77 - Amanda Shafer Pt 2: Sourdough, Consent, and Nursing

Continue with nurse and Omak, Washington native Honored Guest Amanda Shafer as she chats about changes in nursing, her career progression, your safe crying space, making mistakes, the utmost importance of informed consent, and more!

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Transcript

0:01

Alright! We are... Hopefully you guys have stuck around and listened to the full second intro. Because if you haven't picked it up by now, if we have double episodes and the rare triple episodes, sometimes we just record other intros and do different things with it because it's fun. So if you skipped the second episode's intro, stop listening to me. Go back. Listen to the whole thing, because that was amazing. I'm not even going to tell you what Amanda did! She did great. So welcome back Amanda Shafer How are you since I last talked with you? gosh, I am doing fabulous. I still have more projects to do. Good, good. No twins though, and no more sourdough in the oven at the, nothing in the oven proverbially or literally. All right. Clearly established. All right, so we're just gonna jump into this, because I know we have a lot to talk about. I guess let's be, you ended the last episode on a really nice note as far as like, you know, being a nurse for. my goodness, over 18 years. Like you are so old. And ladies and gentlemen, she became a nurse at like seven or eight years old. Child prodigy, it was amazing. So no, it's just, I guess my first question for you is what does it feel like now that your nursing career is literally an adult? Because mine, it will become an adult in January, but it's not there yet. I'm still kind of in those late teens. So what does it feel like being a literal nursing adult now? I I don't think I really want to be an adult. There's a little bit more responsibilities there. So I'm just going to be in denial for a really long time. really nursing is one of those careers where you're constantly learning. So, and I feel that if you don't feel like you're still learning, it might not be the right career. It's a medical career that, you know, it's ever changing. and doing this for this long and each new thing that comes out I think is still making it more more interesting for me. So I think that's probably why nurses, probably one of the longest fields. People don't usually just go to retirement age and retire. They're at it for quite a while or they have no other choice. It's gotta be one or the other. Yeah. That's it. When you get this far, that's it. You're in one of those two categories. And to clarify, I you're not referring to official education, although that can be part of that, but just constantly learning, right? Yeah. the field just constantly changes while you're in it. know, something that you might have done a certain way this, you know, five years ago has evolved, has changed. You're doing something different each time. Each time you're doing basically anything in nursing. New equipment comes out, new ways of doing things comes out. It's a constant learning. New diseases, new infections, new cures, new... There's just so many different things that go into it. And do you find that I've established this more than once in the podcast, but I genuinely feel like it's odd, it's almost a paradoxical thing where in our career, we face some of the most rapid changing newness for lack of better terms. And yet I feel like many of us are some of the more resistant folk to change. I mean, everybody is to a certain extent, but like, how is that even a thing? How are we like, no, we've always done it this way. Why are we doing it like? Right. It's those that have, you know, the longer you've been at it, it's like, we used to not do it that way before. You know, it always worked before. Why are we changing this now? And we do, we do, all of us do. Even those that do like some of those changes, there's still some things we're a little resistant on, like, well, this worked before. Why do we have to change this? It feels like it's making it a little bit harder than the more you do it. You're like, actually, this is okay. We just, don't embrace that change right away. Exactly, it might take a little bit longer if not at all. So, no, so I want to foreshadow what's coming in the episode. There are some things that never change and those are timeless principles. Those are those key like you talk about code of ethics, patient safety, all the things. So we're going to circle back around on that. But in the meantime, we're at the Perfect Springboard for 18 and a half or so years of nursing. What have you done? Have you been a labor and delivery nurse your entire life? gosh, no. So I started out my career working in a medical clinic. So they had family practice there. They also had quite a few specialties that came in that I got some exposure to. Cardiac urology, obviously they had gynecology and OB -GYN there too. So there's multiple GI, lots of specialties that came up into that area. And my job as an RN initially was a triage nurse there, but then I also worked with all these different providers in their specialties. So it gave me good experiences learning all these different things in that clinic side of it. And then from there, I went to hospital nursing and I started out in a med surge and I wasn't actually on med surge for very long. when the opportunity came up for me to apply for a labor and delivery position, at that time you had to be doing med, med search for at least six months before you could even apply to a labor and delivery position. It's a small rural hospital. So you needed to have experience in some things before they would start training you elsewhere. and I applied to labor and delivery, but I also applied to ICU at that time. Yeah, it was great. And my first week of labor and delivery orientation, I actually almost switched to ICU. I had a very hectic first week of, we'll just say, patients and diagnoses at that time that I kind of came out of a room going, is every situation like that? And my preceptor at that time was like, no, that's just special. And I was like, Okay, because I was just about to take the other position then because I was not going to be able to do that every single time. Like, no. but to clarify you were going to go from labor and delivery to the ICU like that's some