Labor & Delivery: Interview with Tequa Morrison, RN, MSN
Implementing evidence-based perinatal safety practices
Perinatal Safety Specialist, Labor & Delivery
Dignity Health California Hospital Medical Center
Downtown Los Angeles
Can you describe the trajectory of your nursing career up until now?
As a new grad, I started my career at St. Francis in Lynwood straight of out of college. My ultimate goal was to work in labor & delivery and I was lucky enough to land a position in the St. Francis new grad program in labor & delivery.
From 2005 to 2007, I was back in school at Mount St. Mary’s to earn an MSN with an emphasis on education while still working at St. Francis. I had wonderful supervisors who encouraged and supported me in advancing my education. I stayed at St. Francis until I transitioned to Dignity Health in 2012.
As a perinatal safety specialist, what are your responsibilities?
In that position, I do some of everything. My responsibilities include assisting with the implementation of evidence-based practices within our units and helping with staff education, quality assurance and issues related to compliance and other initiatives. I also serve as a resource person to the staff for various issues related to the quality of patient care and various aspects of clinical practice.
In addition to the nurses and other staff, I also work with the providers — including physicians and midwives — in support of the adoption of evidence-based protocols and initiatives.
New initiatives are vetted at the corporate level and others are identified locally. I am part of the team that ensures that we are implementing the initiatives accordingly. We’re a teaching hospital, so these types of changes in protocol or practice can have a profound affect on the nurses, midwives, residents and other staff.
On occasion, I interface with patients because I help with the training of our new hires; I’ll occasionally be at the bedside with the nurses in that capacity. Otherwise, my patient care and contact are fairly limited. I miss the hands-on nursing sometimes, so I do sometimes go out on the floor.
How have some of these newly adopted initiatives impacted safety?
We’ve seen a lot of great things over the years. One initiative came from the March of Dimes — it recommended the elimination of elective deliveries prior to 39 weeks of gestation. Based on the latest data, we are now 100 percent compliant. Any deliveries prior to 39 weeks must have a clear medical indication and our nurses are well-versed in those regulations.
We also have initiatives regarding assessing patients for shoulder dystocia prior to delivery. In shoulder dystocia, the anterior shoulder is unable to clear the pubic symphysis without significant manipulation, which can cause fetal distress and problems for the mother.
If the possibility of a shoulder dystocia is suspected, we make sure we have all precautions in place, such as assistance being at the ready and bedside stools in place for performing of the proper maneuvers. These are evidence-based precautions that have proven to assist in such situations. Everyone on the team is well aware of any patient who is at risk.
A cardinal sign of shoulder dystocia is the retraction of the baby’s head against the mother’s perineum, similar to a turtle pulling its head back into the shell. So, we have a special sign with a turtle on it that we place on the door of every patient with an identified risk for dystocia. We all know what this means and are prepared for potential complications.
How has technology impacted the birthing experience in the early 21st century?
I think technology has greatly impacted birthing and there are always pros and cons. We need to remember that technological interventions aren’t always appropriate for every patient, but they can be invaluable in many high-risk situations. On one end of the spectrum, we have holistic midwives who want as few interventions as possible; on the other end of the scale, we have providers who are overly reliant on technology and monitoring.
The most important piece to keep in mind is looking at the individual first. What is necessary in this particular birthing process? We have those patients who are much more complex, especially expectant moms with comorbidities such as diabetes, lupus and hypertension.
A fetal monitor can be an L&D nurse’s best friend, but we sometimes rely on them too much and don’t take the bigger picture into account. Other technologies include the use of ultrasound. When there are multiple comorbidities, ongoing monitoring is obviously called for and very prudent.
Here at California Hospital, we have a good mix of midwives and physicians; it keeps us balanced in our views and practices. We offer water birth and the nurses can get experience with that. You can become jaded if you only focus on the medical management of birth and see no alternatives. When you see the other side, sometimes the light bulb goes off.
EHRs allow nurses to document at the bedside and that’s a wonderful technology. We currently have a hybrid documentation system — half paper and half electronic — and we go live with a full EHR in March of 2016. Labs, orders, nursing notes, pharmacy and other information will all be interconnected in one seamless platform. The nurses are really looking forward to its implementation.
What feeds your spirit about your work?
Knowing that my work is necessary and directly affects the care that patients receive is very gratifying. I’m educating, helping to implement important new protocols and then assessing the outcomes. It’s awesome to see the protocols bear fruit.
Last week, a mom came in with a prolapsed umbilical cord, which is a medical emergency with great risk of fetal distress and injury. Due to our prolapsed cord protocol, we had that patient in the OR and the baby delivered within eight minutes of arrival to the hospital. Everyone in the OR knew what to do and what their job was and the outcome was amazing.
What are some of your greatest challenges in your work?
The one issue is that when there is a need for adjustment, not everyone is receptive to change. Sometimes, we’re changing the way that something has been done for years; that can be a challenge. It takes a little extra finessing and caressing to get everyone on board and win them over. I understand and appreciate that change can be hard, but medicine is always evolving.
If a number of major changes come down the line in quick succession, we sometimes need to prioritize and choose which is most important to address first. Something may seem important, but if it interrupts and disturbs the nurses’ workflow in a significant way, we may need to incorporate it more slowly.
In what ways would you like to grow professionally in the next five to 10 years?
In the next few years, I’m considering continuing my education to become a clinical nurse specialist. I already received the necessary didactic education in my MSN program, so I would need to focus on the clinical hours and training.
I’m also interested in becoming a lactation consultant so that I can be even more of a resource for staff and patients.
For those interested in L&D as a potential specialty, what would you recommend?
I would recommend that you have a conversation with someone who is experienced in labor and delivery. It’s not always a bed of roses. There’s a misconception that patient ratios are low and it can be an easier clinical path, but L&D can be very difficult. There are fetal demises, very sick patients, and complicated and stressful situations. You have to be able to deal with that.
Have a genuine conversation with an L&D nurse, learn the pros and cons and make sure that it’s truly your passion. L&D is about cheerleading; coaching; supporting patients, families and babies; and working as part of a multidisciplinary team. Yes, there are many tasks, but it’s much more than a task-oriented approach to patient care.
It is a very emotionally taxing nursing specialty, but one with many rewards as well. I can’t train you in being a positive emotional support for mothers and families, so make sure you know what you’re getting into.
If you’re clear that L&D is for you, take classes and become certified in neonatal resuscitation even before you’re hired for a position. Put those extra classes on your resume and show your spunk and initiative. When I see someone going the extra mile, that’s a plus. If they’ve studied fetal resuscitation or fetal monitoring, that’s a sign of true interest and passion.
Remember that every delivery is a gift. Having the opportunity to be a part of that experience and support that mother and her family is one of the most amazing things that you can do as a nurse. Don’t take it for granted — the sixth delivery of the day is as sacred and important as the first.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.