#65 Nursing Committees: Small Changes, Big Impact with Carly Dahl

In this episode of Happy Hour with Bundle Birth Nurses, Justine and Sarah Lavonne discuss the importance of nurses getting involved in committees and making a positive impact in their workplace. They are joined by Carly Dahl, a labor and delivery nurse and Bundle Birth mentor, who shares her experience of being part of a committee and the value it brings. Carly emphasizes the importance of following your passion and taking the initiative to make a change. She also highlights the benefits of interdisciplinary collaboration and open communication within the committee. Carly encourages nurses to start small and focus on areas they care about, as even small changes can have a significant impact. The episode concludes with a reminder to nurses to take care of themselves and find fulfillment in their work. Thanks for listening and subscribing!

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Transcript

Justine:
Hi, I am Justine.

Sarah Lavonne:
And I'm Sarah Lavonne.

Justine:
And we are so glad you're here.

Sarah Lavonne:
We believe that your life has the potential to make a deep, meaningful impact on the world around you. You as a nurse have the ability to add value to every single person and patient you touch.

Justine:
We want to inspire you with resources, education, and stories to support you to live your absolute best life, both in and outside of work.

Sarah Lavonne:
But don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life. Trying to add some happy to your hour as we all grow together.

Justine:
By nurses, for Nurses, this is Happy Hour with Bundle Birth Nurses.

Sarah Lavonne:
I think this topic that we're going to talk about today could be a little controversial. It could cause some differences in opinion because I know that we have part of our population that's like, don't make me work anymore, don't make me do anything. All I want to do is sleep and go home and come to work and get paid and leave. And then there's other ones of you, many of you, who are the game changers, who are the above and beyond and maybe are tired and are involved and trying to do more, and trying to make change or trying to help your unit's culture. And then maybe there's some of you that are the types that are kind of like, I would love to dabble, but why me? And who am I? And I don't know, I don't feel confident. What would I do and how would I help? And how would I get involved? And maybe I have some good ideas, but I don't really know what to do next.
And so I think what I'm excited about for this episode is that we have Carly Dahl here who is one of our Bundle Birth nurse mentors, and also works on the floor as a labor and delivery. And we are going to pick her brain about being a part of a committee. And particularly what that looks like on our floor. And I think no matter where you're landing on the spectrum of how you feel about the whole thing, I'm excited to learn because I know for me, I've been in the bucket of like, yeah, give me it all and I want to be a part of every committee. And I've been a part of every committee. And then I've also been like, screw it. I want nothing to do with anything. I don't want to help anyone. You don't appreciate me, I'm not giving you my time. And so I think there's value here for all of you.
And so I am thrilled to introduce Carly Dahl. This is a long time coming that it took us four seasons to get you here because you have been a part of the Bundle Birth family for a very, very long time. And remember you, as a part of my mentorship group. So I currently, as a part of our 12 month mentorship program, if you don't know, we have an incredible training program that is 12 months long, 13 classes, 185 pages of extra workbook information and mentor calls with a community of nurses from all over the world to help support you in your practice. It's really the training program that we always dreamed of.
And so in the process of that, we started out and it was me and Justine with 30 people being the mentors. And I took cohorts of mentees for, goodness, at least over a year, year and a half, probably. And then slowly phased out. And now we have this incredible team of four/five mentors with Justine in there. And Carly has been there for ... how long has it been?

Carly:
Two years.

Sarah Lavonne:
Two years? One year.

Carly:
Yeah.

Sarah Lavonne:
Two years. So we get to see her on the regular, she is a part of our team. And then what I love about Bundle Birth nurses and all of our nurse mentors and nurse educators is that they are also functioning as nurses, as well. And so she can pull from that experience when she's on these calls. And so Carly, all of that being said, welcome to the podcast. We're so excited to have you. We would love for you to just introduce yourself. I'd love ... before we get into the committee stuff of just how you found Bundle Birth and your story quickly of getting involved with mentorship. Because I think your story, particularly, is really interesting to our audience. And I think a lot of our audience can relate to you and where you were. And eventually, where you could be if you're a listener.

