#30 How to Keep your License Safe with Jen Atkisson

I have been looking forward to this guest on the podcast since we started season two, and I feel like I do say that a lot. I guess we just look forward to a lot of episodes we record on this podcast. But she is a good friend of ours and she’s going to bring you lots of nuggets today on this episode. And this person is Jen Atkinson.

And she is going to introduce herself a little bit, and we’re going to get right into it because we have some very important questions to ask her about all things getting sued, titrating pit, calming our nervous system. So we’re just going to learn all the little nuggets today. So Jen, if you want to just introduce yourself.

Yeah, I’m Jen Atkinson. I’m a labor and delivery nurse, still staff nurse, per diem staff nurse at my little hospital. I just renewed my license, so I’ve been a nurse since 2007. I do all the things like education, and why most people like to listen to anything that comes out of my mouth is I do quite a bit of consulting and expert witness work, and have for the last eight-ish years.

I think people want to listen to you more than just because of that. I think there’s a lot of knowledge in there. I was driving today, and I was like, I just want to know all the things that are in your head. And then I was thinking, I get to sit in this zoom room right now with you and Sarah. If I had all of your guys’ knowledge in my head, I feel very privileged. I just wanted to say that.

But I was listening to the selfie podcast this morning and last night as preparation to talk to you today. And you said something that was like, oh my gosh, I wanted to write it down. I didn’t have any paper. But you mentioned that people say a lot of times like, “Well, I don’t want to lose my license, or I’m not getting sued.”

But in reality what they’re saying is, “I don’t want my patient to get hurt.” And I loved that. So when I hear someone say, “I’m going to lose my license, or I don’t want to risk my license,” there’s a lot of emotional charge behind that. When I feel like it is true, it does go down to I don’t want my patient to get hurt.

And I loved that mindset, and I wanted to know if you wanted to talk a little about that first before we start, of how that could change the way they practice. And how they can look at losing their license or getting sued differently than they do if they change that slip in their head.

Yeah, so most of my work around lawsuits, I think when you go to a typical talk, they’re always how to document to prevent liability. Or there are these really negative… You always leave being like, oh my God, I’m so stressed out. And I started teaching legal stuff at the same time I was becoming more trauma aware and more trauma informed, and those two pieces to me just really went together. And so I do believe people always make sense if we know everything behind it.

And so when nurses say, “I don’t want to lose my license or I’m not going to do that,” they say it because it works. It’s an immediate back off. It’s like the animal signal back off thing, and everybody does respect that. That’s almost like this line in nursing that you would never cross. You could never ask somebody to do something that would put their license in jeopardy.

And we know it and we use it. But people make sense. And I think, one, that’s not how people lose their licenses, it’s just a basic misunderstanding of these systems. There’s multiple systems in play here. One’s the Board of Nursing, which is licensure. One’s civil court, which is where birth injury, malpractice, all that plays out. And then very rarely we have criminal court, which we did see come into play in the last year with nursing negligence, but still super rare, probably not, hopefully not going to happen, or come in when it comes to labor and delivery stuff.

But what the truer thought I think is, which is a really more tender, more vulnerable thing to connect to, is when we say that what we’re really saying is, “I don’t want to do that.” Because the only way you’re going to lose your license is if somebody’s getting hurt. The only way there’s a lawsuit is if somebody’s getting hurt. So when you say, “I’m not going to do that, I don’t want to end up in court.” What you’re saying is someone could get hurt or this isn’t safe, but for some reason we connect more to that defensive part than that tender vulnerable part.

We don’t want to be tender and vulnerable at work. We are tender and vulnerable at work, and it gets us destroyed sometimes. You guys do so much with Krysta Dancy and stuff and that trauma awareness, and there’s so many good educators out there around regulation, nervous system regulation, how it’s our superpower. But man, if you start using your nervous system, it’s out there and also, it’s our power place, but it’s also our vulnerable place. And so I get why nurses are really skittish around that.

That totally makes sense. And I’m wondering though, if we change the narrative to, “I don’t want anyone to get hurt,” it would cause less fear around getting sued. Because these new nurses are hearing these nurses saying, “Look, well, I don’t want to get sued. I don’t want to lose my license. That’s going to hang you in court.”

And it’s like, what? Day one, we start hearing that. And so that could be a way. Do you feel like that could be a way to decrease the fear?

When people start tapping into that, that’s when that advocate self really starts to galvanize. And I see that with nurses, that’s simultaneously, I think people aren’t prized at how much less scary it is. Because when I say in the court of law, everybody goes like

You feel it in your body. You get that real visceral. But if I say, “Hey, let’s talk about patient safety.” Everybody’s like, “Boring.”

So funny.

But lawsuits, except it gets that charge out of us, like you were saying. But patient safety, we know that, we can do that. We know how to do that.