big step down Well, no, not quite some big step down, just kind of the other focus of where my brain could go. If I had the two choices, these would be my top choices. I worked labor and delivery at that hospital for like about eight years. At the time, I also picked up ER shifts. I worked a lot of extra before moving on to Providence. There was a one year time span in between that hospital nursing and Providence's nursing for liver and liver that I actually did a different type of clinic nursing, which was respiratory and an outpatient care setting. So I was learning about CPAPs, oxygen, BiPAPs, non -invasive ventilators for ALS people, COPD people, going out, doing home visits on them, assessing them and their respiratory status and what they need. and setting those things up. So I did this kind of multi -different fields of nursing, but in a way it helped me learn a lot. And there was a lot above just labor and delivery that I could apply in my own practice with patients. And labor and delivery isn't just having babies anymore. It's a very complex field with lots of different patients who have different complications and being able to handle those different complications is, I think, helps me out a lot. Amazing. I appreciate you sharing that because everybody listening is already well established. Nursing is one of the greatest fields on earth. We'll defend it to our dying day. And especially one of the qualities is because so much lateral movement. You can go here, you can go there, you can go wherever, you can do whatever. So, I mean, here's Amanda's career, outpatient, inpatient, back to outpatient briefly, and then inpatient. And in no time, it doesn't sound like, you know, You're not being forced out of these things. You're just, you know, by their life circumstances, know, something, you know, a change in desire, you know, me, pedsonc all my career, wait, you know, now we're gonna pivot and get into women's health, get into postpartum, which, know, for sure, for sure. But it's hilarious that you're talking about the clinic and all the different like specialties you had in your clinic. And it just brought me back to one of my very first job, absolute very first job of my life. 14 years old, got paid under the table, totally illegal, whatever, I don't care, I appreciated it. Didn't really do well with the money, but that's okay, I spent it, because I was 14 years old, right? But I was a janitor, I was what is now referred to often as environmental services. But back then I was just a janitor, and a 14 year old wanted that. And would you like to know of all the specialties that we had, and it was at outpatient clinic, same thing, ENT, family practice, all the things. Would you like to know what my primary unit that I always had to start my shift on was? OBGYN. As a 14 year old, ridiculous nerdy kid, I'm coming in pretty much at the end of day, right? Like they're closed and doctors are wrapping up, nurses are wrapping up. There's not really patients anymore. I am emptying bags of vaginal speculums. You know what I mean? Like dumping this stuff out and all that. But there's a... a serendipity and an irony to that. You know, here you go, full circle, 30 years later, and it's like, okay, maybe that was, I don't know, God's sense of humor, I'm not sure. So I just. time, you can also appreciate what those people do for cleaning up. Absolutely 100 % do not. And ironically, this is Environmental Services Week. you know, I don't care when you're listening to this, well, you you thank those people because my goodness, I love them so much. And I actually was talking to Marina about this just this last week. I'll name drop. She's one of the most amazing environmental service techs that we've ever had. Just always positive, always smiley, always laughing. I have a night shift one that I love to death. Her name's Mary. Yeah. that's what I mean. I mean, it's like, just thank everybody, because we're all a freaking team. Anyway, this is one of those squirrels we were talking about. Woo, undiagnosed diagnoses taking over. Let's pull this back around, shall we? What do you, so you talked about these two different reasons why people end up being in nursing for so long. I don't find you as being one of those ones that were forced to stay in it. So. Your passion for nursing and your love for nursing is evident. What do you love about nursing? What I love about nursing, so besides the constant learning, I mean, I do like that you can just, it's a field that you can constantly learn in. I think that for a lot of us, nursing is more of that calling that, you know, we have it in our heart to want to care for people, to help them through their good times, to help them through their bad times. You have to have a sort of a passion for people. And I usually say this, that it's just, You have to have compassion for them. You need to be able to understand that everything they're going through, there's something behind, but at the same time, you can be the one to help them. And to me, that's like a feel good thing. Even your most challenging patient, you can still find good things in that too. So nursing, while difficult and can be very frustrating and tiring at sometimes, it's also very rewarding. So and that's that is the primary reason I feel like you don't mean that that will defend this career to our dying days because it is just despite the challenges and not not even despite I think sometimes because of The challenges, know, we get it's it's just so rewarding and I try to you can't convey it I try to convey in nursing students who are listening I try to convey it to my nursing students You don't see my face while I'm talking about this. You don't see that you hear the passion, but you don't see the passion Even my nursing students see it and I still think I do it such a disservice because it is so rewarding and so life -changing and so, man, I'm I'm glad. gonna have those times where you get in your car and you cry. Everybody has that. mean, you see all the videos online that, well, the stock room's the crying room. That's where you could have cried. Well, no. You have tough times. You have tough challenges. But, you know, if that's your passion, the nursing field, you find which part of that nursing field is your passion for you, and you find your ways to deal with your tough days. or go in