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Unknown
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. Hey, guys. Welcome back. Today on the podcast, I was kind of thinking,
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Unknown
you know, we were talking last time about our biggest ex, but some of the, the biggest tools also that have helped us
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Unknown
in our careers when it comes to evidence based practice or practicing
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Unknown
working within the evidence. And one thing that came to mind was
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Unknown
having a questioning attitude.
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Unknown
And
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Unknown
you know, Heidi was like telling me last night about her shift and
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Unknown
like, you kind of had to really persist in questioning the scenario, right? Yeah. And I think that that's something that we tend to do a lot in our, in our career. And it can sometimes like feel exhausting. But I think it's good because as we've talked about things change all the time.
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Unknown
And so just the importance of
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Unknown
having that questioning attitude without questioning with attitude. Oh, well, that's especially Talia t right. I haven't
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Unknown
have a questioning attitude until there's going to be a point in time and you have to have this friend on the unit that, you know, will question with attitude, you already that person popped into your mind.
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Unknown
We don't have to explain what it is. You all just saw
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Unknown
that nurse. Yeah, there is a sketch artist around. There was a there was a very particular face that was drawn that was drawn into that. Yeah. Yes. For you. So yes. Having a questioning attitude, it does get exhausting, but it's something that I've realized can really be like trained, like it's a muscle that you can start to flex a muscle memory, if you will, a muscle memory.
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Unknown
It can get more comfortable. Right. Because things that are unfamiliar to us or by default going to be less comfortable, they're going to feel scarier. It's going to be scary to question a doctor if you don't question anything. Right? So, you know,
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Unknown
And do you thoughtfully think like, okay, do I have all of the orders that I need? Does everything seem to be here? That should be here. Do I have, you know, are the eyes and O's making sense for this patient, or, like, do these vital sign trends make sense for my patient? Is there anything out of, you know, out of the norm here for my tracing?
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Unknown
Right. Do we do we regularly have that kind of questioning that we practice? Because if we're not even doing that, then yeah, like turning around and asking questioning the charge nurse or questioning a provider midwife or a doctor is going to feel like really, really uncomfortable. Yeah. It's not going to feel good. Yeah. And one of the things as you get really good at it, you start to do is not only do you become someone who can answer questions, you start to question the answers.
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Unknown
And that is the crux. Do you sure do. Right. And hence, like all of the rabbit holes we go down to and
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Unknown
when you start doing that, all of the things that like we've taken for granted or like that's the way it's always been starts to fall away, right? And I think like as I was reflecting on, like us starting this podcast, it was really like, oh, we do this all the time on our unit.
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Unknown
People are very comfortable questioning hashing things out. Like, I remember we had this midwife who used to work with us and now she's on the East Coast. I think she's at Duke. Shout out to Erica Coppola.
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Unknown
But we were in a spirited debate at the nurses station about the definition of Corio, and I was like, it's this. And she's like, no, it's changed.
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Unknown
And I was like, and we finally we could both find stuff that supported us for our patient. It like actually didn't really matter by like all definitions she had Koryo.
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Unknown
Or AI but like that never. What did that even stand for?
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Unknown
Intrigued or in infection something it never took off.
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Unknown
But then wasn't it IAE for a while too? Yes. II for a little while. To be clear, it never took off and we all still say Corio, we have people have are out there like screaming at their cars.
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Unknown
It's like that
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Unknown
like total dum dums right now. But anyway, so we. So that's just something we've always had is like, you know, always comfortable questioning.
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Unknown
there's even some like, you know, these like sacred, you know, things that you just don't question or never come up for question.
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Unknown
And I think
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Unknown
the first time this happened to me was and we'll get back to this topic later on a different episode, but
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Unknown
with this phenomenon called sudden unexpected postnatal collapse.
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Unknown
And I if you don't know what it is basically a baby's born well, normal Apgar and sometime in the first like 24 hours has a cardiorespiratory collapse. And this happened to me like just after birth, I had like 8 or 9 Abkhaz for this baby. They were I was doing my filling out my bands, all this stuff, and I looked over about five minutes later and I was like, that baby doesn't look quite right.
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Unknown
But in Portland, Oregon, obviously, we have almost no lights on in our rooms at the time of delivery. Like, right. It's very, very dark in these rooms. I just the light of the warmer. And I was like, that doesn't look quite right. But so I go over and I look and kind of give it a little nudge. And I was like, oh my gosh, this baby, he's like has stopped breathing.