Can you give us a blurb of what you would tell a new grad labor and delivery nurse about the actual risk to our license?

Non-existent, basically. Yeah, the state Boards of Nursing aren’t interested in taking away nurses’ license. So whether it’s a lawsuit or a state, like a licensure action with the board of nursing. Typically, there has to be some sort of complaint. Something has to have gone wrong.

Well, how do things go wrong? They go wrong because for the vast majority of them is because we’ve deviated from those safety practices that we know. We deviate from that advocacy, we deviate from informed consent, we deviate from shared decision making. Those are the things we deviate from. Somebody gets hurt and now there’s an action. There’s probably a lot more actions with malpractice than there is with licensure.

But you want to hear how savage Oregon is, and this might help people. They send every licensed nurse in the state once a quarter, a list of all the names of who’s had a licensure action or investigation and what they did.

Oh my gosh.

And you can go online and look. So go to the Oregon State Board of Nursing, little baby nurses, and read what gets people’s license taken away. It’s usually having sex with a client or old people homes going south with… Oh, it’s a lot of that kind of stuff.

Narcotic, like stealing narcotics, that kind of stuff. It’s not you getting your patient out of bed when they’re ruptured, it’s usually pretty scandalous type stuff. But yeah, you can go read everything, how nurses in Oregon at least get licensure actions and it’s usually…

Fascinating.

Like that kind of stuff.

When I was in nursing school, we had to go to the California Board of Nursing, like a hearing, and sit there and watch it. And I remember it was so boring. I was so bored because it was all… You would think as a nursing student, I’d be like, “This is so cool.” But it was all DUIs or stealing narcotics like you’re saying. And I was dying.

And then all of a sudden I’m falling asleep, and I hear the person say, “And so it’s true, you were standing in his bathroom with a bat waiting for him to come home.” And we were all like, “What?” We all looked up. I was very excited at that point. But it made me realize, like you said, it’s a lot of those kind of reasons that you lose your license. It wasn’t clinical.

It’s not like I’m a good, kind, caring well-meaning nurse and I inadvertently did something.

It sounds like that’s a important potential practice change or culture change that needs to take place. Honestly, I feel like I’ve learned more about legal nursing in the last couple of years of Bundle Birth stuff in talking to people like you, and I think my nervous system has been down regulated strictly by education. We talk about what helps down regulate our patients, is understanding about the process, the shared decision making process or patient education stuff. And all of a sudden they’re like, “Oh, it’s normal.”

But how often, and I challenge everyone listening, that think about how often legal is thrown around on your unit as that excuse. And I love that you framed it that way, that it’s like this, I’m scared or I am nervous about patient safety. Or I’m uncomfortable with something going on, and I don’t want to move forward with it. And yet, if we were to shift the narrative, how much less we would be so nervous at work. And be more free to practice and think about it as I have an art and a skill that I’m applying to these patients that I’m caring for.

You should feel great at work. I am here for that. But two things that are always kind of like quick shifts is when you hear, for new nurses, so charge nurse, whoever, preceptor, whoever, whatever says, throws out the, “In the court of law” or whatever, just for a moment say, “How do you know?”

Can you imagine?

How do you know? Only 5% of nurses are ever going to be deposed, and in a lawsuit it’s not like we think it’s inevitable.

Oh, I was told you just wait. You just wait. It’s coming.

Only 5% of all nurses, labor and delivery is not even the most highly sued area. And in a lawsuit, there might be 10 nurses getting deposed, but we’re really only asking about one or two. And then I think what you said is the way I talk about, it’s for anything, hemorrhage, anything that’s scary is the first step is to make the unknown known.

We do that all the time in our lives, is once we have it all built up and then we learn about it. So a lot of the times I just start with, do you even know how the lawsuit system works? Here’s how it works. But just making that unknown known can already release a lot of that fear for people.

And we make up story, it’s don’t write their story. We talk about that with other people. But we make up story about… And that’s the anxiety cycle that I talk about with clients in particular, of one thing leads to this and then leads to this. And then I’m here and now I’m sued, and then I lose my license and I lose my whole life. And now I’m homeless on the street. Like, whoa, whoa, whoa.

The story is wild, and pervasive. And that people would live with that for a 30-year career

Or they have lived with that their entire career.

So yeah, that’s not cool. We need our nervous system for way more important things than spending it on this thing that’s very unlikely to even happen.

Well, thank you for that. I love that. So I wanted to ask you, and I didn’t give you this ahead of time. If you have to think about it for a second. But I did give you, I wanted you to explain what a prudent nurse means. And maybe talk a little bit about your class that you give, because it’s a great class, I’ve taken it.

