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SoldierNurse22, BSN, RN, EMT-B (43,783 Views)

Joined Mar 29, '10. Posts: 2,175 (67% Liked) Likes: 6,895

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  • Feb 12

    Agree with the PP. My hospital trains inexperienced new hire L&D RNs (even if you have previous RN experience) for a minimum of 4 months on full time, regardless of your part time/prn/full time status as specified in your actual job. It is a very unique specialty to begin with, but it is also highly litigious. You do NOT want to go into L&D nursing without feeling quite confident in your skills, knowledge and abilities.

  • Feb 12

    I appreciate your enthusiasm to encourage better care for your patients.

    However, at best, all you can do is encourage change. When it comes to enforcing and really strongly promoting a policy, that's the job of management.

    With that said, be careful how you come across. Ingrained habits are hard to break, and yes, it will be a significant amount of work for your L&D nurses in PACU if babies stay with mom. If it's coming from you personally (even if it's just your name on the email), be prepared for backlash, whether outright our passive-aggressive.

    Personally, I'd leave the crackdown to the management. They're paid to be the bad guys, and paid more than us to boot. Don't take the fall for them.

  • Feb 9

    To follow up to your story and springboard off my previous post, I had a patient a few months back who was admitted for an elective IOL at 39 weeks. She was a G1P0 and had a borderline favorable cervix, but overall, I felt it was probably best to wait, especially because her Bishop score was close to favorable, but it was definitely not good enough to indicate induction under our new policy. My charge checked her and fudged the numbers a bit, I think because she didn't feel like going toe to toe with the doc that morning.

    After my charge nurse left, I did exactly what you did. I advocated for my patient. I told her that if she kept her water intact, she could opt out of the induction at any time. I told her she could refuse an AROM and to make sure she stated to the doc that she didn't want to be AROM'd with a nurse witness present.

    Anyway, I left for the day and came back that night just as they were taking this patient back for a stat C-section for fetal distress and failure to descend. Apparently, baby had been having lates all day. They AROM'd mom when she was 2 cm and ballotable.

    As the icing on the cake, the doc had the gall to be in a huff and all pissed off that she had to section this lady because it was the doc's husband's birthday, and she was supposed to be eating out with him that night. Nevermind that this poor lady just had an unnecessary c/s because her doctor is a selfish, sad excuse for a human being. Nope, she was all mad because of the missed birthday dinner.

    OK, then don't set up an unfavorable G1P0 for an elective induction the morning of your husband's birthday and expect to be footloose and fancy-free that evening, you moron!

    UGH.

  • Feb 9

    Because we had a certain group of docs who liked to do this at my work (and one very charismatic, well-liked who still does), we recently instituted a policy at my facility.

    No inductions before 39 weeks for ANY reason other than medical.

    Elective inductions MUST have a favorable Bishop score from the MD to be referred for an induction. In order to proceed, the patient must have a favorable Bishop score based on the RN's assessment. If the RN finds the Bishop score to be unfavorable, the charge nurse takes it up with the doc. If the doc has an issue with it, our manager talks with the doc. If the doc still wants to induce and finds a way to weasel the induction into a medical induction, then the doc has to come in and do a full H&P, otherwise, no dice. The patient packs up and heads home.

    Many of the main offenders (like the horrible OB in your story) have started going to other hospitals. Good riddance.

    Y'know, while I certainly hold the OBs accountable for influencing the decisions and opinions of their patients, you have to admit that a bit of blame belongs on the patients, too. In this day and age of accessible and trustworthy medical info, if they don't know better as competent, intelligent adults, well...yeah. I'm not saying it's their fault entirely by any means. I mean, how do you tell someone you shouldn't always trust your doctor? I wish there were reputable sources that told women and their partners how to spot these types of physicians and how to say no in a safe, legal way. It would be a different kind of job.

  • Feb 9

    Unfortunately, OP, the bad is just part of the job, as it is in just about every nursing specialty I've encountered. You'll see it everywhere in varying degrees. While larger hospitals are generally going to see more in the way of stillbirths, birth defects, and antepartum disease processes that affect both mom and baby, that's not to say that kind of thing won't show up in a smaller hospital setting, and in my experience, when it does, it's often even more traumatic as many smaller hospitals aren't equipped to handle those kinds of problems and the potential for really, really bad outcomes is much higher. As far as abuse and other social issues? Beyond L&D and even nursing, that's everywhere. You'll see your fair share of that wherever you go.

    I was an infusion nurse once. It is in fact the lower-acuity, repetitive (and yes, sometimes mundane) nature of the outpatient setting that can seemingly shield nurses from "the bad", but that's only because we're not there when our outpatients are admitted for treatment when their disease process(es) worsen beyond what can be managed in an outpatient setting. So in short, "the bad" is always there; it's just a matter of how close you are to it.

