Debby Menders wrote of her experiences with a neonatologist. Definitely was
a description of a bad situation, with potential for becoming worse.
As an RNC in a Level 3 NICU, she has knowledge and skills working with sick
and preterm babies. And she has knowledge and skills about breastfeeding
and breastmilk. Sounds like an ideal staff member to have. However, if the
medical director does not "like" or "get along" with a staff nurse, it
definitely decreases the effectiveness of the care that can be given.
I speak as one of those people who is willing to take the risk and "rock
the boat". I recommend choosing battles carefully. It is truly sad when
there are other issues than providing the highest quality care. Life's
tough, sometimes, but at least it is not boring.
One of the factors involved in changing beliefs (and this neonatologist has
beliefs more than information) is that change is hard. When a person is
presented with information that challenges his beliefs, he tends to defend
those beliefs more tenaciously. When things become a battle, remember that
a person cannot argue with himself. Don't play the "game"; choose when to
just listen. It was appropriate to ask why he was advising that cultures be
done, but (in hindsight) providing information that did not support him was
not what he wanted and the situation escalated into the incident that was
described.
Understanding power theory could also be useful in this situation. It is
entirely likely that this doctor's practice and beliefs will not change,
but working conditions for the nurse will be tolerable if she understands
how to work within the relationship. I am a staff nurse/LC on a mother/baby
unit. The Special Care Nursery is in close proximity to our unit. At one
point I was told that I was "banned" from the SCN (NICU). However, if a
mother wanted me to come with her, I could go. I requested an appointment
to meet with the neonatologist, and talked about my role.
Now, I go to the NICU whenever it is appropriate, including just "hanging
out" with the staff. Whenever he requests, I will take down information and
slogans from the bulletin board, because it's just not worth a
confrontation. However, I did not find it necessary to change the
information sheet that I wrote for families about "What do I need to know
about breastfeeding?" If he asks why we are not supplementing a baby in the
normal nursery, I act as family advocate and tell him that the mother
understands the information and requests that the baby not receive formula.
He tells me that he told the mother that formula was like medicine. I tell
him that the mother has the right to make her own decision and that he
would be better able to explain what he wants, and may need to talk with
her again. I am always available to assist him in any way, but I am
obligated to provide nursing care and must listen to the family. This
doctor can be really unpleasant to deal with, but he "likes" me, so that I
can do some of the things that I think should be done.
My general recommendation is to discuss with him areas other than
breastfeeding for awhile. Use the typical nursing behavior of building upon
strengths. Talk about the areas in which he has taught well or otherwise
been helpful to staff and families. I know it is frustrating, and you can
E-mail me privately if you want to "talk". Incidents like this are very
familiar to me; I finally decided to pay attention to the Serenity Prayer
(Lord, Give me strength to change the things that I can, and accept those
that I cannot). Making a little difference is better than nothing.
Becky Engel, RN, IBCLC
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