Carly:
Thank you. Thank you for having me. Yeah, I'm Carly Dahl, I'm a Labor and Delivery Nurse. I live in Berkeley, California, and I'm a Bundle Birth mentor. So I started out with Bundle Birth as a very burnt out nurse. And something about me, usually when I'm feeling overwhelmed, I think this is unique. Overwhelmed or burnt out, I need more, not less. And so I knew that I needed more education.
I felt like I didn't have enough tools in my toolbox showing up to work. And obstetrics is hard and I wanted to make a bigger impact. And so I found Bundle Birth and I was like, this is perfect. This is exactly what I need. And this was back in 2021, getting into mentorship was a very big deal. I was so nervous. I was like, this is what I need, this is going to save me. And indeed it did. So I did the year long mentorship. I felt so renewed, I learned so much. It completely shifted my practice. And then at the end, you guys were posting for a job for mentors. And I applied thinking, "What the heck? Why not?" I interviewed, I talked to you guys about witches.

Sarah Lavonne:
You did. We had them do this crazy interview process where we made them prepare a training, right? It was like a little quick like-

Carly:
Teach you something.

Sarah Lavonne:
Teach us something. And it could be literally anything. We had people do the most obscure topics. And the one that she chose was witches, specifically related to OB and the history of it.

Carly:
Yeah.

Sarah Lavonne:
It was so interesting.

Carly:
Basically witches are the original nurse, female healers. These are our roots. And so I find that very fascinating and I wanted to share it with them. And you hired me, two years later.

Sarah Lavonne:
I remember after your interview, me and Justine were together in person, right Justine? And we were like, "It's going to be Carly." We had a number of incredible interviews, like it was a very hard decision. But we were like, "I think it's Carly." And also we knew you, that helped because I always say life is an interview and you were so engaged on all the calls and active. And I remember your beautiful apartment with all your plants and loft style, everything. It was just so memorable. And we FaceTimed you, you remember this?

Carly:
You did. On an unknown number.

Sarah Lavonne:
It was like 9:00 at night and we were like, "Let's just call her."

Justine:
She answered on an unknown FaceTime.

Carly:
That's the [inaudible 00:06:14]-

Sarah Lavonne:
At like 9:30 at night.

Carly:
The first thing Justine said is, "Why did you answer?"

Sarah Lavonne:
Yeah, so fun. But I remember both of us just being so excited to tell you and you being like, "What?" Your face was so ... it was just so fun to get to tell you and say, "Welcome to the team." And you were one of our first hires. I mean, Mykel and Breanne were there, but they were kind of just ushered in because we'd had preexisting relationships and we knew them and we knew how amazing they were. But this was a real interview process and all that. And so that was so fun to be able to invite you to the team. And the rest is history. Now you've been here as a mentor for a very long time.

Carly:
Yeah, it's so wonderful. Yeah, mentorship, it's everything. I've shared it with so many colleagues and I just can't speak highly enough of it. So very lucky that I found you all and-

Sarah Lavonne:
You were in the unique group-

Carly:
That we continue to work together.

Sarah Lavonne:
You were in those groups where you had to wait till midnight and sign up, right?

Carly:
Oh yeah.

Justine:
What's funny is we're doing that again.

Sarah Lavonne:
That's coming back.

Justine:
Yeah, we're going to do it again. I feel like it adds a little extra to be like, you got to be committed to want to finish it. Because it's so powerful when you finish it.

Carly:
Yeah, what's your statistic? Only like 8% of people finish things they say they're going to.

Justine:
Yeah, in general in life, 8% of people finish things that they say. Which is very low, very low. Yeah.

Sarah Lavonne:
Well, and one of the things that we learn in mentorship at our very last module or our last class is called Leading Change. It's taught by Mykel, one of our other mentors. And as a part of that class, we teach you and walk you through the process of what it looks like to make change on your unit and be that person who is helping to better their unit and who really takes it to the next level. Because once you're equipped and once you're excited and once you're rejuvenated and no longer burnt out, the goal would be that we together as a community continue to make our profession better.
And so what a perfect transition into talking about your committee and all of the work that you've been doing, so that we can learn from you. And glean any kind of wisdom and insight for those that are maybe interested, who maybe are leery or maybe there's no committees at all on their hospital. They're like, "Maybe I could start one." And so with that, so Carly, tell us what got you interested in being on a committee at all? What piqued your interest? Because I think, to be honest, I think about it and I'm like, "Oh, it's just more work." And I mean, I wouldn't call myself lazy, but I can be lazy in certain environments. So what got you interested?

