[AmAnRN]

Hi, i dont know how many of u know me, but i started working PP in january after working on a medical floor for 6 mths. anyway, i had 2 questions..
1) i was thinking about orienting in L&D.. i was just wondering how long it takes to catch on to -i guess -"guesstimating" ?? how the labor process is going (as far as dil/eff/station) because i mean, how do u know what numbers to give what you feel? get my drift?? i guess it just takes practice?
and 2) as far as PP.. do alot of you all get medical overflow on your floor? we have been getting a lot more medicals lately and we hate it! we are OB nurses!!! we want to work with OB patients!!!! the other night we had 12 pts and only 5 were ours (OB.) but anyway, just wondered how the other hospitals out there were.
Thank you!!!

[hollybear]

well it just takes lots of practice and when in doubt call more experience nurse in to check and verify. its not as hard usually as you think good luck

[moz]

I learned by feeling the cervical dilatation charts, over and over and over and over again. I heard one nurse say she felt mayonnaise jar lids, doorknobs, anything to compare sizes. Having a good preceptor really helps also. I've done this for 7 years and sometimes I still after a check go to the dilatation chart to double check myself. You may find after you've done it awhile that certain docs will always be a little more or less than you on exams. The most important thing to know is if they are complete or not .
We do about 50 deliveries a month, and we get hysterectomies now, rarely to we get just med surg overflow. I agree, I want to do ob, not med surg. Floating is not a favorite of ours either.
Good luck to you!

[SmilingBluEyes]

There is not a set timeline as to when one becomes competent and independent in L and D. But I have to say, it took me about 1-2 years to feel any real confidence in independent practice in L and D. It's a bit more complicated and fast-paced than PP and M/B is (ok a LOT)......

Practice is what it takes....that and time. Try to find a really good mentor: An RN who is very experienced in L and D and likes to teach and follow that person.

Also, yes, we DO get surgical and occasional not-too-complicated or "infected" medical overflow in our PP rooms. You need to understand something: OB is on the BOTTOM of the hospital food chain in staffing and bed assignments. If you have an empty bed and they are busy in med/surg, you can expect they will fill your bed with a "clean" female patient. We as OB nurses may not like this, but it is necessary. I suspect this practice will become increasingly common as medical/surgical beds remain full all the time. (our ER's and PACU's are full of patients waiting for beds frequently where I work).

Additionally, In some hospitals, OB nurses are expected to float, when their floors are not busy enough, to help out on these other floors. It's very common. You can either accept this or find a hospital that does not do these practices; they are few and far between unless you work on an exceedingly busy OB floor. All that said....

I think orienting to L and D would be a smart thing to do. Don't be afraid to explore this and further your knowledge base. I wish you the best!

[ShandyLynnRN]

our "women's health" unit gets all post op hysts, many other post op "female" surgeries, and overflow from the med surg floor as long as they are female and non-infectious. I actually like it because it helps me keep my med surg skills current.

I think the more you practice, the better you will get with cervical dilation. There are always the charts to double check yourself with, and I still use them after 2 years of doing L&D. I had wonderful preceptors, and wasn't afraid to ask questions.

Getting the station down, well, I still haven't mastered that one. It's more of a guesstimate for me. Effacement is pretty subjective. I just start with thinking about the cervix being about 2 inches at the beginning, and going from there. I just call it "thick" until I can safely call it 40% effaced or so.

Good luck!

[mark_LD_RN]

it takes time to get it down I used to ractice with dialtion charts, would close my eyes randomly place finger in one measure it and quest what it was then open eyes to see if i was right , i also practiced on anything i can find jars door knobs,bottle caps etc.

we alos to clean GYN patients to care for and float to peds which is our counit. we used to be required to float all over the hospital.

don't be afraid hopefully you will have a good preceptor and do not be afraid of asking questions or for a second opinion. i still have to ask for 2nd opinion at times.

[layna]

I must confess that for the first 5 years of my L&D career, I made sure that I had one of those dilation boards with me at the bedside and after doing a vag exam, would immediately check to see which hole on the board represented what I felt. I made it look like I was using the board as a teaching tool for the patients!! LOL

[Disablednurse]

Moz, is that beautiful red headed baby yours? I just had to ask. I love little redheads and this one looks so mischevious.

[Sleepyeyes]

omg, amanda, I could never float to L&D! Med-surg only!! WHY don't they get it??? they are 2 different specialties and are NOT interchangeable!!

I feel sooo sorry for the L&D nurses who hafta float to MS. But they don't hafta do that where I work. *whew*

[ShandyLynnRN]

I also found out that the EFM paper has 3 centimeter/minute spaces on it. So if I don't have a chart handy, I sometimes will measure using the paper.