[nurse-lou]

Hey all,

I'm a longtime member here. For the last 5 yrs of my career, I've been in adult ICU. Currently work in a small community hospital. Last summer I was cross-trained to the OB unit and worked some shifts down there during a staffing crunch. I've been pulled there several times since. Now there is a staffing hole on night shift. My boss, who is also the boss of OB scheduled me to work in OB one night/week on this new schedule. I agreed. Our ICU census was low last week so I got to spend 2 shifts with one of the old-timers, an RN with 30 yrs OB experience for a total of 20 hours.....
I've observed a c/s and two vag deliveries at ths facility and feel fairly comfortable taking the baby after birth. Of course I am not NRP certified and I don't expect to be taking active labor patients as I am not trained in vag exams.

I've got pocket OB references and am going to purchase one for my PDA to have on hand.

Any other words of wisdom for me?

[SICU Queen]

Who else will you be working with? That's not a lot of orientation if you're supposed to be someone's backup in an emergency.

I transitioned from ICU to OB a few years ago, after floating there several times as "helping hands" when they were crazy busy. I usually would recover their c-sections; as an SICU nurse I felt pretty comfortable with the post-op stuff. After becoming staff, I got 8 weeks of orientation, and still felt unsure with some of the trickier deliveries. You should know, being an ICU nurse, that things can go very wrong with the best of patients... and a c/s and 2 vag delivery observations do not an OB nurse make, even if you did some OB floating at another facility.

If you're going to be the third or fourth nurse, then books and PDA software should help you out nicely... but if you're #2 and are expected to know what you're doing and function as an experienced OB nurse, especially when you have to deal with a crashing baby or mother, then I'd ask for more hands-on orientation.

The babies and mothers deserve that.

All that being said, good luck!! OB is a wonderful area and I loved my time there.

[nurse-lou]

Well, they consider my time I spent down there last summer---about 2 shifts a week for two months---as my hands-on. Tomorrow night, I'm the 3rd RN. But, after that I'm #2. This is a small OB unit....6 beds...plus all the post-op hyster pt's go there after OR. So, if there's an active labor pt, I won't be caring for her. And I won't be doing vag exams. I'll take ALL the mom/baby couplets before I'd get the active labor pts.

The OB docs usually like to deliver their patients during the daylight hours and that is what usually happens...if a person isn't progressing on pit then the head OB will send the person home. They Had a mom maxed on pit last week with no change to her cervix and no fetal distress..pit was stopped, they were gonna try again the next day but the OB sent her home.

Oh believe me, i KNOW I am not an experienced OB nurse....and I won't put myself or the patient in jeopardy.

[everthesame]

I would encourage you to get NRP certified. Maybe STABLE too if you don't have a NICU and would have to care for a sick baby until a neonatal transport team arrives. You never know when a seemingly low risk delivery suddenly turns bad for either mom or baby...or both.

[peds-n-obgirl]

I think I would put my foot down and demand some more orientation for the sake of your license and for the sake of those patients. It doesn't matter how many mom/baby couplets you offer to take, if you are the second RN, your butt will be helping out with the crashing baby. No questions asked. At my hospital we are required to have NRP even if we just work out on the postpartum/peds floor, much less the nursery and L&D. When I first started L&D, I had only two c/s with a preceptor under my belt and I swore I wouldn't do c/s because I hadn't been properly oriented. Low and behold along comes an emergency case and who's butt is in there? Darn right, mine! After that I went to my boss and told her I needed more orientation if she expected me to competently deal with the patients. And I got it too. I'm an LPN/scrub tech, but I've been an active participant in two neonatal codes in the last three months. If you're the second RN, you have no choice but to participate. If you're not going to ask or aren't able to get more orientation, I would at least get NRP even if I had to pay for it myself.

[bagladyrn]

This sounds like a very risky situation, both for your license and for your patients! As the 2nd nurse, you may think you won't be taking the active labors, but what happens when the 2nd (or 3rd) laboring patient comes in while the first nurse is busy with a delivery. As others have said, as 2nd, you WILL be helping with any infant resuscitations - unthinkable to be doing that without NRP at a minimum. Remember that quite frequently when one of the couplet (e.g. mom) goes bad, so does the other (infant).
Even in small low risk units, things can turn around quickly and bad things can roll through the door without warning or time to transfer. (Said as someone who has seen 28 week twins delivered at a remote level 1 facility).

[Jolie]

Please check with AWHONN and AAP guidelines. I believe they call for 2 people to be present at every delivery who are capable of carrying out a full neonatal resuscitation. I think you are well within your rights to refuse to float as the second nurse until you have completed NRP, which your manager should set up and pay for. I also highly suggest checking the standards of care for fetal monitoring certification, and making sure that your hospital enables you to comply with those standards.

A plaintiff's attorney would have a field day with a nurse who has not met basic competencies for working in OB.

I admire your willingness to learn and expand your expertise, but you need to insist that your employer is meeting nationally recognized standards of care and competency.

[canoehead]

Working in OB without NRP and fetal monitering class is like working in ICU without ACLS. Sure no one plans to leave you on the spot, but if you spend enough time there it will happen. Make a date to get certified, and know your limits until then. Be careful, you sound like a wonderful nurse.