Connecting NICU Mothers to their Babies

A little over a year ago, one of my staff nurses found a system called the NICView that allows mothers to see their babies 24/7 using a webcam technology.   This seemed like it was going to be an easy thing to implement for our unit, except for the money it was going to cost to implement, I thought it would be an easy sell to get it put into place.   Who doesn't want a mother who has a baby in the  Neonatal Intensive Care Unit to have access to see her baby all the time?

Here is a link that explains what the NICView System is: http://www.natus.com/index.cfm?page=products_1&crid=1027

What I found out was it was not as easy as I had thought.   I had to use a lot of my negotiation skills to get this approved and then the staff nurse who had the idea took this to our hospital volunteers and they decided they would fund this remarkable system for our unit.   
A policy had to be written, a consent had to be written and we had to work through all the implementation pieces with our Information Systems department.  

In November, we implemented the NICView and it has been a great success story.  It is so wonderful to hear the stories of the mothers with babies in our NICU saying how it brings them peace when they are not with their babies.  They can turn on their phone and see their baby and it allows them to fall asleep easier knowing their baby is ok.   

To Amy, RN who brought the idea to our unit, thank you!  To our Volunteers who helped us purchase the system, thank you!  To our Information Systems team who helped with the implementation, thank you!   To our Risk Managers and Legal Services, thank you!  To my Security Department, thank you!   WE love this system!  Optimal Healing Environment, that is what it is all about!

The Florida Highway Patrol and Me

So today, I had a great experience!   I had an early morning appointment with my ophthalmologist (Point A) to check on my cornea transplants followed by a meeting at the Children's Hospital (Point B) with the Vice President and NICU Director.   I was driving from Point A to Point B and stopped at a stop light to turn left.  A Florida State Trooper car pulls up on the right side of me and motions for me to roll down my window...

Thoughts go through my head.... What is wrong with my car?   Did I turn my directionals on?  Was I speeding?  Is it because I have this hot red Kia Sportage with a UGA Bulldogs tag holder? Oh no!

I roll down my window.... He says to me...."What's the deal with 40 Weeks?"

I laughed. "40 Weeks is the number of weeks for a full term pregnancy!!  Takes 40 Weeks to grow a baby!!  I deliver babies!" 

He responded with a smile, "Oh Ok Ma'am!  That is cool!  Makes Sense!  I just had to ask!!"

I start laughing and say, "Have a great day!"   

You made my day Officer!    Go the Full 40!

Surviving Hurricane Irma in SW Florida

What I am thankful for...

<in no particular order>

The leadership team at the hospital where I work. Long stressful hours, keeping their cool and keeping everyone safe in our care. Praying when things got hairy as a group.  

My team. Long stressful hours, smiling, good snacks, their professionalism and expertise in taking care of patients and families, including some very complex cases during the hurricane. Right down to seeing people who do not usually do housekeeping services routinely, doing them and whatever else needed to be done.  

The physicians and midwives who stayed with us in the storm. Thank you. Not one complaint.

The support staff... Security, Plant Ops/Construction, Food Services, Housekeeping, Information Systems, Pharmacy, Lab, X-Ray, Care Management, Social Work...Some of these people took the brunt of the abuse from people who should have been thankful that they were there during the storm. I thank you. You were amazing.

The people who worked in both the Pet Shelter and the Child Care Center. Thank you Thank you. It made such a difference to our team to have you there and care for their littles and fur babies. 

Hugs. No matter who you are, if you gave me a hug, I thank you. Hugs are good.

Families of my team who were there sheltered on my unit. Thank you. Thank you for being great during the storm. Helping and volunteering to do what ever needed to be done. The kids were amazing! And who can't smile with cute little kids around? I also learned the second verse of the Star Spangled Banner from a 95 year old dad! We had two elders who were with us too and so special to us.

The pregnant ladies and their support people in the Stork's Nest. They were wonderful and appreciative. Even though several of them went into labor and we had to deliver them! 

The patients and their support people on our unit. Why? because they were amazing too. Even when we had to move them into the hallways to be safe, not one complaint.

The people in the Command Center. They were great at coordinating the show and getting us information when we needed it.

Us, Monday Morning After the Storm

Tonight I can rest because I know my Team B will be there picking up after the storm and continuing to keep people and families safe under their loving care.

Looking out the window on the 5th Floor at our Cape Coral
Hospital, We are the Heart of the Community!

I thank you!

Sign, Sign, Every Where a Sign!

I work on a LDRP obstetrical unit.  This means, in one room, we may have a woman in labor, the next room a mother/baby couplet, the next room an antepartum patient, the next room a cesarean birth mother baby couplet, the next room a gynecological surgical patient.  It is important to know who is in what room and to maintain the privacy of each patient.  We have a lot of signs on our unit to help us do this.

