Episode Summary
Maggie Runyon spent a decade at the bedside before she stopped to ask the question that became her book. What does it actually mean to help inside a system that often asks nurses to do the impossible? In this conversation with Hillary, Maggie unpacks the gap between what nursing programs teach about advocacy and what advocacy looks like on a real labor and delivery unit, where unit culture, shift dynamics, provider preference, and hospital policy all collide in the same patient room.
We get into the parts of nursing culture that rarely get named out loud. The savior story that gets passed down from one generation to the next. The hero language that flattened during the pandemic and never really left. The high turnover that puts newer nurses in charge roles before they have built the clinical confidence to push back on a questionable order. Maggie is clear that nurses hold real power in birth care, and she is just as clear that the power gets squandered when no one has time to process what they witness before the next admission rolls in.
If you are a birth professional who has felt the pull to keep giving past the point of sustainability, this episode lands. Maggie talks about Code Lavender, debriefs, and the practical ways units are starting to build trauma response into the workflow instead of treating it as a personal failing. She also talks about the friend group that holds her accountable to her own rest. The throughline: you cannot save the system, you can advocate alongside the people in it, and you have permission to take the cape off.
Listen to This Episode
Episode Time Stamps
00:20 Welcome and why this conversation
01:13 The kernel behind I Thought I Was Here to Help
02:46 What nurses are taught about advocacy versus what they practice
04:53 Charge nurse at six months in
06:04 Why night shift sees the least experienced staff
07:06 Layers of nursing culture, unit by unit, shift by shift
09:24 Building advocacy muscles through small acts of pushback
11:14 Holding the room when provider preference clashes with patient preference
13:24 What is and is not the nurse’s job
15:20 Where saviorism in nursing comes from
17:09 Community care as the foundation for self care
20:02 The line between saving patients and saving your community
21:52 Trauma informed care starts with your own nervous system
24:08 The ego check that birth work delivers every time
25:09 Hero capes and why the label causes harm
27:23 Witnessing trauma without space to recover
28:53 Dr. Karen Foley on avoidable and unavoidable trauma
31:29 Toeing the line as a hospital nurse who birthed at home
33:35 Trauma rolls downhill to the next admission
35:44 The lab, blood bank, and techs nobody debriefs
36:49 Code Lavender, serenity rooms, and what real support looks like
40:19 Building debriefs into the incident report itself
42:10 What empathetic leadership actually requires
43:17 The journal prompts and tools inside the book
44:06 Where to find I Thought I Was Here to Help
Key Takeaways
1. Nurses are told to advocate, then handed almost no practical training in how. Maggie names the gap directly. The code of ethics says advocate. The unit culture decides what advocacy is allowed to look like that day. The result is moral injury that gets blamed on the individual nurse instead of the structure she is working inside.
2. Charge roles too early are a turnover symptom, not a leadership pipeline. When a nurse is running the board at six months in, that unit has a staffing problem. The patients pay for it in inconsistent care, and the nurse pays for it in the confidence that never had time to develop.
3. Provider preference and patient preference are not the nurse’s to reconcile through pressure. The job is to liaison, not coerce. Maggie is firm that nothing in the nursing scope authorizes convincing a patient out of what they want so that the team is more comfortable.
4. The hero label is not a compliment, it is a workaround. Calling clinicians heroes lets the system avoid staffing, debriefing, and adequate resourcing. Maggie wants language that names humans doing hard work, not superhumans who do not need rest.
5. Trauma rolls downhill when there is no space to process it. The nurse who loses a patient and gets a new admit thirty minutes later is not actually starting fresh, and neither is the family on the receiving end. Unit policy that does not build in recovery time is shaping the next labor in ways nobody is tracking.
6. Self care without community care is not sustainable. Maggie is clear that helpers stay in this work by being held by other helpers. The friend group that calls you out when you are pouring too much in. The colleague who notices and asks. The manager who offers the next shift off without making you ask for it.
7. Code Lavender exists in more hospitals than nurses realize, and most of the lines are broken. The training Maggie ran found defunct numbers and dead links across well-funded support programs. The systems are in place. The plumbing needs checked, and the stigma around using them needs named.
