Transcript

SPEAKER_00
0:04

Hey Denise, how are you today? Hi Ginger. Doing great. How are you? I'm good. You know what? I'm really ready for some review. I mean, it's pretty close. We're like up to 105 degrees in the city today.

SPEAKER_02
0:20

It's like, oh, that's too much. Nothing to full, full bring it, bring on the fall. Just bring up.

SPEAKER_00
0:33

Uh but I will say, in my new raised bed garden that is like an experiment this year.

SPEAKER_02
0:40

I got one cucumber. You got a whole cucumber? A whole. You're not like fighting with any squirrels or rabbits to take it from you? Uh no.

SPEAKER_00
0:49

No, they haven't. Maybe because it's raised, it's elevated. I don't know.

SPEAKER_02
0:53

They there's some flying squirrels. They'll do whatever they can to get the things going. Not that maybe that's next year's challenge. Next year's. Yeah.

SPEAKER_00
1:01

That's hilarious.

SPEAKER_02
1:02

It maybe that will be the hostile environment that you're in, you know, you're dealing with next year in your plant life.

SPEAKER_00
1:10

Well, we're going to jump from hostile, hostile uh critters to hostile work environments. Uh what a great lead. What a great lead there, uh, Denise. You know, we have we have um over time, and I I think it's becoming a little more frequent, worked with midwives leaving practices who want exit help because they just feel bullied and unsupported. We have worked with midwives who have been reported to disciplinary boards by their colleagues or not defended by their colleagues or reported by nurses. Yeah. Yeah. And and uh sort of the incivility that's going on the workplace, I think needs to be exposed more.

SPEAKER_02
2:00

I think you're right, Ginger. I mean, I I think it happens more than anybody ever talks about, just kind of like miscarriages that happen frequently and nobody talked about them, right? I mean, not that it's completely related, but yeah, it's all things that are kept under the rug.

SPEAKER_00
2:17

Really an under-researched area in our profession, in particular, compared to once again, Europe and the European midwives, all of, you know, focus a lot of research on really meaningful issues. This is this is one of them. So um one of the things that popped up when I was doing my early search was the American Organization for Nursing Leadership, the largest organization, A-O-N-L, who surveys their leaders every year. And this is their survey from January of 25 to October of 25. And they list the top five challenges and what's what's so interesting here. Um, having recently interviewed Shana French, who's working with practice directors, I'm going to read these to you, and you're going to go, oh, that sounds familiar. So these are leaders, right? The people who are supposed to be overseeing their nursing team, staffing, financial, fiscal evaluation. Oh, yeah. Emotional health and well-being, and bullying and incivility. Okay. What does that tell us about like what's going on out there? You know?

SPEAKER_02
3:41

I mean, it's this has been going on for so many years, um, so many, so many, so many decades, actually. Um I remember that was part of my second dissertation topic, which, you know, that was in the academic setting. Right. Um, but then it was recommended that I not continue to research that because it would be politically uh difficult to finish my dissertation. But that was related to academia.

SPEAKER_00
4:07

I totally forgot that. You forgot that, Ginger? No, I now I remember. I know.

SPEAKER_02
4:12

And so it's been it's been forever a dear topic of mine, forever and ever. Um, just because you would not believe the number of people from all disciplines that wanted to be interviewed about this topic. But yeah.

SPEAKER_00
4:27

I think as we look at a lot of uh discussion boards that social media is rampant with people talking about why they're leaving the profession. And we know midwives are exiting faster than one would anticipate for the amount of money they're investing in time.

SPEAKER_02
4:43

And passion.

SPEAKER_00
4:44

And passion is is the practice environment, the work alignment. Uh, and not feeling respected or valued or supported in addition to the work and the fiscal contributions. But ACNM does have uh a position statement titled Bullying and Incivility in Midwifery that was updated in March of 21. We'll add that to uh resources people might be looking for, but it's definitely an issue in in our profession. So why don't we tackle that today?

SPEAKER_01
5:19

Okay, we're gonna tackle that. How do we tackle that? Where do we start, Ginger?

SPEAKER_00
5:24

I I I think just validating the fact that that it's true. I mean, uh midwives who are not defended by their colleagues in their practice for a questionable action, let's just take the route of it probably was the wrong decision. So how are we going to help people who let's just say our new grads who are still learning? How can we sort of mitigate incivility or bullying for new grads? You have them all the time.

SPEAKER_02
6:03

We do have them all the time. And uh I you know, I think of specific instances um where you know they they feel bullied. And I can think of an instance where very new grad, um, it it sometimes it comes down to, well, anyway, a new grad was really bullied by the nurses that that she worked with. And um often the argument is, oh, well, she never worked as a nurse. Oh that she never worked in labor and do every, she doesn't know what she's doing. And I do think there is a little bit about nursing culture that when when one is exposed to nursing nursing culture, sadly, you begin to learn how to deal with some of that culture. But why should that have to be a baseline? Like that's not you don't have to be a nurse to be a midwife, um, and you don't have to be a labor and delivery nurse to be uh, you know, a a nurse in a hospital a midwife in a hospital. Like, so like I don't know. It was really, you know, about how she went about doing a delivery, and the outcome was fine, but it's it's like the reverberations that occur, like talking about it. Yeah, the emotional trauma that comes. I mean, they came to me and I said, listen, like she's gonna be here for a long time. Why not um why not have a conversation not about her, but with her, about what you're experiencing, and why can't we help to mentor um her progress? Um, you know, and and then the flip side, then I wasn't in a position to be, you know, I'm not her manager, but she often came to me. So I said, you have to, I think an idea that would be helpful is to verbalize what you're thinking, put it out there so other people know what you're thinking about, the steps that you're going through for like a delivery so that they're aware they don't know what you don't what you're thinking, they don't know what you know. Maybe you don't know what you know until you say it out loud. Right, good point, that that helped, I think, to for that situation. Um, and then just talking with the charge nurse and saying, please help her instead of fighting her or finding something wrong with her.

