Maternal and Child Health Nursing is the focus in this episode of the Nursing Notes Live podcast. This week we had a panel discussion on our topic. On the panel is Karen T. Harris, president of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), and vice president of Patient Care Services and Chief Nursing Officer at Henry Ford West Bloomfield Hospital in West Bloomfield, Mich. Also joining us is Ginger Breedlove, president of the American College of Nurse-Midwives and professor of graduate nursing at the Eleanor Wade Custer School of Nursing at Shenandoah University in Winchester, VA. Here’s that discussion.
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Jamie Davis: Hello Karen and Ginger thank you very much for coming on the Nursing Notes Live podcast. It’s great to have you both here with us today. I’m going to start off with my traditional first question and I will ask Karen first. Karen, if you could tell us a little bit about why you wanted to become a nurse.
Karen Harris: Hi, Jamie. Great to be on the call with both you and Ginger. Why I wanted to become a nurse? To be honest with you, since I was a little girl, aged four, sitting on the porch with my mother, and she asked me what I wanted to be when I grew up and my answer was a nurse. Honestly, I never deviated from that. I have always said that. So I think it’s just was innate to what I was meant to do and I think the reason in that is that I just have a true sense of curiosity about people. I love to understand why things are the way they are and how can I make a difference. So the science of nursing along with the art of caring really just comes together for me to make the difference that I want to in people’s lives.
Jamie: Ginger, How about you? Tell us a little bit about your reason for becoming a nurse.
Ginger Breedlove: Absolutely, Jamie. I want to also just express my excitement be able to be on this podcast with Karen. It’s fascinating to listen to people’s stories because I remember the years I spent as a labor and delivery nurse while women were in labor asking them to share about their lives and about their relationships. There’s something unique that hearing someone story that resonates with the listener and hearing your journey has been incredible. I think what strikes me is how we all find our way through our lives based on life experiences, networking and opportunities. So I came a little less traditional, perhaps a little more non-nursing approach as I was a political science major in my undergrad degree and had debated a lot in high school as well as college-level debate and was on my way to law school. Until one of my older brothers who was in law school at the time asked me a little bit about what my intent and my future was. We had a great conversation and the University I was attending had just started and within their second year of baccalaureate nursing education. So I had this heart-to-heart talk and had come from a lot of service health-related volunteer jobs as well in high school from the traditional candy striper to working with mentally and physically disabled children. I realized at some point as I was surrounding myself with people in my dorm about nursing that maybe that’s really what I wanted to do. So it took me about 2½ years to end up doing what my parents thought I should do but at that young age refused to do.
Jamie: Oh, that’s great and I have to say that it’s very interesting as I was listening to the two of you. I’m going to ask you to explain maybe some of the differences and compare-and-contrast the differences between, Karen, your approach as a women’s health nurse practitioner and you, Ginger, as a nurse-midwife, both advanced practice nurses, both nurses focusing on women’s health and care. Maybe, Karen, you could start off and tell us what are some of the differences between those two types of advanced practice nursing.
Karen: When I worked as a women’s health nurse practitioner I was really working in a resident-run clinic at that urban hospital setting. I primarily in my role performs intakes on most patients or return OB appointments with some GYN but not very much. It’s very much what I was doing very different from what I see from the certified nurse midwife. They do do that. I see patients in the clinic setting like that as well. But the midwives that we also work with they are also delivering the patients in the inpatient setting. They do the continuum of care. Whereas I was at that time more focused in the clinic setting primarily. There are women’s health nurse practitioners that sometimes will work in triage. In our organization, we have the benefit of having the midwife in triage because they carry their own patient load. Then there’s some of that continuity when they’ve seen the partners in their particular practice. Ginger, do you have anything to add?
Ginger: Yes, I would say in addition to the intrapartum period of managing the moms and families in labor and birth, we’re also doing comprehensive immediate postpartum care. Some do newborn care based on if they’re on a freestanding birthing center or a few hospitals around the country. I think that’s really the biggest difference because WHNPs and CNNs have comprehensive training related to family planning, care through the lifespan, preconception counseling, hormone therapy, prescribing and managing. It’s really that unique childbearing period at the time of birth and postpartum where the professions have a different scope of practice.
Jamie: So we’re talking about women’s and children’s health and really, I guess, focusing on both the overall picture and also that moment when women are giving birth and having neonatal childcare going on. Why is it that nurses are so integral to that process to women and children health issues in the country? Why is that such an important place for nurses to be involved? Ginger, you want to take that one first?
Ginger: Sure, I’ll start with that and I’m going to plug the March of Dimes here. I think that – and particularly I served on the national nurse advisory council of the March of Dimes. I think that nurses, whether they are in AWHONN or WHNPs or CNNs are equipped to be the most dynamic and specifically targeted for position health educators for childbearing families. We really have a unique ability to talk about, at the patient level, health promotion, risk reduction, healthy choices, engaging families. Because we’re really about the business of focusing on wellness, we’re not in a mode of disease and surgery-based care, which we need in our healthcare team. But we are the perfect complement to help women, in particular, understand in a way that they can communicate back to us as the caregiver that they understand how making their decisions can impact outcomes of their care.