    As far as how to approach stillbirths, fetal demises, neonatal loss, maternal deaths, miscarriages, and all the bad things that can happen in pregnancy, I can tell you that unless you've experienced something that yourself, you will not know how to handle the situation, and even if you have experienced something like that in your personal life, it's still different when you're the nurse and not the patient. It's normal to feel uncertain and out of place in those situations, especially when starting out. You will likely rely heavily on your preceptor/senior nurses/charge nurses to guide you through the process and draw from their experience in how to comport yourself, what to say, what not to say, etc.

    Personally, despite my own experiences with loss, when I was orienting on L&D and encountered these types of situations, I watched my preceptor like a hawk and said very, very little. I watched everything from her body language to what she said to how she approached the patient. I saw things I liked, things I'd change, and things I wanted to add to my approach. And of course, people handle things differently, so not only do you need to find your own way to approach patients experiencing these events, but you also need to learn to approach appropriately for their emotional state/phase of grieving/religious beliefs/overall feelings toward the event. It really is a process. Don't put undue pressure on yourself and expect to go into this field feeling confident in this particular area. You almost certainly won't, and that's OK. Give yourself the freedom to learn.

    People handle "the bad" in different ways, but I'd suggest that you minimally start with professionalism, compassion, and a healthy dollop of self-awareness (which, based on the fact that you posted on this topic in the first place, I'd say you already have!). Working in this field is very different from having your own pregnancies and babies. It is much less personal--except, of course, when it's not (and those moments can often pop up when you least expect them in the midst of both good and bad). If you can't take the bad with the good, you may not be cut out for the job, and there's no shame in that. It's something that's good to find out early.

    https://cervixwithasmile.wordpress.c...-job-on-earth/
    10 Things You Should Never Say to a Woman Who's Had a Miscarriage | What to Expect
    Helping Someone After a Miscarriage

    PS: the web is full of stories and blogs from women who have miscarried, experienced still births, and all kind of problems in pregnancy. I found it useful to read about their experiences and try to understand their perspective so that I could better meet their needs.

    Also, try doing a search on AN (top right of the page) for fetal demise, miscarriage, etc. There is a lot of experience and expertise here from which you can gain a lot of wisdom!

  • Feb 9

    Quote from cdsavannah59
    Try postpartum position first, then eventually tell your department manager that you would like to witness a few births and assist if needed so you can gain some experience in labor and delivery to see if that is a potential position you would like in nursing. That way you will find out if it's truly what you want to do. Labor and Delivery nursing is much more stressful from what I've noticed at work.
    The OP wants to work postpartum, not L&D. The issue is that the job openings are in L&D and she's applied to PP with no luck.

    She should have a much more immediate opportunity to explore L&D to determine if it's something she's interested in by way of shadowing. At any rate, I would not recommend taking a job in one department with the hopes that months or years later, you can try to get into another department that you think you could potentially want to work in, but ultimately have no exposure to. It's one thing if the OP were to try L&D, find she has some interest in it, and accept a job, hoping to eventually transfer to PP. It's another thing entirely if she accepts a job blindly or even knowing she doesn't like L&D, but hoping to ride it out until something in PP opens up.

  • Feb 7

    This topic is also very relevant to L&D nurses. Many of us are with the parents and family all the way through the diagnosis, labor process and right through delivery. In the case of stillbirths and extremely premature deliveries (pre-viable) where treatment is not going to happen, we are often the ones who deliver these kiddos and help the parents and family members make use of the limited time they have to make memories with a child they'll never know. For the ones who go to NICU, it's a matter of balancing caring for mom's physical health as well as her emotional health as it pertains to baby.

    I must agree with the OP--it has been one of the greatest privileges of my career to help women and their families through stillbirth, fetal loss and newborn demise.

  • Feb 6

    This topic is also very relevant to L&D nurses. Many of us are with the parents and family all the way through the diagnosis, labor process and right through delivery. In the case of stillbirths and extremely premature deliveries (pre-viable) where treatment is not going to happen, we are often the ones who deliver these kiddos and help the parents and family members make use of the limited time they have to make memories with a child they'll never know. For the ones who go to NICU, it's a matter of balancing caring for mom's physical health as well as her emotional health as it pertains to baby.

    I must agree with the OP--it has been one of the greatest privileges of my career to help women and their families through stillbirth, fetal loss and newborn demise.

  • Feb 5

    As an L&D nurse, I can tell you a few stories about home births gone wrong. However, I could probably tell you even more stories about hospital births gone wrong.

    For all the concerns that people have about giving birth at home, people tend to forget that many of the emergencies that we see in a hospital setting are of our own making: aggressive induction, unnecessary induction, elective induction of an unripe cervix, jumping to start epidurals only to have mom's BP crash and baby circle the drain, excessively rough cervical exams, unnecessary episiotomies, impatient providers that can create traumatic birth situations, patients being bullied into c/s for the convenience of the doctor, postpartum hemorrhage from inadequate/poorly thought-out treatment plans, and a slew of other issues.