SPEAKER_01
8:23

Yeah.

SPEAKER_02
8:24

Because we want people to stay for a long time and we want them to feel like they're in a comfortable environment. So, like yeah, yeah, it's a great one example.

SPEAKER_00
8:34

It's a great example with nurses. And I think sometimes we've had a lot of clients in hospitals. Um, and when when we're in these meetings with everybody, even face-to-face experiences, the nurses often aren't saying anything because of course the doctors are right there and the midwives are in the room. So I think sometimes the nurses might feel like their voice doesn't matter. And and then if if they see the the unit as their real estate, their voice all of a sudden is more important uh when it's a situation that they think they should be controlling.

SPEAKER_02
9:09

Right. Very true. Another really interesting recent example of a new new midwife, she was in labor and delivery nurse for a long time, is she said, I'm finding my midwife voice. And I'm like, what does that mean? And she's like, um, you know, I'm fine, I'm now saying I'm being directive about what needs to occur. Like, I no longer just soft and gentle. Yeah, if something needs to happen fast, I say it louder. You know, I'm finding my midwife voice. So again, it's a way of unfortunately, um really, but I think needs to happen, actually, is like reassuring everybody else in the room about what you know. Yeah. And I'm not sure that has that same expectation comes with other disciplines, you know, physicians, you assume they just know. Right. But um, but when you're a new graduate, I think you have to really audibly practice your midwife voice.

SPEAKER_00
10:08

I love that.

SPEAKER_02
10:09

Yeah. I was just I loved it. And I and this is from someone who was, you know, calm and stuff. And I'm like, that's why I was like, what does that mean? You know, and I and I love it too, because I do think we have to use learn to really audibly practice.

SPEAKER_01
10:24

Yeah.

SPEAKER_02
10:25

And that's a second example of just one was a recommendation, the other one was a totally different person who said, That's what I had to do.

SPEAKER_00
10:33

Yeah, who kind of figured it out on her own.

SPEAKER_02
10:36

I know right, figured it out. I mean, maybe somebody guided her, but she yeah, she was doing it, you know.

SPEAKER_00
10:41

Yeah. Well, you know, we also have this these situations where some of our physician colleagues are not as supportive as others and either try to set you up for an event uh or just outright disrespectful. Um and again, I've been in those face-to-face meetings where I've heard some things said that I can't believe are allowed to be said publicly in a room. Like, do you really think you're that important? You know, that there aren't other humans in the in this circle around you. But um physicians can be harsh um and sometimes sabotaging.

SPEAKER_02
11:26

Oh, for sure.

SPEAKER_00
11:27

How do you how do you navigate those people?

SPEAKER_02
11:30

There's there's sometimes some certain element of some attitude, I don't know where it comes from, of a greater I'm I'm greater than that, the, you know.

SPEAKER_03
11:38

Yeah.

SPEAKER_02
11:38

Um, and that's really difficult. Um I think it I think I'm very lucky to be in an environment, Ginger, where I now get to work with a lot of interns who become first year, second year, you know, they then become attendings and the the humility which develops uh the change, the transformation which develops from intern to then attending is very different. Um, they're very lucky both as midwives working with them and them as attendings to learn how to be humble and how like you just you can realize you're as a physician, maybe that you didn't know everything before and you can actually learn something in terms of maybe midwives differently see the value of the team.

SPEAKER_00
12:25

Absolutely 100% of just being the dictator of the team.

SPEAKER_02
12:30

But how do you do it when you didn't get that experience? What do you do?

SPEAKER_00
12:34

Well, yeah, I mean, that's kind of my question to you is let's let's think about onboarding and effective, what would an effective onboarding look like and from the perspective of the new grad or the new person in an environment they haven't worked in before?

SPEAKER_02
12:51

Or even a very traumatized midwife coming from coming from a practice where they're it was just very different.

SPEAKER_00
12:58

What might what might the questions be to not have a repeated event? Like how do I say this carefully? You know, we all have friends who have been in multiple emotional abusive relationships or marriages, and it's almost like they just keep attracting that same cycle of really unfortunate uh relationships. Yeah, yeah. So how how can you break that increased risk or potential from happening again to you? Because I'm my guess is it's gonna take two or three events where people are mistreated and they're out. They're done. Right. Um what is their role in kind of putting out those questions? And one of them that I always suggest is I I I never say this quite right. When is what's the longest uh or what's the shortest amount of time a midwife has stayed? Or how long what's the average length of time your midwife stays in this practice, right? To try to get some idea of recidivism.

