A day in the life of an OB charge nurse
The OB charge nurse. I work in a community hospital, but that doesn't mean we don't do our share of deliveries. I will talk about what I do from the moment I walk in the door until I clock out. I will include my daily tasks, some situations I am dealt with (I'll even dive into some nurse behaviors, staffing issues, etc.), and how prioritizing is key to the charge nurse role.
“All you do is sit around until a baby is born,” “your job must be great, all you do is sit and hold babies”, “be happy, you’re in the happy part of the hospital.” I have heard it all. My job as an OB charge nurse is nothing like sitting around, holding babies in the happy part of the hospital. Many of you know that OB nurses care for the fetal demises that come through the unit, but we also see much more unhappiness. Abused mothers, drug addicts, and drama within the families are more common than the hard-working, married couple with jobs in the world. That's not to say I don't love my job; I love my job.
As an OB charge nurse, I want to give you a “day in the life.” I frequently get asked what I do all day at work when I am in charge...well here it is.
5:00 am - Wake up and get ready for my day. If I don’t start the day with a cup of coffee, I will have a headache by 7 am, so there’s where it starts. I get showered, make sure my family is set for their day, and off I go.
6:20 am - I arrive to work. Yes, I am one of those. My shift doesn’t start until 7 am, but I need to know what I am in for. I get dressed into my fancy scrubs, work shoes, and pull out my nurse toolkit (pens, highlighter, pencil, stethoscope, badge, vocera holder, and notepad), and head to the breakroom. I always put fresh coffee on for my coworkers. Always take care of your tribe. I may or may not take a cup with me, depends if my son was up during the night (so usually yes).
6:50 am - I glance at the hallway. I can tell you if the night was bad or not if the hallway is a mess. Somehow, before 7:00 am, everything is cleaned up. We have the respect for each other not to leave a mess. Take care of your tribe.
6:58 am - I am awaiting my crew. I glance at the assignments and plan (ha) how the day will run. Here they come, “coffee's on, ladies.”, and we await the report.
7:00 am - We listen to report about the floor, not a detailed report, but enough to get us an overview of who is in labor, who has issues everyone should be aware of (family drama usually), and what is scheduled that day. I take over as the charge nurse and tell my coworkers what I will do for them. Sometimes, I am lucky enough not to have a patient to start with; I am pretending this is one of those days.
7:15 am - I say goodbye to the night shift, and offer them a cup of coffee. Wish them a safe drive home, and say a little prayer for each of their safety (take care of your tribe). I start my QC checks. I always will start with my operating rooms. There are two of them. I have a scrub nurse, but I always try to make sure these are ready to go because you never know what the day will bring. I check all of the QCs in the unit, including, three crash carts, refrigerator temps, discard old medications or specimens, clean dirty equipment (even though I have an aide, don’t ever think you are too good for any job), and check to make sure I have some labor rooms set, as well as a triage room. If I can get through that without too many interruptions, it’s a good day. I think about my family, try to call my husband, sometimes, I just get a text from him letting me know everyone is off to school and that he made it to work.
8:00 am - Our first scheduled inductions is usually scheduled at this time. I help as much as I can with that patient, as well as answer phone calls from various departments, answer physician questions about patients, and start getting the postpartum patients ready for discharge or post op care.
9:00 am- The lactation nurse arrives (thank goodness). Breastfeeding, as natural as it is, is always a problem. Some baby can’t latch on; another mother has flat nipples, and another wonders if her baby is getting enough milk. There is only one lactation consultant and limited nurses. I step in to help who I can, when I can.
11:00 am - The pediatrician arrives, and the Pitocin is started on our inductions to try to have new babies by the end of our shift, ideally. Now, the office is calling. They are sending over a patient who thinks her water broke at 4 am this morning, every 10-minute contractions and hasn’t felt the baby move. There goes any lunch I thought I might get that afternoon.
12:00 pm - The triage patient arrives, it turns out I know her, or she knows me. I delivered her last baby. I don’t remember her, but she said she'd never forget me. That’s why I do this; I tell myself. The day is good. I am in the happy part of the hospital, but still haven’t held a baby, or sat down. I check to see if she has ruptured her bag of water, it is not, but she is 5 centimeters, and she's due. Let’s have a baby! I phone the physician, admit her into the computer, and start her IV.