the room and cry and then we all feel for you and we know it and come on out, we'll start over again. but that's part of dealing with the tough days, right? Like that's it, that falls under that umbrella. And I think when you're first come to it, those tough days do get you pretty good. a lot, I've seen a lot of newer nurses come out and they have those tough days and it's just like, I don't know if I can do this. Like, you can do it. You're good. You can learn this. You're doing a great job. It's providing them with those positive things and then they have to find their way to work through those tough things. why this exists is we're trying you know what mean trying to not allow the death of a nursing career before it even has a chance to get started. Yes. Being, having people just, you know, be those encouragement for them. Like be there to, hey, yes, this was tough. This is the type of situation that's very tough and it hurts and it sucks. But here's all the good things that you did. Or even the mistakes that we make. I make mistakes all the time. I make mistakes at work, but we learn from those mistakes. hold on one second. So wait, you make mistakes. What is that? Mistakes? Mistakes. I've heard this word before. don't know. What does that mean? don't understand. We do. We have all made those mistakes on the job and they can feel like something that's minor. let's do this right now. We're gonna do this right now. This is fun. Okay, so, you, would you mind, and I'll reciprocate after you, of course, because I wanna see how bad yours is, but do you have a story of a med error that you've made or a mistake that you've made that still bothers you to this day? I I do. I'm going to start with because of that med error, recently I was actually able to help somebody else through that exact same med error. I mean, not perfectly the same, but the same type of medication and the same type of fear. so it would be with a labor patient and labor patients have babies in their tummies that respond to lots of different little things. So you have two patients and one of them can be little bit harder to get to and harder to take care of. So it always has in the back of your mind that, you know, that's your harder patient is the one inside because it's not that easy to care for. But we use a medication, Pitocin for augmenting labor, helping contractions along, helping a person get to complete dilation so they can have their baby. And I was staying over and working extra to help out on the unit and I had taken over our patients and on the IV pump we use LR for hydration, fluid, or if they have a epidural, you know, we also use it to help with that. But she was also on Pitocin and came about that she needed a bolus of Kind like D5LR or D5 normal saline. But because of the way I had my lines hooked up, I thought I was bolusing this D5 that was hooked up. The pit was bolusing. And the patient had a, it probably only got, it may seem like a small amount, like less than 10 mils, but that's a lot of pit in a short little area. Cause you think about it, we started out at one mil unit a minute sort of thing. Like it's really, really a small amount, but it's enough to cause a uterus to go into attack -assist -a-leave point where the baby's not getting much oxygen and babies can get D cells. And yeah, yeah, my patient had a very, I'd like to say a very prolonged contraction of that uterus clamping down and that baby responded to it with a large D cell. in that short timeframe and that clued me in and I looked up and I stopped that pit and yes, can I treat it? Yes, hydrate her and give her a medication that's going to reverse that contractility, but you leave that room feeling like you're the worst person ever that you caused harm. That's what it feels like. And technically, yeah, that is harm. I wrote myself up. I contacted the provider. I felt awful. I told the patient what I did. This is what happens. because you take accountability. And I just remember for weeks, I felt so bad about that. Just weeks. Didn't have that patient anymore. She had a great birth, everything else, but I felt horrible for a very long time. And luckily in a similar situation, pit was hooked up to a patient's line. And luckily it wasn't started yet. But the tubing that was hooked up to this patient who was going very quickly was the pit tubing instead of just the LR tubing. And it was caught before everything was started. Unhooked that. hooked up the other one, but that nurse felt so bad. And you know, she needed time to process that. But that time was like, let's talk about one of those times where you want to go to a crying room and you want to cry about it. She did, but I was able to go in and talk to her and say, I've done that mistake, but worse. And it's okay to feel bad, but look at this side of it. Yours was caught before anything could happen. And that's why there is more than one person in there. This is why we can double check each other all the time. Those mistakes can be caught. And just kind of talking her through, but telling her my experience of what I actually did, I think helped her out a bit too. And that is that right there. Like I think the key point that Amanda brings out in this, first of all, if you haven't observed already, Amanda is still a nurse. She made a error, a significant mad error, and she's still practicing. Crazy how that works, huh? But more than that, I love what you say like about that accountability thing and about because here you are, you're an open book and you were able to help someone through it, however long down the road and be like, hey, guess what? You're not the only one. And that's the huge thing. The big takeaway is do not, do not. So, no, I'm just gonna, I'll go to mine. I did promise I would reciprocate. And this is the story I tell all my practicum students I tell. I'm like, just, it's, when I interviewed originally to become a nurse, my very first interview, and I said, because they said, well, what's your, know, I don't remember if it was Greatest Fear and all the things. And I'm like, well, I said, unfortunately, I know that I'm a human and therefore I know I'm going to make a mistake. I said, my biggest hope is that it's just not a mistake that hurts or kills anybody. I recognize this there. I will do everything I can in my power to prevent that from happening. But