[ursula10]

Hi Guys,
I am a charge nurse at a small rural hospital. We deliver babies but have no L&D nurse most nights. I often come in to find that I have to care for a new mom and baby and I have no experience with post partum at all( other than nursing school 6 years ago). When I tell the off going nurse this, I get a brief run down on a fundus but it's not at all what I need to porperly care for my patients. No one has had any major complications but I would like to feel secure in knowing that I would know what to do in the event of an emergency or even just notice when something's not right. It might also help if I knew about a boggy fundus and wht type of teaching I need to do for my patients. I don't want to orient under the staff here because I feel that they are sloppy and do not do a good job. I love my job and the facility, but I refuse to keep taking on the liability of caring for patients and I know nothing about this type of nursing. I've never had any kids so I don't know whether this bleeding is too much, too little etc. I'm a complete novice. Unfortunately no one here seems to care. I guess just becuase I've been a nurse for a number of years they figure I can handle it. I have complainded several times, but it never fails that I always walk back in to the same situation. So, I've decided to take matters into my own hands. Does anyone know of any good seminars or courses that I can take to orient me to L&D and post partum care? PLEASE HELP ME!

Thanks in advance :-)

[EricEnfermero]

On the baby side, you could look into a couple of courses. Neonatal Resuscitation (NRP) and STABLE come to mind. Here are some links.

Neonatal Resuscitation Program - http://www.aap.org/nrp

STABLE Program - http://www.stableprogram.org

I don't take care of the mamas, but I know that someone will be along with more suggestions soon. Good luck to you.

[Jolie]

Originally Posted by ursula10

Hi Guys,
I am a charge nurse at a small rural hospital. We deliver babies but have no L&D nurse most nights. I often come in to find that I have to care for a new mom and baby and I have no experience with post partum at all( other than nursing school 6 years ago). When I tell the off going nurse this, I get a brief run down on a fundus but it's not at all what I need to porperly care for my patients. No one has had any major complications but I would like to feel secure in knowing that I would know what to do in the event of an emergency or even just notice when something's not right. It might also help if I knew about a boggy fundus and wht type of teaching I need to do for my patients. I don't want to orient under the staff here because I feel that they are sloppy and do not do a good job. I love my job and the facility, but I refuse to keep taking on the liability of caring for patients and I know nothing about this type of nursing. I've never had any kids so I don't know whether this bleeding is too much, too little etc. I'm a complete novice. Unfortunately no one here seems to care. I guess just becuase I've been a nurse for a number of years they figure I can handle it. I have complainded several times, but it never fails that I always walk back in to the same situation. So, I've decided to take matters into my own hands. Does anyone know of any good seminars or courses that I can take to orient me to L&D and post partum care? PLEASE HELP ME!

Thanks in advance :-)

Both you and your patients deserve better.

As daunting as it must be to care for a newly-delivered mom and baby, what happens if a labor patient comes in on the night shift?

First of all, check your BON. Some states actually have language in the Nurse Practice Act that PROHIBITS an RN from taking charge of a unit to which s/he has never been fully oriented.

Secondly, go to Risk Management. I can't imagine the payout if a new mother or baby were to be harmed by a complication that you were untrained to assess and manage.

Thirdly, be ready to suggest an interim "stop gap" staffing measure to care for these patients until you are properly trained to do so. Could there be an "on-call" system put in place to provide coverage for the nights when your hospital has OB patients?

Insist that you be sent to a neighboring facility for adequate clinical training. This kind of arrangement is made all the time, even among competing hospitals. When our facility was preparing to open a NICU, all of the nursery staff members were sent to a nearby hospital for clinical training. Same thing when our cath lab opened. Ask for 2-3 weeks minimum of full-time post-partum and nursery or mother-baby clinical training.

As helpful as a seminar or conference may be, you need hands-on experience. Good luck!

[SmilingBluEyes]

Agree w/the post before mine. I would not work in this dept w/o lots of hands-on experience AND continuing ed.

[bargainhound]

Also. think about the liability you have/chance of being sued big time
if something goes wrong. "I wasn't trained" will not save you from
judgment against you. Protect yourself. No one else will.

[Jolie]

One thing I'd like to add is this: In my opinion, nurses at small rural facilities need to be even MORE educated, trained and experienced than their counterparts at large teaching hospitals.

Having worked in both settings (and virtually everywhere in between) I can attest that in the large hospitals, there is ALWAYS someone else around who can help you out, offer a consult, remember what was done in a similar situation, etc. But in a small, rural facility, YOU ARE IT. That, more than anything else, is why you must be competent to handle anything that may walk thru your door.

When I posted earlier that you should have at least 2-3 weeks of hands on care experience, I assumed you were speaking strictly of post-partum/newborn care. I've re-read your post and realize that you may be responsible for laboring moms as well. That raises the stakes to a whole new level.

SmilingBluEyes can advise you as to the AWHONN standards for L&D staffing. I can tell you that a miminum of 3 months of orientation to L&D is a must! NRP guidelines call for 2 healthcare workers to be present at every delivery who are capable of carrying out a full resuscitation. Unless your OBs are NRP certified (which I doubt), then you and another staff member must be. That second person can be an ER doc, RN, RT, etc.

It sounds like your facility has a long way to go in order to comply with basic safety guidelines for OB staffing. I would most definitely refuse any OB assignments until such arrangements are made.

Best of luck to you!

[ursula10]

Thanks for the advice! Here we are not responsible for the labor and the delivery, we call nurses in for that. My problem is that as soon as the baby is out and the initial paperwork is done both mom and baby are sent to the floor. Patients may hemmorrahge and have all kinds of complications. Not only do I have the responsibility of being charge nurse and have to do all admissions, and help my other nurses with any problems that may arise, but I also have 3-4 patients of my own. I am definately looking into the stable program and sny seminars that I can find. Thanks again for all of your help!