Mentioned in This Episode
I Thought I Was Here to Help by Maggie Runyon
Dr. Karen Foley’s research on the seven types of psychological trauma in nursing
Code Lavender and serenity room programs in perinatal units
Read the Full Transcript
This transcript is auto-generated and lightly cleaned. It may contain errors, misheard words, or formatting quirks. We have left the speakers labeled as recorded.
DR. HILLARY MELCHIORS (0:20): Hello, Maggie. MAGGIE RUNYON (0:23): Hi, Hillary. How are you? DR. HILLARY MELCHIORS (0:25): I'm so good. How are you doing? MAGGIE RUNYON (0:27): Oh, I'm just so happy to be here. I'm very excited for this conversation. DR. HILLARY MELCHIORS (0:31): Okay. I'm gonna attempt not to fangirl a little bit because I've been a long time follower of yours on social media, and in case you didn't know that, I love what you're doing. And then I saw you wrote a book. I was like, okay, clearly we need her on the podcast. MAGGIE RUNYON (0:51): Oh, yeah. Thank you so much for the invitation. I'm really excited about the work that you all have been doing. Ready to hear the conversation that comes from this conversation. DR. HILLARY MELCHIORS (1:01): Oh, I love that. Fantastic. Well, I want to jump in a little bit and start with, where did the initial kernel of the idea for this book start? Let's start there. MAGGIE RUNYON (1:13): Yeah. So the book is called I Thought I Was Here to Help. And the kernel was really that sensation of feeling like so much of becoming a nurse, I really did think, I am a, I talk about this a lot. Like I'm an empath. I'm a type 2 on the Enneagram. I am very much a helper at my core, which is not a bad thing. And it is a complicated role to carry in the healthcare system, in my personal life, in anything. And so I think when, probably 10 years into my nursing career, I was really, really wrestling with, what did this mean? What does it mean to be a nurse in the system, particularly within birth care? What does it mean to show up? How am I helping? How am I hurting? What does my advocacy need to look like in this space? And so then three years ago, I was really at this crossroads where I was like, okay, how do I start having this conversation with more folks outside of my circle? And was kind of like, okay, do I go back into the nurse educator role? Do I write a book? And I decided to do both. So here we are. DR. HILLARY MELCHIORS (2:20): Oh, I love it. So I've been a fan of you partly because of your obstetric violence work as well, because that's very much in my heart as a doula and as an academic. So that's how you were on my radar in the first place. And then I'm like, oh, amazing. First, I want to ask, how much are nurses taught about advocacy in their training? Because I know that nurses are told they're there to be advocates, but how much are you taught actually to do that? MAGGIE RUNYON (2:54): Yeah, I think that's the crux of it. I think we talk about it. Nurse advocacy shows up in our code of ethics and any text. When you think about the nursing role, we talk about being advocates. Where the rubber meets the road is then, how do we actually do that and what does that look like depending on the culture of your unit? I find that it's very unit specific, very hospital systems, very state specific, country specific. And so I think that's where a lot of the moral injury, burnout, a lot of the difficult mental health issues and stressors and trauma that nurses experience through our role comes from. That not understanding, that identity piece of feeling like, oh, yeah, I was supposed to be an advocate. Then I showed up here and when I tried to advocate, I was told, this isn't your lane. I was pushed back into my place. I realized that advocating for my patient was at odds with the hospital's policy. That's where a lot of the stress comes from. So yes, in my personal experience and most of the nurses who I've talked to, we talk about advocacy a lot and then we end up feeling a little bit light on the practical implementation, practice of that idea. DR. HILLARY MELCHIORS (4:07): I hear pushback from a lot of nurses in my life, as a birth doula, who say, yes, and we have to still respect the hierarchy of everything and know who's in charge. Agreed, all of that. And you also still have to advocate for safe care and self care. MAGGIE RUNYON (4:31): And self care. Sure. DR. HILLARY MELCHIORS (4:32): Do it both, for sure. I was really interested to hear if there is actually practical advocacy work. I assume part of the practical training that you're doing as a nurse on the floor, and you talk a little bit about that in the book. I was shocked to hear how quickly you were basically put in charge. MAGGIE RUNYON (4:58): Oh, yeah, right. DR. HILLARY MELCHIORS (4:59): Wild. MAGGIE RUNYON (5:00): Yeah. DR. HILLARY MELCHIORS (5:01): That's not standard, correct? MAGGIE RUNYON (5:04): No, it is not standard. It shouldn't be that way. So yeah, I share in the book that I was operating as a charge nurse within, like, I think it was like six or nine months into my nursing career, which was intense. And I talk about how I had a lot of support. There were lots of other people, I'm in charge in quotes, but there's obviously other more experienced nurses who are also there. You're not on your own, but yeah, that is not typical and for good reason. DR. HILLARY MELCHIORS (6:03): Oh, interesting. MAGGIE RUNYON (6:04): Yeah. And so in a lot of places, especially on night shift, you're going to see nurses with younger, less years of experience under their belt because of the way that hospital hierarchy staffing stuff works. A lot of times night shift is not desired by as many folks. So that's the stepping stone on the ladder to getting the hours position you want. And so it is not uncommon to have newer folks in that role step into the charge earlier in that space in particular. DR. HILLARY MELCHIORS (6:49): And do you feel, I feel like some of that's culture, and maybe that's just me as an anthropologist coming in, always saying, oh, it's culture, it's culture. But culture change is, Lord. MAGGIE RUNYON (7:04): Yeah. DR. HILLARY MELCHIORS (7:06): Can you talk a little bit about what you feel might be contributing there? MAGGIE RUNYON (7:13): Yeah. So I think, we love talking about culture and I think the work we do, because I think so much of it is embedded. I think there's nursing culture, the big overarching umbrella for all that. Then there's perinatal birth care culture and then there's the individual hospital, unit, state, what they're used to. There are very distinct cultures between day shift and night shift, between this crew and that crew. There are so many standards that we are held to. There are standards within the nursing profession, then there are standards within birth care, and at times those are at odds with each other. And then I think nurses are often put in the middle of it. DR. HILLARY MELCHIORS (10:55): I completely agree. I always say, I can have the same nurse, but if my client has a different provider than when I was with that nurse the last time, that nurse might act completely differently because nurses have to navigate so much of provider preference. MAGGIE RUNYON (11:39): And I love to talk to nurses about how our role is a patient advocate. I have to be aware of the milieu. I have to know about all of that stuff. I have to be aware of the family who's at the bedside, and their doula and any other supports. And I am not responsible for managing all of those people's experience. In fact, all of us are meant to be there to support the birthing person. When I am struggling, when I'm in positions where I'm finding that there is that rub, just to recenter on the person I'm taking care of today. I am never going to convince the patient to do it a way that they don't want to do because that matches up with a provider's preference. That is solidly not my job. DR. HILLARY MELCHIORS (13:24): Thank you. MAGGIE RUNYON (13:26): That is something I want all nurses to feel very confident in. We are not here to coerce or convince anyone to do something they don't want to do to make someone else feel more comfortable. DR. HILLARY MELCHIORS (15:18): And that's the importance of advocacy. I loved that you went into the history of the profession of nursing and talked about why there is this culture of saviorism within nursing and why that's so problematic on so many different levels. How do you find yourself when you're pushing back against this norm? MAGGIE RUNYON (16:25): Self care can't happen without community care. And when we are surrounded by people who are committed to doing this work together, who are ready to advocate rather than save, we can figure out, okay, I can't save anyone, but I can advocate alongside everyone I meet. I can support my friends when they're struggling, when I see that they are burning out from this work. When we are surrounded by community, it gives us comfort and safety, and then caring for ourselves in that sense of knowing, I'm not holding this line by myself. There are lots of us who are doing this work. I am so lucky to have been able to cultivate this friend group where we can lovingly call each other in and out, when we're seeing like, hey, are you doing too much? DR. HILLARY MELCHIORS (19:48): It can be a fine line, though, sometimes between, I'm trying to save my patients and I'm trying to save my