when it does, and I tell people, it's when, it's not if. When it does, then you learn from it. And I said, you know, if I make a mistake once, man, I promise you, I will not make that same mistake again. And so then you fast forward a few years that I'm charge. So the takeaway from this is not, Amanda stayed over and she was tired and made a med error, and I was charge and busy and made a med error. It happens. It doesn't matter what you're doing. But the long story short, I'll try and make this long story short because this is your episode, not mine. But this story, my gosh. And I'm going to take it all the way back to actually very first quarter of SCC, community college, as a nurse. And I'll never forget, that instructor was like, I need you guys to know you're going to make a bad error. Kind of the same thing, right? It's not if, it's not if, it's when. And she said, you, I promise you, most of you in that moment will be tempted to cover it up. You'll be tempted to lie about it. You'll be tempted to whatever. Resist that temptation. She says, and I'm listening to her. I'm a fairly straightforward guy. You know me. I try to be as honorable and all the things. Faithfully married, all the, you know. So in that moment, I'm going, okay, I mean, I'm logging it in. I'm like, eh, that applies to other people. I'm not gonna, you know, I'm honest about things to a fault, not worried about it. So now you fast forward to this night and I'm charge and I had this wonderful teenager and we'll avoid a hip information, but this particular teenager, so this is Peds Oncology, we give chemotherapy and one of the chemotherapies has a medication that you give with it and then after it called Mezna that protects the way I describe it to, to various nursing students and that sort of thing, or to patients was it's like a band-aid for the bladder, the interior of the bladder, because this particular chemotherapy can cause hemorrhaging of the bladder. Long story short, so I go in and this patient has a double lumen -Hickman line and has a fluid line and then a med line. And I think they were separate if I recall correctly, but as part of your assessment you make sure everything's connected, all the things. So both lines are connected, life is good, I'm answering phone calls, I'm so sorry, hold on, blah, blah, yeah, blah, blah. So I infused, I was on near the start of my shift that I needed to give that first follow-up dose of Mesna, and then we would give another dose about, I think, four or six hours later, I think it was four hours. And so gave that first dose, I went down to the things, came back, four or five, six, whatever, and gave the second dose of Mesna. And so now, fast forward, and it's middle of the night, and teenager patient, and all the things and I had gone in the room for, I don't remember, it like probably late night vitals and you know there's a weird smell, mesna for anyone who has worked with mesna. It smells at times has been described as like, I describe it as like a wet dog or electrical fire. It's got a very pungent aroma. I did not smell that, I smelled like it almost there was some odd smell in his room but it wasn't mesna. I knew what mesna smelled like. So I'm like, man, like I'm not thinking Is his computer overheating? All the things. I'm sniffing his computer while he's asleep. The weird things we do at night, right? And he's dead to the world. You haven't sniffed a computer at night? Come on. It's so fun, let me tell you. I'm trying to like, I don't know, whatever. So, while I'm in there finishing charting something, he rips a good one. And I'm like, well, maybe that's it. So I go out and as we do with good teams, I'm like, hey, so and so, can you go double check this? And just, can you go in his room? I don't know where the source is. I don't know if it's in the wall. I don't know if it's, you know what mean? I'm really concerned about stuff. And she went in, she came out, she's like, no, she goes, it almost smells like he's passing gas, but not quite. And I was like, she was like, is he? And I said, well, I mean, he coincidentally did do one while I was in there. So that's probably it. So we leave it be. About an hour later, he has to call, and he's like, Hey, Eric, I just want to let you know I went to the bathroom, which I needed to tend to, but he's like, also, while I was doing that, was barefoot and there's something sticky on the floor. was like, I'll take care of it for you. Get back in bed. Don't worry about me. I, man, I still do this day. I click on my pen light and I'm looking at the floor and I, a white sheen. And this white sheen extends from the my side of his bed all the way under his bed, passed through the bed, fortunately, because then he stepped in it. And I'm looking at all this going, what in God's green earth is going on? I cannot figure this out to save my life. And I'm like, what is this? What in the? So then you go through the critical thinking. Anyway, what had happened was his med line, which was on a syringe pump separate from the fluid line, was coiled up as I'm investigating what happened. I don't know at what point it happened. I swear still to this day he was connected, at least for that first dose or the beginning. But it was coiled up and hung on the clamp for that syringe pump and it was just dripping onto the floor. And so I infused at least one, if not both doses of mesnol onto the floor. This is 435 in the morning, whatever. Yeah. I'm just, yeah, floors. Man, that floor is not gonna hemorrhage. But no, I, and my, mean like you said, just pit in the stomach. And this particular teenager had already had bladder issues. And so that, I'm like, I'm going, am, my gosh, like I'm picturing he's gonna, you know, they're gonna need like surgery and ostomy, all these things. I'm like going. those worst case scenarios in your brain. is where you go. And I went to the restroom and I sat down and I'm like, I'm close to crying. I'm shaking. I'm close to crying. And in that moment, how do I cover this up? That is what came in my brain. As honest of a guy as I try to be, that's what came in my brain. And I seriously, you you're kind of playing with that one around a little bit. And it was like, no, I have to call this in. hitting in your brain, how do I fix this? How do I fix this? how do I make this right? And I was like, nope, I got a