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madwife2002, BSN, RN Guide 96,483 Views

Joined Jan 17, '05 - from 'Ohio'. madwife2002 is a Clinical Service Specialist. She has '26' year(s) of experience and specializes in 'RN, BSN, CHDN'. Posts: 10,271 (21% Liked) Likes: 6,059

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  • Jun 29

    One night in the UK on a very very old ward the PCT told me about the gray lady who walked around the hospital when death was near or had just happened. How I laughed to hear her storys so I asked and how do these ghosts walk? Like us? No she said they sort of floated and she claimed to see ghosts all the time. About an hour later we heard the running of feet upsatairs and we knew there was a cardiac arrest. So I said smartly I expect the gray lady is walking then.
    About an hour later I went out into the corridor to use the bathroom when I looked up the dimly lit stairwell I saw this vision floating down the stairs. I couldn't help myself I screamed really loudly and the vision screamed too I had frightened the life out of the PCT from the upstairs ward who was coming downstairs to borrow something.!!!!!! So much for my ghostly encounter.

  • May 8

    There needs to be some sort of discussion going on between you and your manager. This is a form of bullying and cannot be allowed to continue. The potential for causing patients harm could be occurring here, if they do not do the vital signs and sign them off.

    Your FA ot HR needs to stop this behavior now

  • Apr 17

    An OB/GYN staff nurse is a registered nurse who provides direct care to women. OB-GYN nurses may work in hospital labor and delivery and post-partum units, as well as at birthing centers and maternity or outpatient clinics. Their duties include admitting patients, taking medical histories and assisting physicians during procedures. They may administer medications, apply fetal monitoring devices or perform ultrasounds. They may also lead childbirth preparation classes or educate women individually about sexually transmitted diseases, birth control or prenatal care.

    Gynecology/Obstetrics Nurses care for women from puberty to menopause. Not only do they help women during pregnancy, labor and childbirth, they can work with women who have health issues with their reproductive system. They may also lead childbirth preparation classes or educate women individually about sexually transmitted diseases, birth control or prenatal care.

    Work Environment

    OB/GYN nurses can work in a doctors office, pre or postnatal floor, OR and the labor ward. Many nurses who want to work in labor and delivery will often start off on the pre/postnatal floor, then move to L and D once an opportunity arises. It is normally expected that you will cross train, to enable you to work in all areas. This is a huge speciality and for the purpose of this article, it is impossible to touch on all areas where an OB/GYN nurse has the potential to work.


    You do not have to have nursing experience to work as an OB/GYN nurse, jobs can be few and far between for inexperienced nurses, and some facilities can require previous nursing experience. Many facilities will offer 6 - 12 months orientation for the inexperienced nurse.

    There will be extensive on the job training for new OB/GYN nurses.

    There can be lots of opportunities for advancement for nurses with L & D background, including lactation specialist, Certification as a Nurse Midwife, NP in women's health.

    Education and Requirements Depending on department

    • Registered Nurse
    • LPN
    • Fetal monitoring
    • Experience in Lab/Delivery
    • Analytical Ability
    • Visual, hearing and sensory touch acuity

    Responsibilities can include but is not limited to:
    • Care of the laboring woman
    • Antenatal care
    • Post natal care
    • Monitoring FHR
    • Monitoring contractions
    • Support
    • Pain management
    • Cervical exams
    • Induction of labor
    • IV infusion therapy
    • Documentation
    • Education for the new parent
    • Contraception
    • Breast feeding education
    • Scrubbing for C/Section
    • Care of the newborn
    • Sexual health education


    L&D RN salaries are on a par with other nursing specialties with a median salary of $64,690 as reported by the Bureau of Labor Statistics Occupational Outlook Handbook. RN salaries may be as low as about $44,000 and as high as $95,000 depending on several factors including work experience, state, employer, and specific nursing role

    Staff Nurse - RN - Obstetrics Salary |

  • Apr 14

    The eyes of the world are watching the new experimental POT shops, which have recently opened in Colorado, selling legalized Cannabis for everyday consumption, for everyday people. Who would have thought that this would happen in our lifetime! The lines went round blocks and shops feared they would run out quickly.