One of my favorite signs is one we have on every laboring mother's room.   It looks like this:

Labor Room Sign Lee Health

I like this one because it makes everyone who is entering the room take a deep breath and enter the room with intention.   It brings the family voices down and helps with providing the woman respect for doing the hard work of labor.  

We encourage women to be up and about when they are in labor. Walking and movement is great for supporting the natural birthing process.  We have noticed that women read the things on the unit walls when they are up doing their labor walks!  A few months ago, we started posting some positive affirmations for women around our unit.  <as well as some cute baby sayings>  What do you think of our affirmations so far?

 Be Awesome Today

Do Something Amazing

Enjoy the Little Things

Be the Reason Someone Smiles Today

She Believed She Could so She Did

Sometimes the Smallest Things Take up the Most Room in Your Heart

A Person's A Person No Matter How Small

Believe In Yourself

Nothing is Impossible the Word itself Says I'm Possible

Enjoy!  Don't forget to enjoy the little things and be the reason someone smiles today!

My Little Bag of Sunshine

I just returned from the Florida AWHONN Section conference that was held in Jacksonville, Florida.  As part of the leadership team for Florida AWHONN I was a part of a   leadership meeting prior to the conference starting and we were each given a beautiful bag with our name on it and some very colorful pieces of blank paper!

Our Florida Section leader, Dr. Shannon Morse, asked us each to write something about each of the other leaders around the table.  It could be anything, something you liked about them, some thing they do that has inspired you, something that they did!  We had a few hours to write our thoughts and then deposit them in each other's bags.   It sort of reminded me of valentines day a long time ago when I was in school and we did this with our valentines day cards!   

When you are surrounded with so many amazing women that you do not get to see every day, but know they are all making a difference in their communities promoting the health and well being of women and newborns, you have a lot to say about them.  These are some pretty special women to me.   

Tonight, I made it home from the conference and sat in my bed, opened my beautiful bag and read my colored pieces of paper from my friends and it really touched my heart and made me smile.   It also made me think.  We all need to reach out and touch the people who make a difference in the lives of others.  Tell them that they make a difference. I will strive to do this more often.  

A lovely experience that you had us do, Shannon! I am very inspired once again at AWHONN!

Our Journey to Become a Baby Friendly Hospital

The Baby Friendly Hospital Initiative is a program that was launched by the World Health Organization and the United Nations Children’s Fund in 1991 to encourage and recognize hospitals that offer an optimal level of care for infant feeding and mother infant bonding.  The program recognizes and awards facilities that successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing Breast Milk Substitutes.  This program assists the hospital to provide mothers with the information, confidence and skills needed to successfully initiate and continue breastfeeding their babies or feeding their babies formula safely.   The journey is exciting, challenging and worth it!  Our journey has created opportunities for development of a high performance team and has built leadership skills among our staff.  The team is very proud of our work on the Baby Friendly project.  It has definitely enhanced our patient satisfaction and has improved health outcomes for our mothers and babies.

Becoming a Baby Friendly designated hospital is a comprehensive, detailed and thorough journey toward excellence in providing evidence based maternity care with the goal of achieving optimal infant feeding outcomes and mother infant bonding.  During the process, the facility has to examine, challenge and modify policies and procedures.  It requires training and skill building of all levels of the team.  As part of this program we decided to certify all of our Women’s Services Registered Nurses as Certified Breastfeeding Counselors.  We currently have 100% of our nursing staff certified.

In support of Baby Friendly USA 10 Steps to Successful Breastfeeding, the Florida Breastfeeding Coalition designed the Quest for Quality Maternity Care Award program in 2012 to reward birthing facilities in the state of Florida for improving hospital maternity care and infant feeding practices based on the Ten Steps to Successful Breastfeeding.  The program awards a series of 5 stars for each level of the program ending with Baby Friendly Hospital designation when the fifth star is awarded.  The Women’s Services team at Cape Coral Hospital embraced the program and applied for the first star in July of 2012.  In October 2012, Cape Coral Hospital became the first hospital in the state of Florida to receive the one star award.  As the team continued to implement more of the 10 Steps to Successful breastfeeding they have had the honor of being the first hospital in the state of Florida to receive the second, third and fourth stars.