Karen: Yes, when Ginger earlier referenced that birth experience that changed her trajectory, I too look at birth as that miracle moment. That is always just an incredible experience I think for everybody in the room. But the difference that the nurse truly makes, in my opinion, is that comprehensive assessment and management of the patient, that entire labor support. This is focused on the intrapartum setting but the nurse could be in a clinic setting providing prenatal education, postpartum providing breast-feeding support. There’s an entire curriculum or focus for that frontline nurse that really is the hands-on makes the difference in the moment. But it really is based on knowledge and putting those pieces together to make sure that they’re managing the appropriate situation. I mean there’s many high-risk things that arise. And so being prepared to understand what’s going on and what is the most up-to-date appropriate treatment, how do I communicate with the provider and the other care team members to ensure those optimal outcomes. So the difference that that nurse makes is really, to me, making that ultimate decisions in the moment because you may be the person standing there when that baby is delivered and understanding the course of care that you need to provide. Now that’s just referencing the frontline nurse. Whereas the midwife, of course, is a different perspective perhaps in some ways. But I would say still many of those factors correlate to the midwives’ practice as well.
Jamie: So what are some of the key issues right now? I know in the United States here primarily there’s a lot of changes going on in our healthcare system and nurses seem to be stepping up to the plate in many ways to help fill some of the gaps that we have in our system. But what are some of the key issues regarding maternal and child health that you two see as being important for nurses to focus on at this time? Karen, would you like to take that first?
Karen: Well, actually, Jamie, that’s a great question. We just had an immediate release of a multi-organization call to action identifying and addressing safety concerns in labor and delivery. This was the four collaborating organizations were the American College of Nurse-Midwives, American College of OB/GYN, the Association of Women’s Health Obstetric and Neonatal Nurses, and the Society for Maternal-Fetal Medicine. Additionally, there were some other partners that – communication is really a key factor in what we do, in how we collaborate. In my consulting work that I have done, it was always a core competency to promote those optimal outcomes. Just through the team training components, we are seeing very high acuity moms in the intrapartum setting. Postpartum hemorrhage has been on the rise and we’ve done a lot of work putting together initiatives to address and mitigate those and educational components as well. There’s many things that we need to be prepared for as a team. I think that the collaborations and partnerships that we have has really taken hold and is going to help us continue to grow in the future to promote those optimal outcomes.
Ginger: I would highly emphasize what Karen just said. The team approach is really emerging and, probably for the first time in the history of these maternal child health-related organizations, we’re starting to play in the sandbox better – for lack of a better way to describe it. The nurses and doctors are coming together to address these issues. The other thing I want to highlight, Jamie, is really from the patient’s side and the social issue side. That is, our infant mortality in the US is an embarrassment. We still have a preterm birth rate of 1 in 8 or 1 in 9 based on the statistics you look at. If you look at some of the southern states, in particular, their infant death rate is higher than places like Botswana and Lebanon. It is highly correlated to this high mortality. It is highly correlated to less-advantaged groups. So addressing health inequities in our country in the maternal-child population is something that is, for me, as important as dealing with hypertension and postpartum hemorrhage. It’s a very complex issue but we are not getting better. We’re actually getting worse. So there’s some social agenda items that I think, at some point, has to come to the forefront addressing health disparities. There’s a great author. If anybody likes TED Talks, they have all my doctoral students in statistics. Go to Hans Rosling’s TED site that talks about the correlation of poverty and fertility to the health of a country and we are a very sick country. I think it’s a reflection of our maternal-child health statistics.
Jamie: I definitely have to provide a link to that in the show notes for this so the people that hear you talk about that will be able to find the link. I’ll get that from you. It’s interesting you brought up how the infant mortality rate is higher in the US than it might should be in what we would like to see and certainly, as you said, maybe an embarrassment in some ways. What are some of the things that even the frontline nurse that’s not specializing in maternal and child health care but maybe in public health or even in the Med-Surg unit that’s seeing a family or from even an outside practice or clinic, what are some of the things they can do to be proactive in helping to get women and children to the care they need?
Ginger: I can take that. I think that one of the things I encourage my baccalaureate students is to get to know your community. What are the resources available that help families from not only on healthcare’s perspective but from social services, legal services. Basic necessities for one to be able to live, let alone thrive. As we have ACA impacting more and more people enrolling, which I think we’re up to 9 million enrolled in this cycle, we have more women in particular seeking care for services and not always getting into those services as quickly. As something as simple, if you come across a patient who feels like they are invisible or don’t know how to navigate the system, doing role-playing with families, handing them the resource, calling resources for them, that demonstrates a caring and a willingness to be engaged in helping them find the next step. You’re not going to fix the family issue, but you are going to be demonstrative of a caring health professional and, hopefully, all nurses are doing that.
