know what you think." But I primarily review for midwives now um on the plainif and the defense side. So the people who are suing and the people who are defending and it has really strengthened me as a health care provider with knowing that sometimes we take absolute perfect care of patients and bad outcomes happen. and you are not a bad nurse and you are not a bad midwife or nurse practitioner, whoever's or physicians assistant, whoever's listening to this. Um, and then sometimes there's stuff that everything um, does go wrong and I look at it and wish that the documentation would have looked better, but you know, everybody fears their license and know unless you go to work with with the intent to harm, your nursing license is pretty much protected. And I guess that's what I would love to talk about today is that we're in a really hard spot in healthcare right now with patient care because they get a lot of ideas not from great sources on social media and they show up and what do we do? What do we do for the patients who decline everything? What do we do for the patients that we don't think are getting proper consent? What do we do about chain of command? So those are all of the things that I think are important to talk about. And the other thing is, you know, knowing that when we're caring for patients, the way that we protect them is that is that we we think about are they being heard and are they safe? And most of the time, if the patients feel safe and heard, you're going to avoid litigation. Say that again. safe and heard, right? Are you at the bedside advocating for the patient to be heard? So that means when they don't feel comfortable with what a provider has talked to them about or they feel like they are being pushed into one intervention or an intervention that they don't want. You know, are they being heard? Are you huddling at the bedside? Are you bringing the provider back in? is the patient being told about the risk, benefits, and alternatives of anything that we are recommending for them to have. And um so a lot of this is um increasing your communication at the bedside with the patient that the patient understands and that the provider and the nurses are all on the same page. Mhm. So you're saying that if I build my skills in specifically shared decision-m meaning that we as the care team probably doctor midwife has a recommendation patient listens to it and there's some sort of hesitation we stand in the gap and we help them be heard that we ask them those questions we slow it down we advocate to the doctor hey this is what I'm hearing this is seems to be important to them that that in itself is going to help you avoid litigation let's think of the patient that comes in that is going NCB and is in transitional labor and they're all over the bed and you can't monitor that patient, right? And you're putting your hands on the patient's belly and maybe maybe you've got a little bit of a concern like I think I heard a variable or you know is this maternal or what it is and the patient's like get your hands off of me. Don't touch me. And so the nurse is like, "Okay, I'm not going to touch you." But in the back of your head, you're concerned. You're like, "I don't really know what's going on." Such a good example. Instead of just writing, um, patient refuses or I personally like declines better. Hey, Mary, I you're doing such a good job, but I really need to make sure that your baby is okay. I can't tell if your baby is not okay if I can't get your baby on the monitor. Okay, that's that's kind of explaining to her what your concerns are. If she says, "Go to hell. I don't want you to touch me." Then you say, "I'm not sure if your baby is okay." And she still says, "I don't want to be touched." You can say, "Discuss the risks and the benefits of me putting her back on the monitor." And you're going to call your provider and say, "Get in here." Um, but the patient might say, "Oh, I didn't know that they were concerned about the baby. Okay, go ahead and touch me." Right? But it's a little bit like, think about expanding it a little bit more. Your patients who are declining an IV or your patients who are declining vitamin K for your baby because I know that we're seeing a lot of that right now. Do they understand the risks of what they decline? And if you are writing in there that they understand it, you can't do anything else because then you're kind of it's basically assault, right? So it's just really important for the patient to understand what your concern is. So I would say that is one of the biggest nuggets that I'd like to put in your head now is just making sure that you add that into your note. You might have said it, just add it into your note or just verbalizing with the patient. And what would your note sound like? Patient uncomfort like let's just take Mary Mary at 8 centimeters rocking and rolling in in active labor. Monitors flipping all over the place cuz she's all over the bed. Um dis uh difficulty with obtaining fetal monitoring strip secondary to patient discomfort. Discuss with patient need to place baby on the monitor um to assess fetal well-being. Patient continues to decline. Provider notified and asked to come to