And then on the opposite side of that, if you can lean into what would an L&D nurse do that would be deemed negligent? What are some things that you’ve seen that are negligent on the L&D nurse side specifically for nurses to hear?

Like, don’t do this.

Oh, yeah. Reasonable and prudent is the name of my course, and I took that because it’s what the definition of the standard of care is. And every state, it reads a little bit different, but you’ll find it in their jury instructions. So standard of care is actually not even a nursing term. It’s a legal term. We don’t come up with it. They came up with it. And it’s the measure that juries have to decide the merits of a malpractice case on, for instance.

But the standard of care for an architect. So there’s standards of care for all sorts of liability, but for nursing, it’s what a reasonable or prudent nurse would do in the same or similar circumstance. So it’s highly, highly contextual. And that’s why when you hear people say these, don’t chart xyz.  You always hear these little quick things, do not get caught up in those.

It’s what a reasonable prudent nurse would do in the same or similar circumstance. And the biggest standard of care is just to use that nursing process. And once you’ve been doing it a while, if I go back and look, I’ll look back at my charting and it’s, oh yeah, I showed my assessment. I showed what I thought was going on. I did some interventions, then I reassessed.

And we see this that it goes… We do that over and over and over and over. So the things that I see nurses… The claims when I’m reviewing a chart, how it works is the hospital’s named but the nurses or the agent of the hospital. So nurses don’t actually get sued, that’s the other myth that people don’t realize. The hospital gets sued, but they’re also named as employees or agents, or something like that.

And so we have to say how they didn’t meet the standard of care. And so a lot of them, actually the most, and this surprises people, everyone thinks it’s like documentation. It’s actually knowledge deficits. And you guys see that. Nurses, God bless them, God bless those nurses who come into our classes who are all over getting that Instagram education, but it is technically a standard of care for the hospital to have nurses be trained. But yeah, the joint commission’s found that which is a big malpractice insurances, is we all think we hear either communication or documentation, but it’s actually knowledge deficits.

How does that show up when they’re being deposed?

So a very typical example is failure to maintain fetal oxygenation. And I’ll see just tachysystole, tachysystole, tachysystole, and they’re either keeping the pit the same, they might even be increasing the Pitocin because they were trained to pit it out.

Pit it out.

So that’s a knowledge deficit. One, you can’t pit it out. And two, they don’t understand that they’ll be asked questions around, do you know what happens during a contraction? The lawyers will even soft ball it and be like, “Do you agree that the oxygen is reduced during a contraction to the fetus?” And they’ll say, “I don’t know.” Of course it does. We all know that.

So whether they really don’t know or they’re afraid in the moment in a deposition, but it’ll be those really common… It’ll just be basic physiology questions that they ask them to establish, does this nurse have the knowledge? They’ll ask them why might too many contractions be dangerous? You would just say, “I’d be worried the baby isn’t getting enough oxygen.”But they’ll be like, “I don’t know. I don’t know. I don’t know.” Oh, Sarah. Girl, you should read some my depositions.

You can’t see my face, but every time she says, “I don’t know,” I’m like, “Huh.”

So it’s just these really glaring basic physiologic knowledge of what happens during the labor process. And that’s a pretty easy standard to prove. Because we have AWHONN textbooks, we’ve got [inaudible 00:18:37] I think even asks questions that basic, it’s in our nursing school books, there’s articles about it. It’s in the fetal monitoring court. It that’s a very basic amount of knowledge to know. And even more basic beyond that is if you walked up to a pregnant person at the Trader Joe’s or something, for sure pregnant, don’t like accidentally walk up to somebody and they’re like, “I’m not pregnant.” You’d say, “Do you think your nurse is going to know labor physiology?” And the the pregnant person’s going to be like, “What do you mean? Yes.” Right? There’s this social contract that we’re really not living up to because we’ve gotten so… We don’t know what we don’t know.

Interesting. Yeah. So would you say that education is one of the best ways to protect your license?

Yes, Sarah, I would definitely say that.

I’m like, I haven’t even made that connection for what we do, but now I’m like, oh, interesting. Another benefit.

Right? Right. Yeah. There’s very little core knowledge things that I teach. I teach fetal monitoring for AWHONN, But yeah, in our reasonable recruiting course, or a lot of this other classes I have, it’s really just we start with knowledge where a lot of hospitals jump to communication. Well, if sure, if you’ve got a communication issue in your hospital that that’s a good place to start, but why do you have a communication issue? Well, either nurses don’t know what to… They would communicate if they knew that this was important.

It usually is that very, very first step before you get to even skills. But we usually start within the hospitals, you’ll see them bring in communication programs, team steps or whatever, which expects you to speak up for safety. What if you don’t know it’s not safe? Or then they’ll back up and they’re like, “Let’s do simulations.” Well, what if you don’t recognize why not to pit somebody like crazy that’s going to cause a hemorrhage? So you’ve got these… You can only get so far. And then advocacy is really that last part. But if you don’t know what to advocate for…

Totally.