SPEAKER_02
14:11

Right, like what is the retention rate? Yeah. Um yeah. Maybe not like the range, you know.

SPEAKER_00
14:19

Yeah, that's not that's not a good way to say it.

SPEAKER_02
14:21

But yeah, some people are gonna stay forever. Yeah, because they can stay in an environment that isn't positive or even abusive for so many reasons. But what is you know, right? What does the long-term story tell you?

SPEAKER_00
14:36

Yeah. I do think the idea of the onboarding process and feedback loop is really important. And maybe maybe that process, and I don't know if you guys do this or not, is monitoring one's feeling of being undervalued, mistreated, inappropriately spoken to, like these incivility. I'm gonna call it that more than bullying, to be honest with you. In civ incivil behavior within the work environment. Are we really tracking that?

SPEAKER_02
15:11

I don't think so.

SPEAKER_00
15:13

I don't think so either.

SPEAKER_02
15:14

I don't think so at all.

SPEAKER_00
15:15

So it's an after the impact reaction. Like this happened to me and I can't believe it. Well, is that a pattern?

SPEAKER_02
15:25

That's the thing. I mean, I think there's they're isolated and doesn't mean they're not repetitive, but they're isolated and there's not there's not a accumulation of data to really that that is kept about those instances.

SPEAKER_00
15:38

You look at the problem protected, right?

SPEAKER_02
15:41

You can look at somebody's like they did something wrong pattern, but you don't look at how people around them are reacting to them, yeah. Which makes it very unilateral. It's very frustrating.

SPEAKER_00
15:54

Yeah, yeah.

SPEAKER_02
15:57

Um so mentoring, onboarding, so it's onboarding, maybe it's the mentoring that's the the help.

SPEAKER_00
16:06

And maybe it's the monthly check-in. Has anybody felt inappropriate behavior over the past month? And if it's no, then you go on to the next, you know, topic. But increasing awareness of this being a growing problem in the healthcare setting, it it is exponentially rising across the professions. Even ACOG has a statement about it now. And of course, nursing. We don't have we don't have a really a lot of data yet in midwifery, but we know we're part of that team, right? Right, right, right. If we're not even acknowledging it as in the top five, as important as staffing challenges or fiscal challenges, then we're ignoring it.

SPEAKER_02
16:52

So that's a good idea to do a monthly check-in. Is that within the role of the the director or who takes that on?

SPEAKER_00
17:04

Maybe, maybe, well, I always believe in sharing the the agenda. So it's not the director running a meeting, but it's everybody reporting out on sort of what they're been what they've done, like your data for so many years.

SPEAKER_02
17:16

But so just make it a um a part of the check-in, uh talking about patient concerns, talking about incivility episodes. Yeah, I think that's a great idea.

SPEAKER_00
17:27

Yeah, and like begin to think about it if there's any frequency, or in a safe environment, be able to talk about it. So then maybe the practice director can assist or uh in the conversations with with whoever happened it, you know, whoever it happened to. You don't want to triangulate this. I think it's always important to say it in the moment if you feel like that was inappropriate, but not a lot of people can do that. Um I'm just sort of brainstorming here with you because as I read a few of the articles, even ACOG's statement, it should be it's zero tolerance. It should be zero tolerance.

SPEAKER_02
18:12

It should be zero tolerance.

SPEAKER_00
18:14

And yet it's not.

SPEAKER_02
18:16

Right.

SPEAKER_00
18:17

I would venture to say it's can be quite dependent on who you're working with that particular day.

SPEAKER_02
18:23

Oh, for sure. And then what's allowed, like again, back to the culture of you know, culture of safety really involves um, like who's created the safe space for you to work in and who is addressing these things.

SPEAKER_00
18:37

Yeah. Yeah. Um there's a couple of hospitals we've worked with in particular that we have mentioned team steps to. Have you heard of that program, Denise? We do those, yeah. Yeah, where um, and then AHRQ has a program as well, and ACOG has a program as well, where you can have teams come in and sort of not just assess quality, but safety in terms of communication. And what we're talking about here is communication. Exactly.

SPEAKER_02
19:09

That's exactly right. And we're not talking about outcomes, we're really talking about the process of what occurs here.

SPEAKER_00
19:15

Right. Even Jaco has, you know, taken up this issue in in measuring and trying to assess because of its impact on outcomes. Um I'm afraid to consult with a physician in a timely manner because I'm afraid, I'm afraid. Right. I'm afraid of that person. And it is actually in the top three, I think, with the doctor's company uh data for midwife uh malpractice cases. We're gonna talk about this in in October on a panel. It's it's a delay of communication. And often the delay is fear.

SPEAKER_02
19:50

Fear, fear of being yelled at, fear of being like diminished, you know, devalued, fear of being like sarcastically looked at, like yeah. Yeah.

SPEAKER_01
20:00

Yeah.

SPEAKER_02
20:01

I mean, even like um, I mean, I think also related to like a new graduate situation, um, sometimes I hear like they consult too frequently. Um and um like don't they know what they're doing? I mean, and there, you know, there is two sides to that story, I think. Um, one side is that there should be the freedom of being able to consult with somebody that you're collaborating with. It should be freely open. The other part that I think is missing, Ginger, I mean, I I I have to say is building up confidence in what you do know and having an interaction or discussion with maybe maybe a mentor, another midwife, before you are frequently consulting so you don't overuse that um that line of communication, because then you are frequently questioned as to competence or ability to make decisions. So there's a there's two sides to that one too. Um, but it comes back to the onboarding part where you say, How can you help a new person or somebody who's experienced really a very constant traumatic relationships with in their work um environment? How can you help them before they they recreate the situation in a new environment or feel feel like they're being questioned? Um I have an idea.