Carly:
Yeah, I think initially it was the first committee I joined just really represented my passion. So supporting vaginal birth. And I think part of it was I wanted to learn from them. And another piece was that I knew I would be an asset, but I think in the beginning it was curiosity. And it was like, "I want to see behind the curtain. I want to see what decisions are being made that are affecting me when I show up to work." And maybe influence those a little bit and help.

Sarah Lavonne:
And you're a part of a couple other committees, correct? So what are you doing now and how has that transitioned for you since starting till now?

Carly:
Yeah, now I can't stop. I just keep saying yes.

Justine:
I'm like you.

Carly:
Yeah. So I'm on the Supporting Vaginal and Birth Committee, I'm on a Health Equity Committee. And then most recently, DMQCC is doing a learning initiative for hospitals all over California. Invitation based, so if you have a need for them to basically evaluate you individually and using their toolkits, it's supporting vaginal birth through an equity lens. If you have disparities in your care, CMQCC will invite you to work with them in an 18-month-long program. Anyone on the unit can join and basically attend a meeting every month, where you bring a report on your progress. And it's a learning environment, you're growing, you're discussing. It's really wonderful. It just started in April.

Justine:
Does this mean you're burnt out again if you're committing to all these committees? That's the first thing I thought of when you're like, "I can't stop."

Carly:
No, I think I'm more excited than anything. I don't feel burnt out.

Justine:
Good.

Carly:
I think that it all works together too. So I'm not choosing things that are super disconnected. Everything is informing the other thing. And so I feel like I'm becoming an expert by honing in on what I care about, which is supporting vaginal birth and health equity. I'm gaining tools that I can bring to and from the different groups, which is exciting. I wouldn't believe that I'd be here.

Sarah Lavonne:
So for somebody that maybe has never been a part of a committee and they're like, where do I start? Obviously it's going to be different in each hospital. But in your environment, where did you start? And how did you find the committee? And who's on the committee? Give me the lowdown as a clueless human of what should I expect? And also I just show up to a room and I'm like, "Hey, I'm Sarah." Oh, do I have to say something? Do I get paid? Obviously that's per hospital, you should be paid, I hope.

Carly:
Yeah, I was lucky in that we, at Kaiser, have a lot of committees already existing. So this one landed in my lap as something that I might be interested in, and it was already pretty formed. We have a midwife chair, we have two other midwives who are on the committee, five nurses. The nursing team kind of ebbs and flows with just the time commitment. We have a few residents moving throughout the residency in and out of the committee. And then we have a medical lead. So Doc, who happens to be our medical director, which is wonderful.
Our manager will attend whichever meeting she can, like an A&M. But it was already in its beginning phases. This was all post-COVID, so everything was virtual. As we moved through COVID, we started meeting in person more. And this committee was really throughout COVID, our C-section rate, I think nationwide, went up so high for a variety of reasons. But Kaiser recognized that we need something like this. And so this is all the Northern California Kaisers have a Supporting Vaginal Birth Committee. So it's not specific to our Kaiser.
But I think for someone who maybe they don't have a committee on their unit yet, I would start with research. I would start with finding evidence that you want to implement on your unit. Maybe find another person who's interested and passionate, so you're not doing it alone. Identify your goal, your mission of your committee. And then bring it to a manager. Oftentimes they have a budget for this, so I am paid for my time on the committee. But I think without the research, without the evidence, and you have to have the energy to go out and get that, no one's going to do it for you. So that's what I've learned is there's so much more potential than I realized, but I need to go out and do it.

Sarah Lavonne:
Is it once a month? How many hours?

