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whitewriterIts not fully confirmed, but I can't help but feel like it is. Which is nice.
It's either that or I love working with DI in MAC.
Even though the place was falling apart and people were piling up in the waiting room and we had no doctor til 09:00 because?? they were at a meeting to decide wtf to do since women were all piling up in postnatal, leaving birth unit backlogged with women in every bed (meaning they can't start their prescious IOLs which means that also, if a spont laborer comes in - more than 4 - they'd be left to either birth in the hallway, or we would have to put them in some really random room that isn't prepared for birth (or move a postnate into one of those random consult rooms). Can you imagine?!
They talked about diverting to MSH this AM, and I don't know if they actually had to do it during the day because I kept my head down and my butt up whilst I worked through the antenatal algorithems in my head.
At one stage DI sent the medical student to go get "whoever is next" from the waiting room and she came back with a Cholestasis that was in MAC overnight from 23:00 to 02:00 waiting for the doc, got sick of waiting, discharged herself AMA to go home and sleep (too right seriously) and returned for her RMO review only to wait another 2s hrs: except I wasn't going to bother bringing her into a MAC bed just so she can sit and wait. That's a waste - bring one of the others who needs the CTG space -- except of course, the medical student doesn't know that.
She can put in a canula but can't take a blood pressure. I sorta half heatedly showed her how to do it (aka. I did it and she stared at me).
She asked me where I learnt how to read CTGs and I'm like "on the job" (fat lot of good you did for me CSU- but to be fair, its 1 yr and 9 courses to learn how to be a midwife, so realistically, their subject matter is going to be limited). OH, and HETI does have a good package that's available to all employees. I'm not sure if students get access- and I didn't ask.
It makes you wonder what you actually need to do to become a registered training institution. If you can condense a 3 yr degree into 9 courses - at the end of the day, it just comes back to the same thing I've always been saying this entire year.
No one will make you a good midwife.
The midwives you work with, will to an extent shape you (so you always want some good and competent and patient people around you willing to support you through the growing process) but at the end of the day: you need to be responsible for your own practice - and do your own teaching and self learning cause if something happens to a lady: its your registration, and your own stress that your going to feel when someone's baby dies. Right ?
The Letter Lady
Some women are just plain annoying. Di was dealing with this lady that wanted a letter that stated she was fit for her duties at work until XYZ date (which was probably her going on leave date). Di informed her as we don't know her duties and that we are not going to read her position description and make a letter for her - that her GP can do that - but we do give a letter of confinement -- what an outdated term-- and thats it. AKa. a letter that says her due date and that's it). Supposedly she sweet talked the doctor? to write the letter she wanted? which then ended up being wrong, doc was in ED/ out so the lady was waiting ... the letter saga drove Di crazy, like we didn't have enough things to do than to chase letters for people. I didn't find out if the letter ever got fixed or if Doc refused to write what she wanted or if she just caved and went whatevs.
But also, some people have commented that they haven't seen her since.
Some midwifery seniors complained well its all well and good for them to up and quit (bar the 3 months notice)- at the end of the day, they have the power and can band together like that. They all have multiple jobs in multiple hospitals and rooms and etc that they run (I have no idea how they keep it all straight!). Whilst as we run the place, we only have 1 job in 1 place. So if we quit, there goes our income.
I asked Di if it was this bad last year, and she said no, but also she said MAC didn't exist in the old hospital.
I have two jobs - and I'm leaving so, maybe I should make that into a political statement about the place. I heard too many senior midwives in the tea room or behind doors saying that they hated the place and wanted to leave. Except that I want to continue in casual role, so actually burning my bridges would not be a good idea. Maybe I can try to get casual at MSH instead since they're better run. I only need to pull about 10 shifts a year to remain registered! (bear in mind, I still want to improve my skills so 10 probably won't cut it).
The medical student was asking me about the culture of the place and if its good to work at SSH (it was her first day back there after 6 months, and I don't know if she asked other staff during the previous rotation). I asked her what she defines as a place being "good" -- as I explained for midwives, a good place means often: the roster and she said, her idea of "good" was based on culture. I skirted around the question and said it depends which department, but I also whispered "no one here likes the manager very much".
I didn't really have time to think deeply about the work culture of a good workplace.
Until now.
What I think makes a good workplace.
I feel that what makes a good workplace is when you feel supported by your manager - with :
1. A good roster that takes care of your needs.
If you need to have certain days off for your kids.
If you need not to work 6 or 7 days off in a row.
If you need not to do moe than 25% night shift or you feel sickly.
