Inner City Vs. Community Hospital Patients
0Aug 11, '12 by LDNURSECITYI work at an inner city hospital on the L&D floor. I was thinking about going to a community hospital. Another nurse told me she would be afraid doing her own vag exams and calling a doc from home. What is a typical patient like at a community hospital? Here is a "typical" shift at my hospital:
-At least 1-2 people coming in triage at 7cm or more (1 delivering in triage)
-At least 1-2 STAT sections
-Sometimes, all recovery rooms (4 beds) and all triage rooms (5 beds) filled and all L & D beds filled (12 people on monitors at one time, viewable on our huge flat screen)
-1-2 preterm patients
-At least 3 patients with some high risk condition: No prenatal care, preeclampsia or GDM, prolapsed cord, placental abruption, HELLP, Barthalows Cyst etc
-Most patients coming alone (FOB not involved)
-Most patients in their early-late teens or early 20s
-Most patients with limited education and resources
-24/7 NICU team for all questionable deliveries
-residents to do all vag exams
-Attendings and residents in house at all times
Obviously, L & D is unpredictable. I do not need someone to post and tell me that. But I would like to know what a community hospital setting is like.
0Aug 11, '12 by NJNursingI work in a community hoapital. We only 6 labor rooms, 2 antenatal / mag recovery rooms, but in a squeeze, we can deliver in them. 2 or's/pacu beds, 5 triage beds. We can have 1 patient all night, we can have 13. There is usually at least one section a night, most was 7. We always have 2 docs in house but we have 4 ob groups who like to do their own deliveries, but if they don't make it to the hospital in time, the laborist will do the delivery. I don't mind doing vag exams, but if they are complete with pressure, i get a doc to double check. It's about learning a new skill and bringing the knowledge with you.
0Aug 12, '12 by dreamworx07Guess I win for most rural so far....4 labor rooms, I triage and 8pp. No residents, midwives come in when complete and pushing. Docs come for c-sections. Nurses triage and if patient looks good, call midwife and make recommendation over phone to admit or d/c. During day nurses don't catch too many babies, but at night it happens. All cervical checks are done by nurses unless midwife is in unit to deliver. Ancillary staffs are limited and usually suck (sorry) at night so constant battle to get the easy stuff done, nurses work with so much autonomy that it usually ends up, do what we need and then let the doc/midwife know what we did, We do plan on transferring high risk out but not always possible, so have to be ready for anything. Breech delivered vaginally and 24 week twins back to back last week with just two nurses on the unit. OR team takes an hour to arrive to do a section, CRNA not in house at night, call them in-they do epidural and leave so we are managing pump and bolus's. I happen to love it. It can be really really scary at times, but you use all your nursing skills and then some!!! Have to be confident in your skills and confident in those you work with!!!
0Aug 12, '12 by monkeybugI work in a regional facility that is sort of a hybrid. We do have residents, but we do more with our large private practice. So, we are a teaching hospital, but only to a point. I find that we have a whole lot of autonomy, and the MDs really rely on our judgment and skill. When it comes to the patients that belong to the medical school, we constantly are in a state of irritation because we could do it all so much faster! We must be proficient with vag exams. In fact, we are often expected (especially in July and August) to check behind the residents and verify how dilated the patients are. When we have 2 years experience we are expected to place our own IUPCs and FSEs. When I call one of the privates to tell them that their patient is having lates, they expect for me to already have done an exam, turned off Pit, put on O2, put on an FSE, repositioned, and done a fluid bolus. They expect me to know to do all of this without prompting from them. The private docs are there so much less, but they can do that because they know we are there. I would HATE working in a full teaching hospital. I've tried it before, and I was miserable. I felt like my hands were tied all the time. When we triage a patient, we monitor, do a vag exam, then do labs as we see fit (wet prep, ua, nitrazine) and call the private docs only after all the results are in. Many patients are triaged and discharged without the MD ever laying eyes on them. As for the patients, in our state, 48% of babies are born to unwed mothers, so it really doesn't matter who the doctor is, chances are the patient is going to be young and single. We do get the occasional married woman with husband in tow, carrying an insurance card, but it's one of those things like a four leaf clover. Nice when you run across one, but you don't expect it all the time!