Latest Comments by SoldierNurse22

Latest Comments by SoldierNurse22

SoldierNurse22, BSN, RN, EMT-B (43,685 Views)

Joined Mar 29, '10. Posts: 2,172 (67% Liked) Likes: 6,893

Sorted By Last Comment (Past 5 Years)
  • 2
    SororAKS and NICUNurseEliz like this.

    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.

  • 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.

  • 0

    The very nature of labor can be fast-paced and intense, even in non-emergent situations. You're often dealing with patient in intense pain, and that can be crazy enough. Add in a patient's overly-concerned family members, an impatient OBGYN, a busy anesthesiologist, and an understaffed unit, and you've got a recipe for trouble.

    https://cervixwithasmile.wordpress.c...-job-on-earth/

    The last night I worked, I finished up a patient's recovery after a vaginal delivery. After that, I headed straight to the OR for a C-section assist on another nurse's patient. Immediately after that, I got a patient through triage who was contracting and ended up getting admitted. During the rest of the shift, I assisted with another patient whose epidural was messing with her blood pressure, assisted in admitting two other laboring patients, and helped two other nurses transfer their patients to postpartum. All of that is in addition to caring for my own patient, including getting her an epidural, starting Pitocin and doing her 30-minute checks.

    L&D isn't for the faint of heart. There are very few shifts (especially if you work in a bigger hospital) where you'll find yourself bored. Most shifts, you'll find yourself wishing you had time to eat, pee and drink water!

  • 0

    My hospital has a whole 16-week system they put us through that involves textbook reading and goal planning for each week. We completed AWHONN's basic course, STABLE, NRP and our computer charting orientation during this time. We had 2 weeks of OR training. More experienced nurses may not need as much time, but we've found a lot of the new nurses we hire in need the full 16 weeks to feel comfortable before starting on their own.

  • 0

    Some people really aren't cut out for L&D, and if that's you, then it's best to figure that out early. Is there a way you could shadow on L&D and see what it's like? It can be a very fast-paced, intense environment that can take a while to really figure out. If that doesn't sound like what you're interested in, then you may be wise to steer clear.

  • 0

    Sorry to hear you're having so much trouble, OP! I know at 3 weeks in, I had the same feeling of being completely overwhelmed! My preceptors focused primarily on completing physical tasks at that point in my training, however, so charting didn't really enter into it until a few weeks later. They wanted to make sure I had the tough part down (the actual patient care) before introducing me to what they considered the easier part (charting!).

    Are you struggling with remembering everything you need to chart? Is it typing speed? Is it an unfamiliarity with the system? Has your facility provided you with computer training in order to familiarize you with the system and give you practice with charting? There is a lot to chart in OB, and sometimes (especially on orientation) it can seem like you don't have enough time to chart and do all the physical tasks required of you, too.

  • 20

    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.

  • 6
    RunBabyRN, zimdivaRN, obrn2, and 3 others like this.

    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!

  • 0

    Quote from CarryThatWeight
    I am childless by choice also. However, I've had a few surgeries that have made me unable to have children even if I wanted them. When patients ask me if I have children or when I'm going to, and I think they are being nosy or rude, I just say bluntly, "I can't have children." Every now and then someone will then say something about adoption, but mostly it makes people feel so bad for being insensitive that it stops the conversation right there. It is none of their business so I have no problem making them feel guilty.

    Maybe I am a bad person...
    Wish I could like your post more than just once.

    If you're a bad person, then so am I. I work L&D. Like FlyingScot, I have also miscarried.

    There are two types of people that I will readily discuss this with:

    #1: Other women who have miscarried/lost babies/experienced infertility. This can be an incredibly powerful way to build rapport with a couple, especially woman to woman. Often times, patients who have this kind of history can be pretty nervous (as I expect I will be someday as well) and I think that for them, knowing that I understand their nerves and can validate their feelings helps assuage their fears. They often times take it as assurance that I'm going to do right by them because I'd expect nothing less if I were in their shoes, which is absolutely correct for all of my patients.

