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Welcome to Hello Uterverse, where perinatal peeps come for more evidence, more clarity, and fewer WTF for Jen and Heidi. Labor nurses, educators, and research obsessives here with you in podcast form. From deep dives to surprising rabbit holes, we're here to help you think differently about the work you do every day. Let's launch.
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Unknown
Hello, Uterverse.
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Unknown
Hey, everybody. Welcome back. Welcome episode to
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Unknown
you know, last week we were talking our last episode, we were talking about, what is evidence based care? Because we got
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a DM from somebody who follows us. But I feel like I just, like I've been marinating on this question a little bit more, and so I want to talk about it.
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Unknown
I had a few more thoughts, and I know you're going to have a few more thoughts too. So just to refresh everyone's memory,
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Unknown
they asked us what if there is risk, right. Like we're worried about our patient, but I don't have the evidence or like the science words, to have that conversation. And, you know, every nurse is certainly at some point in their career felt that.
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as I was thinking about it, I was like, oh, I think what they're really saying is,
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you know, I'm concerned, but how do I communicate in a way where I'm going to be taken like seriously?
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And there's this real hierarchy that nurses, I think, at least perceive whether it's real or not. You know, that's going to be unit specific and process specific.
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But like
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there's a real hierarchy and this real like oh I need to have these like
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articles ready to just like
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bam like whip them out and, and you know, cite, you know, chapter and verse kind of a thing and
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I don't really see that that's
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been the most helpful for me in my practice.
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I mean, I don't think so with mine either. I don't
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really remember ever having to necessarily have articles in my locker or anything to whip out, but I think that people sort of default to that because,
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when some nurses start questioning a provider,
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some of them default to, well, this study says x, y, z, and I think nurses are all always looking for a point of connection or for point of community.
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And they think that, well, that's how their brain works. That's how they speak. That's what I need to do because we hear that all the time when we're teaching or whatever someone in the audience always asks us, could you provide me with a study so that I can print it out and take it into the providers I work with?
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Unknown
Oh, well, that happened yesterday when we were teaching Speedy Delivery. What was that question? It was like, oh, so, you know, we talk about the uterus and uterine contractions and speedy delivery and the contractions. As contractions get closer together, they do get weaker. There's like an inverse relationship. And now there's a sweet spot between wanting to have enough contractions to move things forward, but not get them so close that suddenly,
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you know, oxygen can't get to the muscle and blood, and then lactic acid can't flow out.
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And she's like, well, where's our research study? And it's like, babe, it's just that's just science. That's just physiology, okay? Just that's what's in the textbooks. I mean, so I actually did think about that. I was like, I think it actually probably goes back to culture. I oversee is research from Montevideo.
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Unknown
But that's like we're digging stuff up from the 50s.
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Unknown
Yeah. And you know I think I do get that they want to be taken seriously, but it's like do y'all not just make it all the way through a whole nursing school program? Like, what did you think those were? Those were science words. And so, yeah, like, we don't give ourselves enough credit a lot of the time
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we don't.
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So I was really thinking, like, how could we make this a little bit easier? And I feel like the first step is always just recognize, like, what am I actually looking at and seeing? I'm seeing minimal variability or I'm seeing contractions that are too close together.
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And then then you can interpret it. But we do because we're doing so much stuff is coming into our brains at once.
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Unknown
Especially right at the bedside is we tend to want to like, jump through it quickly and put all of the information. But we really got to look at just like, what is this one piece? Oh, now I see it's this. Okay, what does that mean? And now what do we have to do? Okay, maybe all we have to do is turn the patient.
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Unknown
Oh, I've stepped back giving myself that, like, a little bit more perspective. But yeah, no one should be pulling up, like, up to date at the back. Like, we don't have time for that. Maybe. Maybe you can't pick up a slow moment, but like,
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Unknown
yeah, I don't know. I think part of that too is because as nurses and especially in the specialty that we're in, we're always thinking three steps ahead.
