Duties of OB nurses (and others) Please feel free to add!

[SmilingBluEyes]

For the benefit of new nurses and future/prospective OB/GYN nurses and doulas, midwives, others, thought I would try a sticky that discusses various duties/skills sets and other characteristics that make a "good", well-rounded OB nurse, doula, midwife or other professional dealing with Women's Health Issues. This question seems to come up now and again, so let's help em out.

I will start. Here are skills sets for OB nurses that I found apply in most areas. Again feel free to add to this; I want to learn as well!

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OBSTETRICAL ASSESSMENT SKILLS

Inbound facility tranfer unit

Outbound transfer to other facility

Identify fetal position (Leopold maneuvers)

Fetal heart tones

Severity of contractions

lady partsl exam, dilitation & effacement

lady partsl exam, station & presentation

lady partsl exam, culture collection

CLINICAL SKILLS

Set up tocotransducer

Intrauterine pressure catheter

Auscultate fetal heart tones

Intact/nonintact membranes

Nitrazine test

Internal fetal monitor

Interpreting normal/abnormal fetal heart patterns

Baseline interpretation

Early decelerations

Beat to beat variability

Late decelerations

Prolonged decelerations

Set up OB pack

Set up baby pack

Cord blood collection

Artificial rupture of membranes

COMPLICATIONS/FURTHER DUTIES

Pregnancy Induced Hypertension

Antihypertensives

Clonus

Diabetes

Abruptio placenta

Placenta previa

Prolapsed cord

Preeclampsia

Eclampsia

Malpresentation

Premature rupture of the membranes

Premature labor

Magnesium sulfate

Drug dependent

RH incompatibility

Herpes

HIV

HBV

Hemorrhage

Blood transfusion

Forceps delivery

Vacuum extraction

Precipitous delivery

Gestational Diabetes/Diabetes and its sequalae

Starting IV's

Cesarean section-circulate

Cesarean section-scrub

Central line placement, set up & assist

Epidural, set up & assist

Spinal, set up & assist

Local, set up & assist

Foley catheter placement

Pain control, narcotic

Intrathecal medication delivery

Episiotomy, set up & assist

Uterine massage

Lochia assessment

DVT

Induction of labor

Cytotec

Prostaglandin supp

Oxytocin infusion

PATIENT TEACHING

Relaxation/breathing techniques

Premature labor prevention

Phone triage

Also:

Labor coaching/support for birthing mother/family

Neonatal assessment/resuscitation as needed

Breastfeeding initiation/support/ongoing teaching

Self-care and baby care once you go home

Care of any surgical wounds/therapies

After-care telephone triage (answering questions once a new family has gone home)

[sqky]

I would like to add to your list. To that list add resources for adoption. The time of discussion of this topic is not during labor. Our local hospital has prenatal classes which has added special night for the birthing mother who is considering relinquishing her child. On that night an adoption social worker, birthmom and birthgrandmother come in to answer questions about the adoption process and their experinces.

It is a very positive environment for everyone.

Your job is very intense and dealing with a child being relinquished only adds to the difficulty. Develop and use your "natural resources in your community"........ those who have been there and done the ups and downs related to relinquishment and live to share about it. It works.

The local Planned Parenthood use the "natural resources" I have referred to, I am the birthgrandmother they call.

[SmilingBluEyes]

Agree, we need to know what resources are available to our patients, as well as ourselves, to be able to handle all manner of situations as they arise. THanks for the suggestions.

[AF-NRS]

How about:

shoulder dystocia (mcroberts, suprapubic,etc...)

collection of cord gases

precipitous delivery

delivery of placenta (signs that placenta is ready to deliver,...)

lady partsl exam--fetal presentation/lie

telephone triage (we do this at our facility...)

delivery of multiples (lady partsl and cesarean)

fundal height assessment

that's all i can think of...your list is pretty comprehensive.

[AF-NRS]

I don't know how many times a patient has been "pushed" to breast feed when they where not interested. There is a line between teaching and bullying and though I am pro breast feeding I feel that the patients belifs and deires NEED to be respcted.