    It is estimated that 37 shops opened their doors 1st January 2014, and by January 6th 2014 speculation is mounting that shops will soon run out of supply.

    It is estimated that over 1 million dollars was spent in the first 24 hours on legalized Pot.

    Do we think that people want cannabis to be legalized, do people think we should be allowed to buy 'pot' from shops, yep I think we can safely say if this past week has shown anything, that everyday people want to buy pot.

    Although it has to be pointed out that in all photos, videos and media shows there appeared to be a huge population of men shopping and buying pot than women! I did not actually see a woman in the shops, I am sure there were some?

    I can see it now, 'Honey can you pop out to the pot shop for me'

    Alcohol companies are fearful for a drop in profits, and I think they should be! For the addictive personality swapping one addiction for another may well be the way forward.

    As healthcare professionals we should consider how this might actually benefit our patients, the cost to lives, reduction in violent crimes, reduction in ER visits and all the other health care benefits we are lead to believe happens if you smoke cannabis.

    There are many research projects out there, attempting to prove that cannabis is safe, that cannabis has many health properties.

    According to one source there has never been an overdose of cannabis because you have to consume 20,000 to 40,000 times the amount of THC (short for Tetrahydrocannabinolin),which is present in a joint to be at the risk of dying.

    Police worry that using cannabis increases the chances of moving onto harder drugs, but there are no scientific studies to date that support this claim. Police also worry that using cannabis will increase violent crimes, behavior and suicidal tendencies, again at this time there is no scientific study to confirm this belief.

    In 2010, overdoses were responsible for 38,329 deaths. Sixty percent of those were related to prescription drugs. In the same year, a total 25,692 died of alcohol induced issues , including accidental poisoning and disease from dependent use.

    Benefits to our patients include but are not limited to...

    • Antiemetic for general patients
    • Increased Appetite for the chronic sick and elderly patients
    • Decreasing neuropathic pain, especially with MS patients
    • Reduction of pressure within the eyes of glaucoma patients
    • Some studies have shown reduction in tumors in cancer patients (although studies are not conclusive but we can expect a lot more studies in the future)
    • Reduction of nausea in chemotherapy patients and increase of appetite

    Side Effects

    Short-term (one to two hours) effects on the cardiovascular system can include increased heart rate, dilation of blood vessels, and fluctuations in blood pressure

    Short-term memory loss

    Increase in psychosis (newer studies are disputing this)

    Schizophrenia (newer studies are disputing this)

    Drop of about 8% IQ in patients under 18, although starting after 18 does not appear to cause an IQ drop

    Driving is impaired and studies in the UK say if you drive within 3 hours of smoking cannabis you are twice as likely of having an accident.

    An interesting side note, shares in one cannabis growing company increased their share prices by 53% overnight!

  • Mar 31

    Majority of quality improvement jobs in health care can have many responsibilities that fall into specific categories, including but not limited to evaluation, analysis, training and education, regulatory and compliance responsibilities, and risk management. A quality improvement health care specialist would ideally be responsible for gathering and evaluating clinical data from the organization; analyzing data for patterns and trends in the delivery of healthcare; researching root causes for specific patient care trends; training and educating staff to promote good quality practices and ensure compliance with all applicable laws and regulations; working with leadership and staff to create policies and procedures to ensure good quality care and minimize harm to the patient; keeping up to date with all federal and state laws and regulations.

    Quality improvement can be defined "as systematic, data-guided activities designed to bring about improvement in health care delivery in certain settings and particular situations".

    A quality improvement strategy is defined as "any intervention aimed at reducing the quality gap for a group of patients represented by those encountered in routine practice".

    Gaining a more in-depth understanding of the role that nurses play in quality improvement and the challenges nurses face can provide important insights about how hospitals can optimize resources to improve patient care quality.