1:00 pm - Another call from the office, they will be sending over a patient for a repeat c section, she is in labor, or sounds like it from the phone call. I have the aide prep a bed for a section (we add a different mattress), and go through my nurses to see who could take the next patient. Everyone is crabby, I take that back, hangry. No one has eaten lunch yet, and the pediatrician just left. She put in her orders for discharge, but the first patient to go isn’t going to leave until 2 pm. Unfortunately, that nurse will have to take the c-section.
2:00 pm - My patient needs an epidural, she's booming contractions out and cannot take it anymore. She is 6 cm. The c-section patient has arrived, she ate an 8:00 am, but is contracting. The doctor says to get her admitted, and we’ll have to do her c section. I am trying to find an assistant, let other nurses know, the anesthesiologist, and try to prep my patient for an epidural and delivery.
3:00 pm - My patient received her epidural. She is progressing! I need to find a nurse who will help me with my delivery. In the midst of the patient relaxing after her epidural, her blood pressure drops to 60/40; she is symptomatic, and the baby is in distress. I push ephedrine with the physician at the bedside, as well as administer O2 via facemask, bolus more fluids, and pray that the baby recovers, or we will be going back to the OR before the other patient.
4:00 pm - Thankfully, the baby ("my baby" is what we always say when it's our own patient) has improved. The C-section patient is ready to have a baby. Prepping the OR and counting the instruments, as well as arraigning a code pink team, and the team prepares for delivery. The patient is prepped for spinal anesthesia and laid down to a left tilt. The circulator takes over, on her own, and back to the floor I go before my patient delivers. I make a second batch of coffee because I didn’t eat. I sneak a cookie from the break room for my breakfast and lunch.
5:30 pm - The c-section went well, mom and baby are recovering. My patient is 8 cm and sleeping. We’re tired and ready to go home. I figure out staffing for the night shift and clean the triage beds from earlier. Just in time, another triage patient arrives who is bleeding. I find another nurse for, and luckily, after an hour, that patient is safe to go home.
6:30 pm - Almost quitting time, but wait, my patient is complete and ready to have her baby! I prep her for delivery.
6:52 pm - Delivery time! The patient delivers a healthy baby girl with no problems. I can have a nurse step in my place at 7:00 pm.
7:00 pm - The upcoming shift received a report. I stop and say thank you to all my coworkers for their help. Always take care of your tribe.
Throughout my day, you will notice, I held no babies. I did everything but sit, and that day, no sadness, but always lots of drama. If you want an adrenaline rush and an ever changing day, become a labor and delivery charge nurse. You have to be able to multitask and think on your toes, and you must always remember to take care of your tribe!
About JanineKelbach, RN
Janine Kelbach, RNC-OB is a freelance writer and owner of www.WriteRN.net. Janine has been an RN since 2006, specializing in labor and delivery. She ventured into writing in 2012. She still works in the hospital. She, her husband, and two boys reside in Cleveland, Ohio.
32 Years Old; Joined Jan '14; Posts: 34; Likes: 36.Jan 3 by knurse10Ugh being charge is hard! I work pcu/Tele, but I know what you mean when you say "take care of your tribe." Nurses are the last line of defense for patients, but charge nurse is the last line of defense and support for nurses!Jan 3 by klone, MSN, RNJust out of curiosity, why do you not start Pit until 1100 on your AM IOLs?You have to love what you do to be able to pull through day after day....but hey charge nurses get a whole quarter more an hour lolJan 4 by nutellaThis is interesting to read - I never worked a single day in GYN - OB other than nursing school clinicals. I have no idea how you guys do it !Last edit by nutella on Jan 4 : Reason: wrong topicJan 4 by klone, MSN, RNQuote from JanineKelbachAh, so it's not planned that way, it's just the day was so crazy it didn't happen until then? Yeah, we have those days too.hahaha, right?? the physician would be up my butt asking as well!
P.S. - if you hit the "quote" button underneath the post you're responding to, it quotes the person you're responding to, which makes it easier for everyone to know to whom your response is directed.Jan 4 by BeachNurse3484My goal is to be an L&D nurse. I know it's a hard area to break in to, but it's really where I want to be.Jan 4 by LibraSunCNM, BSN, CNMQuote from kloneI wondered the same thing! We only start inductions at night, with the idea being they will get cervical ripening overnight and (hopefully) be favorable for Pitocin by morning. I feel like it's super rare that we have a scheduled induction whose Bishop score is already 6 walking in the door, but maybe we are stricter than other institutions.Just out of curiosity, why do you not start Pit until 1100 on your AM IOLs?
OP it sounds like you work in a facility that does LDRP? I've never worked in one and I always thought it would be extra difficult to staff a unit like that, although it would be great experience as an RN.
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