Whatever your needs are roster wise, within of course the formalities of the job (you need 10 shifts a fortnight, you need to work at least 25% night shift you need to have adequate break time rostered in), you need the ability to feel like if you needed a swap last minute, you'll find it at least 90% of the time.
A lot of people seem to complain that they get 7 days straight in a row, followed by say 1-2 days off, then 3 days on then 4 days off. and feel inadequately rested post the 7 days. It's not illegal to give someone 7 days in a row, but then to not give them adequate rest post that, seems silly.
Some people work odd roster hours like 28 hours a fortnight or 30 hours, on a 8-12 shift pattern to make up the hours. Then they complain they don't get a "good roster" like "other people" who work full time. This, I think is because the person who makes the roster often utilises people who do these odd shift patterns to "fill in the gaps" rather than actually giving them a nice pattern. Like, a late shift, followed by an early, followed by a night then 1 day off and then an early.
People who have children, are automatically given simple patterns.
People who don't are seen as able to cope with weird patterns.
I'm mostly okay with them but I also live 1+ hour away from work now so I refused to sign the 10 hr gap form. (meaning that I don't do late-earlies unless you wanna start me at 0800 instead of 07:00)
I used to do weird shift patterns when I had external motivation: dragon boat racing and training were priorities so I'd work some weird shifts and be fine with minimal rest.
I'm too stressed currently, and I'm really trying to focus on just work and my own mental health... maybe I'm still new, or maybe they're trying to keep me because I look good on paper, or maybe, I'm expensive (which I am as an 8th yr RN), maybe -- I'm really easy going and even though my patterns aren't great and I'm used to doing some weird patterns in my old job, my roster looks like holiday to me. (other grads are getting 7 nights/roster so I'm gonna shut up now cause I only get 4 thank the heavens, and she stacked my shifts nicely so my 1 week off actually turns into 12 days off straight).
Okay. So good and well supported roster so you feel rested and not needing to call sick because your overworked or tired.
2. Your not worried that the senior staff are too stressed to support you.
I feel this one frequently at SSH.
I don't blame them.
Some of the juniors today complained that if the "some people" (I think they meant the seniors) would just stop complaining and get on with it, the thing they're complaining about would be resolved in the time it took them to complain about it.
Then in the next breath they admitted that complaining out loud makes them feel better -- which is what I think the seniors do in their safe place (aka. the tea room and also: source of most gossip).
I think that's what I do here. I don't want to be viewed as a winger. I'd rather be viewed as part of the solution.
3. On the days when its busy you feel your being heard and your working together to resolve the workload.
Rather than have seniors complaining.
Rather than have your boss come up next to you and ask if you want some "overtime in the postnatal ward" -- It would be nice, if maybe just for an hour, or so, the manager would come and work along side us.
My ex-manager Paul tried to do that a few times. He would offer rolls, or even, I've seen him take on a patient. It always made me giggle a little and wonder when the last time he suctioned a patient was, but it made me feel like at least he realised what it was like for us - in the moment.
Once again I think this comes back down to how midwifery and nursing are staffed very differently,
with birth unit having the same number of midwives regardless of women. And ICU being specifically staffed on nursing hours per person. If you need an extra, then you need to find an extra. You can't really work short. You can work short of skill: say putting an AIN where you'd really like to have an RN's expertise, but the RN and AIN can work together to divy up the workload and have the AIN do AIN stuff (like obs or keeping the patient's hands away from the lines) and the RN does the RN stuff (review, meds, etc).
4. You respect your colleagues.
I found this sometimes more so in midwifery than I did in ICU.
More so in some midwifery wards compared to others.
I admired the senior midwives who had the skills I didn't have - the skills to competently VE anyone, to ARM almost anything that was at least a good 1-2 cm, to reassure a woman and have a deep conversation that gathered everything together neatly and pointed them in the right directly.
Calm a room by their presence.
In ICU... I am a senior.
am I respected? By the nursing staff, I'd like to think so. By the consultants - I also like to think so. They've seen my face for about 7 years so I'm sure they at least know my face. I tend to keep fairly quiet though I think. Unless I like you. Then I treat you like your my journal.
5. Your not asked to document the same thing over and over again in 50 places at once.
I'm exaggerating but that's what it feels like.
This is loosely based on location - (I've only worked in 2 HCP and in both, I have to say midwifery has so much duplication: I do agree though MSH is less so than SSH).
Lets put it like this. I do a BP, pulse and temp at SSH in MAC. I will document it:
1. on the sticker on the CTG
2. in the ASSA chart
if they're here for a BP profile I'll also write it:
3. on the whiteboard so the doc can easily see it
4. in powerchart
For each phone call we get and woman we see there's 20 questions in e-maternity to fill out. And the form is clunky. It asks for a "note" and we can defer and write "see powerchart".