Carly:
Yeah, so baseline, we meet once a month. We're often working towards a specific project or a skills day. And in those cases we're meeting more often in smaller groups in person. So maybe once a week if we're doing something like that. I have a lot of individual things that I do as well, that I do on my own time.
But when we're working towards skills day, which we'd host, we'd bring in docs, midwives, nurses. And we'd basically choose where are shortcomings? Where are we? Where are weak spots? And then creating a curriculum around those and then teaching it. So most recently we did a four-hour teaching in February, we did nine classes. So nine four-hour classes. And we got almost all of our nurses through it. We've got a lot of doctors through it and almost all of the midwives through it.
And during those teachings, we covered Pitocin protocol, we recapped EFM with a lens on the focus on IA and how it better affects outcomes. I did a short teaching on [inaudible 00:14:27]. I did a brief teaching on pelvis, maternal positions. I always talk about hormones, no matter what. I think that's always appropriate. And we talked a little bit about Med-legal because when we were looking at our inductions, we were looking at our failed inductions, Pitocin was often a piece in that. And a lot of times it was not using Pitocin adequately, allowing our emotions to inform how we're augmenting patients in terms of a fetal tracing, feeling uncomfortable with fetal tracings, not evaluating fetal tracings correctly. And it all kind of came back to Med-legal and wanting to educate nurses and doctors on how well-protected we are. And again, what the science is showing us. So oftentimes turning Pitocin off too early because of non-recurrent rates, something like that. And then that patient not really getting a fair shot in their induction.

Sarah Lavonne:
That's a really interesting take, I feel like-

Carly:
I know, I know. It was interesting and it was really uncomfortable. It was very pro-Pitocin. It wasn't pro-Pitocin like everyone needs Pitocin. But it was, if we're going to use Pitocin, let's use it correctly and let's understand the science behind it. And if someone needs to be medically induced and we're turning the pit on and off 10 times throughout their induction, is that what's best for them? They ended up in a C-section. So trying to understand and standardize care more than anything.
So less about pump the pit, pit to distress. Obviously those things we're not promoting. But understanding when it's appropriate and how to use it appropriately and make sure that everyone's using it the same way. We're seeing big discrepancies too, and night shift, day shift, staffing is affecting this. So how can we standardize care? Because that's the beginning of delivering better outcomes, is making sure that we're all on the same page. So there were a lot of discussions, a lot of discomfort in the room. But it was very healthy.

Justine:
That's good.

Carly:
And our numbers have been better.

Justine:
That's what nurses need.

Sarah Lavonne:
Well, and it is like the reality, we're using pit. And we say here all the time, we like pit, but it's just how are we using it? And you're right, medical inductions. The inductions aren't going away and they need to be in labor. And I feel like option two, we see so much choreo right now, choreo everywhere. And it's like, yeah, could we have decreased the labor time if we had some Pitocin going?
We're seeing often and there needs to be a supporting vaginal delivery on my unit. But they're not putting IEPCs in and so we're not being able to really check off, are the contractions adequate based on the same QCCC checklist? But at my hospital, we put the IEPCs in and we have a lot of new nurses at night. And so they think there's some fear in that, which I get it. I'm like, I'd rather not put an IEPC in, for sure. So that's interesting.

Carly:
Yeah. What was interesting was when we were auditing our charts, we would see a lot of people starting Pitocin and then just leaving it and at that steady state. And when you learn about how our body processes oxytocin and those pulsatile waves, that's not doing the patient ... that's not fair to them and their labor course. And so if we're starting it at two, maybe upping it to four and then leaving it there because they're having non-recurrent variables, and you're uncomfortable about increasing it, what are you doing? You need to either continue turning it up until you achieve a vaginal delivery. When you're racing against time with a placenta that's decompensating, that's the best thing you can do for the patient. Or if it's not safe to keep it on, then turn it off. But that's what we were seeing when we audited and we looked at what was happening at our hospital.

Sarah Lavonne:
And then when you turn it off, what are you doing then? What are you doing to support the theology?

Carly:
Right, yes. Exactly. And it's not one or the other. So we're not saying up the pit in the setting of [inaudible 00:18:16]. We're saying up the pit, utilize your other tools, your intrauterine resuscitation tools.

