Nursing Notes newsletter delivers a look at the Perinatal Nursing specialty. I got the chance to talk with this month’s Featured “Get to Know Nurse” Cyndy Krening. Cyndy’s a perinatal nurse specialist at Littleton Adventist Hospital in Littleton, Colorado and I asked her about how she got started as both a nurse and her interest in perinatal nursing.
MP3 Audio Podcast
Jamie: Hi, Cyndy! Welcome to Nursing Notes Live.
Cyndy: Thank you. Glad to be here.
Jamie: We’re going to talk a little bit about Perinatal Nursing this month. One of the questions I would have – and perhaps people don’t understand – perinatal nursing, is that just another word for “labor and delivery nursing” or is it more than that?
Cyndy: It encompasses labor and delivery nursing but the word “perinatal” really is a broader term that means the time surrounding childbirth. It really encompasses the antepartum period, the antenatal period during pregnancy through labor, delivery and recovery and then the early post-partum period. It’s a broader term.
Jamie: First of all, how did you decide to become a nurse? Everybody has a story to tell. What drew you to the nursing career?
Cyndy: I’ve been asked that a lot and I don’t have a very glamorous story for that. It was one of the situations where my high school counselor said, “What do you want to do?” I think, for years, I had said as growing up as a kid that I wanted to be a nurse. Yet, as I’ve looked back on that, I don’t recall having any specific thoughts of why I wanted to be a nurse. I feel like I had just always said that. Yet, as my journey unfolded, as I headed off to my bachelor’s program and now had a career in nursing, I do feel that that is absolutely was my calling and somehow subconsciously I must have known that from the start. I just had the sense that that’s what I should do and started on that journey and have felt that it was right from the start.
Jamie: Now, perinatal nursing, is that something you were involved with right out of school or is that something you found along the way after starting off maybe in Med-Surg or some other more traditional area?
Cyndy: In nursing school, I got a little worried as we started doing clinicals because there were some clinical areas that I didn’t love being in. I thought, “Oh, gosh. What area of nursing is going to interest me?” Just as I began to worry, I had the opportunity to be in a couple of more acute care clinical areas like ER and then labor and delivery. Labor and delivery is one of those things that people either, I think, love or hate. I made that decision in nursing school that that was an area that I would really enjoy working in. Years ago, they didn’t hire new grads ever into labor and delivery. I ended up working my first couple of years actually on a neurology unit, which wasn’t my favorite at all, while I waited for the opportunity to get a job in labor and delivery. I’ve been a nurse for 31 years and 29 of it I’ve been on the OB arena.
Jamie: With the expansion of perinatal outside of the traditional labor and delivery realm, you really are dealing with the health of a family not just a mother and a new baby. Really there are so many aspects of a family’s connection with the mother and the new baby or babies – because we have lots of multiple births going on. What is your feeling about how you reach out to families as part of your job as a nurse?
Cyndy: Well, and that’s the fun part, the very fun part of my job. I think that perinatal piece started because my first job, an area that I ended up working, was a unit that had a very high-risk pregnancy population. We had many, many, many women who were transported in and spent days and weeks and months with us nurturing along a complicated pregnancy in trying to come through that with a viable live child that they could parent. That was my first opportunity to get to know families just because there was a longer term component to the care that we provided. The wonderful thing about the OB arena is we really get to sort of step in to those intimate times. Childbearing is one of those sort of developmental tasks of women, for women, and it brings families together usually whatever their cultural and these sociologic values that that family brings to the experience really come out. It’s just the privilege to get to be a part of that real intimate time for families.
Jamie: Postpartum depression is something that’s been in the forefront of a lot of news in recent years. Is this something that, as a perinatal nurse, you are making sure you’re aware about and focusing on for new moms? Is this something that your short-term aspect of care after the birth – does this encompasses that or do you pass that along to another nurse caregiver?
Cyndy: It is on our minds, I’ve only done – I’ve predominantly done intrapartum nursing care for OB families. I am seeing them more in that specific timeframe related to labor and birth and immediate recovery. We are absolutely aware that postpartum depression is a significant issue and there are lots of women who are on medication for depression even in their pregnancies. We screen all patients. All of our providers screen patients in the prenatal period so we know folks who might come in to us with that risk factor. We do a short screening of all patients in the postpartum period in order to try to support follow-ups for those folks who have a higher risk profile so absolutely very important.
