2 questions...

  1. Hi, i dont know how many of u know me, but i started working PP in january after working on a medical floor for 6 mths. anyway, i had 2 questions..
    1) i was thinking about orienting in L&D.. i was just wondering how long it takes to catch on to -i guess -"guesstimating" ?? how the labor process is going (as far as dil/eff/station) because i mean, how do u know what numbers to give what you feel? get my drift?? i guess it just takes practice?
    and 2) as far as PP.. do alot of you all get medical overflow on your floor? we have been getting a lot more medicals lately and we hate it! we are OB nurses!!! we want to work with OB patients!!!! the other night we had 12 pts and only 5 were ours (OB.) but anyway, just wondered how the other hospitals out there were.
    Thank you!!!
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  2. 12 Comments

  3. by   hollybear
    well it just takes lots of practice and when in doubt call more experience nurse in to check and verify. its not as hard usually as you think good luck
  4. by   moz
    I learned by feeling the cervical dilatation charts, over and over and over and over again. I heard one nurse say she felt mayonnaise jar lids, doorknobs, anything to compare sizes. Having a good preceptor really helps also. I've done this for 7 years and sometimes I still after a check go to the dilatation chart to double check myself. You may find after you've done it awhile that certain docs will always be a little more or less than you on exams. The most important thing to know is if they are complete or not .
    We do about 50 deliveries a month, and we get hysterectomies now, rarely to we get just med surg overflow. I agree, I want to do ob, not med surg. Floating is not a favorite of ours either.
    Good luck to you!
  5. by   SmilingBluEyes
    There is not a set timeline as to when one becomes competent and independent in L and D. But I have to say, it took me about 1-2 years to feel any real confidence in independent practice in L and D. It's a bit more complicated and fast-paced than PP and M/B is (ok a LOT)......

    Practice is what it takes....that and time. Try to find a really good mentor: An RN who is very experienced in L and D and likes to teach and follow that person.

    Also, yes, we DO get surgical and occasional not-too-complicated or "infected" medical overflow in our PP rooms. You need to understand something: OB is on the BOTTOM of the hospital food chain in staffing and bed assignments. If you have an empty bed and they are busy in med/surg, you can expect they will fill your bed with a "clean" female patient. We as OB nurses may not like this, but it is necessary. I suspect this practice will become increasingly common as medical/surgical beds remain full all the time. (our ER's and PACU's are full of patients waiting for beds frequently where I work).

    Additionally, In some hospitals, OB nurses are expected to float, when their floors are not busy enough, to help out on these other floors. It's very common. You can either accept this or find a hospital that does not do these practices; they are few and far between unless you work on an exceedingly busy OB floor. All that said....

    I think orienting to L and D would be a smart thing to do. Don't be afraid to explore this and further your knowledge base. I wish you the best!
    Last edit by SmilingBluEyes on Mar 27, '03
  6. by   ShandyLynnRN
    our "women's health" unit gets all post op hysts, many other post op "female" surgeries, and overflow from the med surg floor as long as they are female and non-infectious. I actually like it because it helps me keep my med surg skills current.

    I think the more you practice, the better you will get with cervical dilation. There are always the charts to double check yourself with, and I still use them after 2 years of doing L&D. I had wonderful preceptors, and wasn't afraid to ask questions.

    Getting the station down, well, I still haven't mastered that one. It's more of a guesstimate for me. Effacement is pretty subjective. I just start with thinking about the cervix being about 2 inches at the beginning, and going from there. I just call it "thick" until I can safely call it 40% effaced or so.

    Good luck!
  7. by   mark_LD_RN
    it takes time to get it down I used to ractice with dialtion charts, would close my eyes randomly place finger in one measure it and quest what it was then open eyes to see if i was right , i also practiced on anything i can find jars door knobs,bottle caps etc.

    we alos to clean GYN patients to care for and float to peds which is our counit. we used to be required to float all over the hospital.

    don't be afraid hopefully you will have a good preceptor and do not be afraid of asking questions or for a second opinion. i still have to ask for 2nd opinion at times.
  8. by   layna
    I must confess that for the first 5 years of my L&D career, I made sure that I had one of those dilation boards with me at the bedside and after doing a vag exam, would immediately check to see which hole on the board represented what I felt. I made it look like I was using the board as a teaching tool for the patients!! LOL
  9. by   Disablednurse
    Moz, is that beautiful red headed baby yours? I just had to ask. I love little redheads and this one looks so mischevious.
  10. by   Sleepyeyes
    omg, amanda, I could never float to L&D! Med-surg only!! WHY don't they get it??? they are 2 different specialties and are NOT interchangeable!!

    I feel sooo sorry for the L&D nurses who hafta float to MS. But they don't hafta do that where I work. *whew*
  11. by   ShandyLynnRN
    I also found out that the EFM paper has 3 centimeter/minute spaces on it. So if I don't have a chart handy, I sometimes will measure using the paper.
  12. by   SmilingBluEyes
    Great idea, Shandy. I remember a VERY experienced labor nurse telling me that too. I am like Mark; I am NEVER afraid to ask a 2nd opinion when I simply am unsure. I always love back-up and have NO pride when I am unsure. I think the best nurses always want to be sure so they are unafraid to ask for help when needed.
  13. by   ShandyLynnRN
    Originally posted by SmilingBluEyes
    I always love back-up and have NO pride when I am unsure. I think the best nurses always want to be sure so they are unafraid to ask for help when needed.

    A great idea to live by!!!
  14. by   mother/babyRN
    Everyone giving great advice...Just a thought..We all get medical overflow and it isn't wonderful but remember this. You may be an OB nurse but you are a nurse first....In the old days we had to first do at least a year of med surg for a reason, not because we ever expected to get so many medical overflow people, but because all the things, good, bad and horrible, that can possible occur with medical patients ( with exceptions of penile/prostate problems lol), can and do occur with OB/GYN patients. They stroke out, have Mi's, pneumonia, AIDs, surgery with resultant complications, diabetes, depression, cancer,psychosocial issues,bad attitudes,sad stories, critical illness..In fact, I have said this before but delivery is the scariest (albeit coolest) place I have ever worked and I have ICU/ER background. So, you may be a good or potentially good OB nurse, but you will never be a great one unless you ( and I hate cliches) think outside the box...Use these medical overflow patients as learning experiences vs being overly frustrated by them....Good luck in Labor and delivery. It surely takes time and if you make a mistake just treat it as a lesson....Everyone will be helping out someone so motivated as you seem to be...Take care and welcome!

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