Don’t know what to do. So if you don’t have knowledge, you don’t know what to do, you don’t know what to say and you don’t know what to advocate for. So that knowledge is step one.

To further that. What if I have all of that and then the provider disagrees and it’s like, “Well, there’s moderate variability.” “Yeah, tachysystole, but moderate variability. So keep going.” How do I chart that to show the court, hypothetically if we’re going to court and to keep the patient safe, how do I chart that so that they know that any nurse would do the same thing I did. The little thing you had, the blurb you had.

Oh, did you turn off the pit?

Well, what if they said don’t? They said, “Keep the pit going. It’s moderate variability.”

This is a chain of command issue. So there’s differences of opinion, right? Docs, midwives, whatever they do stuff that sometimes I disagree with. The induction’s here, and I’m like, “Oh God, I don’t think this person really needed to be induced, but not my call not unsafe or whatever.” But especially when we’re talking about Pitocin, we start to… It’s not just a difference of opinion. We know there’s like… I’m guessing your policy says not to keep the pit going. There’s no research that says that that’s a safe idea. We know basic physiology says that that’s not a good idea.

And there’s plenty of standards that say, even with moderate variability, anytime you have tachysystole, you have to intervene. And so that’s one of those things that’s not just now a difference of opinion. And the Nurse Practice Act is going to say you have to challenge that. And so you would say, “I’m sorry, but I’m turning down the Pitocin in half.” Which is most likely what your policy says to do. And if they want to make a stink about it, then you would pull in your charge nurse. So you can have your little therapeutic triangle as I call it.

Explain that. Explain your therapeutic triangle.

Triangulation and communication’s generally not a healthy dynamic. So in family systems, triangulation is like where you talk about the person with a third person and then they talk. So this is really not healthy. But I think when it comes to… It can be used therapeutically in this situation where sometimes you just need that third person as a buffer to the conversation to reinforce, “Hey, yeah, we have this policy. It’s not safe to continue Pitocin in tachysystole, we’re going to turn it down by half.” And in fact, most places you work you’re not going to need the provider’s order to turn it down in half. You’re going to just be able to do that. If they’re really throwing a fit, I remember the first time I read a case and was I was depressed for two weeks. I was in my covers. It was like, we don’t ever see what you see as an expert witness as a bedside nurse.

And I just remember thinking, I’m never going to choose my own comfort in that moment over keeping my patients safe. It is not easy. But every nurse has to sit with that and know exactly what that means because oh my God, I’ve always worked in a fairly healthy place, but as a very new nurse, I remember this one doctor was just vicious. And I just remember being like, we get beat up a lot at work. It’s not cool, it’s not fair, but you have to make it crystal clear within you, I know this is not safe. I am going… I don’t want to live with what could happen on the other side though.

Well, and I think Pitocin is the perfect example because I feel like that’s probably… First of all, I’ve heard from you that that’s one of the highest things that sends people to court. It comes up in court all the time. But second, that I feel like is one of those really big overarching issues at the bedside where there is that push and pull constantly of like, “Well, it needs to go off, but…” My question is, what if you don’t have policies?

Oh, because some hospitals are just trying to get rid of their policies. Oh, man.

I worked at a… It’s a very large prominent hospital in Los Angeles that has zero policies.

So the hospitals below the standard of care, the standard of care does require that hospitals give their nurses policies. It’s one of the big-

Well, there’s basic, but not on everything. And especially OB, they have a policy manual for how to report things and whatnot.

But not an inpatient.

Not Pitocin management.

And it’s not in their order set.

Yeah, there would be directions in the order probably.

Directions. [inaudible 00:25:57] This is how it goes. And turn it off if X, Y. So usually it lives in one. So when I say policies, they have to have something. So some places have chosen to put those in the order sets, some-

Okay, that’s helpful.

It’s just that if one group of people’s working, keeping the policies up to date, and usually the people who are working on your ethic order set stuff, they might be different people and they get out of sync. And then when they mismatch and somebody just that can cross… So some hospitals have identified that as something they need to fix. So yeah, they’ve made them either live one place or the other. Okay.

What about specific to pit? So I’m looking at contractions and I’m palpating, and they’re super mild. It looks like a irritable uterus, but they’re showing up on the monitor as if it looks like tachysystole.

Oh, but are they at least 40 seconds?

Yeah. Yeah.

And it’s showing up as tachysystole?

It looks like tachysystole.