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Unknown
So I take it over to the warmer. We give it a few pops of PPV and it like turns right back or you know, and I was like
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Unknown
So this is like a full ten, 11 years ago. Like
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Unknown
people are like, why is she talking about this? No, no, this is like ten years ago.
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Unknown
And we were going out to the nurse's station and this nurse who's now retired, but like, you know, one of those, one of those nurses that you like will just, like, look up to forever, like, remember fondly, Peggy. Peggy's like, I think it's the skin to skin.
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Unknown
I was like, oh,
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Unknown
what? You can't say anything bad about skin to skin, right?
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Unknown
We worked so hard to to get there, right? And lo and behold, I mean, she was a little bit right, but not in the way she was. So that was like my first experience hearing somebody question something that was like sort of held to be sacred,
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Unknown
but was not the last. Okay. So what do you want to talk about today then?
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Unknown
Something that we don't question the answer on. Okay. You know what is not actually evidence based. What.
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Unknown
The niche categories. Dun dun dun.
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Unknown
Yeah. So nht the categories category one, two and three. So evidence means we had some sort of like study,
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Unknown
research, something that went into it before it's adopted and rolled out. Right. This was not studied, not research anything prior to 2008 when it was integrated into the Nichd nomenclature category, which is 18 years ago.
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Unknown
That's a long time. I go I remember first becoming an eight one fetal monitoring instructor and thinking like, oh, it's been five years. Surely they're going to circle back around
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Unknown
a few years out. We already knew category two was like really probably like really, really challenging for people. Oh yeah. And we haven't though I know I keep waiting,
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Unknown
I keep waiting and thinking it's going to happen.
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Unknown
But now with how? Call us, call us. We're here, I think fill out our fill out our contact form. And you needed more nurses on that guys? Yeah. More nurses. I think it was mostly guys probably. But yeah. Yeah. So you know, step one was like, let's get everybody on the same page of like calling things the same words.
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Unknown
And then and that was in 2005. And then we're not going to call variables carrots anymore WS subtle lates shoulders all the things. Yes all the words. So we we we we dialed in our bed and then I don't know where it came from. I've heard law that maybe the categories were like thought of like an a cocktail napkin in a bar.
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Unknown
But that was I don't I
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Unknown
don't know if this is like a reputable source that it's just we'll call it folks tale or like a, it's a, it's a folk tale, a adjacent conspiracy theory. It's a conspiracy theory. Yeah. So that's our labor nurse conspiracy theory. I don't think that, but that's the word on the street that I was told as a new nurse and
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Unknown
they decided like, well, let's make them into these categories and that will make things easier.
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Unknown
But we didn't really have any evidence that these three categories worked or were going to make things easier. We had some people studying categorization. We had like Julian, pair with the five tier, right, right. And he didn't even quite, you know, he had been working for several years. We had studies here and said he's there. That had different combinations of features.
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Unknown
And the likelihood that that baby was acidic at that time. And from there he I think it's like 200 and something different. Fetal heart rate. Yeah. There's so many different combinations. I knew the exact number.
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Unknown
it's like 233 or something like that that fall into that category too. Yeah, it's a lot. It's a lot of different combinations between variability D cells different types of D cells, accelerations, tachycardia Breda cardia normal all of those.
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Unknown
And he put them into this table. But one, two and three had not been studied. Yeah. Which I think is really interesting. Yeah. And and so after that you know then people were like, you know this is what we have. So let's add to it. Right. As opposed to going backwards and like back to the drawing board. They're like, let's make some algorithms.
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Unknown
Right. Because there there was knowledge in science and evidence prior to that. That said obviously like different combinations of features are more worrisome or less worrisome. Right. And you have a certain amount of time for those different combinations. So we had all of that. So I don't know quite why they decided on the three categories, especially with category two being so big.
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Unknown
But what is evidence based are
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Unknown
the Cat two algorithms.
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Unknown
But what do people ask us like all the time is like,
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Unknown
oh, I'm nervous that this isn't Nichd, therefore I shouldn't use it. Yeah. They really they're really kind of nervous about about using it or implementing it because it's, it's different than that. But yeah, it is funny because then, you know, people haven't really questioned Nichd.
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Unknown
It's just sort of like those were like the commandments of fetal monitoring that you just sort of.
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Unknown
you know. But but the thing is to with that, it's like that really just gives us language and terminology, not the actual like application and interpretation of using the fetal monitoring. Right. And that's where that's where people get so lost.
