WORKING NURSE: What is your nursing specialty and role?

MEG KELLY, RNC, BSN: My nursing specialty is labor and delivery. I am a charge nurse at Arrowhead Hospital with my certification in inpatient obstetrics.

How did you choose this specialty and train for it?
When I was in nursing school, I tried to figure out where I would be happiest. I must admit that I assumed everyone would want to do labor and delivery and it wasn’t until later that I realized it is not necessarily the case. I applied for a job at Good Samaritan Hospital and was accepted into their new grad program. Good Samaritan Hospital is a tertiary center, which means that there is a level III nursery on site. They accept women who are 24 weeks pregnant and accept some of the highest risk patients in the country, including multiples. It is also a teaching hospital with medical residents so everyone is up on the most current medical treatments and trends. I knew that was the hospital where I wanted to learn my specialty. There was a 90-day orientation with special instruction and advanced fetal monitoring classes. I was required to hold current CPR and NRP cards. I was also required to attend advanced fetal monitoring classes once per year or attend monthly fetal strip reviews at the hospital.

So how long have you worked for Arrowhead Hospital?
I have worked at Arrowhead hospital for four and a half years. I chose Arrowhead because I was looking for standard routine pregnancy and labor and delivery. I remember asking one of the high risk MDs at Good Samaritan if all twin pregnancies were sick and he told me that it was time for me to see how the rest of the pregnant women were delivering! I decided he was right and applied for a position at Abrazo Health Care. One thing I really like about working at Arrowhead is the full-time dedicated nursery available to all mothers.
Take us through a day in the life of a charge nurse for labor and delivery if you would.

A typical day for me starts with making appropriate assignments for all my labor patients. I try to match the nurses with patients and MDs depending on their needs so that the nurses will be successful and the patients will have a good experience. Then I make rounds to the other units of nursery and post-partum to see if staffing is appropriate for the volume and listen to any issues pertaining to patient care, equipment, or anything else that may come up, including social issues for patients. I then return to labor and delivery and field phone calls from patients and doctors concerning a variety of requests.

I relieve nurses for lunch, monitor fetal monitoring strips, admit patients and help in triage. I direct traffic to enhance patient flow from triage to labor to post-partum. I try to fill in when nurses are busy or become overwhelmed. I also have a variety of chores to do each day. Mostly, I try to enjoy the process of labor and delivery and try to make every patient’s experience what they want it to be for the birth of their child.

That sounds like a very special role. What do you enjoy most about this type of nursing?
First and foremost I love being invited to be a part of the birth of a family. That is the way I look at labor and delivery. We, as labor nurses, are invited to be a part of a miracle, the birth of a child, which holds all the hopes and dreams that the potential parents feel. Each labor is a different experience and many laboring mothers are filled with a variety of emotions: uncertainty about pain and their ability to deliver their baby, fear of something going wrong, expectations of the labor process, and hope and joy.

I am invited to share this process and try to ease my patients’ fears, take away the pain, and be encouraging when fatigue and frustration set in during pushing. I listen to a mother’s concerns and try to make the experience the best one for that individual family by supporting and advocating for them when they have a hard time communicating with the doctor. Placing a healthy baby in a mother’s arms for the first time and seeing the bonding take place is another miracle that I am thankful to be a part of each day.

Anything you find challenging?
There are always challenges at any job, and this one is no different. Handling calls from frustrated doctors and patients when elective inductions cannot be admitted due to full beds can be challenging. Many times patients don’t have the experience of knowing when they are in true labor and are very disappointed when they have a false alarm. Another area that can be challenging is keeping the flow of patients moving smoothly. Sometimes scheduled procedures run late and that flow is disrupted, which is frustrating for me because the rest of the day is spent juggling schedules.

What advice do you have to offer nurses who may be interested in labor and delivery as a specialty?
I would tell a nurse considering labor and delivery to put on your running shoes and be sure you really love this specialty because it requires a lot of passion and energy. It is exciting, fast moving, frustrating, frightening, incredibly amazing and occasionally almost unbearably sad. You must be something of a control freak in terms of attention to detail and yet also be willing to work as a team. Learn to put your own feelings aside and concentrate on what each specific patient wants from the labor and delivery experience and try with all your might to make it happen even if a patient is swearing and yelling at you in the midst of the pain. The rewards of labor and delivery are the smiles and hugs and the celebration at the start of a new life and a family!

FURTHER REFERENCE

Organizations:
Association of Women’s Health, Obstetrics and Neonatal Nurses, www.awhonn.org

Books:
Maternity Nursing Care, by Lynna Littleton and Joan Engebretson
Management of Labor and Delivery, by Robert K. Creasy, M.D.