bedside. That's it. Or patient understands we'll we'll get you know we'll get baby back on monitor at this time. If you saw that in the chart, you'd say they did their thing. Okay. Correct. They did their thing. Same same with an IV. You know, you might be the best person on the unit to throw in a 18 gauge in somebody's anac, but we all know how quickly things can can go ary when you've got a postpartum hemorrhage and the best person on the unit can't get a line in them. So just talking like that the patient understands the risks of not having IV access just a saline lock um in in case of an emergency um and you discuss those risks and it should be a part of what your your provider hopefully is doing too but it also will will allow somebody that's coming in to review the case an expert to say wow this nurse really like this was a wellthoughtout note that she talked to the patient about the risks and the benefits of doing this and the patient still declines. It kind of shows that forought that the that the nurse was acting as a prudent person would at the bedside. I think when I'm thinking about these scenarios, I think the fetal monitoring one is so good because we all are so sitting stressed in a bundle of stress about like, oh my gosh, I can't see it. I can't see it. I can't see it. and you're wanting to touch them and they're yelling at you not to touch them and you don't want to touch them cuz they're saying not to touch you and all of that. So, if we take that example, I can just picture in my mind the fact that I'm picturing that you have no tracing like just blah like little dots here and there across and obviously things are moving but this baby comes out depressed and needs resuscitation. Let's say it needs cooling. God forbid, but it needs cooling. That I I just like I I can hear the conversations at the nurses station saying, "Well, I'm going to get sued," you know, or anticipating a bad outcome. Not even going to a bad outcome, right? But anticipating an outcome like that and the conversation at the desk being, well, but you have to cover your license, but you have to cover your license, which means you have to do what you want to do to make you feel comfortable regardless what the patient is declining. So, what would you say to that um argument? Because I think there's like a cultural environment that we work in that that sort of is the covering your license. you want to do what you feel is best as the medical professional, which from a medical standpoint might be safer. Um, but ultimately what we're toying with here is the autonomy over their body is the the self-efficacy is, you know, all of those ethical legal considerations and which one stands, especially in the case of an of a bad outcome. Yes, there's always the talk at the nurse's station, I'm going to get sued for this, right? But the other thing is is like you know just picture this is that you do have a bad outcome. How important it is to still huddle at the bedside with the patient afterwards to explain the sequence of events. That should be a no-brainer. It should be happening all the time. If you have an an a poor outcome that the provider and the nurse and anybody else that was there or the charge nurse, the baby nurse, whoever it is, huddles at the bedside and first you provide empathy. I am so sorry that this happened, but let's go over what we saw, what happened um you know that caused this kind of outcome with your baby, right? And you sit there and you talk through the patient because the one thing that that you know it's shown over and over that a lack of communication to the patient is usually the number one reason or the relationship that the patient has is usually the number one reason that they decide to sue because they're everyone's kind of right everyone's running away right from what happened. And sometimes we don't see bad things that are going to happen. Sometimes, you know, it's the patient that that wouldn't let us monitor and it comes up in that debrief that was like, you remember when we were having difficulty monitoring your baby and we talked to you about that we were concerned about the well-being of the baby and then all of a sudden, you know, we saw a bunch of blood and the baby came out and, you know, the baby went to the warmer and the pediatricians worked on the baby and it's just basically in the moment talking to the patient about the sequence of events that happened prior to the birth or the outcome. And that's that's legally s like recommended from a legal standpoint. Yeah, absolutely. I mean, a shoulder dia, a hemorrhage, anything like that should be anything that's I shouldn't say out of the ordinary should be debriefed at the bedside with the patient. I love that because we talk about this with our trauma-informed care stuff when we're when we're teaching about trauma-informed care and we're talking about the birth memory and the birth experience and it does it sort of feels culturally kind of like you're pulling hair, somebody's hair to like come just have a conversation with them. We're human. So much of this is human and yet another angle to promote that bedside debrief is for your own legal protection and you know and the the patient