What..work with NO residents?? - page 2

by jodyangel

1,933 Views | 12 Comments

Ok question. I have only worked in L&D in teaching hospitals..and am not considering taking a position at a small hospital with No residents. No 24hr anesthesia...but an OB in the house. The RNs do all assessments concerning... Read More


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    Quote from jodyangel
    Ok read it..but just seemed like alot of legal mumbo jumbo..what and how does this act apply to Me??
    If you work in a small hospital, where you assess pts in possible labor, and send them home based on your assessment, or are involved in transporting a patient to a higher level hospital (either a laboring mother or a sick newborn) you need to know. EMTALA violations cost the hospital tens of thousands of thousands of dollars. If the ambulance arrives to transport your patient and you checked her an hour ago, you better check her in the stretcher before she rolls out, if she becomes complete or arrives pushing at the next facility...your name was on the chart that the woman was stable when in fact she wasn't. We got an early labor patient from an hour and a half away from another hospital (which was VERY rural and had no L&D) who came in private car; big no no. The list goes on of stuff you have to know. In a rural level one hospital, EMTALA is a word we all know.
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    That's a tricky scenario especially when I have seen patient's stay at 2-3 cm and then change pretty quickly from 4-10. Labor is so unpredictable. Charting and more charting before discharge to r/o labor. I'm always terrified I will send someone home that ends up delivering in the parking lot.
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    I work at a hospital exactly like the one you describe except no OB in house. I work nights and the only doctor in house is the one in the ER. However, when things are going down we don't call the ER MD. All of our OBs are 5-10 minutes from the hospital and I work with and amazing staff of nurses. I love where I work and have great nursing skills. I feel like I get to use my judgement and experience better here than I would at a big hospital. All the nurses in my department do l&d, postpartum and nursery. We all stabilize infants if they need a transfer to NICU. Many of my doctors have told us in an emergency they would rather have one of us as a nurse with them than at the big hospital nurses with a NICU because we have such versatile skills.

    Is it scary as hell? Sometimes. But I don't try to avoid the idea of something bad happening. I just try to make sure we are always prepared for worst case scenarios walking in the door. During down times I am checking and stocking rooms, making sure everything is ready to go. I can go through our infant crash cart in my sleep. I try to keep myself educated and up to date. I always end up doing quadruple if not more than my required CEUs. We also do lots of drills and scenarios.

    I firmly believe that God watches over us here at my little hospital. It seems like the worst always happens at shift change so there are extra hands on deck. We have delivered as early as a 29 weeker here. The down side is there are somethings I will never see (and hope never to see) here because those high risk patients are taken to the big city hospital. I have bagged lots of babies and had some pretty serious situations in l&d. In my 10 1/2 years here I still have never delivered a baby, lots of my coworkers have though. But if it happens I will be able to handle it because I am ready.


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