Sarah Lavonne:
Well, and you need to assess the big picture because if they're not actually having contractions and they have a random variable, which is, I'm going to call it for the rest of my life, non-recurring. But it's a rando, I said that in their EFM episode. That if they have a random variable, the appropriate response isn't turn off your pit for that reason. The whole point for EFM is like, what's actually happening to cause the fetus to have an issue, whatever it is, the variability, D cells, whatever. That it's looking into that patho behind there and a random variable with no contractions and an induction that isn't appropriate, to turn it off.

Carly:
Exactly. Information is so powerful in these situations. So just educating our staff, re-educating them on things that we went out and learned more about was really powerful and-

Justine:
That is cool.

Carly:
We're doing better, yeah, since then.

Sarah Lavonne:
And your group, your committee is doing the chart audits? Or someone else is doing it and reporting back to-

Carly:
Yeah, a little bit of both. We do have residents who do the chart audits for us, depending on what we're looking for. But there is a lot of auditing happening aside from that. I'm not as involved with that just because that's usually a resident who does that. But we do have them on our committee gathering that info for us.

Sarah Lavonne:
I have a question. So what have you learned about making change in your hospital after joining the committees? Anything that surprised you?

Justine:
How does it make it more effective? Yeah.

Sarah Lavonne:
Yeah. And what have you learned about how long change takes and the hoops you have to go through and stuff like that?

Carly:
Yeah, that's a good question. I'm not sure if it's just my particular situation, but I've learned that it's easier than you might think.

Justine:
I love that.

Carly:
Yeah, I think there's a few factors to that. I think maybe it's underestimating ... maybe I underestimated myself and what I could accomplish. There's imposter syndrome is real. But I also learned that if you really care about something and you're willing to do the work and sift through the studies and find the evidence, oftentimes you can just go ahead and do it.

Sarah Lavonne:
Yeah.

Carly:
Yeah.

Sarah Lavonne:
Case in point, Bundle Birth.

Carly:
Exactly, exactly.

Sarah Lavonne:
Look at us now.

Carly:
Yeah. If the path isn't there yet, just forge it. I know you resonate with that, Sarah. So I think I've been a squeaky wheel for a long time, and that is still the case. The squeaky wheel gets the grease. So if I continue to say that something's important to me and I'm willing to put in the time, that's the piece. Is I think when you're burnt out, it's really easy to identify all the problems and focus on those, and not necessarily have the capacity to address them. And when you're in a big hospital system, it can feel daunting. But starting small is the best way to go.
So for example, I wanted to introduce more variety of maternal positions on our floor. I felt like we were doing the same positions and my unit is really great. But I wasn't seeing that intentional positioning as much. And so I just created a format. I thought, well, let me make a poster board every month with a different maternal position, why it works, what's happening in the pelvis, what's happening for baby? And I ask for 30 seconds at every huddle in the morning, and I talk about it. And that's not a huge ask, but it creates change. And then I see the positions in patient rooms, I see the poster boards in patient rooms. I see people, I'm a break nurse, and then you go into the room and they're in that position. And it feels great to see that your work is creating change. So I think, yeah, it's easier than you think if you're willing to do the work. No one else is going to do it for you. So just step up, take charge. It's uncomfortable until it's not. That's another piece.

Justine:
I just want to say, you say 30 seconds and I'm like, "I could never do that in 30 seconds." But then I think about you, Carly, and I've never met a more concise person in my life. When you do recaps on mentorship calls and I'm trying to make breakout rooms, I'm like, okay, she took 45 seconds and it was perfectly recapped. I need more time. So anyways, I think that's really impressive, but it makes sense. I would need four minutes and they'd be more confused coming out of it.

