Most nurses are female. Given that women have babies it is reasonable to think that many nurses will have a baby or two at some point in their career. It would seem to make sense that the Nursing profession would be very supportive of women and the challenges of being a working mother, right?

Before I had my baby, I always supported the mothers I worked with by covering their patients while they pumped if they were breastfeeding or by letting them leave if they had a sick child or some other childcare issue. Since I had my first child, I have been supported by my colleagues in turn, but realized just how systematically unfriendly the nursing profession can be to working mothers.

When it came to pumping breastmilk while at work, I found that we were often so short staffed that pumping had to be delayed to the point that my milk supply and ability to provide milk for my baby was compromised. As supportive as my colleagues were, they had to assume care of lll my patients for 15 minutes every three hours so I could do this.

Furthermore, there was no physical place for me to pump. I had to search for an empty hospital room, occupy the bathroom, or hope some administrator with an office was not at work that day. When I did pump in a patient room, I prayed no one would ignore the sign on the door and come in.

When it came to juggling childcare, as a part-time employee it was not practical or economically feasible for me to have full time day care, as a result I needed a basically set schedule in order to be able to work and have child care. My manager told me that I needed to have complete availability and she was not able to accommodate my child care schedule. In the preceding 6 months I was one of the highest rated nurses in the department by this same manager. In addition, several working mother had vacated their positions because their child care needs limited their availability on certain days of the week. This was very difficult for all of us because we all loved our jobs and had been as flexible as humanly possible. At the same time, we were replaced by younger models with no children and a lot less experience.

I understand how difficult making a schedule can be when people have limitations, but the nursing shortage will only worsen if attempts to work with the needs of working parents are not included in our strategy for retaining nurses. I had even found a nurse who would job share with me so we could each work set days of the week, but that was not enough for the administrators. I attempted to have complete availability for a while, but I was spending so much time trying to juggle my schedule and have make sure I had childcare. In addition, my manager would release the schedule about a week before it started and coordinating child care at the last minute is near impossible. So I gave up my part-time job in favor of part-time PNP school and working PRN. I have a set schedule and child care but miss my job and they have a job vacancy it will take them months to fill.

On September 17th, 2007 I became a mother. After working as a pediatric nurse for almost 6 years, I had “educated” so many people in the pediatric ER about basic baby care from how to suction a stuffy nose to what to do when fever occurs. I remember being shocked at how little people seemed to know about basic infant care.

Then motherhood happened to me. I forgot everything I had been teaching others and became an insecure, frightened parent when it came to my own child. During those first weeks home I called my pediatrician because my baby had not pooped for 24 hours. If I had triaged that phone call from myself, I knew what I would have said: not something to worry about as long as baby is eating well and having at least 6-8 wet diapers a day. But the new mom in me was terrified that something was wrong. The terrified mommy wins over the rational nurse every time. I remember going to my pediatrician when Molly was 1 month old and asking her not to tell anyone that I was a pediatric nurse.

In my defense I have been doing pediatric hematology oncology for the last three years so even my knowledge of well baby stuff was rusty. But still. I was disgusted with myself and embarrassed at my complete loss of composure over taking care of my own child.

The addition of mommy doubt and anxiety to my life and my new identity as a parent gave me a new understanding of what parents of sick or well children might need from their health care providers.

Parents need to know that we are listening to their concerns first, diagnosing and treating with those anxieties and fears in mind. How often do jaded health care providers dismiss the seemingly overanxious parent and tell them not to worry about something without having actively listened first and then provided basic education. My own experience with this occurred when Molly was 3 months old. She seemed to be sleeping much more than normal. The new mommy in me called my pediatrician and they told me to bring her in. So I did, even though the rational nurse in me knew Molly was OK, anxious mommy alter ego was in the car 5 minutes later. Once there, Molly was fine of course, but I didn’t feel that I had the chance to explain why I was worried. My pediatrician saw the nontoxic looking 3 month old in front of him and we were out the door in 5 minutes. I did not get what I needed because I still did not fully understand why she was acting so differently.

Healthcare providers do not spend enough time providing developmental guidance and assistance with basic childrearing issues. Most pediatric well visits are brief and do not afford parents the chance to really check in with how parenting is going. Most patients will initially say that everything is going well the first time they are asked. But parents need us to provide more support, especially since people are more isolated from each other but are able to Google almost any health topic and educate themselves. There is a great deal of information out there in the internet, but one must be discerning about information. Pediatric healthcare providers have the opportunity to help parents sort through this information.

I have read many books written by medical professionals about pediatric care, but I find the Touchpoints approach by T. Berry Brazelton to be a very holistic and comprehensive approach to how pediatric care providers interact with their patients. http://www.touchpoints.org/

Through my own experiences as a new mother, my ability to serve my patients as a Pediatric Nurse Practitioner has grown significantly. I have a much better understanding of parents. I understood a great deal about the textbook topics of pediatric nursing care, but had never lived the reality of caring for a little human being 24/7.

