Workflow of Labor & Delivery Nursing - page 2
by Cottontop365 6,393 Views | 15 Comments
I have been a nurse for a year now. I started my career at a huge hospital with an amazing reputation. I work in cardiac surgery progressive care--a step down unit. I also worked for a little while in the cardiac surgical... Read More
- 0Oct 30, '12 by shadowDear OB/LD/PP nurse friends,
We are a small OB unit level one with under 300 deliveries per year. Our staffing fluctuations are kicking our butts since the "predictibility" factor dimminished. We stopped doing c/s or inductions before 39 weeks. I KNOW you are all laughing but let me explain. Our patient accuity has increased during the "OFF" shifts. you know. ANYTHING other than the day shift monday through friday. Who has a GOOD plan for staffing a small unit? We are staffed with 2 RN's at all times. Day shift M-F has the manager most of the time if the flood gates break. Also we have ONE OBT M-F 9-5. The evening, night and weekend staff are 2RN's only. Many days this is plenty or more than enough. More often it's NOT!!! We are considering implementing call, increasing OBT hours, etc...... Anyone have a better idea? HELP!!!!!
- 0Oct 30, '12 by mommy2boysazQuote from FyreflieMost perfect description of life as an OB nurse I've ever seen! You nailed it fyreflie!Sometimes it's slow--until it's not!! I work on a unit that averages 15-25 deliveries in 24 hours. I have worked shifts where 13 of us have sat on our duffs all night and had 1 delivery. I've worked shifts where we've had 18 nurses running their butts off for the entire shift, no breaks. I've even worked a shift where we had 8 sections in 12 hours (16 in that 24 hour period). I've had shifts where we have started the night with one room full and only had one room empty four hours later, and vice versa!
It's so hard to compare L&D to any other type of nursing. I think your closest comparison would probably be Emerg. There are no scheduled meds, and we are often looking up policies and procedures to learn how to deal with something we've never seen before (ie withdrawing from alcohol who had retained product and a general anesthetic followed by IV push sedatives to keep her from seizing). A medically risky person can deliver with no complications and a perfectly healthy young primip can hemorrhage after a quick and easy labour and delivery and lose her uterus. You might care for both these women in one day, and then resusc a baby who had a perfectly normal tracing. You have to be prepared for any or all of these situations to occur within minutes and you have to be able to act quickly when they do, all the while reassuring dad and grandma and staying connected to Mom so she feels trust enough to let you preoxygenate her for an emergency c/s with general anesthetic without panicking, even if you met her 5 minutes ago.
You will learn to mistrust full moons, yell at people who say the Quiet word and firmly believe that pressure changes cause waters to break. You will teach more than you thought you knew and grieve with perfect strangers when something perfect goes wrong. You will learn to hold your tongue and put your judgement on the back burner. You will learn to trust your intuition--sometimes over your experience or common sense. You will never let a first--or even second--year resident check a patient without checking after them just to see how good they are.
You will learn that your work flow has more to do with your personal karma or run of luck than anything else. You will want to call in sick when that flow is kicking your ass!
If you're lucky, you'll love it, and if you're not, you'll switch out pretty fast
- 0Oct 30, '12 by cebuana_nurseTo: shadow
This is pretty much the same scenario at my current hospital. They ended up doing on-call schedules for nurses and we have a calendar full of requests for vacations so that our manager could fairly approve such vacations or reject them due to staffing. We have a 2-RN policy per shift but due to being a small community hospital, such thing doesn't happen due to low patient census. The staff that has the most seniority has a choice to stay in OB or float to other departments and the 2nd RN be on-call at home granting they only like 30 minutes away. Being on-call, you are guaranteed $50 per 8hr shift. Same thing applies to OB-GYNs. We don't have an in-house OB M-F as well as weekends. I totally understand the whole no inductions or scheduled sections before 39 weeks. It's a bummer