SPEAKER_00
21:35

I have an idea. Okay. So let's think, let's think on a timeline when somebody gets an offer or contract, it's usually four, five months before they start. Yes. For that practice director or practice manager or lead obstetrician, whoever, to really have an honest conversation about what is this practice population, right? You have a very high acuity population, Denise. If a new grad is going to come in there and may have gotten a couple lectures on moderate to severe hypertension and have never never managed meds, like what do you want them to start really focusing on during that time they're waiting to be hired? That's a good point. So that they've actually had an honest conversation about themselves. What am I what are my strengths and what are my weaknesses and what am I walking into that I really need to sort of start that I am not comfortable with exactly at all.

SPEAKER_02
22:40

Um I think that is a good point. It's hard, uh it's if they're not already employees, it's I think it's hard to have those conversations because you it's like giving somebody homework. Um, but it it maybe would be um suggestions about how you can become more comfortable with the practice environment that you're entering into, which may be very different than something you've ever done as a student or as a previous midwife, so that you're more comfortable, like creating comfort in your work.

SPEAKER_00
23:10

There's there's, I mean, I've given a lot of people suggestions if they've had a six, 12-month delay from graduation to getting a job. Go take go take a suturing course. Right. Go take the also course that family medicine does. Do something to keep relevant.

SPEAKER_02
23:25

Just do something to keep relevant. Exactly. I do remember coaching a few, even new graduates who, for some one reason or another, they didn't get a job right away. They maybe had a baby, they maybe were relocating, they maybe had a family with a major health issue, um, and or they just weren't getting a job because interviewing wasn't going well, or they weren't, it wasn't it wasn't the right fit, right? Or people weren't hiring new graduates. So, like I do remember saying you can't just sit around doing nothing, right? Because sitting around doing nothing, it just doesn't look good, and you're not helping yourself out. You have to help yourself out to be more um hireable, and also just it that that means creating more comfort within your own ability to even interview, if you will. Right. Um, but also just to say, I've been, I'm I really understand these are the people I want to take care of, and this is what I've been studying. So I go to another continuing education course, or you know, um, I went to a high risks, yeah. So just the same things that you were talking about. Um I think, yeah, I think there's the what you have to do for yourself, um, and uh not also responding to incivility or bullying in a way that's very, you know, combative. I think there's another part that we should talk about as well.

SPEAKER_00
24:50

I and I was about to go there. Do you know you were? We've got a client, we've got a client we've been working with. You you may remember me bringing this up, and we were there in person talking about a particular physician who everybody was afraid of. Everybody, not just the midwives, the nurses, the other dog, everybody. And my response was who wants to take that person out for a martini? Right.

SPEAKER_02
25:16

Right. Extend an olive branch. Extend an olive branch. Um, many times the people that are being very confrontational are really struggling in their own lives, and it's not our job to fix that, but it's okay to like I think really lean on to connection. Yes. Um, I think so many people are suffering from a lack of connection, and maybe they go to work and that's their only connection, that's their only social contact, but they're struggling because we don't really know what people are going through. And so sometimes just you know, friending them or just being there for them in a different capacity that's not professionally related, yeah, can really be very comforting. Um comforting. I I don't know if you know, like I think in midwifery school, ginger I had this experience, um, and you remember it very well. And I won't go into the details, but I remember like having like just a preceptor like asking me things that were not relevant. And I remember like over and over in my mind, I was going through like, how would I talk to them about it? And I remember inviting them to just coffee away from the work site, yes, away from the um educational site, and and then going over in my mind, and I called I called the term, and I I I should just make it official, but I called it comfortation. So you're confronting somebody with um with things that are have made you very uncomfortable, or yes, like it doesn't have to be bowling, but it also works quite well in just saying, like I'm confronting you, but I I want to do it in a comfortable manner for you and for me, you know. So I call it comfortation. I've never heard you say that before. You didn't? Okay, so I do every once in a while to people when I'm talking to them, like if you have to go talk to that nurse. Yes, don't make it intimidating for them, don't be reactive to them because of the fear in the feelings that you have, but make it comfortable talking about your feelings about how it made you feel. It's kind of like nonviolent communication, right?

SPEAKER_00
27:22

Right, right, right.

SPEAKER_02
27:23

Talking about like, but make it comfortable for you so that it's and it's also comforting to them that you can go to them just on a connection and a human level. Um, anyway, I've always loved that kind of thought, just because the person behind all the incivility is is as a human who's potentially struggling or didn't have the great experience of being mentored themselves about how to be kind and compassionate.

SPEAKER_00
27:51

And we don't, at least when I was teaching midwifery and we still help programs start, so I know the core competencies pretty well. Our emphasis on team and respect and communication and problem solving and difficult conversations doesn't seem to resonate to me like how to take care of a hypertensive patient, right? Right, right, right. Um, so I think we're lacking a little bit in that skill set if we haven't inherited it somewhere in our life.