    Educational Requirements

    • Registered Nursing License in State of
    • 3-5 years clinical nursing experience
    • BSN preferred
    • Experience with NCQA, Medicaid and/or commercial regulatory requirements
    • CPHQ- Certified Professional in Healthcare Quality (preferred)

    Duties and Responsibilities

    Participate in design and implementation of Quality Improvement projects for HMO patients.

    Assumes project lead role and develops project plan identifying all aspects of the project including timeline's for each task. Assures timely collection, processing and reporting of data per project.

    Collaborates with IT and Analytic staff to facilitate design and development of appropriate database tools and reports.

    Serves as a proactive liaison to Medical Leadership to facilitate physician engagement in projects, timely completion and submission of QM projects and HEDIS data collection and development of interventions for improvement.

    Investigate patient complaints/grievances received from patients, family and HMO's.
    Conduct QI audits/surveys as a way to recognize and/or identify potential quality issues or trends.

    Attend various interdepartmental meetings as the QI RN representative, to support the departments' requirements.


    Improving health care quality and patient safety are currently high on the nations health agenda, a focus that will only intensify going forward. Patients are demanding better health care, and who can be placed better than the nurse to be the leader of quality.
    In other countries, it is the expectation that all registered nurses are actively involved with improving quality initiatives through research, changes are made through the hard work of floor nurses who strive daily to improve quality outcomes.

    We need to be given the recognition of being change agents, quality improvers and educators. Self identification of issues and problems should be the norm rather than the exception. We should be identifying areas of improvement, making plans of correction and auditing the plans are effective after they are implemented.

    The stakes for US hospitals to demonstrate high quality is increasing; at the same time resources are becoming more and more limited. Therefore, hospitals will have to become more skillful and sophisticated in discerning and pursuing activities that substantively contribute to the achievement of their quality.

    This evolution also will require increased sophistication by the hospitals to optimize available resources to carry out their work.

    Nurses are at the forefront of improving quality care, although it is considered everyone's responsibility to improve quality of care. Nurses often find themselves in the unique position of being the change agent for any patient quality event, we have a high stake in the game and we need to cash in on all opportunities that could improve the quality of life for our patients.


    National Association for Healthcare Quality (NAHQ)
    National Committee for Quality Assurance (NCQA)

  • Mar 27

    Funny thread and I am happy it is not just me who stresses over the mistakes.
    When I lived in the UK there was a show about visiting home nurses who delievered twins it was a joke.

    How about every laboring woman who screams and pushes screaming-impossible to do adequate pushes whilst screaming.
    Plus the placenta never ever gets stuck LOL infact no postnatal women ever has a placenta on TV.

    How about shocking flat liners???

  • Mar 5

    Thank you for sharing the article, through the darkness of the last 5 days this was a light to my sadness. The Brian I knew had a dry sense of humor and was always had a quick return. Generous to a fault, always smiling and had the most incredible inventive mind-his business accrue was amazing and he was always open to idea's and listened to any ideas you talked with him about. He loved his gadgets especially Apple products, you always knew he would have the latest that technology had to offer.

    I want to share with you a funny story, In may some of the Allnurses team, Brian and my daughter went out on SEGWAY's. The guy who took us on the tour told us that somebody always falls off. We rode the SEGWAY'S for 90 mins and I had a couple of close calls but managed to stay on. It was so much fun and laughter-one of the highlights of my year. We completed the tour and returned to the tour office and i drove into a tiny wall outside the office and went flying off the SEGWAY falling hard to the ground. I remember lying there laughing (i wasn't hurt thank goodness) looking up to see Brian standing over me, saying "Can you do that again so I can video it'!! We all laughed so hard, and that is a memory I carry with me and smile

  • Feb 27

    Wonderfully written, being a preceptor is not a game it is a serious responsibility where you help develop a RN who is one you want to look after you or a member of your family

    You are not there to be a best friend, but you are there to support, mentor and teach

    I imagine you have some successful New Grads who were under your wing

  • Feb 25

    So you have decided to leave your current job, you've had enough of working hard, no teamwork, you don't like your boss, co-worker, management, the drive is too long, the acuity is too high, you never get a break and you hate bedside nursing. Yes there are numerous reasons why you want to leave and get a new job, I could go on for pages for the reasons nurses are leaving their job but this article is about how to manage yourself while you are working out your notice.