    What really amazes me is how many women these days (even in 2016!) blindly do whatever their OBGYNs tell them to do. One of our docs likes to induce primips the second they go past 39 and 6. Another one is an extremely aggressive cervical checker. Several prefer c/s cases to natural births, and another likes to scare her patients into "medical" inductions with her "11-lb baby" stories.

    Of course, on the opposite end of the spectrum, you've got the super-granola moms who want to deliver breech at home with a CPM, refuse Vitamin K, and absolutely will not hear the nurse/doc/midwife on why a c/s might actually be a really good idea. I've found there are very few women who fall in between these categories.

    Personally, I'm all for natural childbirth and home and/or birth center births with qualified, competent providers and a pre-determined, well-practiced emergency plan. However, I also wouldn't be sitting here writing this right now were it not for a very compassionate OBGYN who saved my life a few years ago, so I have no problem giving credit where credit is due when it comes to the vital, life-saving surgical skills unique to the practice of OBGYNs.

  • Feb 5

    As an L&D nurse, I can tell you a few stories about home births gone wrong. However, I could probably tell you even more stories about hospital births gone wrong.

    For all the concerns that people have about giving birth at home, people tend to forget that many of the emergencies that we see in a hospital setting are of our own making: aggressive induction, unnecessary induction, elective induction of an unripe cervix, jumping to start epidurals only to have mom's BP crash and baby circle the drain, excessively rough cervical exams, unnecessary episiotomies, impatient providers that can create traumatic birth situations, patients being bullied into c/s for the convenience of the doctor, postpartum hemorrhage from inadequate/poorly thought-out treatment plans, and a slew of other issues.

    What really amazes me is how many women these days (even in 2016!) blindly do whatever their OBGYNs tell them to do. One of our docs likes to induce primips the second they go past 39 and 6. Another one is an extremely aggressive cervical checker. Several prefer c/s cases to natural births, and another likes to scare her patients into "medical" inductions with her "11-lb baby" stories.

    Of course, on the opposite end of the spectrum, you've got the super-granola moms who want to deliver breech at home with a CPM, refuse Vitamin K, and absolutely will not hear the nurse/doc/midwife on why a c/s might actually be a really good idea. I've found there are very few women who fall in between these categories.

    Personally, I'm all for natural childbirth and home and/or birth center births with qualified, competent providers and a pre-determined, well-practiced emergency plan. However, I also wouldn't be sitting here writing this right now were it not for a very compassionate OBGYN who saved my life a few years ago, so I have no problem giving credit where credit is due when it comes to the vital, life-saving surgical skills unique to the practice of OBGYNs.

  • Feb 4

    As an L&D nurse, I can tell you a few stories about home births gone wrong. However, I could probably tell you even more stories about hospital births gone wrong.

    For all the concerns that people have about giving birth at home, people tend to forget that many of the emergencies that we see in a hospital setting are of our own making: aggressive induction, unnecessary induction, elective induction of an unripe cervix, jumping to start epidurals only to have mom's BP crash and baby circle the drain, excessively rough cervical exams, unnecessary episiotomies, impatient providers that can create traumatic birth situations, patients being bullied into c/s for the convenience of the doctor, postpartum hemorrhage from inadequate/poorly thought-out treatment plans, and a slew of other issues.

    What really amazes me is how many women these days (even in 2016!) blindly do whatever their OBGYNs tell them to do. One of our docs likes to induce primips the second they go past 39 and 6. Another one is an extremely aggressive cervical checker. Several prefer c/s cases to natural births, and another likes to scare her patients into "medical" inductions with her "11-lb baby" stories.

    Of course, on the opposite end of the spectrum, you've got the super-granola moms who want to deliver breech at home with a CPM, refuse Vitamin K, and absolutely will not hear the nurse/doc/midwife on why a c/s might actually be a really good idea. I've found there are very few women who fall in between these categories.

    Personally, I'm all for natural childbirth and home and/or birth center births with qualified, competent providers and a pre-determined, well-practiced emergency plan. However, I also wouldn't be sitting here writing this right now were it not for a very compassionate OBGYN who saved my life a few years ago, so I have no problem giving credit where credit is due when it comes to the vital, life-saving surgical skills unique to the practice of OBGYNs.

  • Feb 4

    As an L&D nurse, I can tell you a few stories about home births gone wrong. However, I could probably tell you even more stories about hospital births gone wrong.