SPEAKER_02
28:23

Right, exactly. And it's not, it's not a it's not one of the core competencies, right? Not as direct as what we're talking about. Not as direct as what we're talking about. Um and yeah, you know, kind of on a side note too, or not really on a side note, it's like we are such advocates. We s we hear so much from patients, families, um, and we we fight so hard for them, but we forget that um, you know, we can be mean to each other. Yeah. And that part has always been the most sad thing to me, but very real.

unknown
29:00

Yeah.

SPEAKER_02
29:01

In nursing, in midwifery, and all in in and a lot of different professions. Um, and you know, I always go back to Paula Ferreri, my favorite, you know. Our favorite. Okay, ours, okay our favorite. You know, the theory of oppression is just we learn to oppress other people because we are in predominantly female, yeah. Or more impoverished, you know, yeah. We're not as valued in a way. So we we learn to oppress because we have been in in many ways.

SPEAKER_00
29:36

And it and and it builds power, the oppressors building power. Yeah. I mean, you know that. My whole dissertation was based on on a lot of his work. And it also sort of brings up one of the possible solutions is you know, his belief that education was key to change. Absolutely. And that every, you know, you don't teach in the classical US classroom as, you know, front expert, everybody in rows behind. You're a circle of learning and that everybody brings something to the team, to the table. And so creating these circles of conversations rather than confrontation. Yeah. Could be an idea, you know. Talk about what each of where each of us are so we know each other better, because I think we're you're just thrown in to a workforce shortage, overstaffing, undervalued in so many ways. And it's just like a pecking order of we're we're the vulnerable people, so I can just rant, you know.

SPEAKER_02
30:42

Right. And I think um in in some of those settings, like people are tired. Yes, they are. Everybody's tired. Um, and some of these reactions are coming from sleep deprivation and stress and and so much like frustration that comes from patients yelling at you. I mean, yeah, the other day I couldn't believe how I had to have a conversation with someone who was calling my fellow midwives the B-word. Oh my goodness. And I said, You need to, I need you to not call them that. I don't, I don't think you understand what amazing healthcare providers they are.

SPEAKER_00
31:22

Yeah.

SPEAKER_02
31:23

When you're calling them a bitch, let's just say, yeah. I said, you're really, really unaware of how much love and compassion and and work they put into this. And I said, it's I I just can't hear this. And I need you to hear that that doesn't feel good at all, you know. And they um on this, I mean, and they're coming from a place of being, you know, unloved and unappreciated themselves. So it's it's I know that it it's, you know, they're young and like had a rough life, but it's still like at some point you kind of have to call it out at some point.

SPEAKER_00
31:57

Yeah. On this A-O-N-L survey I mentioned, I I didn't give you all five. I think I gave four, but the highest ranking one, Denise, was violence and safety in the workplace. Yes. And how significant that has risen over the past few years. Yes. Yes. So we're not necessarily the most trusted profession. Like the title of our panel, one of one of the panels I'm doing in the fall is Decline of the Hero Narrative. There's a reason why we called it that. Um because of the amount and increase of disciplinary and administrative hearings in our profession, which is what we what we're seeing, and who it's coming from. You know, it's it's coming from within physicians and and nurses, but also from the public.

SPEAKER_02
32:48

And I and for some reason it's I don't know why that's even allowed. I don't know. Hey. Oh, it's it's raw. So I think, you know, it's hard, it's hard to be working sometimes. It's easier to be at home and doing nothing. Yeah. Okay, that's true.

SPEAKER_00
33:05

You know, go teach a science class.

SPEAKER_02
33:08

Right. So, okay, so we we have really highlighted the fact that incivility is coming from many different levels. Yes. Many, many different levels, um and undervalued, um, basically institutional and individual and interpersonal and and from above and below and everywhere.

SPEAKER_00
33:31

So maybe one of the things that a practice could do or a midwife who is feeling vulnerable wherever they are in their career, is download the AC and M position statement and and say, can we talk about this? And can we maybe elevate this for a while and measure what we see going on if not just 10 of us feel it's a problem, but even if one of us feels it's a problem.

SPEAKER_02
33:59

Okay, I love that. Okay. I love that. I don't know if um we just started having a book, like a book club, not really a book club, but read an article and discussion. And I think, yeah, like I think that would be just a great statement to review.

SPEAKER_00
34:15

Yeah.

SPEAKER_02
34:16

I'm gonna put that out there.

SPEAKER_00
34:17

Cool. Yeah. Um I know that it has been an elevated topic at ACNM, the annual meeting over the past uh couple, couple meetings. I'm hopeful there's some out there um in the fall. But I think part of part of how to work on diminishing this, I don't think we'll ever eradicate it. We can help the transparency. Okay. Not being afraid to show your own vulnerabilities. You know, maybe you wish you would have done something different and somebody called you out, but it was in such a horrific way that it's left you traumatized or whatever. Our own vulnerability and fear. Um, but you know, if left unchecked, it can go it can affect your career, it can affect your license, uh, all kinds of things.

SPEAKER_02
35:12

A slow growing cancer. There you go. Okay, so um you're talking about transparency, and I think transparency is good. Is there an element in this transparency that also might involve like humble accountability?