Yeah. So that’s going to be where some of this arc comes in. So some of the questions that are going in my mind is, as a nurse I’m thinking, “Okay, this is my patient.” I’d be looking at like, “Well, what is the patient feeling? Are they dehydrated? Are they preterm? Are they showing any signs of choreo?” All of the reasons that you might have that irritable uterus. But the research shows pretty clearly that adding Pitocin to dysfunction doesn’t make function.

So it’s like why is a uterus irritable? And you have to have that knowledge to try and troubleshoot those things. You have to be able to think through, is this person getting choreo? Are they just dehydrated? If I start to have tachysystole, but again, they’re like, “Well, they’re not making change. I’ve trouble shot everything else. Baby’s in a good position. I’ve trouble shot all the other things. But they’re not making progress. That little 500 cc bolus will do wonders for…” Because we can’t tell. One thing about oxytocin is it’s very close to anti-diuretic hormone. So if somebody’s dehydrated, they’ll kind of get into that irritable tachysystole or, and even a tachysystole looking thing. And we’re like, “Oh, do they need more pit? We can’t give them more pit. But they’re not really making change.” If you can just treat the dehydration, I’ve seen that do wonders. So then now the contractions are stronger again and they’re more spaced out, and you didn’t have to do anything with their Pitocin.

So you have to have that knowledge base of how does Pitocin work? How does the uterus work? How does labor work to know these sorts of things. So again, it comes down to, kids, we got to dive deep into this. We’ve gone for a long time.

My best friend’s a CVICU nurse, and I remember when she best friend from college, Cheryl, she’s really great educator now, but I was two or three years ahead of her because nursing’s a second degree for both of us. So she went to nursing school only three years after me, and she got into the CVICU and I remember going to her apartment and the books that she had spread out and what she was studying, it was when I realized, I was like, I don’t have that same level of knowledge as a two-year nurse that you are going to have as an ICU nurse. She knows everything about the pressures, the pharmacology, the this, the patho fizz. I was like, I don’t know that as a new nurse, to that same level, I don’t have an equal skillset or knowledge set that nurses in the ICU were expected to have. And that’s when I was like, “Giddy up, girl, we’re getting a book.”

Yeah, I learned something yesterday from you on your Instagram.

Oh, from me. Oh, okay.

Well, about you. So I learned something from you that I didn’t know about you that you have been talking about Pitocin since 2014.

That was my first conference, I actually-

You are a Pitocin expert.

Well, the other thing is when I started doing expert work, it was like eight years ago, and that was really in the heyday of research around protocol, best protocols for oxytocin on how to do it well. And so I remember thinking, yeah, this will be a fun gig, but it’s not going to last because we’re going to have these protocols and everyone’s going to adopt them and we’re going to be so safe and no one will get injured again. We did not do that. And I am now busier than ever.

So you have job security is what I think.

What do you think happened? Why don’t you think that that happened?

I think that there’s a lot of selection bias. So the talk I’m coming down to talk about is the Pitocin paradigm and a paradigm is the kind of normal way of doing things. And we’ve officially crossed into that greater than 50% induction and augmentation. So now Pitocin is the norm, and I think we can’t imagine living without it. And so when all of these studies came out that were like, Hey, basic tenet of nursing is used, the lowest dose of a medication. That’s like joint commission level stuff is like, you got to start that oxycodone at five. You can’t give them 10. You always start with the lowest possible dose for everything basic, basic nursing 101.

And we just had all this information that was so challenging to our confirmation biases that we were like, “No, Stephen Clark has a protocol that’s showed that you get the best outcomes on this very low dose. And if you follow this, it is nearly impossible to hurt somebody or hurt a baby. If you follow this.” Stephen Clark. Steven Clark, this man is probably the most powerfully influential OB and still his policy, his protocol is not widespread widely spread across the US. We don’t want anyone telling us we can’t have our Pitocin. I think, I don’t know what it is, but we just don’t believe it.

I think we don’t-

We haven’t seen enough physiologic birth and we haven’t seen enough of the body just doing it like it does.

And I work somewhere where we have a 13% NTSV rate. So that means…

Wow,

Thank you.

Yeah, that’s a very impressive,

And our induction rate is the same. Our augmentation rate is the same sort of as the nation. So it’s what are we doing in that middle piece? We also have a 60% epidural rate. So 44% of our patients do not even get epidurals. And so I wouldn’t say we’re particularly crunchy, but we had a lot of longevity as nurses. And in 1995, the induction rate was 10%. The induction in augmentation rate was like 9.8%. Those nurses trained me. And now we’re in this Pitocin paradigm where nurses are now the ones who are doing the training, like you said, don’t know what that is. But I worked, I was lucky enough that Barb… I’m shouting out all these nurses like Peggy and Tenley and Barb and all these nurses who were like absolutely unflustered by normal birth to me and trained most of the nurses on my unit. So yeah, I just think that we can’t… But then so Stephen Clark’s thing comes out like groundbreaking. But what’s the study that came out that got the most play?

