Competent and Risk of losing License

cannoli · Nov 22, 2004

Is this a HCA hospital?

Why did the 3 nurses resign? That may be very telling right there.

Good luck.

Goldenearring1 · Nov 22, 2004

what do you mean HCA?

Jolie, BSN · Nov 22, 2004

Hoping for some good advice,
I recently resigned my position as a Level III NICU nurse to accept a position at a local community hospital as a L/D nurse. They hired a new director and she wants to implement mother/baby care to this unit which means that she wants to get rid of the LPNs and have an all RN staff, she told me that I would have an orientation and that it would be sufficient. When I went in for my first night this weekend I looked at the schedule and was discouraged to find that I am only having 3 weeks of orientation and then be expected to labor and deliver and resus an infant with only one nurse, me. Is this right? I have not had OB experience, I have been exposed but....please help. I really want this job but there is no way that I will be competent enough and I don't want to risk losing my license in 3 weeks. By the way 3 nurses resigned on Fri.
Thanks :uhoh21:

This is NUTS! Anything less than 12 weeks of orientation for L&D is unacceptable and unsafe, longer if you will be expected to scrub and/or circulate for C-sections, or recover patients post-op.

Secondly, it is NEVER acceptable to expect a single RN to handle a delivery and infant stabilization. That is in clear violation of NRP teaching and AWHONN standards of care. Some units staff 2 RNs at the time of delivery, some utilize an RN for mom and an RT for baby. There is more than one acceptable way to staff a delivery, but a single RN is not an option.

It sounds like your new unit is going thru some very troubled times. Change is never easy, and that may be the reason for some of the resignations. But you must also consider that the experienced nurses in the unit see trouble coming and want out for the good of their licenses. I would not be willing to stay in a unit which has less than 50% experienced staff, meaning 2 years or more of L&D experience. You will never be able to learn safe and competent care without adequate support from role models and mentors.

I'm sorry for your situation!

cannoli · Nov 22, 2004

HCA, Healthcare Corporation of America.

BETSRN · Nov 22, 2004

That's an unacceptable orientation. At least 3-4 months exclusively in L&D is a minimum. Do NOT do it! Learn mother/baby. That's a great place to start. You're right to be concerned. This new director does NOT have your best interests (or the patients) at heart. RUN, RUN, RUN. L&D is great, but find a good safe place.

Nursesuzi · Nov 24, 2004

I agree with the others, but I think it's unusual for an experienced nurse transfering to LD from what most hospitals consider a "related area" (which NICU is according to my manager), to get 12 weeks. At my hospital, which is in a big metropolitan area and has a great reputation for retaining employees and happy patients, only new grads get 12 weeks then are considered a "half person for another 4 to 6 wks. Most experienced nurses get a month or two and then have a mentor to help them. I would insist on that at the very least.

Now, as far as being alone in the delivery room during recovery. I think recessing a baby alone and having to watch mom simutaneously is dangerous. However, my hospital, which strictly adhers to AWWON guidelines expects that of us. I need to check that out, as do you. I oriented on days and as a new grad, towards the end, I was expected to do that myself. Scarier than you know what. Now that I'm going to night shift, thank god, you have a slew of RN's in the room with you at the beginning of a recovery.

If you decide to take this position, I would definitely check out why the other RN's left. L&D is very different in pace than NICU from what I heard. In the most supportive unit it can be an adrenaline rush. If you are unsupported it could not only double your stress but endanger your license. Do your homework and stick up for your self. Worst case scenario at least you have your NICU exp. to fall back on.

Good luck:chair:

S

purplemania, BSN, RN · Nov 24, 2004

Voice your concerns immediately, or make a stand and say you cannot work under those conditions. Be prepared to back it up. I turned down an otherwise good position for a similar reason years ago. Seemed like a big deal at the time, but now I can look back and see I have not had the stress I would have had in that job.

Nemhain · Nov 24, 2004

No that's not right. You're orientation should be at least 6 weeks. Also, I've never heard of just one nurse caring for mom immediately after delivery and also have to be caring for the neonate. That's wrong.

Jolie, BSN · Nov 24, 2004

Please read the thread entitled "Nrp" and then ask yourself if it is appropriate for a single RN to staff a delivery for the care of both mom and baby.

Goldenearring1 · Dec 2, 2004

I just wanted to thank everyone for their excellent advice. I had already accepted the job before I posted so right now I am a little stuck. This weekend was very hard for me as we had a IUFD at 35.5 weeks. I have seen alot of neonatal deaths working in the NICU, but this was different it was something I will never forget. The mom had called and said she had not felt the baby move since Fri night sometime (this is now Sunday) and that she was getting the run-around from her doc (our hospital was not the one she was supposed to deliver at) so anyway she came in to our facility and they could not find any fetal heart tones, confirmed with ultrasound that the baby had passed and it had been dead for at least 4 days. The doc came in and did a Cytotec induction. The mom contracted well for a good 4 hours and then the strip went flat. Her call light went on and she said she felt something down there. We were just in there 30min ago and had checked her and there was nothing there no bleeding or anything. I thought to myself Oh no and sure enough the babies head was out, called the doc and he said to do nothing and he would be there in 5 min. It was the longest 5 min. all the mom had to do was lift her leg and the baby was out no signs of life. We laid the baby on the mom and let her grieve, so after a few min you could tell that she was fading and we asked if we could take the baby to clean her up and maybe put something on her that mom had brought from home to take some pictures with the family. We tried cleaning this baby up but every time we wiped her it was just....bad, so I had to take a piece of cardboard to put behind the babies body in between the blankets so the mom would not be able to feel all of the infants bones cracking and popping(sorry).....So I took the infant into mom and dad and let them grieve for her and let the family take pictures. I feel so bad for these parents and family I feel that I am grieving with them. This is not what I wanted from L/D, this is a horrible feeling. Am I wrong to feel like this....somebody out there please advise.

BETSRN · Dec 2, 2004

Unfortunately, the sad comes with the joyful in L&D. The less done the better with an IUFD and it sounds like you all did it right. usually, if you leave well enough alone, the baby will come on its own: less trauma for Mon, as there is enoght as it is in those situations.