SPEAKER_00
35:30

How do we add that into a self-assessment process, right? What what, if anything, was I contributing by my silence, by my need to learn more in this area, by that that is part of the conversation.

SPEAKER_02
35:46

I know. I I remember this from one of the MM sessions. Yeah. And I remember this physician who I I dearly love. And he said, you know what, I did wrong. I this is what I did wrong in this case. And it always stuck with me that he had the humbleness to be accountable and to state it in front of everyone about what he could have done better or what he might have missed. And like I think that was for me like a moment where I my respect for him grew so incredibly much because I do think we always want to push things. I mean, sometimes things we do mess up, right? We're humans. Yes. So I think it's important and you gain so much more trust if you can just say that and owing it.

SPEAKER_00
36:34

And is there someone willing to mentor me or provide me some good resources or guide me in what might be the next way to do this differently? Right. Instead of just like, okay, now what? Nobody does anything to help the person.

SPEAKER_02
36:53

No, like I mean, yeah, I can recognize I did something wrong. And if I if it's a one-time thing, fine, but if it's a knowledge gap, yeah, um, or a confidence gap, yeah. How can I make that better?

SPEAKER_00
37:04

That's a tough one. The confidence gap. I mean, we've got we've got midwives out there more than two or three years who still are terrified.

SPEAKER_02
37:11

I know.

SPEAKER_00
37:12

And sometimes it is their work environment. They're being constantly questioned, and that eats away at your confidence.

SPEAKER_02
37:18

Right. I agree. I agree. Okay, so we have so many ideas spiraling around here. Um, all right, so I'm gonna just summarize some of them. One is have a monthly check-in about incivility, two, read the AC and M position statement, and it sounds like accountability and mentorship, they go together. They're opposite, but also not.

SPEAKER_00
37:45

Yeah.

SPEAKER_02
37:46

What else have I forgotten?

SPEAKER_00
37:48

Some some honest self-reflection, you know. Self-reflection, whatever. In that, in that experience. And and I'm not sure how we want to phrase this, but it's the idea of taking somebody out for a martini that you're terrified of, right? Can not confront them, but your word. Um connection. What's your word and comfortation? There we go. Comfortation. Denise Rosalka. Yeah, you know, yeah, I mean, put that on a t-shirt, Denise. I think that is an essential element to the one-on-one resolution versus the system trying to resolve something as the only answer.

SPEAKER_02
38:27

Yeah. I think we we all know Ginger, like the system only goes so far, right? Right. And the system feels punitive most of the time. There has to be like it's rigid, it's there's rules about it, there's it's written down, permanent, there's permanence about it. Um, it's intimidating, it's frightening. Yeah, it's like it back to it's very paternalistic and punitive. I think I think the individual check-in comfortation, like connection is just it's it's such a more humanistic way to go about it.

SPEAKER_00
39:04

Hey, so let's let's throw, let's throw in our guy, William Murray, and how do you get to yes, right? How how can some of this self-reflection journey and putting yourself in the shoes of the other person, right? How can you use some of his remarkable skills to have that confrontation? I'm not saying it right. Spell it for me. Comfort, comfortation. Comfortation. Yeah. You have to be ready to do to do that, or you're or you're gonna end up even depleted more.

SPEAKER_02
39:39

Oh, but it takes no, like seriously, there you have to mindfully walk into it. Like I had a practice, and yes, and then you know what I did? I just also I I recorded myself having the conversation. Um, so I could remember what I said, because the first time I say something is always the best. Yeah. And then when you re-record yourself, you're like, no, that wasn't as good as the first time.

SPEAKER_00
40:02

So you just practice and you know what you're you know what I'm feeling when I hear you say how much effort you put into this. Yeah. It was a very challenging conversation. It was frightening, ginger.

SPEAKER_02
40:13

You're talking about a young student, student who's talking to a professor, you know. And can I tell you something? The end result of that is that as I was going through the line of graduation and being congratulated and handshaking and hugs with the midwives at the end, you know what this person whispered in my ear? Thank you so much. What you did helped me to become a better professor. And I learned so much from it. I have goosebumps. Of course, I cried.

SPEAKER_00
40:47

I have goosebumps.

SPEAKER_02
40:48

Yeah. I know, and because because they everybody can always learn.

SPEAKER_00
40:52

Yeah.

SPEAKER_02
40:53

Um, and if you're willing to just own it, I think, yeah, you our job is to become to transform in life, right? So yeah. Now I got goosebumps.

SPEAKER_00
41:02

Yeah, what a great, what a great story to share for students who are struggling with their preceptors. We know that's another significant problem that is very difficult. I don't care if you're brick and mortar or community-based education program, the things that can happen one-on-one behind a closed door, your your faculty can't see. And so those you're so vulnerable as a student, probably more than when you're working as an employee in some ways. The protections are so far removed. I mean, anybody that knows me knows I've called out a university here in the great state of Kansas.

SPEAKER_03
41:39

Yes.

SPEAKER_00
41:40

Uh, and it is wrong that that can be perpetuated. Right. There are rights that students have in addition to what what you shared, which was your own way to try to resolve this, uh, without involving maybe higher people in the institution.

SPEAKER_02
41:58

No, I didn't, I didn't want to. I needed it to be my learning. I need I needed it to, I needed to do it for me. I didn't want anybody to be my voice.