The ARRIVE.

The ARRIVE trial. And because it confirmed what many people in inpatient care wanted to hear. So there’s a lot of selection bias.

This is confirming all of the work I’m doing for Cancun Prep on physiologic coping.

Okay, girl,

Massively.

You told me this summer at AWHONN do you remember? You’re like, “Are you coming?” I was like, “No, I got these two trials.” You’re like, “You’re going to have FOMO.” And I was like, “Oh. And then it’s a conference. I don’t even really going to Mexico. It’ll be fine.” And now I’m like, it. Holy shit, dammit, I’ve got to go. It’s going to be really fun.”

It’s going to be nuts. And the learning is very much down your alley.

I know.

They probably will supplement everything that you do.

Yeah, but I have two trials scheduled that week. So one, I don’t even know how that’s going to work out, but I am going to be pissed if they vote because most trials do settle. I almost never go to trial. It’s 300 plus cases, I’ve been to trial twice does not happen. I’m like, “God dammit, I know they’re going to settle. I know they’re going to settle. I should just buy the tickets.” But I’m like, “But if they don’t…”

Watch, but they do. You’re going to be so upset.

All right. If they do though, I’m crashing and you guys are going to let me in.

[inaudible 00:35:26] Can talk about that.

It’s going to be like $5,000.

Or not actually, when I went this last time, we-

Last minute.

Decided two weeks before and the tickets were the cheapest we ever got.

Okay. Flex and flow.

Sounds like I’m crashing. I’ll just wait outside the gates like, “Guys. You’re doing great.”

[inaudible 00:35:46]

It’s great. Well, because my friend Heidi, my work wife here was like, “Please, can we go?” And I was like-

Oh yeah, I know Heidi.

“I’m at trials.”

Oh, sad. Well…

Can you just… Yeah.

We’ll see. We hope to see you there.

The judge requires me to stay in the country.

Yeah, imagine that.

Imagine that.

Yeah. There’s a subpoena for my appearance. So they’d be upset if I was…

Right.

The sound bath.

Not to change the subject completely, but I’m thinking about what you just said about the people that trained you versus the people that are training now. And so that’s the reality we live in now. Our clinicals don’t take us to home birth or to birth centers when we’re in school. We’re going to see… Even when I take my students on the units now the first day in debrief, someone always inevitably says, “It’s so much quieter than I thought.” They just think that they’re going to hear more labor sounds. But it is, our unit is-

Come to my unit.

Quiet. No. And my unit is quiet and I think our epidural rate is between 80 to 90%. And the only people that don’t get epidurals most of the time is just they’re too late. They just come in fast and furious. And so what do we do? How do we encourage new nurses to one, believe in birth? And that’s something that Sarah and I talk about. And she teaches on do you actually believe in birth and that birth works. And what do we do? Because those people are retiring. Those nurses that had the 10% induction rate are leaving us in droves and…

Or are already gone.

Or already gone. Right. And so what do we do?

Jean [inaudible 00:37:24] she used to run the fetal monitoring program at AWHONN. She was here in Portland. And you know when you go out to lunch with a nurse and two hours later you’ve solved every problem in nursing, right?

Yes.

We’re like, problem solve, right?

Yep.

This is how we are. And I’ve noticed a lot on Instagram this the conversation being, if a hospital wants me to know something, they need to tell me and they need to pay me to learn it. And I mostly agree with that. But what I think we forgot is how much nursing school has changed. And I don’t think nursing schools and hospitals have… They need to talk about what they’re being handed out of nursing school and grabbing the baton from them. Because when I had two days with donor certified doulas in nursing school, in my labor and delivery class, that’s what we had to do for… So we had two two-hour lectures of labor support skills.

That’s cool.

That was something we learned in nursing school. I left nursing school being able to take three postpartum couplets. That was like, I knew how to do that. And you guys did too. Probably you could take.. Yeah, Sarah’s nodding. But nurses now don’t and so we’re getting really hard on them. Well, I could do these things. I’m like, I think we’re not… And it’s always easier to blame the younger generation and be like, “Gen Zers, they are lazy or X, Y and Z.” One, they’re like the smartest generation of nurses. They have so much knowledge. But we’re forgetting. I think nursing schools have been cutting back, cutting back. We know that some of them don’t even get an OB class anymore. They’re cutting back, cutting back all of these things. I learned how to read a strip in my OB class, not well, but at least we had-

I had an entire semester of OB. I had four weeks full-blown.

Yes. I also had a full-blown, and one of those classes was how to read a tracing. And we had a special guest come in. And so I think we need to realize it’s not these new baby nurses. I think that hospitals, they need to talk because hospitals are now having to do… And I don’t think that they were necessarily prepared to have to fully train square one nurses. And there’s this whole… And yet they’re cutting the orientation. So these preceptors are getting really, really frustrated. And everyone’s going to make their own choice.