benefits as well especially if you're doing it in a way I'm just picturing you know I think it's also important to acknowledge that there's a way to do this in a way that you're not blamy and that you're also not coercive when you're having these conversations that it's an objective lay out the information this is what I'm concerned about but then there's also the layer of I I think we personalize a lot their decisions and we say like well but and like and then we judge and then that potentially changes our subsequent care with the patient because you're like and and I I love you actually like implied this of like instead of just oh they're refusing and they're out of control or they're yelling and like oh they like snapped at me and I'm offended that instead you objectively say okay my job is to make sure you understand what you are declining. and what that could mean for you. And so you know that that's your role and if you have done that you document it in the chart objectively you know and then you follow up as things change that if you were to end up and and you debrief afterwards that if you were first of all your chance of being sued is so much less likely but if you were that somebody like you who's reviewing the chart as an expert witness would look at that chart and go wow they did the reasonable and prudent thing in within their scope and ultimately it's on the patient because they declined. I mean, just think about this. Think about a patient that you know might have had prior trauma like sexual trauma whatever and everything the birth goes fine and then all of a sudden you've got a retained placenta you know or the patient starts hemorrhaging and you think about all of the things that you know you see as the nurse you're seeing sometimes the provider's hand is going into the uterus to either remove the um the placenta or to give by manual compression you know, we're sticking things up patients butts, giving them the sight attack. All of that stuff is going on and the patient's like, "Holy cow, this is so traumatizing. What are they doing to me? Nobody's talking to me." Like, and that's one thing is when the room is kind of cha chaotic is you if you have that one person that's able to say to the patient, "This is what's going on. This is why we're concerned." Um, that debrief at the end is so important. like this was really really scary that all of these people came in the room and that you were bleeding heavily, but this is what we did and this is why we did it to help you know um we we have to remember those debriefs are so important. So this brings up a point because one of the ways that I feel and have felt no regardless my role as a nurse at the bedside when there's a provider at the bedside. So let's say everything goes perfect. They're hemorrhaging. They have their hands inside and they're pull calling for the cytoch and placing the cytoch and no one's talking to them. One of the awkward places I I know I've been in a million times and I know that many of us have been in is when the provider isn't sharing what's going on. And I can imagine I'm not a provider but I can imagine that it's stressful. And I know for me when we're in stress, we know this from a physiological standpoint. Our brocas area which is our speech goes down. kind of goes dark and so it's easy to be like h and you don't really know what to say because you're stressed out. What I've heard and understood is that it's also not my job as the nurse to provide the information about what is going on and what they're seeing. So if I were to say you're bleeding too much, we're placing this now. Their hands inside for this reason, cytootech for this reason, that really needs to come from the provider first. And once it has, it sort of like I imagine it sort of like opens up the floodgates. I actually talk about this in our live colorfully class, by the way. So feel free to join us because we talk all about shared decision-m in this. But I'm thinking about those roles. And so once the floodgates are open, then I can follow up with my nursing education and and sort of like supplement. And how does that sound? and oh here's another way of thinking about it kind of conversation, right? And so what do you suggest for us as nurses when we're in those awkward moments, we're trying to support, we have that standpoint, not as the provider, but no one's talking to them and explaining what they would do. Now, mind you, as a a doula, somebody that functions as a doula who's lowest on the totem pole and very much not allowed to speak to anyone but the patient or else, you know, I've been in those scenarios and one of the things that I just say, and luckily it's me and people typically now I can get away with a little bit more because of who I am and people know I'm a nurse, but I would just say, "Does someone want to explain what's going on?" Yeah. you know, and and yet that takes some poise because if they're truly bleeding out and the the Jada's coming out and they're starting second lines and it's chaos, like how reasonable is that, etc., etc. So, what what advice do you have for us? Because us as nurses, this is so awkward. Yeah, I mean, definitely. I mean, I think that, you