SPEAKER_00
42:06

Yeah.

SPEAKER_02
42:07

Um so I mean, I think also like I'm thinking about students too, um, andor new graduates. Um, again, I go back to it's a two-way street. Um, and sometimes I'm like considered the tough teacher. Yes, you are. Um I mean, the reality is is like my perspective on that is you spend so much passion and love and desire getting into school, and then you spend so much time and money to be a student, and and like you owe it to yourself to do the best you can. And if you're just trying to skirt through, it's not serving you or the people that you're taking care of um the best if you're if you're not trying to be so you know, own a little bit of what your what your role is if you are not up to par. Yeah. And be prepared. I'm re I mean, I think I'm repeating that because I do believe accountability is is really part of your own ability to transform, your own ability to become more confident, yeah, and to then have these occurrences of confrontation and and then you become a leader. You can become a leader, you know.

SPEAKER_00
43:24

Yeah, that's so true. So true. Um graduate school is not a free ride.

SPEAKER_02
43:32

It shouldn't be.

SPEAKER_00
43:33

It shouldn't be.

SPEAKER_02
43:34

It shouldn't be.

SPEAKER_00
43:35

You shouldn't be entitled just because you got in a program, right? No, it's a huge investment.

SPEAKER_02
43:40

And you gotta do your work. You're taking care of people's lives. You're taking care of people's lives and you're, you know, yeah. You're representing. Yeah. And if you're gonna be a midwife, yes, I do have high expectations. I want you to be a good midwife.

SPEAKER_00
43:54

Yeah.

SPEAKER_02
43:55

I don't want you to just be a good thing.

SPEAKER_00
43:56

Hey, Denise, when they come out on the other side, you're always the favorite preceptor. You know that.

SPEAKER_02
44:00

You know, I mean, I don't know. You are. I I love what I do, and I'm not gonna do it um, I'm not gonna do it half-assed ginger. So like if you want me to just sign off, it's not never gonna happen. Yeah, I don't want my name on something or someone if you're not gonna do a good job and try.

SPEAKER_00
44:19

Yeah. It's so funny.

SPEAKER_02
44:20

I tell everybody, like, every day that you're a student is a job is your is your job interview.

SPEAKER_00
44:25

Yes.

SPEAKER_02
44:26

Every day that you're a student, and because I will tell you 100% that, oh, I will tell you that we uh we have maybe not accepted certain students because of the way they treated as people as a nurse.

SPEAKER_00
44:40

Oh wow. So incivility as a student to the to the staff.

SPEAKER_02
44:45

No, no, no, as a nurse to the midwives they work with, they were then, if they went to midwifery school, they might not have been accepted because they were not like maybe a good fit because they just can questioned, challenged, yeah, and would have turned anybody in for any slight thing. And it's like maybe this right here is your lesson. Yeah. Because it was discussed why, and maybe this is your lesson about like really think about what you're doing in the workplace. Yeah.

SPEAKER_00
45:17

I think I mean that's giving me another idea. So if if a setting can identify a frequency or even one event, if you go to Team Steps and AHRQ, even one event is a symptom of a bigger problem. Um we always give people second chances. I know, I know, but still it's it's like if you believe in zero tolerance, that's what it means. Um like a discussion at grand rounds or a discussion amongst, you know, take it up to the next level of this is an this is an observed behaviors. We have sufficient evidence to believe it's happened, we'll just say more than once. What are we gonna do about it? How can we have a convening where everybody can get together in a safe environment so there's no retaliation and figure this out?

SPEAKER_02
46:18

How can we walk together?

SPEAKER_00
46:20

That's it. It's Yuri, right? Right. How do we get to yes?

SPEAKER_02
46:24

How can we walk together and figure this out?

SPEAKER_00
46:26

Yeah, that nobody's more powerful than anybody else here. And if we want the best outcomes for our patients in a workplace climate that isn't gonna cause high attrition because it happens year after year after person after person, when is it gonna stop?

SPEAKER_02
46:42

That's a long sentence, Ginger, but it's all linked and related. It is. Yeah, it is.

SPEAKER_00
46:51

I don't know. Have we exhausted the topic? Probably not.

SPEAKER_02
46:54

I don't know. We could go on and on, probably with examples of what we've seen in you know, people that we have consulted with or coached. Um I mean, there's so, so many of them. I mean, we didn't even really talk a lot about kind of being reported to boards.

SPEAKER_00
47:12

If people want to learn more about that topic in particular, we've about got our PowerPoint slide deck done. It's a panel of four of us, myself, Joe, my husband, who's an attorney, that's gonna talk about the difference between a malpractice case and a disciplinary case and how just inherently different they are. And then two midwives who have gone through administrative hearings within their settings. They're not gonna go into their stories because we don't necessarily think that's appropriate, but the process of having to navigate, worry, uh, survive, come out wanting to stay in the profession, they're profound stories. Um, and we hope that that is something people find valuable to mitigate the risk of those things happening, right? What can we do to prevent that kind of in this one case, a physician who nobody liked in the entire system, uh causing great harm to a midwife for no reason. And yet it took her out of the workforce for months. And in the end, she was exonerated.