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Unknown
And that's where I mean, a category I think is so helpful because you can just be like, okay, do I have moderate variability, yes or no? Have I had significant cells for more than with more than 50% of my contractions over the last 30 minutes, yes or no. And it just like it works you down to
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Unknown
get in a decision like, no, we can give them more time or like, okay, we need to like talk about getting this person delivered and not getting lost in the source.
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Unknown
And that's where I think people get
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Unknown
lost in the source. Yeah. Well, and there's lots of different cat to algorithms, right? Everyone loves to have their own thing, which we get, you know, there's but there's like a handful of them. They all
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Unknown
They all pretty much work out the same way because we've done we did a presentation.
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Unknown
What it's almost been a couple of years ago now where we did a case study, a case study where we gave
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Unknown
the participants the option of like pick your own Cat two algorithm. They could pick. We had we had Clark Shields and five tier and we let them and LR and Esplin and Ella and Esplin and we let them
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Unknown
choose which one they wanted to use.
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Unknown
And we worked through the case study together. Same strip, same. They were getting all the same info and
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Unknown
they all came to like the same conclusions, like pretty much. Yeah, get to the same conclusions.
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Unknown
So whichever one you pick, they're all kind of saying the same thing because they're all drawing on that same body of evidence. Right. So back to that funnel.
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Unknown
It's like, yeah, that evidence that's getting put into the top of the funnel
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Unknown
is the same. These people are using their own experience and, you know, trying to look at it through the lens of their like hospitals or their,
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Unknown
demographics or whatever, their hospital policies, their resources and making these different algorithms for management of those category two tracings, which, you know,
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Unknown
that's also, I think, kind of a misnomer is like, we have this real thing in labor and delivery that most tracings are category two, and that's not true.
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Unknown
Yeah. Well there was like kind of a little saying that was going around quite a while, but for quite a while that it was like 80% of tracings or a cat two at some point in, at some point, yeah. But not 80% of the traces. Right. Right. So at some point, at some point that part of the quote got removed, right?
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Unknown
Yeah. So we have this idea that that cat two tracings are the majority of tracing sense. Not true. Actually category one is the vast majority. It's like 70 something percent of the time the tracing will be cat one as you get closer to stage two, obviously that's going to change. You're going to have a lot more cat two just because you're going to have variable D cells, which are super, super common.
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Unknown
And depending on what what we're doing to the patient to and depending on what we're doing, the patient. So even if they were Cat one, so that there's that idea of that like length of time in that amount of tracing, but that normalization of category two
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Unknown
you know, I think has had a lot of unintended consequences by categories categorizing it as one, 2 or 3, and putting such a large number of tracings into category two.
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Unknown
Yes, this category two mean do nothing, I mean, no, we read that though in depositions all the time. Yeah. Well, and it's also too, because it's like such a large sum of, of things that,
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Unknown
you have cat twos that are less worrisome and then cat twos that we, we call a 2.75. Right. You know, where they're nearing a three.
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Unknown
And so yeah, I mean it is like a call to action that you need to be.
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Unknown
there are category twos that we absolutely no are are the same as far as like the risk for acidosis as a cat three. Right. Minimal variability with recurrent lates.
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Unknown
That is a I don't know why it's not a three. Yeah it is a it needs to be a three or minimal variability with prolonged D cells.
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Unknown
That's a three. Like the risk to that fetus is the same. But I just read a deposition on a case that I'm in not it's not against me, but I'm the expert for the patients and the expert for the defense. Another nursing expert is saying the only time a nurse has a duty to advocate for expedited delivery is if it is a Cat three.
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Unknown
Like, I don't think that that is evidence based. No, I,
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Unknown
I don't believe so. Like that's almost too late. Right. It it it is and okay, this is a little bit of a side step, but one of my biggest ICS with acting on the tracing, you know. So okay, let's say they do decide to intervene when it's a Cat two and be like okay, we need to get them delivered.
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Unknown
And then they deliver them and then the baby's fine and they go see, the baby was fine. We didn't need to deliver them. And I'm useless. Yeah. And I'm like, isn't that the whole point, though, that you like deliver them so they are fine. Did you know? I know, so it's like yeah. You have these warning signs. Right.
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Unknown
So fetal monitoring like we talk about is like how the fetus communicates to us, right? It's not it's not the problem. It's a symptom of the problem. And so if we're doing our interventions it's not responding. You know, then it's showing us that the baby is having a disruption in the oxygen pathway somewhere that they are having to compensate.
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Unknown
So you want to intervene in a timely fashion. You don't want to wait until they're a cat three and they're no longer able to compensate. Right.