know, saying to the provider, can you just at least explain what's going on? And I don't think that any provider is gonna say, "Sarah, be quiet." If, you know, if if I said, "Mary, as long as I'm not the doula." As long as you're not the doula. Right. Right. Um, you know, "Hey, Mary, I I need you to look at me right now." Right. Like the patient's got her eyes closed and everything. Mary, I need you to look at me right now. I need you to listen to what we're saying. There's a lot of stuff going on, but you know, uh, Dr. Smith is is right now we're concerned because you're bleeding and as soon as he gets things stable, he will tell you what's going on, right? And then also, please, please, please, please, please remember the the significant other in the room who is watching all of this go down in absolute horror and yeah, trauma that they go through. Like sometimes I think like, oh, these poor support people that are watching this, like we're doing something, right? They're sitting there watching it like maybe holding a leg like what in the hell is going on here? Right? So, always remember to, you know, if you've got a resuscitation of a baby um that was unanticipated and you've got somebody from the family there is to keep them updated. kind of going back and forth and saying the pediatrician will be over to talk to you as soon as possible, but this is what I see that they're doing for your baby right now kind of increases that communication back and forth too that they don't feel scared and they don't feel excluded. Same with, and I know I'm digressing a little bit, but remember like your urgent sections that are going back or your your individuals who hemorrhaged and you take them back to the O, how important it is to have somebody on the floor be the gobetween between the patient and her family in the room to make sure that they feel again seen and heard and that now we're I mean all of this is like good care like this the proper thing to do as a human and it's legal protection, right? Why not? We'll continue to monitor. A lot of things that I will see on charts and it literally can make me baddy is when like things are going not well. The strip is terrible. I mean, I don't want to say terrible. You've, you know, you've done your inner uterine resuscitation. You're rolling the patient. the variables are still deep and you call Dr. Smith and it's 2:00 in the morning and you know he's been in clinic all day and he's tired and he's got surgery that you know the us that we hear and I will see Dr. Smith aware no new orders received and I'm like okay Dr. Smith I need you at the bedside right now requested Dr. Smith to bedside Dr. Smith says it's okay. That is where you as the nurse have the responsibility of saying I'm activating my chain of command. Now if you are if I see this and you know Dr. Smith aware requested a bedside states uh reassess in 30 minutes and you say to him I'm activating my chain of command. That shows me again forthought, right? like I know that something is not right. I need to get somebody else here to the bedside. So, you call your charge nurse and then the charge nurse calls. Go ahead. Would you say I'm activating chain of command in your notes? You sure can. Oh, you you absolutely can. Okay, keep going. Sorry, I had to ask that. I'm like, really? So then okay so then I'm activating chain of command so that it it clearly delineates that the provider is aware that you are not satisfied with their response and you need more help but they're not responding correct. Okay. And you you know something's you know something's wrong, right? like Mhm. you know, we talked about it when people go out, you know, and and this is kind of a cultural thing on some of the units where people are like, I'm working with so and so today and you know, she doesn't want to hear anything that a nurse has to say, right? Y and so something's going on. You're like, I'm totally getting sued. My license, I'm going to lose my license and I'm going to get sued. And it's like okay but somebody at that desk has to say there's an attend like let's just say it's with a midwife there is an attending on right and even in states with independent uh uh lenture for advanced practice providers we still have to have a physician so you call the physician and let's say that that I mean if we actually had it there are there is years ago and I'm going to tell this person to listen to this podcast because she's going to sit there and smile. I was a fairly new midwife and this patient's strip looked horrible and it was a family medicine provider that was managing this labor and this individual was the assistant nurse manager and she's pacing back and forth and I said, "You know what you got to do? Print the strip off and we're going to send it to our department chair." and our department chair. So, we activated the chain of command, right? It went from the charge nurse to the assistant nurse manager and then we went above that person and we went to the department chair. The department chair called the the board attending um physician and said, "You need to go in and you need to tell them that you are sectioning this patient now. It is the strip is bad." And so, this was probably