Report concerns or risks......

Mandatory reporting is not only in Australia.... the UK is calling for more health professionals to blow the whistle...
NHS staff told to 'report concerns or risk investigation'

Health regulators should warn nurses, doctors and midwives they may be investigated if they fail to report concerns about colleagues, MPs say.

The General Medical Council (GMC), which regulates doctors, said it was committed to doing more in this area.

It is interesting that not many doctors report each other, the old school boy tie mentality is alive and well.... this is evident by the following statement;

The GMC is currently investigating doctors at Stafford Hospital whose own work was blameless, but who allegedly failed to report colleagues.

It seems though no one has a problem about reporting nurses and midwives.....
maybe the culture will change and there will be fairness about reporting all unsafe health practitioners or health practitioners that put the public at risk....

We have to remember it is about professional responsibility, being aware of professional codes and guidelines and aware of what is good and poor clinical practice. It is also about employers being open and transparent about what occurs within its institution and taking appropriate steps to rectify any untoward activities and not turning a blind eye. Clients have to be protected and advocated for by the health professional, not bullied or manipulated into receiving treatments they do not understand or want.

Challenging clinical shift..... a reflection

On first appearances the board looked OK...(and what is the board?...it has every ones name on in the ward so you know the occupancy & whats what at a glance)... it always seems OK when its not completely full. However we all know looks can be deceiving and the acuity of the patient load is not measured by just bed occupancy. Its always good to work with a great team.... because as we know this makes life much easier... and we were all run off our feet. There were three Cesarean sections that afternoon... one after the other... of which I had two... here's an ethical question for you? should women be able to choose to have an elective Cesarean Section (C/S) at 38 weeks? it was an uneventful pregnancy... and at birth the baby is diagnosed with Respiratory Distress Syndrome (RDS). Neonatal Respiratory Distress Syndrome is a common breathing problem in premature infants. Did you know that babies have 12 times higher chance of developing RDS from an elective C/S @ 38 weeks... I wonder if the woman knew this fact before making her decision?

After birth, newborns with mild respiratory distress syndrome may require only supplemental oxygen. Newborns with severe respiratory distress syndrome may require oxygen delivered by continuous positive airway pressure (CPAP)—a technique that allows newborns to breathe on their own while being given slightly pressurized oxygen or air given through prongs placed in both nostrils). In newborns with severe respiratory distress syndrome, a tube (endotracheal tube) may need to be passed into the windpipe (intubation), and the newborns breathing may need to be supported with mechanical ventilation. This would also mean the baby would need to be transferred to a teritary hospital that can provide the staff and care for the infant. This baby was intubated and transferred by the NETS team.... I then spent time reassuring the mother that all would be well, fortunately she was going to bottle feed which therefore meant she did not have to express her milk and send it to the baby hospital. Later in the evening she told me that the baby was doing well and may only be intubated for 24 hours.

My other challenge was looking after a profoundly deaf woman who was not well after the birth... she also had a multitude of complex social problems... I was walking past the room to the loud cries of a baby, walked in to find the mother fast asleep and the screaming baby...this really bought home to me some of the issues confronting both the mother and baby... I picked up the baby and settled it back to sleep.... later I watched dad (who is also profoundly deaf) change the babies nappy.... he was vigorously wiping the baby's bottom and the baby was screaming... not once did he look up to watch the baby... I realised how much education was required.... and spent considerable amount of time talking slowly and clearly so that he could lip read my advice... however you could only do short periods at a time... he appeared to get bored with it all.... they are a young couple whose parents provide a lot of support and help which this also creates a problem. There are baby monitors for deaf mothers... that alert the mother & father to the crying baby... and of course it is important to be constantly looking at the babies face for its expressions...

Family dynamics are always intriguing, we as midwives get to observe them and this can be fascinating. Mother - daughter, mother - son, and then there's the in-law relationship. When there is a disability this then also puts added strain on the relationships...... due to the autonomy of the client and the need to be autonomous... as a parent they have to learn to allow them to make their own decisions... this happens in all relationships.... this one was particularly difficult on all counts....

It was interesting for me... usually when you are in a room there is the noise from the telly or people talking... however this room was silent especially when the baby was sleeping... I was kneeling to empty the catheter bag... it was quiet in the room...the IVAC started to alarm... but my hands were full so I couldn't turn off the alarm.... it was a piecing noise nobody in the room heard it...it must have been going for a few minutes when another midwife entered the room to see what the problem was... she was surprised to see me there and said "can you not hear that alarm?" I laughed and said my hands are full.. couldn't turn it off and I was amazed that the sound was so annoying could not be heard by anyone in the room but me....this experience gave me a small insight into what there life might be like... one I would not want. Fortunately for this young woman she was breastfeeding like a dream.. she had a good milk supply and enjoyed feeding.....I was confident that the baby would not go hungry and at least its crying would be for other reasons... other than being hungry, a small consolation. As you can imagine I could spend my whole shift just with this couple providing them with care and education but alas I have four other clients to share my time with.

On entering another room, I was amazed to see the woman, baby and partner all huddled in the bed together...the partner was almost lying on top of the baby... I said good afternoon and suggested that it was not a good idea for them all to be lying in this small bed and almost covering the newborn baby.....the partner was upset and said "I'm not sure its my baby..." to which I responded... well whoever baby it is, it is not good to all be sleeping almost on top of the baby... the mother responded by saying... he's joking... it is his baby" at this point I wondered why did I come to work today..... as my shift was turning into a shambles.... a baby with RDS, two day 1 cesarean sections, a deaf couple and a man who didn't know if this was his baby... and I wondered how the rest of the shift would go as I had only met half my patients.....