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Unknown
you don't want to wait until this baby already has brain damage or, you know, HIV or or acidosis, like you want clinical successes, like, not fetal monitoring successes.
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Unknown
We're not nursing the tracing. It's information. We're supposed to be saying. Yes, I 100% agree. That is my biggest ick. And it's so much like confirmation bias. Yes. See, fetal monitoring is useless. I was like, no it's not. It's a it's a tool. Yeah. It's yeah. Like we say it's like well yeah it's no good if you're bad at it.
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Unknown
Did you want to be right. Like I don't get that mindset if people really I don't
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Unknown
I truly don't think people who who think or maybe say that do it with bad intentions. I think it is this thing that's been now passed on for 15 years. And I think that the categorization system of one, two and three, because we call it indeterminate and there wasn't like clear direction in cat two, like cat one is you're fine.
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Unknown
Cat three is get the baby out and cat two
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Unknown
is really what's not what they said, but what was internalized, I think by nurses. Yeah. Well and I think so too. I think like we want I mean as nurses, as you know, providers, we all want the same thing. Like we want a good outcome for our, our patients and their babies.
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Unknown
And I think that there was so much held like weighted in fetal monitoring, thinking that, oh, if we can kind of conquer fetal monitoring, that that's going to be the answer to like ensuring all of these good outcomes. But we know that it's like so much more than that. And that, you know, I think we way too much on that instead of like, okay, the tracing is telling us this one thing, but then we don't act in the way that we're supposed to or our actions are delayed or that kind of thing.
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Unknown
You know, that there's a lot more that goes into that, that that's just one piece of the puzzle. Well, and I think back to that, like clinician bias piece that we talked about previously with like whether you delivered vaginally or had a cesarean birth, you were more likely to like kind of push one way or another with your patients.
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Unknown
I think if you think fetal monitoring is useful,
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Unknown
you're going to like maybe act on it and maybe overact on it. But if you think it's not useful, they could have a terrible looking tracing. And we see this all the time in like case reviews. Yeah, we do a terrible looking tracing and they just keep waiting because in their mind, well this is useless like this doesn't tell me anything.
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Unknown
And so I do think there's that like that bias of like what do you even think about it. Right. It's like very pervasive that evidence based bias or that confirmation bias happening I think within labor and delivery specifically or obstetrics specifically.
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Unknown
But it's always been meant to be a screening test. Right. And we used to have we used to use confirmatory tests.
00:20:01:09 - 00:20:33:07
Unknown
We would do like fetal scalp sampling. Did you look you look this up didn't you. Yeah. Yeah I was just looking this up at the the other day video of it, a video of it. Because there are because I was, I was just kind of curious like okay. Like how you know, because it was used in Canada quite a bit and like in Europe and it's still being sold and used in parts of Europe and Australia and everything, and so on the medical device website, they had a video of what it actually looks like.
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Unknown
Yeah. And it's, it's gnarly looking. Yeah. I was watching it. My husband came in and he jumped scared. He's like, what are you watching? That is so disturbing. Oh, I would have liked passed out. Yeah I'm I Brody I think is used to just nail like blocking.
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Unknown
hard left out of the room.
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Unknown
he. Yeah.
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Unknown
it's very invasive and and so then I was looking up, you know, the research on the fetal blood sampling and what that actually tells us.
00:21:00:01 - 00:21:27:06
Unknown
And it's really much more a of a rule out tool than a rule in. Right. And it's much better if the H is like less than 7.05. If you're kind of in like that 7.1 ish, like, you know, like teeter, teeter totter, it doesn't give like great information. But you can definitely rule out. Yeah. And so that's kind of how we figured out with like accelerations how that kind of became a thing.
00:21:27:06 - 00:21:45:15
Unknown
Because back to the fetal scalp sampling. What they do is they there's like this little I mean now they have like more of a device, but essentially what they do is like they would put an Alice clamp, like clamp, a piece of the baby's scalp, and then they have like a little pipette that they draw blood out of and then put it in a little machine, run it.
00:21:45:15 - 00:22:07:19
Unknown
And what they were finding is that anytime the air was at or around 7.2, they were noticing that there was like this increase in the fetal heart rate. So every baby who had an acceleration had a normal for babies who didn't have an acceleration. Some were fine, some were. So again, it's just these like one way we have a lot of one way confirmation tests.