call. So I called and for sure, I mean, the doctor was very straightforward. She was, she's, I love this woman to death. And she was like, okay, all right, well, we're gonna need to, you know, get another dose and let's give that dose and we'll do these labs, XYZ and all the things. I fast forward, again, my story has taken way too long. I'm gonna have to cut some of that part out. But I get to the point where, we're just talking to each other. better again. And I, so I wrote her an email and I said, I said, Doc, I said thank you so much for not ripping me a new one. That was very hard, you know, for me to, and all the things, and I'm so sorry and I promise you, I made that mistake once, it will never happen again. I still can't explain it. I don't know why it happened, but I can guarantee, as best as I can, this does not happen again. And she wrote me back and she said, you know what, Eric, she goes, you know why I didn't rip you new one? Because I knew you'd be beating yourself up. And it's time to stop. And you know, don't, you know, process it however you need to process it. Let it feel for it, like you said, you know what I mean? Do what you need to do, but then let it go. You made a mistake, let's move on. They're likely not gonna be hard. And fortunately, you know, same thing, like, was harm done? Potential, for sure. And fortunately, there was no additional anything that, you know what I mean? Like, all my worst case scenarios did not come true. So all that to say, everybody. part is not having somebody make you feel worse about it. It's you're learning from it. You having somebody basically say, here's the thing, you came forward, we worked on it and work on fixing it or treating or whatever you need to do. it's having that accountability and not having somebody make you feel less because of it. And that's why you, and please make sure you're in an environment where you are telling, because same thing, I filled out, you know what I mean, all the things and filled it out on myself. But that's how we learn and that's how we teach each other. And you've got to be vulnerable and open. And again, in both our cases, in anybody's case who's made a meta error, you got the rest of your shift to do. And that's, that's the hardest part. Like, how am I gonna, like what, I gotta focus on like. giving charge report? Who gives a rat's rear? You know what I mean? can't focus on anything right now. Can I just go back to the crying closet? I'm the most miserable nurse on the face of the planet today and I just can't. Okay. I'm glad we had that discussion. Like that was not planned. This was one of those unplanned things that we had for you guys. But that's it. Like please take that away and know that it's not if, it's when. And be ready to be honest. Yeah. Be honorable, honest, open, teachable. And if you are in a place that shames you for that. Or if you have coworkers that shame you for that. Yeah, you gotta know. So on the subject of things that we're passionate about, mean, I guess I don't, we kind of just circumvented, went all the way around a different way. Anything else you want to talk about your nursing career or anything like that as far as that goes before we move on to our next passionate topic. No, no, I think my nursing career has been very fulfilling. And I just kind of want to make it fulfilling for others that are coming into it. Awesome. Awesome. That's why I'm so glad you're here. So we talked about briefly about how nurses are most resistant to change, even though it is one of the healthcare, you know, the healthcare field is one of those that brings about so many changes so rapidly. And yet there are things that we did mention that are timeless principles, patient safety, things of that nature, that should never ever change and that you hope everyone has learned. And so the irony of Amanda coming on this podcast, Again, I try not to be that guy at work. I'm not going around like, Amanda, have you listened to the podcast? Hey Amanda, when am gonna get you in studio? Hey Amanda. So I don't do that. I don't do that to people and you know what mean? Yeah, that's on purpose. And so, it's bit mean, like Harlee when I talked to her she was like, I was wondering when you were gonna ask me. I'm like, I'm not asking anybody. I want people that are like, just if you want, come on. I'm I'm nurse Eric. go get that princess crown and hand it over to Harlee. I love it. Doesn't she still already have it? Anyway, so all that to say, I'm not that guy at work. I don't do that. Amanda writes me out of blue. She's like, Eric, don't know. I mean, I've listened to some of the episodes. I haven't listened to all of them. And I know you've recorded a bunch more that haven't aired. And I don't know if the subject has come up. So if it hasn't, you really should talk about it. And in any good podcast host or coworker, Their response to that is exactly what mine was, and it was, Amanda, it sounds like you need to come in studio. And so here we are, and we're filming all of it. think that's how you rope people in. I get it. huh, just, just, hmm. Has this been done yet, but hey. It's odd, it's almost like, hmm, I hear it is one of my coworkers who's passionate about something, maybe we need to speak to that to a larger audience. Come on in, let's go. So anyway, like I said, I'll take anyone I work with, I'll take anyone who's willing to talk on the show, who's positive, who's got that same heart of like, let's just nip this eating our young in the bud. So that being said, this is kind of a different tangent, it doesn't have to do necessarily with eating our young, but it's super passionate. subject for Amanda and when she wrote me I was like, girl, I like, teach my, like, I, you can ask any of my former students, this is something that I hammer home. So, what is this mystery topic, Amanda? this mystery topic is consent and absolutely consent. So we are working with people and these people, you need consent from them to do things with them. You need consent from them to touch them. You need consent from them to give them medications. There's so much involved in consent. But the reason I'm so passionate about this is even me doing this for 18 and half years, there are times I forgot to ask those most important questions. And then there are times that it's reminding other people to ask those most