But I think there is enough good education that’s reasonably priced out there. Buy some books. Books are super cheap. And that’s sort of that falling in love process that you go through with birth. So just pace it out. But I always tell people that they… I still take a physiologic birth class almost every year. I’ve taught them, but I take them. I take them from different people. I always learn a new little nugget or I like the way someone says a thing. Right? But you do… You’re going to… Yeah, they’re going to have to. Right. At this point in the game, if you’re like, “I want to be a labor nurse.” You will hate being a labor nurse if you don’t supplement your education.

Well, and I think this goes back to, I don’t remember what episode it was Justine, where somehow it came up of hospitals should pay for it slash I’m not working off the clock is sort of the idea. And I hear that everywhere now. And I think there’s a balance of yes, you need time off, but also you are responsible for your own… Listen to my scripting. I was going to say licensure, but that sounds legal. And I think for me, I don’t mean it as legal. I mean you hold a license. I like the comparison to the ICU nurses of we need to be experts in this stuff. And if your nursing school didn’t prepare you and your unit isn’t preparing you, this isn’t show up to a desk and type some things out and we’ll get by. This is humans’ not only lives and safety, but also timelines in their life. Huge day, massive days,

Magical days in their life.

Exactly. And so this call to action of you need to be learning and you need to take your role and your profession and that art seriously.

Yeah. I think other professions also do some of that too. It’s not… But yeah, we’re really swinging from one end to another. And nursing’s just gotten so shook up right now with a lot of things, right? Because it’s not only we go to work and they’re not giving us the things they do, they’re also pushing us harder than ever, like staffing acuity, all of those things. And so it feels unfair, but it’s again, is it fair that you have to go toe to toe with a toxic provider? No. Your hospital should [inaudible 00:42:41] with that. Do all of us need to make that choice that yes, it’s not fair, but I’m going to be the adult. I’m going to be the professional. I’m going to do this thing. I’m going to buy the physiologic Penny Simkin’s book for $50 and read it.

Sure. I bet your hospital should have given you that, but they didn’t. So that’s also a sign of maturity and growth that we need to do some of that. And it gets easier. You get into the flow. I read more now. The more knowledge I get, I find the more I also am seeking out. Because you start to get into the nuance of things and that’s where the passion comes from. And you’re in this flow. So I do want to say anybody starting out, you’re like, it’s a weight. It’s just a giant amount of information. But they’re true pleasure of this comes in that expertise. So just like, yes, keep going, keep going. I love my job now more than ever. How about that? I love being at the bedside more now than I ever have. It feels better and better and better after whatever, 16, 17 years. So burnout’s not inevitable.

Well, and it sounds like education might be sort of that bridge between hating your job and getting burnt out. And it continues to stimulate the mind, but it also helps down regulate your nervous system so that you can cope because you are more confident in your skills and in your knowledge and in standing up for what’s right and in advocating and all of that.

Oh, yeah. Knowledge is the secret sauce here. The more you know. Yeah, it really blossoms into everything. So yeah, is it going to keep you more safe? Is it going to protect your license? Is it going to keep your patients from getting hurt? Yeah. And it’s going to help you not get burnt out down and it’s going to help you have that long, delicious, beautiful career that we want. So I don’t believe in… I love all of the Get a hustle. Leave the bedside. Yeah, get that bag girls. But I’m never leaving the bedside, so I don’t have any interest in it.

And we all believe, I think we all stand for the fact that you don’t have to leave the bedside. That there are other ways of doing it. And all the programs that both of us have are there to help support and help lift up the profession. So you do feel like you can keep going. And what’s the common denominator of what our side hustles? It’s not my side hustle. It’s my full-time times five hustle. It’s all knowledge. It’s education and support. And that’s where that secret, that’s so funny that that’s what came out of this episode. Because it’s like we’re just [inaudible 00:45:42]

Not what we were going to talk about, right.

Right. But also if that truly is the secret sauce to everything, including burnout, do it.

Yeah. Do it in a way that feels good. Pick the book that you want to read. Yeah, we know your hospital’s giving you some, health stream, some clicky clicky videos. I don’t know. I like to read. Reading’s one of my main ways of learning. I like to read something, then I like to practice it a little hands on and then for me really cementing my knowledge happened when I became an AWHONN fetal monitoring instructor and then I was teaching it. So a lot of times people think I don’t know enough or when do I get to teach something? I was like, sometimes you don’t know enough when you start teaching, but as long as you know are sure of the things that you are saying, it’s a really great way of also learning and preventing that burnout too.