One of the important steps of the Baby Friendly Hospital Initiative is providing skin-to-skin care for healthy mothers and infants immediately after birth and for the first hour after birth.  In 2011, Cape Coral’s rate of skin-to-skin care was 48%.  Currently, the rate skin-to-skin care is 90%.  In 2012 Cape Coral Hospital implemented the Gentle Cesarean program where babies born by cesarean birth were able to go skin-to-skin in the Operating Room.  This program was well received by the birthing community in Lee County.  In May 2013, Cape Coral Hospital became the first hospital in the United States to place triplets skin-to-skin with their mother in the Operating Room during a cesarean birth!

In 2015 Cape Coral Hospital joined the EMPower Breastfeeding program (Breastfeeding Enhancing Maternity Practices, a hospital based quality improvement initiative focusing on maternity practices leading to Baby Friendly designation).  This initiative was funded by the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity and is implemented in partnership with the Carolina Global Breastfeeding Institute and Population Health Improvement Partners.  This program gave the hospital the funding needed to enter the Baby Friendly USA 4D Pathway to designation.  Currently Cape Coral Hospital is in the 4^th and final phase, the designation phase.  We expect to have a site visit from the Baby Friendly USA team in the fall of 2017.  

This project has had many other benefits to our community in the formation of Breastfeeding Clubs for women in our community, the formation of the Lee County Breastfeeding Coalition, and a closer working relationship with the Lee County Health Department and the hospital.

I can not wait to write the blog post that says we ARE a Baby Friendly Designated Hospital, but until that time, if you are trying to decide if you should go on this journey, do it!  It is important for the health of women and for the health of our babies.  Food is Medicine, right from the start!

Going to the AWHONN 2017 Convention

Every year that I can, I try to go to the Association of Women's Health Obstetric and Neonatal Nurses (AWHONN) annual convention.  This year was no different and the convention was held in New Orleans!

I was excited to be going to the convention with one of my internet buddies as my roommate and several other people I work with going too!  I was also excited because I was going to be speaking at this year's convention with two of my other friends from the west coast!    Last year at the convention in Grapevine Texas I sat around a table with Catherine Ruhl and Paris Maloof-Bury and we discussed submitting a proposal to AWHONN for presenting at this conference.  We were talking about Labor Support and providing Labor Support for Every Woman~~ Well, guess what, we did and we were selected to present our proposal!  This to me was a if you dream it, sometimes it will happen moment!  

On Sunday of the convention, President of AWHONN Emily Drake, PhD, RN stated that she had received many rejections in her career, but that did not stop her from trying again!  Great advice Emily!  You never know unless you try!

On Monday, the key note speaker was Stephanie Arnold who spoke of her personal experience with survival of an amniotic fluid embolism.  She wrote a book about her experience, 37 Seconds.  I  bought the book!  What I learned from her talk was Listen to your intuitions.  Listen to your patients.  If they say something is wrong, it very well might be.  Here is a link to her page to learn more:  http://stephaniearnold.net

On Monday, one of my staff nurses, Roseann Civil, BSN, RNC-OB, CBC,  spoke on a panel for Johnson and Johnson on the Power of Touch.  Not only was it a great presentation, I was so proud of Roseann for stepping out of her comfort zone and speaking to a room of 200+!!    The picture above is Roseann demonstrating the Power of Touch with a new dad!  You can do hard things!  You can make a difference!!

And then it was Tuesday, our turn to speak!  So there we were, on the big, big stage!!  It was so amazing to share our knowledge about the very cool things happening on our units with our teams regarding labor support!  It is important to share our knowledge with our professional colleagues.

Next year, convention will be in Tampa Florida!  So what are you going to do?  Will you submit a poster presentation, will it be your time to be at the podium?  Think about it!  They will call for presentations soon!  If you dream it, you can do it.  You have to try if you are going to make it happen!

The Patient Experience

Tonight I saw a post from one of favorite my blog posters, http://adventuresofalabornurse.com on the patient experience.  She was talking about a mother who delivered a 22 week fetus in an Emergency Department and how it was so different in the ED than it would have been on an OB unit.

In about two weeks, I am going to be speaking at the AWHONN Convention in New Orleans about Labor Support and basically a how to make it happen on your unit.  Labor support to me is something that every woman who is having a baby no matter what her gestation age is entitled to.  Providing great labor support is providing an exceptional patient experience to the laboring/childbearing woman and her family.  

Do you ever think about how the woman and her partner are greeted at the front of the department when they arrive?  Is someone saying "OMG there is another belly at the desk?" or are they saying "Welcome to xxx Hospital Family Birth Place!  What are you here for today?" with a smile?  To us, she may be number 5, number 10 or number 25 patient who has arrived for that particular shift, but to her, she is about to have one of the most important days of her life.  This is a day she will always remember.  A day she has dreamed about for a long time.  She is excited, she is anxious, she is scared a little bit (or a lot!).  We are there to help her, to orient her, to assess her and to care for her.  We are there to educate her as she makes this life transition.