    Whatever the reason I personally believe there is a way to give your notice in and leave gracefully. Don't shut the door behind you, leave it ajar. Trust me you just never know if you might need to go back, or how your reputation could follow you.

    Do not let your work slide during your notice period, make sure you maintain your high standards and do not slack off. Hold your head high no matter what the circumstances are that caused you to leave your job in the first place. Remember you are still being paid to do your job, and it is no excuse to say 'it's not my problem, I'm leaving'

    Employers will be contacted for references; most HR departments will only provide dates of employment and will not get involved with lengthy discussions, however they are allowed to answer No when asked if they would rehire. This one word speaks volumes, sometimes new employers will take their time obtaining references, so how you behave in your notice period could have a devastating effect.

    Make sure you give the required amount of time as specified by HR, this can be anywhere from 2-4 weeks depending on your position. Inform your manager as soon as you can, so they can prepare for the inevitable. Schedules may need to be changed, they appreciate as much advanced notice as possible. Put your notice in writing, giving your last working day. Keep it simple and to the point, you do not have to give a reason for leaving.

    If they allow you, sign on PRN which will let you keep that foot in the door!

    No matter how much you hate your job, work your notice! you should not just walk out without working the required notice. People talk and talk follows, you would be surprised how small the HR community is within healthcare and heads up is often given. I often read on that RNs hate their job so much that they walk out without notice which is just not professional.

    Do not under any circumstances 'bad mouth' your current employer, it is not tasteful and causes concerns that you do not have loyalty. It is suffice to say that it wasn't the job for you and you are moving on because you want new opportunities. Be professional at all times, I know you will want to run through the halls singing and shouting at the top of your voice about the news of your new job, but try some restraint.

    Be positive during your notice period, the weeks will soon count down and before you know it you will be heading through the door for the last time. You have choices; you can either slam the door shut or gently pull the door to, allowing it to creep open if you need it.

    Do not commit professional suicide by being miserable, and informing all and sundry how you have to wait for weeks before you can leave, be upbeat and cheerful. I cannot tell you how many people I have worked with who begrudge working their notice and let everybody know that they don't want to be there. There is often huge sigh of relief when they do go, which is a poor reflection on that person. Being resentful has such negative connotations especially with your co-workers who chose to stay

    Think before you slam, your current position may be not what you want but you have a long career road in front of you, life tends to be full of twists and turns so you can never say never!

  • Feb 22

    To clarify when doing your charting in the EMR regarding the normal day to day care of the patient you are looking after you should complete the documentation before the end of the shift. (remember check your facilities P&P to double check)

    With this being said, BDP is to document as soon as you can in your shift. Normal practice is within one hour

    If there is an unusual occurance you need to use the exact times that this occurance happened when you document.

    If you give a medication late-you need to acknowledge that. Your hospital will have guidelines of how early or how late you can administer the patients medications, usually within the hour of the time. Some hospitals have tighter rules and it can be 30 mins either way. You will have to check.

    Normally nurses are not out to commit fraud-fraud tends to be a concious decision.

  • Feb 16

    Quote from rnintwo
    I dont realistically see being able to find quality child care to cover nights, weekends or holidays for a hospital job. It just isnt going to happen, especially for holidays.

    As for salary, Im not sure where any of the previous posters live but here in NY, RNs that work in the hospitals start @ 80K, so I thought it was completely reasonable to expect 60K out of the hospital.
    How old are your children? I am a long time nurse and have always had children, I agree it has not been easy over the years to manage both effectively but I have managed it both as a single parent and later on with a husband in the military.
    I respect that your children come first but you may need to compromise one or the other-nursing is a very difficult profession if you have no back up support or good child care. You cannot drop everything and run home especially if you have patients to take care of.