Sarah Lavonne:
I would need 15. I am the most long-winded human ever. I could just literally talk in circles and you're like, oh yeah, she said a lot. But you could have said it in a sentence.
Well, and I think what I am hearing too is it's just baby things that I think, again, it's the starfish story, it's like everything we talk about. That when the problem is so big, it can feel very overwhelming and literally all you have to do is look at what ... and I think follow the love and follow your passion.
I met with a client, ended up going to coffee with a client who's this badass psychologist. And we were just talking about whatever we were talking about, and she's like, "What if you just follow the love?" I was like, "Oh, that's so nice." And I had to sit and think about it because I was like, follow the love. Where is the love? And really what it came down to was, do what sets your soul on fire. There's that quote out there, whoever said it and say that you love supporting vaginal birth, it makes you excited to see those numbers shift. Or you love sepsis or you love educating or you love IA or you love triage or whatever, go where the love is.
And it sounds like that you've done that and you've found your outlets on your unit to really invest yourself in what you can bring. And I think, again, it goes to show that I think a lot of times we compare ourselves to others, that's where imposter syndrome comes in. It's like, well, I'm not her. She would do it better, blah, blah, blah, and all these excuses. When no one is you. You, meaning whoever's listening and you, Carly, you, Justine, that we all have our own unique perspectives, our life experiences, our brains, our smarts, our studies, our whatever it is to contribute that is unique in its own way. And all you have to do is show up where the love is and invest your time.
And likely a committee might be a really great outlet to be able to invest your time in that direction. I will say we're saying like, how do you lead change? We literally have a Leading Change class that is available for everyone that I think is the most underrated. We don't talk about it enough because it's so incredibly easy, we give you email templates and lay out, what are the steps to approaching your manager? And how would you even get a meeting with the right people? And what are the right people that you need in the room if you were starting this from scratch? But you may not have to start it from scratch.
And that's also what I'm hearing from you, Carly, is you didn't have to start it from scratch. You just had to go where the love is and say, "I'm going to show up." And the next steps come out of that. You may not know what that means for you and your future, but also you have full autonomy over your choices of how involved you get and what feels like it works for you. And it sounds like education is what's come out of your committees. Is that correct? Are there other things that have come out of the committees? I'm thinking for somebody who doesn't know, what's the outcome? What is the point? Obviously decreasing your C-sections if that's the point. But what normally ends up being the action steps?

Carly:
Yeah. Definitely supporting vaginal birth. Our primary goal is promoting and preserving vaginal birth and reducing our C-section rate. Most of that is done through education, educating the whole staff. A lot of it is also assessing unit cultures and how that's contributing to breakdown in communication and then therefore breakdown in care. So evaluating our protocols, our induction protocols, our workflows. We did a little education on SBAR, just our communication, the way we talk to each other. Which was really valuable.
And then also empowering patients and the way we speak to them as well. Which I think is still ... that piece is always a work in progress. I think it would be really valuable for us to get more involved in prenatal care. It's hard to, as you know, the patient shows up in the throes of labor, introduce something new at that point. So I think it would be very valuable to set expectations for the patients. There's always going to be a bit of a disconnect between those two, prenatal when they're in the clinic, what they expect to happen, what they think might be available in the unit. Compared to how it actually is when they show up. And so I'd love to bridge that a little bit better. And we're talking about ways we can do that. Because our committee is primarily focused just inpatient labor and delivery.
But yeah, it's mostly education and we do just follow where ... we go with the flow. So we follow where the numbers lead us, like the auditing. And majority of our C-sections are fetal intolerance of labor and failure to progress. So looking at components of that. But also, what people are passionate about on the committee? So for me, that's coping, that's adding to our toolbox.
And then reconnecting nurses to their why is so valuable. We talk about that a lot in mentorship, and I've kind of brought that onto the committee as well in the beginning of our workshop ... in the beginning of our skills days, we'll take a moment and maybe share why we all started here. And it's a nice grounding moment to remember, we're exhausted, we're burnt out, but there was a point in which this was the most exciting thing to be a part of ever. And sometimes we get far from that. And so reconnecting to that. And then also building nurses' confidence because when you're asking people to try new things, that's a huge component.

Sarah Lavonne:
What have you seen as the value of the whole interdisciplinary piece? Because I think that's also very interesting because I'm sure we are all having these conversations ... at the nurse's station. Everyone's talking about like, oh, Pitocin protocol and what are you doing here, blah, blah, blah. But the whole getting everybody together in one room to really talk about it, can you speak to that at all?