community. MAGGIE RUNYON (20:22): It is my life's work, figuring out how to continue to step back from saviorism, how to catch myself from pouring too much of myself into work that then doesn't let me show up fully in the way that I want to. Like Mandy Irby talks about, one thing for trauma informed care, and it's not patient or client facing, it's yourself. Regulate your own nervous system. Figure out how to care for yourself. Address your own trauma. Go to therapy. Work on healing what is going on with you so that you show up. And truly, if each of us did that work, that would ripple. DR. HILLARY MELCHIORS (23:38): It's so undervalued in our culture. We're just go, go, go. And a lot of what you're talking about requires a pretty big ego check. MAGGIE RUNYON (24:27): One of my colleague Tara, who works at Debriefing the Front Lines, has a workshop all around the ego death of the bedside nurse. We come from the handmaiden, helper role, and then you step into this healthcare hero jargon. We're not heroes, we're humans. Slapping that label on clinicians does nothing to solve our traumatic stress. It does nothing to care for us, for our burnout. It does nothing to shift systems so that people are not expected to show up and to be superhuman. DR. HILLARY MELCHIORS (27:23): And I think you speak about this as well, the PTSD and the constantly witnessing and not really being given the space to recover. To me, that's the biggest disservice we do to medical staff, is not giving them space to be able to recover from what they have to witness. MAGGIE RUNYON (28:53): I love Dr. Karen Foley. She has a theory that explains seven types of trauma that nurses are exposed to through their work. Her acknowledgement that there are unavoidable and avoidable types of trauma in our work. The unavoidable stuff, trauma is part of the human experience. The avoidable, take care of the resources. We should always have adequate resources to do our job. That never needs to be a source of trauma. Get rid of the incivility and the bullying. DR. HILLARY MELCHIORS (32:19): I see that all the time with providers and nurses, the immediate aftermath. All of the patients that they're taking care of immediately afterwards for the next year or more. That trauma also rolls downhill. MAGGIE RUNYON (33:05): If I take care of someone who has a really difficult birth outcome, and then half an hour later, new admit, and I'm expected to walk in and act as if I just didn't walk through, as if my heart isn't still galloping, it's completely unrealistic. We need time off to heal. We need to debrief with folks. We need to have that support. When we talk about advocacy, it's not always patient advocacy. This is advocacy for ourselves. DR. HILLARY MELCHIORS (36:38): There are some systems trying to work on this. Is it the code lavender? MAGGIE RUNYON (36:49): Code lavender and serenity rooms, lavender cards. A whole initiative to get supportive services to folks after there's any sort of trauma. Usually at a minimum, there is a cart that has soothing things, prompts for mindfulness activities, audio tracks, relaxing teas, mood lighting. Often someone from social work or chaplain available to process. MAGGIE RUNYON (38:20): One is the stigma piece, then the other is, it theoretically exists. But how do you get it? We did a training and asked perinatal leaders to walk through and activate all of their resources. Defunct number. Link goes to nowhere. By walking through that process, they found that people on the other end of the line did not know they weren't getting connected. One person checked at nighttime, couldn't get through, sent some email. She had three calls back within the hour. So many people are invested in this. They want to provide this care. DR. HILLARY MELCHIORS (42:10): It takes a really empathetic leader and structure to make sure everyone's feeling supported within the healthcare system. MAGGIE RUNYON (42:41): These shifts will not happen, these are not one person shifts. These are us gathering together, making sure our voices are heard, working collectively for what we need. DR. HILLARY MELCHIORS (42:58): I really appreciate about your book that you also give people tools. All these mindfulness tools and journal prompts. MAGGIE RUNYON (44:06): MaggieRunyon.com has all of the insights. There are links to buy the book. It is available on Amazon. For folks who don't love Amazon, there are options as well to buy it right from the printer. And there's an ebook for folks who want to just have me in their back pocket at any moment. DR. HILLARY MELCHIORS (44:29): Maggie Runyon, thank you so much for coming on The Birth Geeks Podcast. MAGGIE RUNYON (44:38): Thanks much. I appreciate it.