[Elisheva]

I'm hoping to get a job in L&D after my nursing refresher course.

What's the biggest mistake you see new nurses in LD make? Or, to put it another way, what's the most important thing(s) a new nurse in labor and delivery should remember?

I love this forum. I'm studying in advance and I appreciate seeing the reality of L&D nursing that I would never get in a school environment.

[hf82rn]

They stress this is nursing school, but many people don't take it seriously.....Always double check a doctor's order with the med book.....bad orders are given, and in L&D, you have two+ lives on the line. I witnessed an IM med pushed IV (vistaril). No ill effects were caused, but they were lucky. This was per doctor's orders, so ALWAYS double check, especially when giving meds that are not usually given in your unit.

[Elisheva]

Hf, I saw this happen when I was working med-surg. Another new nurse (one of the confident ones that all the older nurses LOVED) gave a med IV push because the doc wrote the order that way. Made quite an impression on me. I was the overly cautious nervous new nurse - not so popular- but my charge nurse told me that while I drove her nuts with too many questions she never worried that I would do something like that. It pays to be obsessive about meds; it's just having the time to be thorough that I worry about.

Thanks for the reminder!

[rninwch]

I just want to point out that even when you know the drug, the proper dose and the proper route you can still screw up. A few yrs ago I gave Vistaril IV, even though I knew it was an IM only and had frequently given it. Order was Vistaril...IM NOW and thats what I did.

I realized my error just as I was finishing my IV push and explaining to my pregnant kidney stone pt's husband what I was giving her. The only excuse I have is that it was toward the end of my extremely busy, 12hr night shift.

I immediatly assessed the pt's IV site and informed her and her husband to let me know if her arm hurt. It never did. I then notifed the doc who laughed, told me not to worry then asked just before he hung up, "Sooo, did her arm fall off yet?" I could have hit him! I felt so sick because I screwed up and I couldn't sleep that day.

I realized that day that even good, careful, experienced nurses make med errors, though usually they are the benign ones.

FYI, Vistaril will only cause problems if given through an infiltrated/blown IV or via inadvertant arterial injection. Proper IV site assessment and drug dilution prior to ANY IV push drug is very important since many other drugs can cause similar problems...Phenergan is one that we give all the time and don't think twice about it, but give it through a bad IV or into an artery and you are in big trouble.

Assess site, Dilute drug, Push slow!

New recommendations call for no more than 25mg of Phenergan to be diluted in 10-20mg NS and given ideally over 15 minutes but no fewer than 5 minutes, or hang it as a piggy back on an infusion pump

[bagladyrn]

The most important advice I can think of that is L&D specific: If the patient says she has to push ( or feels like she needs to move her bowels) - even if you checked her 5 minutes ago and she was only 4 cms. - CHECK HER AGAIN!! I've seen it happen too many times that nurses discounted the pt.'s statement and ended up with a baby in the bed if they were lucky, or in the bathroom/toilet if they were not!

[Elisheva]

I think I'll remember that one!

[Dustie]

Most important thing for a new LD nurse to know.....

(1)... your limitations. Always seek help when you are not sure.
(2).... that this day, and your role in it will be remembered forever by your patient and her family. How do you want to be remembered?

[Elisheva]

Dustie, what a beautiful post. You are so right; I remember the nurse who took care of me when I was having my daughter 31 years ago. I hadn't really thought about what it would like to be part of someone's history and that puts a nice perspective on labor and delivery.

[PegRNBSN]

Mine are more for any nurse.
When you are busiest, take the most time to check, double check and triple check. Make feeling rushed and stressed your trigger to slow down.
Never be afraid to call a doctor or act on your gut instinct because you are fearful of their reaction. Remember the consequences to calling are perhaps personal discomfort, the consequences of not calling or acting can be harmful to your patients.
Don't let any physician, midwife or co-worker talk to you in a disrespectful, aggressive manner. We are all professionals and we deserve to be communicated with as such. Even when you are in the wrong, don't let anyone yell at you or personally degrade you. It's amazing how if you stand up for yourself that behavior will stop.
Good luck as you start your journey on a very rewarding career path!