Carly:
Yeah, it's been so valuable. For example, so at my hospital, we're a teaching hospital. Residents do most of the vaginal exams because they're learning. But nurses are losing that skill because of this. And there's a lot of ... I don't want to say animosity, but there is some resentment towards that structure. Nurses losing their skills, not being able to check their own patients, not feeling like they're autonomous in that their effect on their labor. And we had a big discussion about that during one of our skills days.
And when the nurse would check the patient, the doctor would chart RN check. And a lot of nurses took that to be offensive, to think that meant maybe it's not accurate. Five ninety minus one RN check. When we discussed it in the class, we realized that the residents put that because they may get in trouble from their superior for not having checked the patient. And they also want to continue to ... they want to build consistency in who's checking the patient. And so something as simple as that, that RNs were getting really offended, what does this mean? How dare you? My check's accurate. I've been checking patients since 2005, whatever. It really didn't mean anything.
So moments like that where it's an us versus them, when it really doesn't need to be, we're all here to take good care of our patients. We might have different goals in what we need to get done that day. For the residents, that's an enormous amount of learning. And so trying to build a bridge and then also learning where can nurses fit better into the resident's education, in a way that will empower them. That's also been something valuable to come from that. So all positive, but definitely not always comfortable. But important discussions. We're working in close quarters in very stressful situations, emotional situations together. So it's good to have space to debrief that.

Sarah Lavonne:
Well, and where else are you having those kind of conversations and connecting in that way? I'm thinking back, I'm like, shoot, I had ... what a missed opportunity. I was a part of a ton of committees. And there would be doctors and I'm like, I didn't even think about the opportunity to ... that is a chance to build the relationships with the doctors that we talk about in Bundle Birth Nurses.
Remember that mentorship moment we always talk about, we're on the real talk, we are like, "We're so terrible. We didn't even think about what's their experience? And what are they going through? And what if I ask them about their day?" There's this separation. And so I think about those other opportunities. If you are really trying to integrate with your unit and you're really trying to be the professional that we should be and know your people and work well with them, teamwork. I mean, what did we learn? I redid my BLS recently and they were like, there's the whole section on teamwork. I'm like, that module is so dumb, but it's also closed loop communication. I mean, for real, that's helpful. But you think about these modules that like when else are we in a low stress environment able to have those conversations other than a place like that?

Carly:
Yeah, yeah. And they're under so much stress. I mean everyone ... we don't understand each other's experiences unless we talk about them. So it's been a good platform to do that. And just giving others the benefit of the doubt and remembering that we're all in this because we fully care about our patients and their outcomes.

Justine:
I appreciate that viewpoint because I will say, I was thinking like, "I'm going to start charting resident check on mine." That was my first thought.

Sarah Lavonne:
That's actually a great idea.

Carly:
I mean, that's fair.

Sarah Lavonne:
That's what we need.

Carly:
That's fair.

Justine:
When is it? When do they come? July or June, I forget. Is it July? They're coming.

Carly:
It's July. They're coming.

Sarah Lavonne:
July is the scary ... no, for patients listening, you didn't hear that. But July is a different vibe on the unit. I have like a bunch of births in July.

Carly:
I'm excited. They're going to have our committee do a little teaching at the new resident teaching.

Justine:
Oh, that's cool.

Carly:
During their didactics. Yeah, so that's going to be great. So I'm going to hit them heavy with [inaudible 00:32:36] birth.

Sarah Lavonne:
That's right. You hit them. Have them download motion themselves.

Justine:
Oh yeah, that's a great point.
You mentioned earlier that it was easier to start a committee than you thought, and that was one of your pieces of advice. And I think too, so one of my jobs is that I'm in the supervisor role. And I got to say nurses that come to the management team with an idea or a passion, they follow the love. Those nurses, the management team want, it's like a breath of fresh air. Unless they're so overwhelmed, they're like, "Oh, thank God. Someone wants to do something." Because they probably do have ideas/they had ideas. And then now they're in this job that's just not what they expected. I think I have so much compassion for our managers and directors and unit educators because it's not easy. And so to have the staff that wants to make change and help ... like someone comes to you with a whole research backed idea, you're like, "Oh yeah, great. That's awesome."