important questions. And my biggest one is you can't just assume that because a patient is there, that everything you do with them, they're just expecting, or they could be expecting, but you still need their permission to do it. And I'm going to give an example here of obviously the area I work in has some very personal spaces that have to be assessed very frequently. And in labor and delivery, that's going to be cervix is that is that's inside a woman's vagina. You know, that is very personal space. And even though they, you know, that they're they know they're going to have a baby one way or another, or that exams are part of it, it doesn't always mean they might be comfortable with it. It doesn't always mean that you can just go in and do that. In our labor injury triage, you know, we have patients undressed from the waist down sometimes, right? When they come in, they have a sheet that covers them. They know they're going to get an exam. If I'm sitting there and I'm talking to them, finding out what they're there for, and maybe it's a labor check and I'll say, well, Part of finding out to see if you're in labor is seeing if your cervix is making any changes. Have you had one of these exams before? Some will tell me yes, some say no. If no, I explain. The ones that say yes, I'm like, so if you're okay with it, I would need to do this exam to see if your cervix is making change. And they'll say okay. If I'm having them change at a later point, I'll step out, let them change, come back in. So even though they've already told me okay for this exam, When it comes to that exact moment, I ask them again. Before lifting up a sheet or blanket or anything like that, once I have my gloves on, I say, is it okay if I do this exam? I've gone in rooms with providers, labor rooms, triage rooms, and they'll come in and be like, I'm going to check your cervix. This is the part where I really encourage nurses, new nurses, old nurses, anybody, find the one that's in that room. There's a fun little phrase that I like to say when a provider does that. And it is what your provider meant to say was, it okay if they do this exam? That's cluing whoever is doing that exam into you need to ask, but it's not saying that in a confrontational way, it's reminding them. And it's. me being their advocate for that patient of they still need your permission. Yes, and like you said, isn't a diatribe on, you know, we need the down and dirty, Amanda. Who are the providers who never, you know, this isn't anyone who's maybe happens to listen to this and is like, she talking about that incident or whatever. This isn't a diatribe on anyone, because like you said, we'll forget on occasion for whatever to do what it is that we need to do. Maybe in that moment, that person forgot. But that's what the patient advocacy is for. And I love that because you, I wanted to use that word back in first episode when you're talking about your son, because that is, that's what foreshadowed this here. Because you're being an advocate for your own children as we parents need to be. And now here you are, that's in your personal realm and here you are in your professional realm. Nursing students, do not be afraid to speak up. I don't care if you've been on the job a day or 18 and a half years. You say, know I'm new here, but can we, or however you're gonna do it, do not be afraid. Sorry, continue. those are just, those are the biggest. It's, you know, there's, there's nice ways and not nice ways, obviously. but it's not just, I don't want people to get stuck on, it's not just for something very personal, like a vaginal exam. It's for all the things too. I go in a room and ask a patient if I can touch their belly and adjust monitors. I go in a room and anytime I'm touching a patient, I ask their permission. I always ask, is it okay if I get a blood pressure on you right now? Is it okay if I change out your IV dressing? That is asking their permission. This is still their body. This is still their body that you're touching and it's still their life and you should be asking them if something's okay. and you're valuing their life. As a pregnant woman, and as a woman who has taken care of numerous pregnant women, how often would you say people just touch your belly for funds without asking for permission in society, let alone, you know what I mean? Like, you're pregnant. what? They just go to touching and be like, you've lost some weight. Let me rub your tummy. No, it's like, just, can't. I mean, people do. But once again, like we said, you know, even those of us who've done it many times, there's gonna be times we forget to ask even on those minor things. And it was actually what reminded me to text you. That's what got me to text you about this is, It was after a shift and I went and I did my usual asking consent to do an exam on a patient. And this patient said to me, goes, nobody's ever asked me that before. And I just sunk, like, and I actually apologized to her. said, I am sorry nobody's ever asked you, but they should. They really should. My other thing is I, you know, I'll empower patients. It's okay to tell somebody not to do something. It is okay to say, didn't you mean, can I check your cervix? Obviously a lot of patients aren't going to probably speak up for themselves as much as having somebody else like a nurse or even a provider, somebody in the room, just speak up for them in those types of situations. And that's why, so she writes me this and I said, my gosh, Amanda, like I said, you don't even know. And I'm glad you brought out it's the simple things too, because that's what I preach on, is that it's, know, because everybody's like, well, it's obvious, you you guys are in a very intimate, like, I don't have to do cervical exams, I'm in postpartum, but I'm a male nurse in a woman's world. and part of our job is assessing mothers, so I see breasts. I have to pull, I don't have to, but as part of the assessment, it is recommended that we are looking and checking for bleeding, especially while we're doing a fundal assessment, and that involves some exposure of areas of the body that our bathing suits cover. so everybody's like, well, yeah, I mean, of course you're a guy. I don't care if I'm a guy. I don't care if you're a guy, I don't care if you're a woman, I don't care if, it's not like you're part of the sisterhood and