Running Head: LEARN REFLECTION 2

LEARN reflection 2: Family focused practice Melissa Jenkins 0517969

LEARN REFLECTION 2 I was assigned to Labour and Delivery (L&D). Initially I was feeling apprehensive about going to L&D. I felt unprepared and uncertain as to how I would react to what I was about to witness. These feelings soon passed as the nurses and anaesthesiologist present in the Caesarian section (C-section) began to converse with me and walk me through the procedure. As the apprehension that I felt passed I began to notice the interactions between the members of the

team, the interactions between the nurses, the surgeon, and the anaesthesiologist. The nurses and anaesthesiologist seemed to have a light hearted friendly relationship, all which seemed to change when the surgeon/doctor entered the room. With the doctor there things seemed to become more formal, less carefree. As I spent my day on L&D, I continued to watch how the doctor interacted with the nurses. As I watched him I began to formulate an opinion of him as somewhat of a rock-star. He seemed to have a certain way he liked things, seemed to waltz in at the last minute, just in time to do what he needed and get out, and he seemed to hold power over everyone around. I also witnessed the nursing staff react to him being the only doctor available that day for deliveries/C-sections. I got the feeling that given the choice between him and another, they would choose someone else. The impressions I got from them were that they did not agree with the way he handled inducing labour and that they found him unconcerned with their views. As I watched the nurses become more and more frustrated as the day went on, eventually reducing one to tears, I began to question what impacts doctor-nurse relationships, and the other factors contributing to my perceptions of the situations taking place. Several situations caused me to form the opinion I did.

LEARN REFLECTION 2 Nurses spend a lot of time with their patients. They get to know them and get to know their concerns, among other things. Nurses develop intuition about patients which helps in decision-making and caring for patients (Green 2012). Intuition acts as a way of knowing, helping a nurse know what is the best treatment or course of action is (Green 2012). I witnessed a nurse try to advocate for her patient only to have her concerns dismissed before even being able to present them. I then witnessed this same nurse having to deal with a drop in fetal heart beat, the same concern she tried to present to the doctor. A second example of nurse intuition being ignored came when there was no doctor present for a birth in a women suffering from preeclampsia. The nurses had been discussing the need to page/call the doctor, the pediatrician,

and respiratory therapy but told to wait. The doctor then stepped off the floor (reason unknown). By following the doctors orders and not their own instinct, the nurses ended up delivery the baby. Something that may happen all the time but this time ended with unexpected outcomes. Effective communication between nurses and doctors is key to ensuring patient safety (Lyndon, Zlatnik, & Wachter, 2011). It is particularly important in L&D as the nurse wants to advocate for the patients desires (i.e. natural birth) and may not agree with the orders laid out by the physician (Lyndon, Zlatnik, & Wachter, 2011). For example, I had one of the nurses tell me she often disagreed with the doctors orders because he would rather start oxytocin than rupture membranes, however in my shift there she never voiced her concern with the orders to him. Doctor-nurse conflict, often resulting from poor communication and little respect, can result in poor patient outcomes and experiences (Johnson 2009). In this case ineffective communication did not lead to a poor patient outcome or poor patient outcome, but continued ineffective communication in the future could.

LEARN REFLECTION 2 Effective communication is so important that Curtis, Tzannes, & Rudge (2011) put out a paper entitled How to talk to doctors a guide for effective communication in the International Nursing review. In this paper they identify barriers to communication between doctors and

nurses as traditional hierarchical relationships, increasing workload, mobile workforce, differing perceptions and language, and prior experience (Curtis, Tzannes, & Rudge, 2011). To combat these barriers they make several recommendations that I plan to apply to my practice in the future when dealing with all team members not just doctors. These recommendations are personal considerations (own emotional state), mental preparation to aid in delivery of the message, structured communication, and graded assertiveness. There was a lot going on the day I was assigned to L&D that could have impacted the way that the doctors and nurses interacted with each other. As a student nurse, I am still inexperienced and learning, so things could have seemed worse than they actually were. Regardless I think that what I picked up on and subsequently researched is a prominent part of our healthcare system. We are taught that providing safe and ethical care requires us to work effectively as a multidisciplinary team. As part of any team there may be those that are hard to work with or challenging to work with for many reasons, but to effectively advocate for patients I will have to try to work around this. Through this experience I have learned that I will likely have differing opinions about care plans, but I also recognize that to advocate for my patients I will have to voice my concerns. Going forward in my practice, I hope to use what I have learned about doctor-nurse conflict and doctor-nurse communication to navigate situations like the ones I saw in L&D and advocate for my patients.

LEARN REFLECTION 2 References Curtis, K., Tzannes, A., & Rudge, T. (2011). How to talk to doctors a guide for effective communication. International Nursing Review, 58, 13-20. doi: 10.1111/j.14667657.2010.00847.x Green, C. (2012). Nursing intuition: a valid form of knowledge. Nursing Philosophy, 13, 98-11. doi: 10.1111/j.1466-769X.2011.00507.x

Johnson, C. (2009). Bad blood: Doctor-nurse behaviour problems impact patient care. Physician Executive, 35, 6-11. http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=45123675&site=ehost-live Lyndon, A., Zlatnik, M. G., & Wachter, R. M. (2011). Effective physician-nurse communication: a patient safety essential for labor and delivery. American Journal of Obstetrics & Gynecology, 91-96. doi: 10.1016/j.ajog.2011.04.021