So where does it begin?  To me, it begins with the environment.  Is the room set up for her when she arrives?   Have you turned the lights down low?  Is the music on and made sure that the room is totally set up so you do not have to run outside and fetch stuff to take care of her?  (Of course, after you get her in bed to assess her, you are going to have to turn the lights up) but, allow her some peace as she enters her birthing space so she can feel that she has privacy for the important work of childbirth.  In our unit we have some signs that we put on the doors of labor rooms.  We are a LDRP unit so there can be delivered mothers right next to laboring mothers and it is important to know which is which!  The picture at the top of this post is one we use on every labor door.  Allow mothers to get into their sacred birthing space when they arrive. 

Know the things to have in your bag of tricks to enhance her experience in labor.  Some are very easy to obtain and to put into practice on your unit. 

 Birth balls, peanut balls, positioning devices, chairs, tea lights for the room and for the tub!

Aromatherapy to enhance her experience!

But most of all, she needs YOU!  To tell her that she is doing a great job; that she is amazing; that she is strong;  that she can do it!!  

All of these things are intentional tools that nurses can bring into their practice to enhance the birthing experience provided to women and families on their units.  These are all a part of the Optimal Healing Environment in Women's Services.  

At the end of the shift, it is all about this... a happy mother with a smile that says it all!   We truly do make a difference in the life of women and it is something they never forget. They may forget our names, but they never forget the experience of that day when they were giving birth no matter what the gestational age.  We .have an awesome responsibility to make it right for her in so many ways.  

The last few months have been very busy and very exciting! People always ask me "why and HOW do you do all the things you do?"   I do what I do because I follow my passion and I try to make a difference in what I do.  So what have I been up to so far in 2017?

On a  local level, it is where I work, my departments and my health system.  We have formed a County Breastfeeding Coalition this year.  Working with our local Health Department with a team looking at the Infant Mortality in our area with various other community members.  We are very busy working on becoming 3 Baby Friendly hospitals!

On the state level, I have been busy with my regular AWHONN activities as a Chapter Leader, State Conference committee member, AIM State Nurse Leader. http://safehealthcareforeverywoman.org/aim-program/about-aim/   I have been busy with my activities with Florida Perinatal Quality Collaborative (FPQC) as a Steering Committee member, Hypertension in Pregnancy workgroup member, Primary Cesarean Reduction Initiative workgroup member and Data Use workgroup member.  http://health.usf.edu/publichealth/chiles/fpqc  I also joined the board of the Florida Breastfeeding Coalition in January!  http://www.flbreastfeeding.org 

Oh and for fun.... I have worked with my Salty Dawgs.... working with our local University of Georgia Alumni on various activities in SW Florida!

I have been busy with my speaking activities!  In my last blog post I talked about speaking at the Eye Bank Technician conference about my cornea transplants.  I also spoke at the Florida Breastfeeding Coalition conference with my friend Carol Lawrence.  Our topic was "Shining Bright-Using the Golden Hour to Support Breastfeeding Friendly Birthing Facilities".   Just this week speaking to nursing director group at our Health System on "Employee Rounding".  Now I am getting ready to go speak at the AWHONN National Convention in New Orleans on "Nurses Implementing Change & Innovative Labor Support Practices" with my friends Paris Maloof-Bury and Catherine Ruhl.  Right now, I am busy working on a webinar that will be presented later this year for one of my organizations. 

I also like to refill my cup and learn new things.  This involves going to conferences and listening to webinars.   Some are even FREE to attend!  When you work on a committee or volunteer with some groups, they actually give you a discount to attend the conference.  This makes it more affordable and it allows you to travel to other places!  This year, I will have traveled near and far to St. Pete/Tampa area, to New Orleans, to Atlanta, to Washington DC!!   Always get as much as you can out of the conferences!  Be open to new ideas that you can bring back to your own place of employment.  Go to the poster sessions!  Meet other people and ask them what they do.  

I also know that I can not do everything I want to do and I definitely can't do anything without a terrific team!   When I have an idea for a project I pass that idea on to my team who can volunteer to work on the idea and make it happen.  It takes a village!   This year two of my staff nurses, Kathy Moses and Roseann Civil went to Washington DC and participated on a project with AWHONN!  Now Roseann is speaking at AWHONN National Convention in New Orleans!!  

So, the answer to how do you do it?  For me, it is follow your passion!  Volunteer.  Make a difference not only in your own small community, but in your state and on a national level!  For me, it is making a difference for a single woman and her baby and thus, many women and many babies.   Have fun.  Enjoy the ride!!  Don't GIVE UP!