the woman walks in and says, hi, I am going to do this to you and they're like, I'm great with you doing that, yes, I'm great you're doing with it, you are a fellow woman, come on in, here, I am spread eagle. It's not, that is not what it's about. no, and it's, you know, it is a personal department. It is very personal. But if you think about that with anything, even if you're going in for clinic visit, like I said, ask them, is it okay if I do your blood pressure? I'm still touching you. just, asking permission, one, it not only is very appropriate and should be done, but it also helps your patients feel very comfortable. knowing that you respect them enough to ask their permission in order to do things with them. And no, no, it's just, I was just saying that it just helps build that confidence they have in you to where if you do have to come up on something a little more tougher to deal with with the patient, they're going to trust you to be able to talk to them, to be able to help them through multiple different things because They've built that respect and report with you off just minor stuff or major. Yeah, and it starts from the moment you enter the room. And that's what I've always preached to my new hires, my practicums, all the things, new students, everything. I'm like, the moment you knock on the door, you don't just barge in. Hopefully the curtain's drawn and not everybody wants their curtain drawn. So you step in and I even like, I'll go so far as to not totally look in. If I see that a curtain's not drawn, I'll look away for a minute. I'll just be like, hey, this is Eric, your nurse. Wondering if it's okay if I come in at this time. That's postpartum, that's peds that's whatever. You start there, and then like you said, what I teach my students is you are invading somebody's bubble, whether you're touching them or not. If you are going in simply just to listen for a heart rate, you know what I mean? Like, hi, is it okay? This is what I'm planning on doing, is this all right? And they have the right to say no, thank you. And everybody gets caught up on that. They're like, well no, I have to get this fundal exam. I have to get these vital signs. I have to... No, I mean, I almost said it that way earlier. Yeah, you don't have to. Yes, it's highly recommended. And the flip side of this, if I can just piggyback before we close your amazing episode here, but we'll keep talking about this subject as long as we need to. But the piggyback on that too is informed consent. And you hear the term. And that informed in your mind should always be married to the word consent. because then what happens is we have, especially, let's just use postpartum, labor and delivery, that sort of thing. There are medications that we highly, strongly, nearly 100 % recommend that mothers take, babies take. There's injections we have to give to babies. Vitamin K, hepatitis B, for example. And some of the biggest sticking points are vitamin K and erythromycin ion amendment. And there's reasons why we give those vitamin K in particular, because babies need help clotting. We don't want them to have brain bleeds and all the things. So. Regardless of what you feel on whatever the position is someone still can say no. And in the case of infants, in the case of Peds, it's the parents who are making that decision for their children. Peds oncology, we have families who are, whether it's religious or non -religious reasons, refuse to take another person's blood. In Peds oncology, where blood transfusions are given often like candy. So there's all these complicating factors that go into And in fact, some things are so severe, we have them, you you have to sign a release form and all the things, yep. But the bottom line is they still have the right to refuse. I tell my families, I say, there's very little you can't refuse. If you decide you're not gonna feed your baby, that is where we're gonna have issues. I don't care if you're formula feeding, I don't care if you're breastfeeding, if you're not gonna, and again, it goes back to basic patient safety. But other than that, you can tell me not to do anything I need to do. And I will document it accordingly. and I'll go back on to my next patient, we'll just, you know what I mean? Like, ugh! Ugh, yeah. It is, and you know that informed consent is, it's not just like, you know, not just when we're asking if we could do something and then give consent, but it's also here's your risks, here's your benefits. They know all these, yep, they know all these different, and they get a chance to make a choice. You know, you can get into, well, consent is implied. Well, certain situations, you're. patient is completely unconscious and they need to be coded and their heart stopped, yeah, that's an implied consent if they didn't tell you or have something written down that they're a DNR, that is an implied consent. That is a, we've gotten permission before to do certain life saving things if you cannot make a decision at that time. And that's the only reasons implied consent is if you are not conscious enough to make a decision, then it is implied that We can do things to help you get you back to a consciously at some point or tell a family member to make some sort of decision on something. Those are implied consent. Otherwise, everything else is informed consent. Or should, mean, absolutely should be. Absolutely should be. And that's what it, and that's what I about the informed part of that too, is that you give the information, you educate your patient. And I always tell my students information is power. And so I say, Amanda, here's what we need to do for your baby. We need to give them vitamin K. And this is something we strongly, and that's how I phrase it. We strongly, strongly recommend it. You can refuse it. We strongly, strongly recommend it. And here's why. And I'll give them a brief little, here's why we do it. Here's the plus. And then, you well, what's the possible risk? Here's, you know, if there's a possible risk, we'll talk about that. And so it's that scenario. And then if after you've given that information, they still say no, done. We're not talking about it again. If you change your mind, please let nursing know. But in the meantime, I'm going to take this med off your thing. If there's a form, you're going to sign this form, whatever. People can