On the flip side I have to be Molly’s mom first and foremost and let the nurse go take a nap when it comes to my own child. That tired nurse gets some sleep for a change.

When I first went to Nursing School 6 years ago, I remember meeting so many idealistic nurses to be with dreams of taking their education and going to work overseas to make a difference in countries less fortunate than our own. Their experiences as Peace Corp Volunteers and NGO employees sounded so noble and exotic to me and I felt somehow inferior for having chosen to become a nurse without consideration for how my knowledge could benefit those living in areas without access to care at a fundamental level.

We undoubtedly have an incredible wealth of resources within our health care system from beautiful hospitals and clinics with multi million dollar architectural features to state of the art medical equipment, computer services, and highly educated medical personnel compared to health care systems in other countries. For example, it is unheard of in this country for a medical facility to have such a shortage of supplies that medical personnel would have no gloves available to wear when handling blood and body fluids or have to wash out the same pair of gloves repeatedly in between patients. When one considers how vastly privileged we are in this country, it is hard not to feel alternatively grateful for our own fortune and disgusted that we have so much when others have so little.

After 5 years of working as a Registered Nurse in pediatric and adult emergency rooms in New Orleans as well as in Pediatric Hematology Oncology at a nationally ranked pediatric hospital, I have come to understand how social, economic and cultural factors interact with one another in our health care environments that illustrate vast inequalities among patients within our own systems of health care.

The divide between the experience of the wealthy and the poor in this country is well documented. If you asked any medical professional if they treat all their patients the same regardless of their race, class, gender, or cultural background most would answer with conviction that they provide the same care to everyone. As individuals caring for patients, I know how deeply we believe that we treat patient equally. At the same time, if we acknowledge and examine all the ways in which the health care system is designed from corporate insurance policies to how our implementation of particular policies in hospitals and clinics may exclude patients who speak languages other than English, we would be forced to admit how our systems are defined to produce and affirm inequality that is defined by differences in race, class, and cultural background.
Too often we understand the concept equality to mean that everyone is treated exactly the same. This construct itself is what produces and supports inquality. Treating people the same way for the same conditions adheres to this notion of equality but in essence illustrates a failure to understand and address how differences in socio-economic and socio-cultural identities change the way people interface with social institutions such as health care. Imagine a pediatrician who sees two children on the same day in the same office, each wih a complaint of fever. Upon examination, the provider finds that both children have bilateral ear infections. Amoxil is prescribed. Two weeks later, one family returns with the same complaint and the provider examines the chil to find that his ear infections have not improved. The provider is concerned. It would seem that the second family spoke Spanish. The provider used an interpreter to explain the prescription the first time and cannot understand why they did not treat their child as he instructed. As it turns out, this family spoke only a little Spanish, they first language is a tribal Guatemalan dialect. In addition, they could not afford the prescription because they do not have insurance and are not eligible for Medicaid because they are in this country illegally. They did not tell the provider because they feared deportation. Finally, neither parent in this family completed education beyond 6th grade level in their home country.

Of course many providers address these issues successfully on a daily basis, however, there are numerous examples of how our awareness of these issues is not heightened until our attempt to treat patients the same fails. This is a process of trial and error in many provider experiences. If a situation is urgent enough or for cases of complicated management of chronic conditions, however, we may not have the luxury of trial and error. Also the difference economically for a family with access to insurance and without is crucial. Most providers have few options to provide the same treatment to families living below the poverty line who must bear the financial burden of treatment themselves. In effect, the differences between how these families and their upper middle class counterparts with insurance and large disposable incomes access medical care and treatment are astounding. Our health care system is designed to provide them the same treatment in theory, but not in practice.

In my own practice as a nurse, I have come to understand that even my best efforts to provide all children with the same care is severely limited within the health care system at times due in part to my own lac of understanding of the social, cultural or economic realities of my patients. I do believe that our resources are vast enough to decrease many inequalities, though complete elimination of inequality is perhaps unrealistic.

I propose that medical professionals must first define the scope of the problem through research. Let us begin to expand our studies of disease outcomes to include data about insurance status, primary language, family income, and cultural background.

Once such data is collected, we can begin to design interventions that will address the specific needs of families with different backgrounds. No doubt the need for health care policy change will be a highlight of such efforts, but we must also focus our interventions to find the most effective ways to treat, teach, and monitor families on the most basic level of how each provider interacts with each patient. We may find that shifting our thought processes away from notions of equal treatment and towards different treatments for different basic human needs is a philosophical shift that produces profound results.

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