SPEAKER_02
48:29

And in the end, she was exhausted and oh will forever carry that with her and hopefully, hopefully, hopefully heal from it and become back and help others, which it sounds like just with your workshop um presentation, that's that's uh I think it's like how do you nip it?

SPEAKER_00
48:49

How do you nip it in the bud? You know, you be transparent, you don't let it go on for two times, three times, four times. And you you you become transparent. Go to the go to the balcony, you know.

SPEAKER_02
49:04

Go to the balcony, find a golden bridge. Um, but again, it comes back to like uh having the resources or the people mentor that maybe can help you if you're not able to do that, figure that out on your own.

SPEAKER_00
49:17

Yeah, because you are very vulnerable.

SPEAKER_02
49:19

You shouldn't have to be able to figure it out on your own if it's yeah, you know, we can help each other.

SPEAKER_00
49:25

Yeah, definitely. And you I mean, you can reach out to Girl Midwives. We're willing to help you if you can't find someone who will listen to your point of view. I can I can think of several midwives who were literally ran out of a practice, and I just sit here and think to myself, what the heck's going on there?

SPEAKER_02
49:43

I know. And such good midwives sometimes, Ginger. I mean, you know, I would keep thinking about how like people always offer the employee assistance programs. I don't, I don't think that. I don't think this is the right, this isn't helpful. Yeah, yeah. It might help the stress, but I think we need um midwife assistance programs.

SPEAKER_00
50:06

I like that idea.

SPEAKER_02
50:07

A map, a map to get through. There's your little ad.

SPEAKER_00
50:11

Oh my gosh, Denise, you just keep coming up with all these ideas. When are you going to do that?

SPEAKER_02
50:14

If you let me talk, I I I often do.

SPEAKER_00
50:20

Oh gosh. Well, why don't why don't we have a map program? There we go. Get get to work, buddy.

SPEAKER_02
50:27

I I'm tired of working this week. Okay, all right, I will.

SPEAKER_00
50:33

Uh let's end. Let's end with some calls to action. Do you want to go or do you want me to?

SPEAKER_02
50:38

You go because I don't even know where to go. There's so many calls to action. I think I already have mine, a midwife assistance program.

SPEAKER_00
50:45

I love that one. I love that one.

SPEAKER_02
50:47

It could be, yeah, maybe. Um keep me talking, maybe something else will come up because there's so many calls.

SPEAKER_00
50:53

To seriously let our listeners know there is an AC and M statement. And to maybe think about that idea of sharing it in in your group and just open the conversation and see if anybody's brave enough to say anything more than once. And and just say, hey, maybe maybe we should measure this like a benchmarking tool or something like that. And and look for prevalence and then begin to think about what could be a plan.

SPEAKER_02
51:23

Oh, it sounds like my second dissertation topic, of which I had third total. Um emotional trauma over that one. No, like I mean, I just uh yeah, my set my first one turned into studying the second one because the behaviors of the related to the first one. Right. People, people, not the topic. And then I surrendered it all and went to something else I'm very passionate about. But yes, Ginger, you're right. Studying it. Oh, I just need to be a student again. Okay, maybe I could just be a postdoc.

SPEAKER_00
51:55

Anyway, maybe you should create these programs because you already know what the problems are.

SPEAKER_02
51:59

I do, I do. I love them. Okay, I should retire and then start over again. But, you know, my firm belief that some of your greatest information comes from clinically working, it's it keeps me there. It keeps me there. I love it. I love it. Okay. Um, so I don't have an additional call to action because like there's a lot of action that's I'm already gonna do from what you suggested. And um, I can't create more work, I just have to do better what I'm already doing.

SPEAKER_00
52:30

Well, I love the fact that you are in the workplace setting. And and man, I might come back to you and go, hey, didn't anybody did anybody tag on to that one? Does anybody go, hey, that's a good idea?

SPEAKER_02
52:42

Okay, I'm gonna um, but I will bring up the idea of the incivility statement because I do think I've already planned that.

SPEAKER_00
52:49

So cool. That's great.

SPEAKER_02
52:51

Well, um, so I feel like this is just this might there might have to be a follow-up on this topic. It's I agree too big. And so I invite all of our listeners to come and make comments, requests, ideas. And I think really this deserves many more sessions, okay, maybe a couple more. Yeah. But we want to hear maybe not just your experiences, but also just like ideas. Yeah. How can we blow this out of the water and just I think as midwives, it's so within our purview to just be able to help fix this.

SPEAKER_00
53:32

Yeah, you know what we didn't even talk about was what your rights are what your rights are.

SPEAKER_02
53:36

Uh, we didn't. So session number two.

SPEAKER_00
53:39

Yeah, and I think bringing Joe on, it might be a good segue for him to talk about that. Okay. Um, and even the people who are sharing didn't really know what their rights were. Okay. Um, and and these were not malpractice cases. These were administered, these were administrative cases. To be continued. To be continued, yeah. I love that idea, Denise. Okay. All right. All right. Have a great day.

SPEAKER_02
54:04

All right. Thanks everyone for being here. Thank you, Ginger. Yeah. Bye bye. I hope we deal with the heat well. Yeah. This is a hot topic in front of you.

SPEAKER_00
54:14

We're going, we're going on a river rafting with our two granddaughters uh over Labor Day weekend, so we're excited about it. All right. Take care. Bye bye.

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