Karen: Yes, I would agree with Ginger. Access is a key component. Transportation and understanding how they navigate to get the care that they need and what resources are out there and available. Even the educational tools, are you connecting so that they understand what you’re relaying to them and do they have those appropriate educational resources and the references. Language, we’re sitting on a big increase in focus to the non-English-speaking families. Earlier, Ginger had referenced health disparities. We really need to ensure that we are communicating in a way that they understand and use the interpreter services. So those educational materials and that support infrastructure really does make a difference to the outcomes and understanding for that patient and family. Then the other thing that I would add is just the whole pre-conceptual counseling component in getting connected in that as soon as we possibly can in helping people understand that and the nutrition. As Ginger alluded earlier that we’re not a really healthy country and the impact that that can make on outcomes as well.
Jamie: Really, nurses not just as a healthcare professional but as an educator and really an advocate for their patients that are in need.
Ginger: That’s right. That’s a life span. More than 50% of pregnancies are unplanned. These conversations really should be going on all the time.
Jamie: One last question and just a brief question for each of you and I’ll start with you, Karen, what is the piece of advice you would offer to that new nurse or that student nurse that’s looking at moving into working with women’s health or obstetrics or neonatal positions?
Karen: Well, my key answer is do what you love and love what you do. You have to have a passion for whatever career choice you make and really stick to your mission, your own vision and values of what you want to achieve. If you are not able to empathize and support and connect that art and science of nursing, you really need to make sure that you are in that right niche, in the right sets. Early on in my career, after I did my two years of the Med-Surg and I was changing role, my colleagues were like, “Oh, you won’t find a better place than this.” But I had to find what was right for me and I did. I did make the right move. So that’s what I would encourage the new nurse to consider. We are under transformational times with healthcare in this country. The key that I see in my role now today is that you have to be flexible. You have to be innovative. You really have to have a sense of resilience. So for the new nurse, how do you find that? We have to mentor our newer nurses. We have to provide that support and infrastructure for them to feel free to ask questions, to have the resources that they need to be successful, to connect them from the University to the floor that they’re working on and how do they actually apply those skillsets. My son is actually a nurse. Going through that journey with him again gave me a set of fresh eyes. As he was studying the meds, I studied with him. As he was studying for NCLEX, I studied along with him. When he got a position, he’d come home, we would actually debrief and talk about the different scenarios that he was experiencing. The key factor is he had rationale for what he did at the time. I supported him in his choices and we talked it through. Every new nurse needs that person to go to to support them in that endeavor and I encourage that person to connect with someone on the floor, someone they might know that is a nurse. Because at the end of the day, if we stay focused to the patient and the choices that we make and use that critical thinking and problem-solving, you do the right thing for the right reason. But you have to have the passion for what you’re doing.
Ginger: I would add a few things. If they’re really focused on maternal-child nursing, immerse yourself in whatever opportunities you can to add more knowledge beyond nursing education. So attend childbirth classes. Attend Doula program. Go to continuing education like I did with ICEA or an organization that has a maternity-related focus. Because I think there’s very little exposure to maternity nursing in nursing school. It depends on the program, but certainly validating if you can through other routes whether it’s a fit. I would also encourage people writing their own philosophy about what that means to go into women’s health or maternity nursing. When you’re approaching an institution for a job, which are very competitive especially labor and delivery, be prepared to ask questions that reflect what your personal philosophy is. Because the most disastrous experience you could have is giving up your belief for a misfit [position] and be patient in the process. It really does take time to get into some of these positions. Joining AWHONN. Whether you’re an OB nurse or not or shadowing people, if you can have that opportunity. And really to follow your goal. I completely agree with Karen. If you can find a job that matches your passion, it’s something few people ever attain in a career job. So I wish them the best of luck and enjoy the journey. It will change along the way.
Karen: Jamie, I would like to add two things. Thank you, Ginger, because you are exactly right on your comment about joining the professional organizations. So thank you for that comment. I actually attribute my entire career to my involvement in my professional organization of AWHONN. I do not think I would be where I am today without the support of that. That is part of that resources and infrastructure. So that is definitely a key component. The other thing that I would add in Ginger’s story. She went into that labor and delivery setting as early on as an assistant and then became a scrub tech. I do think for the newer nurse that might be in school currently, if you can get onto a unit and become a nursing assistant or a unit secretary or some type of role, you will learn a great deal of how that culture works and if that’s the right fit. I would really encourage the newer person in their school if they could do that. I think that’s a great experience.
Make sure you check out the entire April 2015 issue of Nursing Notes where we look at maternal and child health nursing. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our Get to Know nurse Jody Lori, a senior director of Global Affairs and director of the World Health Organization and Pan-American Health Organization Collaborating Center at the University Of Michigan in Ann Arbor, Mich. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes and check out the new podcast player at DiscoverNursing.com!