    For all the concerns that people have about giving birth at home, people tend to forget that many of the emergencies that we see in a hospital setting are of our own making: aggressive induction, unnecessary induction, elective induction of an unripe cervix, jumping to start epidurals only to have mom's BP crash and baby circle the drain, excessively rough cervical exams, unnecessary episiotomies, impatient providers that can create traumatic birth situations, patients being bullied into c/s for the convenience of the doctor, postpartum hemorrhage from inadequate/poorly thought-out treatment plans, and a slew of other issues.

    What really amazes me is how many women these days (even in 2016!) blindly do whatever their OBGYNs tell them to do. One of our docs likes to induce primips the second they go past 39 and 6. Another one is an extremely aggressive cervical checker. Several prefer c/s cases to natural births, and another likes to scare her patients into "medical" inductions with her "11-lb baby" stories.

    Of course, on the opposite end of the spectrum, you've got the super-granola moms who want to deliver breech at home with a CPM, refuse Vitamin K, and absolutely will not hear the nurse/doc/midwife on why a c/s might actually be a really good idea. I've found there are very few women who fall in between these categories.

    Personally, I'm all for natural childbirth and home and/or birth center births with qualified, competent providers and a pre-determined, well-practiced emergency plan. However, I also wouldn't be sitting here writing this right now were it not for a very compassionate OBGYN who saved my life a few years ago, so I have no problem giving credit where credit is due when it comes to the vital, life-saving surgical skills unique to the practice of OBGYNs.

  • Feb 4

    As an L&D nurse, I can tell you a few stories about home births gone wrong. However, I could probably tell you even more stories about hospital births gone wrong.

    For all the concerns that people have about giving birth at home, people tend to forget that many of the emergencies that we see in a hospital setting are of our own making: aggressive induction, unnecessary induction, elective induction of an unripe cervix, jumping to start epidurals only to have mom's BP crash and baby circle the drain, excessively rough cervical exams, unnecessary episiotomies, impatient providers that can create traumatic birth situations, patients being bullied into c/s for the convenience of the doctor, postpartum hemorrhage from inadequate/poorly thought-out treatment plans, and a slew of other issues.

    What really amazes me is how many women these days (even in 2016!) blindly do whatever their OBGYNs tell them to do. One of our docs likes to induce primips the second they go past 39 and 6. Another one is an extremely aggressive cervical checker. Several prefer c/s cases to natural births, and another likes to scare her patients into "medical" inductions with her "11-lb baby" stories.

    Of course, on the opposite end of the spectrum, you've got the super-granola moms who want to deliver breech at home with a CPM, refuse Vitamin K, and absolutely will not hear the nurse/doc/midwife on why a c/s might actually be a really good idea. I've found there are very few women who fall in between these categories.

    Personally, I'm all for natural childbirth and home and/or birth center births with qualified, competent providers and a pre-determined, well-practiced emergency plan. However, I also wouldn't be sitting here writing this right now were it not for a very compassionate OBGYN who saved my life a few years ago, so I have no problem giving credit where credit is due when it comes to the vital, life-saving surgical skills unique to the practice of OBGYNs.

  • Feb 3

    Quote from cdsavannah59
    Try postpartum position first, then eventually tell your department manager that you would like to witness a few births and assist if needed so you can gain some experience in labor and delivery to see if that is a potential position you would like in nursing. That way you will find out if it's truly what you want to do. Labor and Delivery nursing is much more stressful from what I've noticed at work.
    The OP wants to work postpartum, not L&D. The issue is that the job openings are in L&D and she's applied to PP with no luck.

    She should have a much more immediate opportunity to explore L&D to determine if it's something she's interested in by way of shadowing. At any rate, I would not recommend taking a job in one department with the hopes that months or years later, you can try to get into another department that you think you could potentially want to work in, but ultimately have no exposure to. It's one thing if the OP were to try L&D, find she has some interest in it, and accept a job, hoping to eventually transfer to PP. It's another thing entirely if she accepts a job blindly or even knowing she doesn't like L&D, but hoping to ride it out until something in PP opens up.

  • Feb 3

    Quote from cdsavannah59
    Try postpartum position first, then eventually tell your department manager that you would like to witness a few births and assist if needed so you can gain some experience in labor and delivery to see if that is a potential position you would like in nursing. That way you will find out if it's truly what you want to do. Labor and Delivery nursing is much more stressful from what I've noticed at work.
    The OP wants to work postpartum, not L&D. The issue is that the job openings are in L&D and she's applied to PP with no luck.

    She should have a much more immediate opportunity to explore L&D to determine if it's something she's interested in by way of shadowing. At any rate, I would not recommend taking a job in one department with the hopes that months or years later, you can try to get into another department that you think you could potentially want to work in, but ultimately have no exposure to. It's one thing if the OP were to try L&D, find she has some interest in it, and accept a job, hoping to eventually transfer to PP. It's another thing entirely if she accepts a job blindly or even knowing she doesn't like L&D, but hoping to ride it out until something in PP opens up.


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