  • Jan 22

    QUOTE=jdub6;8720120]Oh good, renal/dialysis is my weak spot for sure. I have tons of questions...trying to think of what I need to know the most...
    1. Can you describe the dialysis procedure, what you do when the patient arrives (assume outpatient unless you don't know about that) until you send them off

    This is a huge question, one that takes about 6 hours from start to finish-When a patient comes to treatment you would do vital signs, the RN would do head to toe assessment looking for signs of fluid overload, they would be weighed and the target amount of fluid calculated. Arm if fistula is used would be cleaned and needles inserted, pt’s prescription would be dialed into the dialysis machine and then the lines would be connected and dialysis commenced. Pt should be monitored every 30 mins vital signs taken, access site visualized at all times. Once tx has finished the patient is disconnected from machine, needles are pulled, access is held until hemostasis occurs, then the sites are covered with either a bandaid or gauze. Pts vital signs and weight is taken and pt is discharged home.

    2. What is ultrafiltration and why/for whom is it used?
    Ultrafiltration is defined as controlled fluid removal by manipulation of hydrostatic pressure. Ultrafiltration in dialysis is the removal of sodium and water from the blood. Dialysis patients have ultrafiltration; some of the patients need more fluid removal than other patients.

    3. How do you access an AVF? What type of needle do you need? Is there a difference between the venous and arterial access equipment? Are the venous/arterial access points all in the same place each time and if so what landmarks do you use? What are things that would be indications of problems, reasons not to use a fistula or to stop using it, etc.? What would you see in a fistula that is clotted? Any considerations for the first time you use a new fistula?

    You access an AVF with fistula needles; there are different size needles used on average a 15 gauge needle is used. Needles have blue and red wings for venous and arterial identification. Where you place the needles depend on what method of cannulation is being used. Each treatment the AVF should be examined looking for signs of infection, feeling the AVF for thrill and listened to the AVF for the bruit. If there is no thrill or bruit the fistula should not be accessed as absence of these could indicate the fistula is clotted. Lots of considerations for first use of fistula-experience technician, one needle, size 17 gauge needle, lower blood flow rate.

    4. What do you dialysis nurses consider to be the best/easiest form of access to use (which type of catheter, fistula, etc) and which type or protocol of dialysis is best and easiest for you and the pt?

    The best access without question is the Fistula. I don’t understand what you mean about protocol

    5. When people refer to arterial and venous ports/needles for dialysis, and when we see what I think of as a typical dialysis cath with two lumens, usually one red cap and one blue, are those lumens or (or needles for a fistula) actually one in a vein and one in an artery? My impression is that fistulas are mixed arterial/venous blood. Honestly, I don't know exactly where the catheters end. Do the red and blue caps indicate arterial and venous, as in other parts of medicine? And, again, does the arterial port/line actually end in an artery, or a vein?

    Catheters end in the heart. Red and Blue in dialysis indicate venous and arterial

    6. Can you explain how you use the catheters i.e. do you flush them prior to access and if so with what, which port do the inbound and outbound/return lines go to? After use, how do you flush the lines?

    There is a whole process for using catheters, and accessing catheters. Many steps are involved, what in particular do you want to know about accessing them although it may differ from company to company. In bound and outbound lines are really called venous and arterial lines. The venous side of the catheter attaches to the venous line and the arterial-to-arterial line. The arterial line takes the blood out of the body to the dialyzer (kidney) and the venous line returns the cleaner blood to the body. After use you flush the lines with Normal Saline

  • Jan 10

    People change their minds at the last min sometimes, a tattoo would be so permanent that would be my only concern,.

    I have always said I do not want interventions if there is no hope for some incurable disease, but if it was an accident then I would at least want them to try.

  • Jan 10

    People change their minds at the last min sometimes, a tattoo would be so permanent that would be my only concern,.

    I have always said I do not want interventions if there is no hope for some incurable disease, but if it was an accident then I would at least want them to try.

  • Jan 10

    People change their minds at the last min sometimes, a tattoo would be so permanent that would be my only concern,.

    I have always said I do not want interventions if there is no hope for some incurable disease, but if it was an accident then I would at least want them to try.