Jamie: What’s one of the things that you’re seeing as an advance for the future of your career as a perinatal nurse or perinatal nurses in general? Is there anything on the horizon perhaps with regards to some of the reforms and expanded roles for advanced practice nurses?
Cyndy: Well, it is fun always to sort of dream and see what you think will happen. The wonderful thing about nursing is there is just so many opportunities to be in so many different kinds of roles. I’ve had an opportunity to be a flight nurse, an obstetrical flight nurse for high-risk patients that are being relocated from a rural or a level one facility to a higher level of care. I would see opportunities like these growing as our country try to regionalize health care and provide access to care for patients that are anywhere, rural or urban. There are also some roles popping up for high-risk perinatal nurse practitioners. There are a couple of nursing programs and units who have employed nurses who have received nurse practitioner educations specific to a care of the inpatient, the unstable pregnant woman in an inpatient setting. It’s a more of an acute care nurse practitioner role, which is also very exciting, just because we know it’s reformed that the advanced practice nurses are essential to our healthcare successes in outcomes. Those are a couple, definitely a couple of roles that are out there.
Jamie: I’m always amazed at the different ways that nurses, even within a specialty, find ways to – just find their own niche and role and talk about the opportunity to act as flight nurse in a specific transport setting for a specific type of patient. It’s fascinating to see how nurses just adapt to so many things within a role that is so much – in other healthcare professions, their roles is so much more defined and have boundaries. In nursing, it just seems like we’re always able to reach beyond those boundaries and carry our caring that is the central part of nursing to the patients in many different ways.
Cyndy: Well, it’s true. The flight nurse role really evolved in that way. There was a flight team at the hospital where I work and we were growing these high-risk transport program and those of us working on the unit begin to notice that the wonderful nurses who are bringing these patients to us via helicopter or a fixed-wing aircraft, their expertise was critical care. These are the nurses that where going out on the highways and scooping patients. They admitted to use that these patients – our patients made them uncomfortable. A couple of us went to our perinatalogists and said, “We think we would be better care providers for those high-risk patients and we want to know if we can work to develop a system where we can get on those flights to go get the patients and have more the continuity of care and just provide care of by people who are more the experts. It really grew from there. You’re absolutely right.
Jamie: I noticed in your interview for the Nursing Notes newsletter that you had mentioned that you are an award winner for the Colorado Nightingale Award for Excellence in Human Caring and I think your anecdote right there was just an example why you probably really deserving of that award because I think that it just exemplifies, from my standpoint what nursing is, in reaching out and finding new ways to apply our doctrine for caring for patients in different ways. I applaud that.
Cyndy: Well, thank you.
Jamie: One of the things that you mentioned earlier was your concerns during school. We have a lot of students that check out the show and listen and wonder the same questions. I was amazed when I was in nursing school. The same kind of things that I was seeing going on around me with my classmates was, they all were surprised and often surprised by the rotations they enjoyed versus the rotations that were a little more work to make sure that they were focusing. Things that they thought they were going to love they hated and things that they were questionable about they found out they loved. To nursing students out there, when you talk to them, what do you share about remaining open during your clinical rotations?
Cyndy: Well, I think it’s tough. I remember, particularly in the bachelor’s program, I just remember feeling like I never really got comfortable in the clinical area. Just when you thought you sort of knew the routines and knew where things were that rotation was over. For me, it seemed hard to really try on nursing not till I got since my Capstone sort of experience. I think that was a challenge. I feel like students have the same challenges today. We have them for very short periods of time in our area. You just get a little taste. I found myself going home and thinking, “Why do I love this area versus this area?” I was able to identify that I felt more drawn to an acute care or critical care type area where there was less predictability. Things change quickly and happened quickly. There are other nurses who are so clear that that is – they want an area where they can plan their day and provide the best care for their patients in an organized fashion. That’s definitely one advantage I have. People ask me a lot, “How do you get into this area?” just because it’s harder for nurses to get into the area of nursing they might feel drawn to. It’s sort of “relentless persistence” is the phrase that comes to mind. The focus that are able to come in to my arena as new graduates are young women and men or I guess any age – “young” nurses is the word I mean – who are so passionate and convince they want to be in this area that they’ve taken every opportunity they could find for exposure and education to that area. When we look at our resume of an applicant who has done a Capstone Project whose work as a nurse’s aide or an OB tech who found – I teach a local class in our community, a seven-day didactic class to help educate folks in our specialty – who find this craft as a new graduate and pay out of their pockets to come and get more education, who are popping in on a doorstep of a manager every three to six weeks just so their name and face is right there in the forefront. I think that’s really how people get their foot in a door of an area that they really feel drawn to. It can be tough but I would tell people to stay true to what they feel drawn to and there will be opportunity there.