a good 20 years ago. She brought it up at a leadership conference that we were at about like sometimes as the leader you have to make uncomfortable decisions for patient safety. Yep. And hopefully you have leadership support that when you do that that your leadership can see your your intention that I'm concerned and that's what comes back to that like cuss I'm concerned I'm uncomfortable. this is a safety issue rather than so much personalization and drama and like oh well you like what do they think I I'm they think that I am trying to keep the patient safe and that's where for me personally that's very grounding for me when I'm in those scenarios that I'm like I could come across quote unquote a certain type of way and the question for yourself is is that like am I doing this because I I have a vendetta or because I have a personal preference that I'm trying to push or am I doing this because I have a safety concern and it is my job to keep this patient safe and stand in that gap and if it is the ladder then you're in the right no matter whether you have leadership support or not and so and hopefully you do hopefully you do right and and you know what I could just say this don't don't be the nurse that you know is submitting past reports left and right because of just very minuscule things. Be the nurse that is able to say this is unsafe. I don't feel comfortable with this. And then doing what is right. And you know what I just took actually just took our compliance training and it talks about like if you have you know if you're fear of retaliation which that's that's I would say 98% of it. People don't want to act up because they're feared of retaliation, but you have protection against retaliation in a situation like this because you did the right thing. Your culture at your organization should be one that you're able to speak up and that managers are going to are going to have your back um in a situation like this when you rang the bell. Yep. What other tips do you have for us? I talked a lot about declination and I I just have to say I feel for you guys at the bedside because it is um it's it has to be very very frustrating um when patients are trusting an influencer over over science. So I I want to first say I applaud you for what you do. It's super hard work. um consent. Another thing is is making sure that the patient has given consent for things like breaking water, vaginal exams, placing a balloon, right? Like not a provider coming in and saying, "Oh, let me check your cervix and let's see what's going on. Oh, it's good. Can I have the hook now?" It's like, "Wait a minute here. Do we talk to her? Do is she consenting for um this procedure?" Um, you know, some of the harder ones that that I've seen in my lifetime is, um, we had a patient who walked in, physically walked in the hospital after like a 7-hour second stage at home, um, and actually had a posterior uterine wall rupture because the labor was so obstructed. And the patient came in and they tried to put monitors on and she first declined and the baby looked category threeish and um the patient declined to go back and have a section and everyone was up in arms about it. But I said, "Did did you discuss with her the risks of brain damage and death of her baby?" And they said, "Yes." And I said, "That's all you can do right now. You can't do anything else without the patient's consent." And for us, it's like, how could she do this? But again, the patient has autonomy over herself and her body um to make those decisions. And it's not what this I mean, I think part of the the hard part is is it's not the decision that we would make for ourselves, but we have to respect that if she has been adequately counseledled, yep, she has the right. We talked about this at move and it's coming in the live colorfully class, y'all. So that class is like such a fun little hodgepodge of a lot of this stuff, but the shared decision-making part, the coercion, the misinformation, all of that. And one of the phrases, one of the scripts that we talked about at move and will come up in this class is simply I respect that. that if you get to a place where you've had those conversations and you know that you've done it in a non-coercive way that and they're still declining, the answer is I respect that because I respect you as a human being that you are that has different preferences that has a whole different history that I will never fully understand. And sure, it may not be the the decision that I would make, but I'm still here to offer you the care that you will allow me to give you. and I'm going to respect you and respect that decision along the way. But that is that's hard, man. That's hard. What it becomes though is well, I'm scared of my license. And what I'm hearing is that if you've done that, you really don't have anything to be afraid of. Correct. I mean, literally, in my 30ome years of having one form or another license in Ohio, registered nurse and advanced practice. I mean, I've heard of people having their license taken away for drug diversion. That's pretty simple. Claire, have I ever had do I ever know anybody, honestly, that had their license taken away for unsafe practices? I don't. M