    #2: Nosy/rude people. Yep, I had a baby. That baby didn't make it into the 2nd trimester. I miss him or her every day. That baby has a name and will be remembered in my family on earth until the day we come face to face in heaven, and until we meet, I won't allow him or her to be forgotten. Nor will I refrain from mentioning him or her when specifically asked if I have children, because yes, I do have a child, and I shouldn't be shamed into omitting that fact when asked just because he or she isn't alive/it could make the asker uncomfortable/it isn't socially acceptable to speak of deceased babies.

    I have had some people respond with a fair amount of awkwardness/embarrassment to my honesty, especially the people who fall under category #2.

    To them I have a standard reply: *smile* Hey, if you didn't want to know, don't ask.



    My condolences for the loss of your babies, FlyingScot. I wish you only and all the best.

  • 0

    Quote from maggasaur
    1. What is your understanding of the role of a professional nurse?

    The role of a nurse is hard to define. It’s vast, fluid, and ever-evolving. It changes with every patient, every family, and every new case. The role is all-encompassing; nurses provide beginning of life care and end of life care that includes everything from assessing newborns to helping the critically ill to die peacefully. Nurses care for individuals, families, and communities. The role of a nurse is to work both collaboratively and independently to educate, prevent illness, promote health, and achieve optimal recovery for their patients. Nurses are able to do this by being adaptable and through taking on numerous roles, such as... (I'd give examples here...what kinds of roles do nurses regularly take on?)

    Nurses are compassionate caregivers that tend to the physical, emotional and mental needs of others no matter what the circumstances. They are teachers who help their patients learn about how to better their health and their maximize their care. They are counselors who help their patients cope with both physiological and psychological problems. Nurses are effective leaders who work together to accomplish common goals. They are researchers who use advancements in science and technology to guide their practice and improve patient outcomes.

    The incredible nurses that I have shadowed have shown me the compassion and dedication that the role of a nurse demands. I have watched nurses as they go above and beyond for their patients by both caring more and doing more for their patients than expected of them. Their capacity for kindness is limitless.
    Edited for punctuation, grammar, and syntax; occasionally reworded for clarity and flow. Good luck!

  • 0

    I looked for the rooming-in stats as well, and aside from the last link in my previous post that gives rooming-in stats for the hospital surveyed in 2011, all I could find was this:

    Introduction to mPINC | mPINC Survey | Data | Breastfeeding | DNPAO | CDC

    The CDC is apparently are tracking rooming-in in surveys. However, the stats may be harder to find as the results of specific initiatives (like rooming-in) aren't always available in the final reports, which seems to be true for 2014.

    Breastfeeding: Data: Report Card | DNPAO | CDC

    However, note that not all facilities in the US participate in these surveys, so this is probably going to skew your data.

    Hospital Participation and FAQs | mPINC | Data | Breastfeeding | DNPAO | CDC

    Honestly, I doubt you'll be able to find national stats that are reliable/accurate given the circumstances. Given the fact that it's an initiative and that it's also controversial, I think it's pretty safe to say that the majority of US hospitals don't practice rooming-in yet.

  • 1
    OBwonKnewbie likes this.

    With a background in a clinic, you're really coming in at a disadvantage. You're basically a new nurse in an inpatient setting. How long are you on orientation? What in terms of confidence are you struggling with (IV, basic patient care, cervical exams, C/s, etc?)?

  • 1
  • 3

    Quote from Nurse Leigh
    I myself am in awe of how a baby who is crowning @ 1855 will slide right back up the birth canal and the vagina just closes itself until 0700 the next day. There's a lot of learning in the womb!
    It really is remarkable. Those little ones know even early on they'd better not get themselves born on nights! I'm sure there's a day shifter somewhere who deserves the credit for this vital teaching.

  • 1
    Trina0606 likes this.

    It sounds like you have a decent setup to get hired into OB right away. If that's what you want to do, I'd say go for it. It is quite possible to develop your skills in a specialty and not start out your career on Med/Surg (I can promise you that from experience!)

    Good luck!


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