A bell was ringing..... then a man shouted in pain.... I thought what the hell is that? a few people gathered in the corridor... we are used to women yelling but not a man.... I entered the room to find a man doubled over in pain.... now I really wondered what am I doing here....after making a quick assessment and asking a few questions, it turns out he had injured himself a few days ago and had not been to the doctors and the pain just got worse...his wife had just had a baby yesterday... so as we are a maternity hospital we packed him off in an ambulance.....lesson to men... if you have injured yourself and have pain go to the doctors, it will only get worse if not treated... and if you don't want to go to the doctors, don't visit your wife in hospital.....and complain of the pain you have....

My other cesarean mother had so many visitors I could not get into provide the care required with all the visitors who did not want to go and the mother did not want them to go..... this baby was not ready to breastfeed and they both needed lots of time and education........

could my shift get worse.....with breastfeeding issues...IV antibiotics, complex family issues.....pain relief requests...resiting IV cannula....just the normal run of the mill... everyone running around busy.... it must be the first time I have been late off finishing because I have to write up my client reports..... I must be slipping or I was so busy I just never got on top of things.....it was a matter of doing what was most important first.....but the bells kept on ringing.... could of done with another pair of hands.....

Its funny I always tell my students.... you must make sure you document contemporaneously...which I did at the bedside but not in the progress notes... for me this was the shift from hell...everyone was of late.... it goes to show you that if your client acuity is high you will fall behind in managing your load. It will just take one client to have breastfeeding issues or a complex social problem and you are out of whack....

What would I do differently next time.... probably keep more up to date with my client progress notes.... I could have made time to update each one as I dealt with their issues rather than at the end of the shift... ask the visitors to leave after an hour....and not engage with the complex social issues....easier said than done... profoundly deaf people need a lot of one on one time for communication purposes... I would re-organise the work loads... however there just was not enough staff... so much for the governments 3% cuts.... it comes off at ground level.... just not good enough....

Yes I had a double scotch when I got home........

Run off my feet..... Midwife shortage........

Over the span of my career I have usually changed my jobs every 3 to 5 years, for me this has been a good career choice because I feel it has allowed me to be broaden my views. I also believe that it is important to move outside my comfort zone to continue to grow and give the best possible care by experiencing different ways of doing things.

Clinical work is the same where ever you go, babies are born... what is different are the people, both the consumer and the staff, the institutional polices and the paper work. Once you find your feet in terms of seeing how the institution works and the people within it you can then concentrate on the job at hand.

It is interesting when you begin somewhere new or different, it is important to just watch and say nothing........I usually spend the first few days observing, making notes so I remember simple things like how to page for someone, therefore not having to continually be asking the same question. I have also learned to bite my tongue so as not to step on any toes or upset anyone, this has taken me many years to master (this is only because things are done differently to what you are use to). The other thing I have learned over time is you don’t mention “this is how we do it at.............” yes you guessed it, the response would be if it is so good there go back. I suspect this is the same for everyone and every job, not just synonymous with midwifery & nursing.

What is so disconcerting is the shortage of midwives and the requirement or expectation to do more than is normally required because there is just not enough staff. This can be from pushing beds to highly skilled midwifery tasks and no one to take over when you finish your shift....because everyone is so busy. The problem is that no one is willing to say “no” I won’t do it” and why is that? Because the client/patient is the one that ends up having to wait or is disadvantaged. My argument is put it in writing, put what occurred in writing... and send it to management.... copied to the CEO.... however staff are also reluctant to do this.....and why is that?... because this to takes time and effort..... Whilst we as midwives and nurses have this attitude nothing will change and the expectation will remain the same. This will then lead to work dissatisfaction, resignations and burnout.

The other observation I have made over the years is the concept of “this is how we do it here, it’s worked for as long as I have been here, so there is no point changing”. There have been selected staff that always have this attitude... and you will find these staff have been in the institution for a long time. Change is always a difficult concept for some people and this can make work life difficult. This is not intended as a criticism, rather an observation.

So much work and not enough time or staff.... the good intentions of some staff in doing everything for clients when they ring the bell, an example would be.. "pouring a glass of water or filling a jug of water" where the client should be encouraged to get out of bed and do it themseleves, can create more work when you are very busy. But those good intentions are paternalistic and disempowering. However these attitudes can in themselves create more work for midwives & nurses... also clients equally becoming disempowered just by being in a hospital. Women who have had a normal vaginal delivery.....who by being in hospital gain a ‘sick’ mentallity and lose a sense of their power by expecting the staff to do everything for them.... ring the bell to fill the jug up with water... or to pour a glass of water.... where as if they were at home day 2, they would be getting it themselves... these women should be at home.... birth is a normal process.....(Yes if these women have had a caesarean section and are day 1, then the midwife will be filling the jug of water and pouring the glass of water). If we had more midwives we could send low risk women home within 6 or 12hrs supported with midwifery care at home, a community base service surely this would advantage everyone.... being at home has to be better than in a hospital.

A comical view of Mother Nature

A mothers lament to her son!


Insanity streak by Tony Lopes

I read this comic and thought I would share it..a different take on mother nature.. I'm sure my sons would agree with this.....it did make me smile...and I thought how many other mothers could relate to this...... isn't life wonderful....