What..work with NO residents??

Fyreflie · Sep 3, 2012

My last job was pretty much exactly that and after the first few months, when I was learning to do specs, honing my judgement skills and learning to Triage in a whole new way--I loved it!! I was always a little nervous but I think that's healthy no matter how long you've been working. My assessment skills were waaaay better in all areas by the time I left and I quite honestly miss the independence now.

monkeybug · Sep 3, 2012

That sounds exactly like the first hospital I worked at. You will adjust. And you will be amazed at what you can do! As for the lack of a NICU, if we had a baby go bad and the pediatrician wasn't there, our OBs would step in and help, and our CRNAs would intubate if needed. I felt like I could handle just about anything after several years of that. I did end up at a teaching hospital as a travel nurse, and I HATED it. I missed my independence and autonomy. The hospital I'm at now has family practice residents, but most of our patients belong to the private docs so I get to be my independent self most of the time. Once you get used to it, you will probably like it. L&D tends to attract independent people. I can't speak for all small hospitals, but when I worked at one, it was not unusual to hear the doctor say, "I've been up for 2 straight days. If you really need me, call me. If you can handle it, write the order and I'll sign it in the morning." Or, if the MD found out that a med/surg nurse was being pulled to take care of postpartum patients, I've seen this order in every postpartum chart before he went to bed: "Consult with L&D nurse BEFORE calling doctor."

We really worked as a team there, the doctors respected each of us (once they got to know us) and trusted our assessments and opinions. I remember seeing one of the OBs mop the OR when we were crazy busy, had no housekeeper, and needed to do a c-section. I miss those days!

MamaMadge, ADN, BSN · Sep 4, 2012

I work for a small hospital and we do not have docs or anesthesia in-house. Yes, it can be challenging, but all of our docs live close by and in an emergency, we can have a doc and CRNA there within a few minutes. Conversely, we have had nurses who came from teaching hospitals and they did not know how to to a cervical exam correctly. It really makes you hone those assessment skills!!

Honeychild · Sep 5, 2012

I work in a similar setting. It can be a little intimidating, but I think the atmosphere really depends on the team you are working with. I work with wonderful nurses and doctors that I trust. Work for me is exciting. I used to work in a NICU and loved it there too, but I really enjoy my independence.

HeartsOpenWide, RN · Sep 5, 2012

I work in s hospital like this, plus no MD on site. All of the clinics are close by, but at night you are on your own. You really have to know your EMTALA stuff, we see, assess, and discharge labor checks without the doctor ever seeing the patient. We basically do it all. I have been at RN deliveries when the doc has not gotten there in time and the woman has bombed. You really have to be good at your assessment skills, your docs not right there. I think it would be hard to give up so many skills to a resident, I really enjoy my scope of practice.

jodyangel, RN · Sep 5, 2012

EMTELA??

HeartsOpenWide, RN · Sep 5, 2012

EMTELA??

It's not EMTELA. It's EMTALA= Emergency Medical Treatment Active Labor Act

http://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

jodyangel, RN · Sep 5, 2012

Never heard of it!! Off to read..

jodyangel, RN · Sep 5, 2012

Ok read it..but just seemed like alot of legal mumbo jumbo..what and how does this act apply to Me??

HeartsOpenWide, RN · Sep 5, 2012

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.

passionflower, BSN, MSN, RN · Sep 13, 2012

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.