Careers in Nursing: An Interview with Nurse-Midwife Addie Graham

Careers in Nursing: An Interview with Nurse-Midwife Addie Graham

When you think of a nurse-midwife, you may think that they just help delivery babies (not that this isn’t a crucial and exceptionally important part of their jobs). But they really do so much more.

Adelicia (Addie) Graham, MSN, FNP, CNM, works as a certified nurse-midwife with Connectus Health in Nashville, Tennessee. With the other midwives in her group, Graham sees patients for prenatal care and GYN care at Vine Hill Community Clinic and Priest Lake Family & Women’s Health Center, and they all are privileged to attend births at St. Thomas Midtown Hospital.

What follows is an edited version of the interview with Graham.

Addie GrahamAs a nurse-midwife, what does your job entail? What do you do on a daily basis?

My schedule varies each week as I work a mixture of day and night shifts, as well as clinic days.

My hospital shifts are mostly 12-hour call shifts with an occasional 24-hour call shift thrown in. On a clinic day, I will see patients for prenatal care visits, birth control consults, well-woman exams, and IUD placements, etc. On a hospital call shift, I take calls from my patients and triage them at the hospital. If they are in labor, I admit them and provide support as they labor and give birth. Some of our patients get epidurals and others choose to go natural.

From the moment my patients enter the hospital, I like to make sure they are provided with the information needed for them to make informed decisions about their labor/birth experiences. I want to make sure that they always feel empowered, and that we work as a team to give them a beautiful birth and a healthy baby. Midwives specialize in vaginal birth, but sometimes a C-section is needed. In those cases, we have some wonderful back-up OB/GYNs who perform surgery when needed. I will stay at the patient’s side through the procedure and continue to provide support and encouragement.

Why did you choose to work as a nurse-midwife? How long have you worked as one?

I decided I wanted to go into the medical field as a child, and I have always been drawn toward caring for people with few resources or options. When I researched organizations like Doctors Without Borders and other service organizations, midwives came up again and again as the most needed practitioners. As soon as I entered the Master’s program at Vanderbilt University School of Nursing, I knew that I was meant to be a midwife.

I love the rich history of midwives empowering women and helping them through the most difficult—and the most beautiful—times in their lives. Birth still amazes me, and the strength that I see in every woman who goes through this transformative process is so inspiring. I have been a midwife for eight years, and I am blessed to have worked in non-profit organizations for that entire time. I love the diversity of culture, language, and birth practices/preferences that I get to see every day.

What are the biggest challenges of your job?

The biggest challenge that I run into on a daily basis really is fatigue and lack of sleep. Every practice is different, and I have worked a large range of hours from 24/7 on-call to the more reasonable schedule of defined shifts that I work now.

On a more overreaching note, there is also the stress that comes with being responsible for two lives—mom and baby—and dealing with difficult births and emergencies. Fortunately, the normal births outnumber the emergencies, but I always need to have all of the possible outcomes in mind and be prepared for anything.

What are the greatest rewards?

Women’s health is an incredibly rewarding area of nursing. I love providing detailed teaching in my visits and equipping women with knowledge that will help them to live healthier lives. Providing physical exams and birth control options is just as needed as attending births and supporting women through labor. My patient population is absolutely amazing and inspiring. I love seeing how women labor, birth, and bond with their babies in such similar ways, despite cultural and language differences. I get to take care of patients who were born and grew up in the U.S. as well as patients here as New Americans from countries like Somalia, Iraq, and Mexico. Birth is a beautiful and powerful event in any language.

What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?

I would say that you are in for an intense, tiring, amazing, and beautiful journey… pretty much what I tell all my pregnant moms as they prepare for birth! Be prepared to give a lot of yourself, but also make sure that you take time to recharge and nurture yourself and your family.

As for training, if you are already an RN, you will need a Master’s degree in nursing with a certification in midwifery to become a certified nurse-midwife (CNM). If you don’t have a school near you that offers this specialty, don’t be discouraged, as there are some great distance programs out there as well. If you have a degree in something else and need a bridge program, those exist too. I would recommend asking a midwife—homebirth, birth center or hospital—if you can shadow him or her. I shadowed a homebirth midwife prior to entering school, and it really confirmed that I was headed in the right direction. You might also consider being trained as a doula and attending births as labor support to show nursing schools that you are a part of the birth community, and also to gain valuable experience.

Where can midwives work? They can work at clinics, hospitals, birth centers, and even at home. Most CNMs attend hospital births, but there are a lot of options out there for midwives who want to attend out-of-hospital births as well.

Working with Patients Who Have Alzheimer’s Disease

Working with Patients Who Have Alzheimer’s Disease

While some nurses may find it difficult to work with patients who have Alzheimer’s disease, others find it to be a calling.