Sarah Lavonne:
Wow.

Justine:
And like you said, Carly, they probably do have the budget ... or I don't know who said that. And even so for example, at my hospital, I cannot get any nurses to do a committee. That's not true. One is doing a committee, but her and me are doing bereavement to get there. But our CNO at all of our meetings, like we really want committees, we really want committees. From the CNO standpoint, they have money to back it, but they can't get it to the staff to want to do it because they're in that cycle of like, I don't even want to think about work when I'm not here.
So I think ... actually what I'm kind of taking away from this is if maybe some of the nurses here listening, if they're burnt out, maybe they do just need a little more instead of a little less. And maybe trying to do that. That also makes me feel a little more stressed. But a little more of the love. Don't read or research anything you don't like. But find something you like. So many people-

Sarah Lavonne:
Invest in it.

Justine:
My friend just texted me, she moved and she's like, "My new hospital has a coping cart." There are so many coping carts popping up all over units and I think that's so fun. And they all have their little space lamps on it, and it's just so cute and fun to see that go full circle. But things like that, like little things. And then just start ... you don't have to start a full, we have an agenda, which that's fun too for a lot of people. But just start a little club and this is something we want to do, pitch it and see where it goes. And when they say yes, it's still fun.

Sarah Lavonne:
It gives you purpose. I think that's part of the burnout and that's part of the like, I don't want to do anything. It's this apathy. And so while, if you're feeling that way, I also think there's a balance of rest outside. You've got to disconnect, you've got to sleep, you've got to find some outlets to not just give, give, give in every single element of your entire existence. But then when you show up, it's like follow the love and find your purpose. Because you do have one somewhere in there. And if you've lost it, then take ... managers are going to hate me. I'm like, take a leave of absence. I wish I would've taken a leave of absence and used that money I've been paying into to like ... for your own mental health in order to save your potential career. Take a leave of absence, do our mentorship program, take a leading change class, find other coworkers who are ... or hang around the passionate ones.
Or do a self-assessment of what the heck do I even care about anymore? Is there one glimmer of hope in me of what patient scenario makes you most excited? That like, oh my gosh, when they're stuck at OP and then they rotate and we have those vaginal births, and the doctors look at me like, "Wow, that was crazy. How would you do that?" I'm like, I could just eat it up. Find those ... I mean, that would be one of mine. I want to prove them wrong, and I want to show what the body can do and that fuels me.
There are other things that don't. I don't care about certain things, and yet I'm not pushing into that right now. So I don't think you have to push into everything, but follow the love and identify, is there one little area that does kind of make you come alive? And if you can find that, then ask yourself, what can I do to push into that? Versus just run away from it altogether. And really fan that flame to really make it grow. And then it may turn into a committee, it may turn into a project, it may turn into a way that you practice a little bit differently, it may turn into mentorship, it may turn into you being able to identify what your next steps are. And one of them, I love this, because again, we can feel so helpless on that beach. But knowing that there are other opportunities out there like committees just feels really grounding and really hopeful.

Justine:
And if you follow the love and it's no longer in labor and delivery, that's okay too. If you're doing a self eval and you're like, I don't like it anymore. We don't need nurses that don't like it causing more birth trauma. I'm just going to throw that out there because we don't need it.

Carly:
Yeah, I will say it's not easy, but it's very fulfilling. And we can impact the environment that's causing us to feel burnt out, I think, more than we realize. So for me, it's restoring my unit's belief in birth, and that fills my cup. And it's like an endless well that I can pull from. So while it's hard work, it doesn't feel like it's adding to my workload, if that makes sense.

Justine:
Totally.

Carly:
It's an effort, but one that I am glad to do.

Justine:
Yeah. Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you've heard, it helps us both if you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to Bundlebirthnurses.com or follow us on Instagram.

Sarah Lavonne:
Now it's your turn to go and follow the love. We'll see you next time.