00:22:07:21 - 00:22:30:20
Unknown
And that's like why we can do scalp stem right in the same thing. And then for a period of time we also had the fetal pulse oximeter. And you know oh so Queen Kathleen Rae Simpson were like like truly like foundational literature for our labor and delivery. Nursing practice comes from like this time period like 2000, 20 1012.
00:22:30:20 - 00:22:50:16
Unknown
And it had FDA approval for a period of time. I don't really know the backstory of why it didn't work or didn't worked or didn't or not. I heard that it was like one of the things was that it was it was really expensive to that. There was like a cost angle to it, that it was very expensive for facilities to have it.
00:22:50:16 - 00:23:11:08
Unknown
And then there was also a lot of like people weren't using it like insistently in the same way. And so then the the data was kind of unreliable. I guess that would make a lot of sense. But also it's going to come back to the bias. Like, do you believe what you're seeing or not? Right. And I mean, do we need these extra tools or have we now learned enough about the tracing?
00:23:11:08 - 00:23:39:01
Unknown
And there's some amazing research coming out of like, I mean, we've had a little like for following the rabbit trail, like there's been these little, like, cookie crumbs been sprinkled out for the last 20 years, like really guiding us of, like, if we are good at fetal monitoring and we look at the algorithms and we follow those consistently, we can predict and intervene before a baby gets metabolic acidosis or a brain injury.
00:23:39:01 - 00:24:01:19
Unknown
And like most recently, a couple of like, true like bangers. I'm going to talk about our Tarvin in at all. Oh man. The inter-party zigzag. Don't get me started. We'll come back to this. Yes, the intraparty zigzag is going to be the episode. It's gonna have to. It's going to need its own week. We're going to be. It's got
00:24:01:21 - 00:24:19:07
Unknown
world, the way this girl, when she heard that word and, like, went over it, she's just like, Jan, this is like, two years ago, at least. Yeah. It's like you think she just like. It's like in high school when you met a boy or something, she like. Jan, I just read this article and you're like, oh, really?
00:24:19:08 - 00:24:37:11
Unknown
Tell me. More like the way you went off on that, but you got on the bus right immediately. As soon as, like, read this, you're like, oh yeah. So this crew finished crew led by Tarvin et al, who I thought was a doctor and then I found out is like a midwife, which made me like this person even more.
00:24:37:13 - 00:24:54:04
Unknown
They've been using what I, from best I can tell. Well, maybe we'll see if they'll come on the podcast and talk to us. I think that would be really fun. Oh my goodness, that would be so actually hold up. We're going to Finland. Like I think that's really the only way to I mean, that seems like the most logical explanation.
00:24:54:04 - 00:25:10:13
Unknown
It's probably the most efficient. Yeah. We can we can pack up this podcast thing. We'll bring the sign. We'll bring the sign. I mean, I think I still have the big box. I mean, the sign actually came from Pakistan. So I mean, we could probably just ship one there. No. What is the universe and finish. We'll ask them.
00:25:10:16 - 00:25:36:09
Unknown
See all these reasons for us to go to Finland. Okay. Anyways, we'll go back. Wow. Okay. So they have been working with this like giant data set, like 300 something hundred plus thousand tracings and births. But it's like very clear that like an admission tracing useful that when we act on our tracing not only certain tracings but in a timely manner.
00:25:36:11 - 00:25:55:22
Unknown
And what they was said to us, timely is like every one of these algorithms. And now this last one that just came out, Tarvin in et al. That will like put into the show notes also shows it's your timeliness of intervention will improve your outcomes when it comes to fetal monitoring, not necessarily more
00:25:56:01 - 00:25:57:06
Unknown
tools,
00:25:57:08 - 00:26:02:02
Unknown
software, AI. You know, we have all of these different people keep trying to layer layer, layer, layer.
00:26:02:02 - 00:26:20:13
Unknown
And it's like, I just don't know that we need another thing. If with the problem is, is we truly are just not that good, maybe individually or clinicians or clinician. And that's hard, I think, for people to recognize some of those biases around it to the point that, like I was texting you when you're on your vacation, I was like, girl, you're going to guess.
00:26:20:13 - 00:26:40:09
Unknown
She got so excited. They just got FDA like temporary FDA like research approval for the pulse oximeter. Yeah, the pulse oximeter to come back, maybe. I know I'm I'm like, I kind of just want it to come out because it's just like, I just kind of want to see it in practice. I don't know, you know, you just want one.