Jamie: You made an interesting comment about men and women in perinatal nursing. I think that it’s interesting in my experience that there aren’t a lot of men that are involved in the process of perinatal nursing whether it’s in the acute care in labor and delivery or any of those aspects and yet there’s a lot of male OB doctors but not so many male nurses that are finding their way into that arena. What would you say to the male nurse that’s interested in labor and delivery and perinatal nursing that is concerned about perhaps feeling a little awkward in that setting?
Cyndy: There are more and more male nursing students, which is an exciting and wonderful thing, and I would say to absolutely go for it. Your point is true that we’ve had male obstetricians for years and it is no different in terms of gender for being a male physician or male nurse in terms of patient exposure. We do have a lot of male nursing students and, by and large, our patient population is open to that. Some years ago, the manager actually hired a male nurse who had worked in a Med-Surg area and really felt drawn to Labor and Delivery. I will tell you, he got more patient “thank you” notes than any female nurse on that unit because patients would send him…
Jamie: That’s very interesting.
Cyndy: Yes, they would send him letters about their surprise. Their notes would say, “Gosh, I was a little surprised and a little hesitant when I found that you were going to be my labor nurse and yet the caring and support I felt from you was so surprising…” – they were just weren’t expecting it and absolutely felt the high level of compassion and care that he had for laboring patients. It’s definitely an option for those that are interested.
Jamie: Well, I’m glad to hear that. I’ve heard similar things from other people in the labor and delivery setting about male nurses in that role that the male nurse that come in to that setting are there because they want to be there and end up just being really good nurses in that role. It’s good to hear that the patients are responding well to it as well.
Cyndy: Yes, it’s been wonderful.
Jamie: Well, just a final note here. If a nurse is listening to this that wants to maybe move into a different area of her career or perhaps a nursing student – we talked a little bit about nursing students – but what would you give as far as advice on what they might need to do to prepare to become a perinatal nurse? Is there a nurse certification? Is there an organization that represents perinatal nursing that they should look into?
Cyndy: Our national nursing organization is called “A1” which sort of sounds like the steak sauce but the acronym is “AWHONN.” It’s “Association of Women’s Health, Obstetrics, and Neonatal Nurses.” It does try to encompass that perinatal area. It is a wonderful organization with local and state and then national activity, conventions, education, and it’s a very vital and active organization. That’s absolutely one option. I would encourage them – with the Internet you can find something anywhere. I get contacted almost daily by folks who have gone online and found information about the didactic course, for instance, in labor and delivery nursing that I helped coordinate in the Denver area. My hunch is there are educational opportunities like that around – I think exposing themselves to the area. Most areas of nursing are unique enough that I would – everyone wants to make sure that folks that are being hired into an area have had enough exposure that they know a bit of what it’s about in terms of workflow and stress levels and things like that. The certification in my specialty is more for nurses who have done this a couple of years. Yet, all nurses working in our arena need to be certified in neonatal resuscitation so some nurses who are wanting to get into the area will find a local NRP, Neonatal Resuscitation Program certification, and complete that. Many OB units want their nurses not only…
Jamie: Just to interrupt you, so not just PALS, but they need to have – specifically have neonatal resuscitation as a separate certification?
Cyndy: Yes. PALS is more geared towards pediatric patients. NRP is a certification specific to neonates so that’s babies from zero to 28 days of life. ACLS, that’s required, ACLS as well. The other big thing that takes some time to learn in labor and delivery is fetal heart rate monitoring interpretation sort of like telemetry nurses. You learn to read the cardiac monitors. There are plenty of education opportunities out there for fetal monitoring education too, which is another good idea for getting your resume in order.
Jamie: Well, Cyndy, I want to thank you for taking the time to share your nursing career with the listeners here at Nursing Notes Live.
Don’t forget to check out the entire April, 2011 issue of Nursing Notes, looking at perinatal nursing specialties. This month’s Nursing Notes newsletter includes articles on the long term health impact of preconception care dialogue discussion between patient and nurse, specific roles within perinatal nursing, and a recap of the 2011 NSNA National Convention.
You can read the entire issue online at www.discovernursing.com and don’t forget to catch our other Nursing Notes Live episode this month where we gathered a panel of perinatal nurses to talk about exciting trends and the outlook for the future of perinatal care and nursing. You’ll find this and our other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.