leave. People can leave the hospital when a doctor says they shouldn't. Yes, the whole AMA, like against medical advice. Apparently it's not appropriate for nurses to leave AMA though, but... I still don't understand that Amanda. I don't understand that. They say I should stay till the end of shift. A patient abandonment or something like that, I don't know. It's gonna be too much of a workload on your peers. We'll figure it out. We're working on it guys, we're working on it. So, all right, anything else on this passionate subject Amanda before we wrap this up? No, I just think helping people, reminding them. Even, like I said, even our providers, even people that know they're going to have something done to them, you still ask. Still ask. Give it their option. Yeah, it could be. Right. it's like, well, I know we've done this, but no. Okay. Yeah, exactly. And respect those choices. even if they're not the choices you would make for yourself or for your loved one. our personal choices cannot affect our patients choices. I love it, Amanda. So, you chose three words to describe nursing school. What were they and why'd you choose them? I know, let's go all the way, we're dialing it all the way back to sourdough days. why couldn't that be the word? I should have picked sourdough. mean, school can be kind of sour. word. Honorary fourth word is sourdough. All right, no, it is. You know what? What were the three words you chose? Why did you pick them? And how are you going to make sourdough a descriptive term for nursing school? Go. I got it. Okay. So time consuming and I know it's kind of two words, but it is time consuming. Nursing school takes up a lot of your time and energy and things you have to put into it, but still doable, which brings to the next word, manageable. got it. Nursing school is manageable. It has hard points. It has easier points. And when you combine that with life, it's going to feel hard a lot, but it's still. manageable. You just have to put it in the order that's manageable for you. Do the things that you need to do to make it manageable for you. And tiring, but don't worry, your whole career is going to be a little tiring too. Long shifts, whether you work in the clinic, whether you work eight hour shifts, five days a week, days, nights, is tiring. We can all get tired on our shifts. That's going to be with any career too, but Nursing school is very tiring. You're absorbing so much information and you're trying to take in a whole lot and then you're preparing for exams and you're learning so much information and technically what seems like a forever time but it's also a very short timeframe if you think about it, you get worn out. And those are the people that are like, I don't know if I'm gonna make it. I don't know if I'm gonna. Trust me, I still have life going on outside here too and I've been a nurse for a long time and it's still tiring. But find those positives. There's ways to make that turn back around. And you're gonna have your moments. Do your de -stressing techniques. Whatever works for you to make it better.

Grab your 10: 50:41

30 a.m. mimosa for brunch. Those unhealthy coping mechanisms, Just find those things, but it's... Remember that's only one day, that's only one space, that's only one time. It'll change for you. go find your stock room or your crying bathroom. Go cry it out and come back and get ready to do it. Yep. Yeah. Awesome. sourdough, sourdough. Nursing and nursing school can be a little sour. It be a little sour, but at the end, that full product, that's good. It's baked. It's turned into its final masterpiece that can still have time for growing. And it takes a bit of work to make it happen. And, and what I love about it is that you can keep... No, what I love, well you can, but what I love, that's what I love about it, is that you hear about these sourdough starters that are hundreds of years old. And that's exactly what's going on, what's happening. You made sourdough because you got your starter from somebody else. And in nursing, man, we are just generation after generation. teaching the next one, teaching the next one, and passing hopefully these nuggets of truth along. sourdough, yeah. feed your sourdough, it grows. Just like you feed your students, they grow. You feed your newer nurses, they grow. That's it. It's the Sourdough Podcast. Mind's blown. That's it. Yeah, second episode. Well, one of them will be titled, It's All About the Sourdough. It writes itself. See, my job's easy. It's fine. All right, so before we wrap up, so many things you've already said could qualify for this. If you had one thing that you want nursing students or, yeah, student nursing students, one thing you want nursing students to walk away from your episodes and retain, what would that be? Hmm. I think it's just gonna be, it may seem tough at the moment, but you're gonna grow and always treat somebody how you want to be treated. So ask that consent, care for them like you're gonna care for yourself. preaching it. And as a bonus question, one piece of advice you want nurses, peers or otherwise to walk away with, obviously other than some of the things we talked about, what would that be? Don't be afraid to speak up. Just don't be afraid to, you know, don't be afraid to say what you're thinking. Don't be afraid to discuss things with everybody around you. We are all teams. There doesn't matter which initials behind your name in that medical field. You are all on the same level because you are a team. And the only way that our patients thrive, the only way they do well and the only way we thrive as teams is by working together and having that mutual understanding of each other. And as you eloquently pointed out earlier, doing it with respect. Doing it in a respectful way so that you're not, you know what mean, it doesn't put someone on the defensive. Yeah, yeah. they need to be because they're already hard enough on themselves. Exactly, as you've already heard us talk about. Amanda, this has been the most delightful time. I can't thank you enough. There's no better way to spend a post -afternoon run than to just sit and chew the whatever with you. Ha ha, see? I almost, yeah, chewed. eat it, but the rest of us are gonna eat some sourdough. Chewing the sourdough. Awesome. Amanda, have a lovely rest of your day, Thank you. Thank you so much, Eric.