So being a lifelong learner is often going to turn into people being joyful teachers. We’re going to be those nurses in 30 years who new nurses are like… We all have that legendary nurse. For me, it’s a nurse named Barb Cole. She may even still be a nurse. She’s someone who says that they’re going to retire multiple times, but then suddenly is back.

And just bad chick badass. She’s badass ,knows her stuff but trains nurses. And that’s what I want to be is that just wackadoodle nurse and everyone… Well, she’s not whacka doodle, she’s a badass.

Character.

She’s a character, let’s put it that way. We’re going to be the nurses that help get back to that 10% induction rate or we’re going to have the 13% NTSV rates and we’re going to show our nurses, new nurses. So I don’t know. I have a vision for the future that we’ll get there again.

Same. Well, I like hopeful visions. That’s nice. Well, I feel like you did just wrap it up, but is there one last or two last things you’d like to say to these L&D nurses listening to you right now?

Oh, one or two things.

Or whatever.

Yeah. Again, if someone’s saying anything about the legal system, either out loud, I would love to hear what happens, say or to yourself. Say, “How do you know? How the fuck do you know?” Sorry, poor emphasis. Really monitor who you’re taking an information from. Be protective of yourself. So are they a malpractice lawyer? There’s plenty of people out there that are like, “I’m a lawyer.” But that’s taking OB advice from an ER nurse, right? So do they do birth injury? Are they a lawyer? Are they a plaintiff’s attorney? Listen to the plaintiff’s attorneys, right?

Are they a nurse who does this sort of work and sees lots of cases? I.e. Me. People who actually know, listen to. If somebody tells you something about Pitocin that doesn’t sound right, say, “How do you know? Are you Kathleen Rice Simpson? Are you Stephen Clark? Are you writing these textbooks? Are you AWHONN? No. How do you know?” Challenge it. Really be selective with what information you let in to your life.

I love that. I love that.

So yeah, that’s going to be kind of my big tip. So in nursing in general, but for legal issues, before you let it in, be really selective.

Do you want to talk about your classes a little bit?

Sure. I also have a little prezzie for your people.

Oh, okay.

They can get 20% off of all of them. They’re always cheap because my main way of making money is being a nurse and being an expert witness. So this is more. People think being an expert witness sounds really cool, but it all I see as bad cases, I don’t get good. There’s no good case. There’s no good outcome. So for me, the only way it’s worth it, and I’m just surprised more experts aren’t, we see so much and we see so many patterns. So my people are nurses, so I would be a terrible human if I didn’t take what I saw and shared it. So I do keep them super cheap. But yeah, I have a class on documentation for perinatal nurses. I have one just about the malpractice process. The lawsuit process.

I have one on postpartum unique issues because I know we always talk about labor, but I’m seeing more and more cases postpartum. And that’s sort of like a specialty that I have as an expert witness. And then I have a bigger class called reasonable and prudent, it’s like 12 CEs and it comes with some live calls and we go through all of the ways to just totally worry proof your practice. But I would say… And it’s good, it can fit in anywhere with anybody, with any other courses that people are taking.

Speaking of other courses. So we have a big part of our bundle worth mentorship is shared decision making and protecting your license in that way. Now, I don’t even like to say protecting your license because I feel like that’s like fear or keeping patients safe through shared decision making process. And then on demand, we have our deposition and trial class that we had an expert witness come on with us and I remember Sarah talking about during it being like, what did you say? What was the line, Sarah? “I dare you to depose me” or something.

Yeah. I’m like, oh, I’d kill that deposition.

But, and that’s the goal right through all of this that we just learned through Jen and through all this education of just calming your nervous system about it and not being so afraid and being more concerned with keeping patients safe and doing the right thing, which is ultimately what it comes down to as well. Perfection.

Yeah.

Right. So we will have Jen’s promo code in the class notes as well as Stephen Clark information, and I can’t believe you didn’t even really talk about K-Rice. You’re like love of your life. That didn’t even come up.

K-Rice is the street name I’ve given to ‪Kathleen Rice Simpson.

It is also, now I picked up that street name for you.

Yes. So she doesn’t know it never met the woman, but she’s like, got to be the most published nurse researcher.

Yeah, she’s amazing.

She’s gone gangsta lately. Like some of her major publications, the way she takes out other major people is… It’s the TMZ for nurses. Let’s just put it that way.

Oh, you’re so funny. It’s great. I will link that information in the show notes as well as where else to find Jen. But Jen, thank you so much for coming on with us today.

Yeah, it was so nice to see you guys. I’ll [inaudible 00:52:47] next week.

Yes, you do. In person. That’s fun. Well, thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to bundlebirthnurses.com or follow us on Instagram or TikTok.

Now it’s your turn to go and don’t choose your own comfort over patient safety. We’ll see you next time.