Take Christine E. Crouch, RN, BSN, for example. As a Licensed Nursing Home Administrator and the Vice President and Senior Administrator at Bethesda Health Group, specifically working with Charles Village and Southgate, she loves what she does. “It is extremely rewarding, hard work, and the families become part of your life,” says Crouch. “And they are so appreciative of the care you provide their loved one.”

In honor of National Alzheimer’s Disease Awareness Month, Crouch took some time to answer our questions about what it’s like to work with Alzheimer’s patients. What follows is an edited version of the interaction.

As a nurse working with patients with Alzheimer’s disease, what does your job entail? What do you do on a daily basis?

As a nurse working with Alzheimer residents, my goal is to provide a safe environment while promoting self-worth and dignity for the resident. I want each resident to be able to do as much for him/herself as possible while having a meaningful life.

Why did you choose to work with this type of patient? How long have you worked in this particular area of the nursing field?

I have chosen the geriatric field of nursing because I love working with seniors and have cared for residents with Alzheimer’s disease since the 1970’s. I have always enjoyed talking and interacting with older people because they are so interesting and have had so many life experiences.

What are the biggest challenges of your job?

The different stages of Alzheimer’s disease affect residents in different manifestations of behaviors and daily life skills. So when you are caring for 27-30 Alzheimer residents on your neighborhood in different stages of the disease process, it is a huge challenge to meet every person’s needs (person-centered care) and wants.

What are the greatest rewards?

When someone who has not spoken, smiled, or engaged with staff or family all of a sudden talks, sings, or smiles.

What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?

This type of nursing is actually a calling. You have to want to care for this special group of individuals. Most of the time a nurse assistant or medication tech who worked with this population makes the best nurse.

They would definitely need geriatric nursing training and specialized skills and competency in dementia care. The Alzheimer’s Association offers some training, and also, there are other special programs like the Teepa Snow training and Landmarks for living program, just to mention a few.

Talking Turkey: What Nurses Do When Working on Thanksgiving

Talking Turkey: What Nurses Do When Working on Thanksgiving

Working on Thanksgiving can be great—extra pay and often a quiet day. But it can also make nurses wish they were home with their families.

We decided to ask nurses what they do to celebrate Thanksgiving when they do have to work. They told us what they do with their “work” families.

When Doria Musaga, RN, was working as a nurse, she said that the hospital would provide them with a free meal. But since it was, as she calls it, “the pressed turkey thing,” she adds that “it was dinner all the same and free.” She and her coworkers would often bring in more homemade foods to add to it.

“I have worked on the OB unit at two hospitals since I became a nurse. Usually, the hospital provides turkey for each nursing unit, and each staff member prepares a side dish to enjoy. Patients can choose to order a turkey dinner for their meal from food service. We give thanks for our healthy moms and babies. For the families being dismissed that day, we try to expedite the process so they can enjoy celebrating with extended family.”

—Lois Williams, RN, MN, RDMS

“I don’t work holidays any longer but my staff usually plan a feast with each one bringing some home-cooked part of the meal. The hospital usually provides a holiday meal, but rarely on the actual holiday–usually several days before.”

Lisa Fiorello RN, BSN, CCRN, RN-BC

“We would bring in pot luck snacks for Thanksgiving but we also scheduled shorter shifts to be home part of the day and rotated it year to year.”

—Janine McCowan, RN

“Everybody brings a dish in. We have a unit thanksgiving dinner during the shift.”

—Barbara Benzing Smith, RN

“You celebrate and give thanks with your work family as you would at home. Always be Thankful! Everyone brings a dish!”

—Cheryl Murad, RN

“At some places I worked, we would all bring a dish of food and have an open buffet so everyone to could get something on their break.”

—Theresa Zubrowski Woodson, RN

“I always had my own ‘Kristie’s (Christmas/Thanksgiving/Easter/etc.)’ with my family. At work, we always did a pot luck–usually it’s not quite as busy, and we could enjoy ourselves.”

—Kristie Davalli, CRNP

“We have pot lucks, and every one brings a dish to share.”

—Kristen Corkran, RN

“When I had to work Thanksgiving, my family would take sympathy on me, I never had to cook nor clean and had dinner waiting for me when I got home.”

—Estelle Schwarz, RN

Nonprofit “Nurses of Pennsylvania” Vows to Make Changes in Health Care

Nonprofit “Nurses of Pennsylvania” Vows to Make Changes in Health Care

This past summer, a group of nurses in Pennsylvania created the nonprofit Nurses of Pennsylvania with the main goal to be to focus on the safety and care of patients in health care.

According to a statement issued in September, Nurses of Pennsylvania is a group “of, by, and for nurses focused on improving the bedside care nurses provide. PA nurses work in cities and small towns, at large hospitals, in nursing homes, and more—tied together by our commitment to our patients, our families, and our communities. United for quality care, Nurses of Pennsylvania is focused on leading the state to a healthcare system that gives nurses a seat at the decision-making table and puts patients first.”