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Unknown
And so I think we kind of go to like, oh man, if I turn the pitocin down, they're going to be upset. I'm going to get an email from my manager. The provider's going to come. They're going to be mad at me. I got to have a defense rather than
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just, like you said,
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pushing pause, zooming out. I mean, like,
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What if I just turn them, give them a fluid bolus? I have my pet and see what happens.
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Unknown
I was told by a mentor, like, I think pretty early in my career and this that, you know, because I, I'm someone who learns best when I'm able to, like, teach something. So I will understand something, but, like, it's not until I get to explain it to someone else that it really, like, cements for me.
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Unknown
And a lot of people are that way, nurses are that way. And I think that's why I do tend to do a lot of, like,
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a lot more patient teaching than I certainly did when I was new. It's not like that reinforcement, but this mentor told me at the beginning of like, my teaching more educator role career with like, teaching A1 fetal monitoring, or classes like that is if you can't explain something simply, you don't understand it well enough.
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Unknown
I like it in some ways, but not in the other, is that I like it as though as permission to not need to start like citing molecular biology or you know. Yeah, you know, if, if you can explain something to your patient, right. You're not dumbing it down. But like, can you make this idea digestible and, and that's because when maybe other members of the team or other clinicians, they're bringing out those studies because they think, oh, if I can use enough big words, people will think, I know what I'm saying.
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Unknown
And we know and we know that's not the case. That's not always the case. Yeah. Just throwing a word salad of large multi syllabic words out at somebody will shut you down. Yeah. And a lot of times the things that they say at least
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Unknown
when I've heard providers say oh well this study x, y z, you know, whatever.
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Unknown
It's like well what do you mean by that really. Like I had for example, I had one provider that was giving this nurse just a really, really hard time. I was charge and she's like, I can't keep upping my pitch. And I've had to turn it off a couple of times. And he was just adamant that she could still have it, have it on.
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Unknown
And and she's like, he's telling me that, like, there are all these studies that say it's fine, blah blah, blah, blah, blah, blah. So I end up having a little conversation with him and and he's like, well, show me. Then he asked me to show him a study
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saying that where minimal variability is bad
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and I'm like, well,
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really the textbooks, right?
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Unknown
Yeah. You know, so I think you got to kind of question them back a little bit. And I think that's what we kind of get a little bit scared of is then when they're saying, oh, this study here, then it's. Yeah, exactly what you're saying that it like puts off this persona that, that they are smarter than us or whatever and kind of goes back to that hierarchy.
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Unknown
And, I mean, that's not the case everywhere. There are, you know, plenty of places. And I feel like where, where I'm at and where you're at, you know, we can have like good conversations with the providers and it doesn't feel like that hierarchy. But I know that that isn't the case everywhere. And so I think if we can just kind of ease the road for people a little bit and help them have a little bit more confidence in their journey, then it's going to be easier to have those conversations and not
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get lost in the sauce so much.
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Unknown
Yeah, we're looking for understanding, not, you know, a bibliography that you might pull out.
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Unknown
Yeah. I mean, I would say that that's definitely how conversations tend to go where where we work is like we're trying to get to like mutual ground. And so thinking back to that, like evidence based practice funnel is like,
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Unknown
you know, you have to input all of the, you know, latest research but also the old physiology.
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Unknown
Right. It doesn't. There is this idea that like a random eye, a less than five year old randomized control trial is always going to trump
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everything else, right? Yes. We don't repeat studies over and over if it's settled science or if it's just basic physiology, there is not going to be an RCT on that or a systematic review or a meta analysis or whatever.
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Unknown
Right. But it's so drilled in, it's like to write your paper. Yeah, you got to be citing some, you know, current stuff, current stuff. We can do that.