I get that e-maternity is for data collection (and therefore for example, ED can't see the chart) but it feels like too much duplication. Why can't the ASSA just upload direct to powerchart so that say, ED can see it. So we can put our notes in the one damn place.
I take a blood pressure in ICU, sure I do it hourly, but you know where I write it? Once. On the observation chart and then in my notes in blood pressure I'll write one sentence (it supported, unsupported, its range is this and our target is blah).
I'm gonna say it again: how can SSH use such an outdated partogram. I heard in the tea room that some seniors found the newer ones hard to use and so they had to go back to the old (really shitty one). That's a load of cock and bull- how did the seniors at MSH deal? the new one is so much nicely spaced, with fewer redundant questions.
This goes to the next point:
6. Good work flows and escalation practices.
in midwifery. If I have a concern I have to find the team leader or press a buzzer (makes everyone run - which is silly - that there's no good 3 buzzer system at SSH like MSH : in MSH the pt buzzer is for the woman, if she presses it no one will except the midwife in charge of that lady will go. If the assist is called, one senior will attend (that will be the midwife calling for help) and if its a real emergency then there's the emergency buzzer. SSH is brand new. For some reason they don't like to use the assist buzzer. Instead they have all decided that the pt buzzer is either the woman or the midwife wanting assistance (and ideally you have already talked to the in-charge or another midwife about what the problem is and if it goes off you will attend: or on handover everyone knows if its a post-nate or a labourer : so if its a labourer, birth is imminent and if its a post-nate its a woman wanting to get up : one can wait and the other can't. It's still messy. A buzzer goes off: everyone should know if its a woman buzzing or a midwife buzzing. Rather than sorta half guessing the first point.
ICU: doc is there most of the time. I'm the RN. I usually have a swathe of PRN meds I can use. OR pumps I can adjust. Escalation isn't hard and if no one's coming there's one main button and if I press it the whole world will arrive. Feels really straightforward.
7. Break times are supported.
Birth unit is such an "everyone for themselves" regarding breaks.
So this means on night shift no one sleeps (half the people don't go for a break)
and during the day, you figure out and schedule your own break.
I get that you could be shifted and moved and in all sorts of places depending on your woman and her needs (early IOL = go early before it gets busy, starting Second stage= fuck u cant leave, your going for a section =- definatly can't leave, your CTG looks like shit= probably going for a section are your notes updated? can't leave, or you have antenates and its all chill= leave anytime, try and support your colleagues with labourers to have a break... )
ICU has such a good break culture. I can't believe people in ICU complain about their breaks. I judge now, even harder, those who are all like "I haven't had my break" and seriously: there are some that seem to say that phrase every -fucking- day.
If your in ICU and you haven't gone for a break that's your fault for not going earlier or sussing it out sooner. It's such a chill and regulated environment... If you have scans, go early. Work with your buddy its well do-able.
Come to birth unit and then talk to me about your breaks.
Midwives seem to complain the least about their breaks. They complain, but not like what lazyballs I see in ICU complain...
7. There are people at work you can have a chat to and just spitball with.
I usually didn't like to make friends with work people. I actively tried to avoid it at the beginning.
But a few of the ICU crew did get under my skin a little deeper than the superficial conversation one has at the bedside at 3pm. I convinced some to get into dragon boating - that actually didn't make us closer despite being on the same team.
Sometimes, when you go out with colleagues, all you talk about is work.
Which is probably the main reason I tried to stay away from "friends at work" because then, also, you don't want to feel back stabbed if something happens.
Or feel your treated differently in front of other colleagues just because your "friends". Eg. if say, Sally is allocating, she gives me the good pt, because we are friends outside of work. Or Sally asked for my help with ... rolling the pt, I'm super busy but now I feel obliged because she complains to me whilst we were chatting- outside of work that no one helps her. So I take on extra workload, just cause I feel sorry for her.
I find I don't need to be your actual friend, to actually spitball with a colleague. After a few years, I'll have figured out whose who that I can confide in and who I can't. Within the work environment.
But it is nice if someone can arrange after work drinks, or I liked MSH's team dinner on Thursday where all the senior midwives will cook and prepare a dish to share with everyone. They put effort into it, too and the dishes were lovely. Apparently the boss at SSH thinks it makes us all lazy and that we all eat together and ignore our women. But I think as we are 1:1 we always put our responsibility to the women first - and if we can arrange it so that we're all free together for 20 mins to catch a bite together, where's the harm in that. You can always put your plate down for 10 min and tend to your lady and return.
