I didn’t want to be a nurse. Even as I enrolled in nursing school I did it grudgingly. I could see the value of some nurses to the birth process, I certainly had my favorites at our local hospitals, but overall I subscribed to the stereotype that nurses were just there to do what the doctors told them. If I had to be a nurse to be a midwife I would do it, but I didn’t have to like it.
But as I progressed through nursing school something changed in me, and it wasn’t my attitude about childbirth. Instead it was my understanding of what a nurse was and what a nurse does. I began to realize that being a nurse wasn’t really about passing out medicine and filling out charts. Yes, nurses do those things, but not because they focus on them. Instead a nurse is focused on the whole health of the patient.
So what does this mean? A nurse is a holistic health care provider. The nurse identifies areas where the individual, family or community health are at risk and then creates a plan to manage those risks. This might be difficult to understand without examples, so let me break it down a little more.
These things identified by the nurse fall within the categories of “nursing diagnoses” which are health issues and conditions identified by the nurse that the nurse is able to manage without consulting a physician. These differ from medical diagnoses, which is the underlying health problem identified by a physician or advanced practice nurse. Let’s take an easy example, perhaps you fell and now your leg is swollen. You go to the emergency department and the physician gives you a medical diagnosis: you have a tibial fracture. The physician orders pain medication and applies a cast.
Now enter the nurse, who will view your situation holistically. The nurse identifies that you will probably have problems with mobility, and those mobility problems may create other problems such as nutritional deficit because you are not able to stand for the time it takes to prepare food. Your new health issue may mean you are unable to drive and now need to find a new solution for getting to work. You may have questions about how to best use the pain medication and how to use the crutches effectively, and the nurse would answer those questions to lower your risk for additional injury. If the nurse determined that you needed more help, she would collaborate with the physician to ensure you received a physical therapy or social work consult because nurses are patient advocates. You may have other injuries from your fall which could put you at risk for infection, so the nurse would make sure you knew how to properly care for them. Want to see a list of all the things nurses look for and treat? You can view a list here.
Remember I told you I didn’t want to be a nurse, and I didn’t really have a good impression of nurses. I had been in nursing school for three semesters before I started realizing that the primary role of the nurse is to educate and empower her clients so they can maintain the highest level of wellbeing possible. As I started to realize that I suddenly began to see that what I was doing as a childbirth educator and doula falls within the domains of nursing. I had been a “nurse” the whole time, I just never realized it.
Going through that list of nursing diagnosis, here are a few of the ‘nursing diagnosis’ I addressed long before I was a nurse:
- Activity Intolerance – pregnant women get tired faster and don’t want to move
- Fatigue – pregnancy makes women very tired
- Sleep Pattern Disturbance – near the end of pregnancy it can be impossible to sleep through the night
- Anxiety – Some of the women I work with were nervous about labor and becoming a mother.
- Fear – This one was very common
- Pain – much of my doula role in labor was devoted to managing pain
- Risk for Injury – I teach women ways to prevent injury as their body loosens up at the end of pregnancy
- Constipation – this was another common issue
- Incontinence, stress – this is one of the reasons I teach Kegel exercises
- Breastfeeding, effective – I wanted to get my mothers to this point, and most of them achieved it
- Fluid volume deficit, risk for – I push drinking water on the mothers I work with
- Altered Nutrition, Less than body requirements – because nausea and vomiting can make it harder for women to eat well,
- Sexual patterns, altered – always had to talk about changes in sexuality as the body changes
As you continue down that list the number of things I was doing starts to really increase. So you see, I really was working within the nursing role without ever knowing it. If I had ever understood what a nurse really was trained to do I probably would have become a nurse my first time in college. But as I admitted, I thought nurses were unimportant and just did what the doctor told them.
Do all nurses do a great job of being a “nurse?” No, nurses are people first and they become nurses for different reasons and they bring to their nursing different points of view and experiences. But to judge the profession on stereotypes or misinformation is wrong and unfair. I’m very sorry I ever did that. The truth is, my nursing school education did a much better job of training me to do the work I do than my childbirth educator or doula course did. Things I had to learn on my own, things I identified as missing in my training that I pursued because I realized I needed them were simply part of training as a nurse. Nursing school was much more thorough and required me to educate myself directly from research rather than trade books (every teacher has said the lag time from writing a book to having it published is too long and so papers always required at least three research sources from within the past five years).
I could continue, but I think by now you probably get the idea that my mindset has completely changed. But, and this is a big but, I don’t think nursing school is for everyone. It is very challenging, demanding of time and requires a broad depth of knowledge of the human body. If you have the time and can do the work I promise it will only add to your effectiveness in caring for expectant families.
Besides, the best way to get labor and postpartum nurses who are supportive of natural birth, breastfeeding and advocate for families rights is for those who already support those things to become nurses and work for change inside the system. I don’t say that lightly, nurses truly are policy makers in hospitals. You might be surprised by the impact you are able to have.