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Unknown
And part of that best research is your textbooks, your basic physiology. That's why you take pharmacology, all that stuff. So I do think nurses have a good basis of of what those science words are
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Unknown
But then that we get to that middle part where I think it's really like those rich, great conversations and where
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Unknown
I'm putting my experience. You're putting your experience provider, midwife, whoever. And then those choices are ultimately, you know, presented to the patient based on, like, their input and stuff. And so
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the final for
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evidence based practice funnel is meant to keep everyone moving to the point where the patient's making a choice that's best for them.
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It's not meant to be like some weird, you know, weird battleground.
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Unknown
And now, you know, back to that quote. If you can't explain something simple, you don't understand it well enough. Like there are things that are complicated, like, but it's putting in the time to understand it will allow us to like have those conversations, I think, a little bit more smoothly.
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Unknown
And obviously reading one research study can't give you
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the deep level of understanding that, like we're all working towards, we picked this job for a reason.
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Unknown
Yeah. And I think to when you said job, we were talking about this other day about how it is a job, but you also have to treat it like a career terms that you're investing into it.
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Unknown
You're investing in in your education and your skill in those sort of things so that you're enhancing your tools. And that's how you're going to
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get better and stay. We're just looking for the girl. Yeah, yeah, that's what we want. Yeah. I mean it is truly lifelong and it's yeah I like that idea of it's not it's not a job.
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Unknown
It's a career. It is a professional endeavor.
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Unknown
When I was like a new nurse, I think one thing that would have been helpful is I. I nobody was telling me, you can read a book or you can learn something. It wasn't until I started becoming actually interested in expert witness work. And the person who I was asking was like, well, what do you think makes an expert?
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Unknown
And of course, it's one of those questions that you're like,
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Unknown
I should know that I should be able to answer that. What is an expert and what she told me was, it's just somebody who knows more than almost everybody else on this topic, and
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Unknown
there's no rules to that, right? Like, you can
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become an expert on any topic if you read,
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you dive into the research, you go to classes, right?
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Unknown
There's no degrees and expertise.
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Unknown
And I think a degree will help. But yeah, I think that's an interesting perspective because I think the knee jerk response to that is someone who's had 20 years or the sort of thing that we really associate expertise with years in the field, and that doesn't always translate. That's not it's not it's not a given.
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Unknown
It's not a rule. No, a rule is the the bar is
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do you know a lot about a topic,
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minutes that it is going to take some amount of time, but like is there some sort of there's no gold medal that gets handed out for expertise at like 20 years or ten years or 76 years.
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Unknown
I mean, we put people in charge of a whole unit here, like 1 or 2, it sounds like these days, which is, you know, different than it was. But, I mean, that happened to me about a year and a half in.
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Unknown
I was six months in working my first job on Med Surge. They tried to make me a charge nurse, and I was like,
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Unknown
what Hallucinogenics is this manager on?
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Unknown
Yeah, that I am at all equipped.
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Unknown
Yeah, but here we are. Here we are.
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Unknown
Here you are.
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I know.
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So just
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to remember, if
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if you're feeling nervous, you're feeling like something is a risk or
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isn't safe. What you're really thinking is, is like, you know, I'm worried about my patient, and it's not about sounding smart. It's about being able to to pause and think clearly and work through that, like, recognize, interpret, act
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Unknown
with just a bit of time so that you can act when it really matters.
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Unknown
Yeah. And I think that's just like the big hitter there. And just like you said earlier, you know, just really describing what you're actually saying, like
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Unknown
I've had minimal variability for X amount of time. And these are the things that I've done. And I'm concerned about x, y, z. And I think just being really clear cut really goes a long way other than just saying I don't like how this is and not giving a whole lot of information behind it.
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Unknown
Yeah, you got this, you got this. We're here for you. Yeah. If you don't got this, we got you. So stick with us and we're going to keep working our way through all of the evidence based research
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moves grooves
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and whatnot. And we'll see you next time. Bye
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Unknown
Thanks for listening to Hello Uterverse!
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Unknown
For more evidence, clarity and community. Head to Uterverse.com
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Unknown
Nursing is wild. Practice with confidence.