I mean you hear um where was it over in Europe in England they had a nurse that was um going in and hurting babies in the NICU. That person yes that was with intent she did that. Um should she lose her license? She absolutely should. Um, but you know, I have never I mean, I've seen some pretty horrific cases over my 22 years of doing expert witnessing work. Like I'm like, how is this the United States that this is the care that this patient was provided? Those individuals did not lose their license. I think that's good level setting and good like for our nervous systems. Yeah, absolutely. That's And none of us want It's still embarrassing. Sure. and you get you end up deposed and you you will likely get deposed um at some point in your career. It's sort of just a part of it. And when you do come take her deposition and trial class because I remember taking it and being like, "Oh, depose away. Like, I got this." You know, it was very, very reassuring of like, "Okay, I know what I'm doing and I know how to do this now and I know what to expect." And so, it's very very helpful. Good. I'm glad that you you thought that. I mean depositions when you know when I'm getting deposed as an expert I always dread the deposition because the attorneys will keep you there for hours and hours and hours and then let's just say the case doesn't settle and you've got to go to trial and you're like oh my god I've got to do this again I can say trial is probably my I would rather go to trial than be deposed because at trial remember they've got a jury and that when you're getting deposed, it's you you your lawyer and their lawyer and maybe somebody else's lawyer, right? Because sometimes you'll have anesthesia lawyer or the hospital lawyer and the physician or midwife lawyer. And so they can't act like uh an idiot. Um they don't want to act like an idiot. They want to act like the nice guy when they've got a jury sitting in front of them that's going to decide who where where this case is going to. What I look for when I'm doing these cases is did the nurse or did the midwife practice within the standard of care which means that they are practicing what a reasonable and prudent nurse or midwife would do. And all the examples that I gave you today I would say helps you to practice within the standard of care. So, I would just say keep on doing what you're doing with good communication, dragging those physicians and midwives back to the bedside to do some huddles that everyone's on the same page. Um, respecting the care and support that the doula brings in. And um, you can't over overcommunicate with your patients. M you know I can say this state by state there are certain states and I'm not going to mention which ones that I would probably run to the next state before I would allow them to touch me in an obstetrical like it seems like there are just pockets of the United States that I'm like h how how is this you know so not all units run the same and so I think that what would be really fun is that if we got some um crowd participation on like what what the culture is or or what's going on in their unit or is this provider just cutting aziottoies and not saying anything like I think those would be really insightful comments because if they have a question probably 5,000 other people have the same question. So next season we're going to have you back and so if you have a legal question or a legal scenario everything will be anonymous. I'm going to leave in the show notes down below two things. One is a quick form for you to fill out and two, you can send in an actual voice note and we'll play the voice note and answer the actual like you get to be on the pod. And so we have both of those capabilities. check the show notes down below and then we will come back and answer your burning questions because I do think that like it's one thing to have this shorter conversation and I think the tips that you gave are so practical and helpful and help regulating our nervous systems and I've been to whole legal conferences for like 3 days straight of all the different ways and documentation tips and all of that and so if you want it let us know what you want us to focus on and then we'll continue this conversation so that one we can protect our license, even though I don't love that terminology, but that we can just settle in. Because if anything, what I want for you is to be living your best life, to be able to practice in a way that is free, that is open, where you can offer yourself and offer your care without living in such fear. We know that also fear is not good for our nervous systems. It's not good for our decision-m. And so to really live in that freedom as you go forth and care for your patients and ultimately help our patients have safe outcomes within the realm of autonomy over their body and their choices. 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 newsletter, or follow us on Instagram. Now it's your turn to take what you learned today, apply it to your life, and continue to build your communication skills at the bedside, encouraging those providers to come talk to your patient and do those debriefs, especially in your harder cases. We'll see you next time.