00:26:40:09 - 00:26:55:18
Unknown
I just I want one. Yeah. Yeah. I mean, the best research that we have is from is from when those tools being used, you know, I mean, all of our intrauterine resuscitation,
00:26:55:21 - 00:27:06:18
Unknown
we're going to link all those articles. Yeah. We're going to if you are in the birth world and you have not read Simpson and James 2005 and like 2008, I think
00:27:06:19 - 00:27:14:21
Unknown
like those are like foundational of fetal monitoring, foundational to entry, like just don't go to work another day without having read these articles.
00:27:14:22 - 00:27:23:15
Unknown
I mean, it really, it breaks down like, you know, when you're when you're going back to like what? We don't question the answers. You know,
00:27:23:18 - 00:27:35:18
Unknown
we've we've been taught it's been ingrained in us. When you fluid bolus someone you give 500ml or a liter. But why. And the why is from that research. It's from that research. Right. Yeah.
00:27:35:19 - 00:27:40:11
Unknown
The why of why we're doing these things is we're doing everything. Yeah I mean classic
00:27:40:14 - 00:27:44:08
Unknown
well done. Like chef's kiss. Right? So,
00:27:44:09 - 00:27:49:13
Unknown
I mean, we really covered a lot of ground. We did. We just we did not waste any time
00:27:49:19 - 00:27:57:08
Unknown
to Ellen Esplin to like, we just like we did a whole global power dash. Yeah.
00:27:57:10 - 00:28:23:08
Unknown
But we also, you know, obviously we can't put everything into a podcast. So if you are someone who either enjoys fetal monitoring and wants to know more about it, or is this something that you're, like, endeavoring to like, get your CFS or you need C use credits that are fetal monitoring for your RNC, then we do have like a whole for our fetal monitoring course.
00:28:23:10 - 00:28:43:04
Unknown
We do. Yeah. And we talk about all of these things in there and will help prep you for your test if that's the route that you're wanting to go. Or like Jen said, if you're just wanting more, education or hours because we need to have that learning attitude where we're just, you know, forever learners, we're being curious.
00:28:43:06 - 00:28:44:00
Unknown
Then check it out.
00:28:44:01 - 00:28:47:12
Unknown
Lock in, geek out. Buckle up. Here we go.
00:28:47:12 - 00:28:49:18
Unknown
Keep having that questioning attitude.
00:28:49:19 - 00:29:01:05
Unknown
and so let us know at the end of this if, you know, did we just totally blow your mind with the whole cat three, cat two not being or one, two, three not being evidence based space like,
00:29:01:07 - 00:29:06:17
Unknown
people probably blacked out as soon as they heard that and then crashed, drove the car off this
00:29:06:19 - 00:29:08:13
Unknown
Notably not
00:29:08:17 - 00:29:10:02
Unknown
oh boy, oh, boy.
00:29:10:06 - 00:29:12:03
Unknown
Yeah. So join us next time
00:29:12:05 - 00:29:19:18
Unknown
where we will go down more rabbit holes and go after those carrots. Yeah. All right. Talk to you soon. Bye bye.
00:29:19:18 - 00:29:22:07
Unknown
Thanks for listening to Hello Uterverse!
00:29:22:09 - 00:29:25:22
Unknown
For more evidence, clarity and community. Head to Uterverse.com
00:29:26:02 - 00:29:29:11
Unknown
and follow us on TikTok and Instagram at hello Dot Uterverse
00:29:29:17 - 01:41:12:19
Unknown
Nursing is wild. Practice with confidence.
01:41:12:21 - 01:41:13:10
Unknown
Murphy.
01:41:13:14 - 01:41:15:06
Unknown
Today we're going to talk about your birth.
01:41:15:09 - 01:41:21:03
Unknown
How do you feel about evidence based practice, Murphy? Do you feel like it's a stool or a funnel
01:41:21:07 - 01:41:26:01
Unknown
when you have to challenge a provider? How do you feel comfortable.
01:41:26:05 - 01:48:30:19
Unknown
No comment. Okay. You just laid back and chill. He. He doesn't have a question. The attitude he pushes with attitude. Yeah. It was right now. Like how relaxed is nervous system is. He's ready to go.
01:48:30:21 - 01:48:40:23
Unknown
oh my God, I was going to create a monster. I accidentally push that button earlier I don't know.
01:48:41:01 - 01:57:10:11
Unknown
That's the one. That's the one. Okay.
01:57:10:13 - 01:57:23:00
Unknown
Thanks for listening to Hello Uterverse! For more evidence, clarity and community. Head to Uterverse.com and follow us on TikTok and Instagram at hello Dot Uterverse Nursing is wild. Practice with confidence.