As stated on their website, more than 10,000 nurses have joined—either online or in-person—since the group launched. Initially funded by union nurses in SEIU HCPA, the Nurses of Pennsylvania is managed by a volunteer board of nurses and advocates in the health care field.

Under the heading “Why Nurses,” the group states: “Nurses are the single biggest group of people in the healthcare system. We spend the most time with our patients, and are the people who they see and interact with the most. We provide most of the care that patients receive, and our priority is always our patients’ well-being first, money second. We are the most respected profession in American for the last 15 years in a row, and we live in every county in the state. If anyone has the power and the motivation to fix healthcare in this country, it is nurses together, and if we can do it in Pennsylvania then we can do it anywhere.”

The nonprofit has already released a report, “Breaking Point: Pennsylvania’s Patient Care Crisis,” the results of which are based on a survey of 1,000 nurses located throughout the state of Pennsylvania. The results found that while Pennsylvania is not currently experiencing a nursing shortage, staffing decisions made by individual facilities and the ability to retain qualified nurses have fueled a crisis in patient care. An overwhelming 94% of nurses reported that their facility does not have enough nursing staff and 87% reported that staffing levels affecting patient care are getting worse.

“We spend the most time with patients, and we’re the people patients and their families rely on the most,” Jake Reese, a nurse in Scranton, PA as well as a Nurses of Pennsylvania board member, said in a statement. “As nurses, we take pride in buckling down and figuring out solutions at warp speed, but there is only so far any one of us can stretch. Giant corporations and multi-billion-dollar hospital systems are making decisions about care and care delivery farther and farther away from the bedside. This has to stop. We’re playing with first and we cannot stand by any longer. As Nurses of Pennsylvania, we’re speaking out and sharing our stories like never before.”

For more information about the Nurses of Pennsylvania, visit www.nursesofpa.org.

Using Simulation for Patient Practice

Using Simulation for Patient Practice

Simulation is being used more and more in nursing schools as well as in other types of educational situations for experienced nurses.

Christine Park, MD, president of the Society for Simulation in Healthcare, a professor of anesthesiology and medical education and co-director of the Graham Clinical Performance Center at the University of Illinois at Chicago, took time to answer questions about simulation and how it’s being utilized in the nursing field.

“Simulation is a technique that creates a situation or environment to allow people to experience a representation of a real event for the purpose of practice, learning, evaluations, testing, or to gain understanding of systems or human actions,” Park explains. “In health care, we use an exciting array of methodologies, including simulated task trainers, mannequins, full-scale environments, virtual and augmented reality, and even simulated patients. That means we can simulate anything from an ‘arm’ for a nursing student to practice starting an intravenous line, to difficult conversations, to training interprofessional teams in hospitals, to testing system-wide patient safety solutions before deployment.”

So why should the nursing field use simulation as opposed to having nurses immediately working on actual patients?

“I find it helpful to think about how other high-risk industries use simulation. In commercial aviation, simulation is so integral to training that for certain aircraft, the pilot trains exclusively in simulation. When they fly the real aircraft for the first time, it’s with passengers,” says Park. “That might seem scary at first, but in health care, I believe we should strive for a similar goal—that we train extensively in simulation, to the point that by the time we interact with real patients, we are truly ready.”

This is exactly why simulation can help. For example, Park says that when there are new learners/new nursing students, it enables them to hone their skills before caring for real patients. That’s not to say that the way of working with actual patients initially is wrong, but it can provide the students with a sense of calm when they are trying procedures for the first time. It can help longtime nurses as well. “When it comes to more advanced learners and practicing providers, we can provide a safe environment where not only is it allowed to be imperfect, but we encourage the discovery of solutions through reflection on threats to safety in individual performance and systems vulnerabilities. This is the kind of process needed for robust lifelong learning,” says Park.

Currently, Park states, simulation is being used widespread in U.S. nursing schools and is gaining popularity in hospitals as well. “An example of impactful simulation in a hospital setting is the use of in-situ simulation, using the actual operating room or ICU, to practice ‘code blues,’ or disaster simulations in the Emergency Department,” she explains. “In large part, simulation for the practicing provider nurse is driven by their hospital, clinic, or whatever their practice environment is. As far as mandatory simulation for continuing education, we are beginning to see this in isolated pockets within health care, among certain medical specialties.”

Park believes that simulation use in nursing in incredibly important throughout each nurse’s career. “At first, it’s about learning the basic nursing skills—both technical and communication skills. It’s about optimizing performance in the work environment, and that includes interprofessional teamwork. But it doesn’t stop there,” states Park. “Throughout the 30 or more years in a nurse’s career, there are constantly new skills to be learned and skills to be refreshed and adjusted. Using simulation and analyzing our performance in simulated environments, we can discover how individuals, technology, and systems contribute to errors. Using data from both simulated performance and real outcomes data, we can discover our strengths, weaknesses, opportunities, and threats when it comes to patient safety. Ultimately, we can disseminate best practice.”


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