So I am new to L/D..I'm actually still on orientation. I have been preceptoring with my mentor since mid september and today was the first day that i had to balance 2 active pts. Admitting one, then juggling my other active pt next door (luckily they were right next door to each other!). It was really difficult, and my preceptor did have to help me, but I would have never been able to do it myself!! How do you experienced ones out there do it??! Esp when we had to prep one for her epidural...things like that make me wonder how I will be able to manage more than one pt. ( esp when u need to update the docs, administer meds, titrate pit..etc..) I 'm sooo ovewhelmed..HELP!!:angryfire
Nov 7, '06
A lot of hospitals try to do one-to-one nursing once a woman is in active labour. I just had an interview for a labour and delivery position, and I'm very hopeful that I got the job... I'm also very hopeful that they have a one-to-one policy because, like you, I can't wrap my head around managing two labouring women at once. What if one woman is ready to start pushing and the other runs into trouble?
Also, it just simply doesn't seem safe to leave a woman receiving pitocin without a nurse... what if she goes hypertonic?
I'll be interested to see the responses to your post.
Nov 7, '06
We do one to one as much as possible, i can't imagine having 2 active patients. what if one is a multip and gets complete while you're helping the other with her epidural? what if they both start having late decels at th same time? the what ifs go on and on.
we might have one active pt and one cervidil patient, but generally, as much as i've seen in the 9 weeks i've been there is 1 active labor=1 nurse
Nov 7, '06
What's your institutional policy? What do they consider an "active" labor patient? Do you do electronic charting? If you're in one room can you see the strip of your other paient? How often do you have to chart on these patients?
For a new person in L&D, 2 active labor patient's are too much. Unless they're trying to burn you out! Keep your charge nurse up to date with what is going on with your patients. Politely ask her who will be watching your patient while the other one is getting her epidural placed. Sometimes, the charge nurse doesn't have the whole story about the patients on the floor.
On the other hand, there are people who will "milk" a cervidil induction for all it's worth, running around like a chicken with their head cut off (you'ld swear their patient was precipting) but really walking the hallways!
You do need to know the guidelines of your hospital, since these are the ones that will protect you in court.
Nov 7, '06
flytern covered it very well. Know your policies and procedures ---the standard goes by stage. For example, two laboring, uncomplicated patients can be cared for by one nurse. BUT when a patient is receiving a regional block or is pushing, it goes to 1:1 during this time. This requires a lot of team work and juggling at times. And yes, it can be very tough. Generally where I work, we try to keep all actively-laboring patients 1:1 if at all possible. If we are really full, we will do 1 labor patient and 1 couplet for a nurse, if possible. (the nice thing about being an LDRP we can do that). But when the patient is pushing or getting epidural, or is very complicated/high risk (diabetic insulin drip, or Mg sulfate), we keep it 1:1.
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