I totally agree with you. if it's a 1st time mom , i try to encourage her a little bit more (only because sometimes they are just afraid becuase they they think it will hurt) but for those that have other kids, i leave them alone.....these moms know what they are doing and dont need to be guiltied into one method or the other.....

[AF-NRS]

SHOULD I BE INTIMIDATED BY OB NURSING? I HAVE BEEN CONSIDERING THIS AREA. :uhoh21: HMMM ...

dont!! it is a special type of nursing just like ICU and emergency medicine...it's like any other type of nursing...you either love it or you dont!

[mjsobrn]

If it helps do what I did if it is offered.. I was a student nurse extern my last year if school on L&D I did all of the nursing duties under the supervision of a preceptor (with acception of vag exams) it made me more prepared to handle the stresses of being a "new nurse" the down side to it... it took me over a year to shake the stigma of being the "extern"

[TashaLPN2006RN2012, ASN, RN]

What is the difference of LPN/LVN's in L&D and RNs?? I just graduated and i have applied for a position on a military base for L&D and they take new grads, but have not recieved a call yet for an interview. Just wondered if the LPN's were more "aide" like or if we would get to do a lot of what the RN's do.

[jode1012]

HI! I am getting ready to graduate in May and have a job lined up on the OB floor in our local hospital. I was wondering if anyone could offer some helpful advice or tips to help me in my orientation. Thanks

[mamababynurse]

feel like i have to add my two cents. i am a mom/baby/gyn nurse. i do everything BUt labor and delivery. just want to tell you: in my facility (an HCA facility) I am expected to do EVERYTHING but deliver the baby. I am supposed to be a mom/baby/postpartum nurse and I get everything BUT the actively laboring patient. I get antepartum, even though I am NOT qualified to read a strip, I get gyn patients with multiple issues, to include bilateral PE, hx of DVT, patients withdrawing from drugs, with b/ps 212/119, where I am required to sit one on one at bedside pushing apresoline, I have gottenn patients with thrombocytosis who require special care, can't even begin to describe the patients I have gotten with extraordinary issues that come to my floor, all because their primary doctor is a OB dr. Should I as OB nurse, get lap chole patients? I think not. Should I get patients that require one on one care, sitting at the bedside pushing apresoline, meanwhile I have 3 other patients who require my care, with no tech and no secretary? NO Not only is that unsafe, but it is ABUSIVE. I have been so totally abused to the point where it is dangerously unsafe. All in the name of saving a few dollars.

Bottom line is: DO NOT work for an HCA facility, they are the most severely understaffed system (corporation) I have seen. I have no support from my supervisor and am forced to take on patients that I as a PP nurse have no business messing with. I feel I have been so abused that I have no desire to continue as a nurse. WE get no support from docs or administration and I am tired of being shat upon. Like I am some stupid piece of dirt under the doc's feet. Who needs this? I tell everyone I know, "do NOT become a nurse, you are treated like dirt and get paid so little for the abuse you must endure." AND, dear God, do NOTmove down here from the north, you WILL be sorry. I HATE Florida, theyare the worst paying state for nurses, and they are about the stupidest people I have EVER met. my god, get a grip! To them, it's all about Medicaid and more babies. If you live up north, PA etc, DON"T move down here, you WILL be sorry. I know I am.

I just know that I wish I had never become a nurse. It SUCKS>

[mamababynurse]

HI! I am getting ready to graduate in May and have a job lined up on the OB floor in our local hospital. I was wondering if anyone could offer some helpful advice or tips to help me in my orientation. Thanks

Yep, have some advice. RUN as fast as you can. You have NO idea the kind of patients you will get, if you work in a hospital. You will get, oh gee, hysterectomies, but guess what? they will be 80 years old and have all sorts of cardiac/dvt/respiratory issues. You think, "no, not where I'm working" Well, YES, if you plan on working in a hospital, you will see things you had NEVER planned on seeeing. Women with history of DVTs, women withdrawing from crack (that's a real treat). Old women with a history of some kind of heart thing going on. girls who are having asthma attacks who just happen to be pregnant. YOU have NO idea. It SUCKS. all these things they will not tell you. you think it's all about cute little babies and goo goo gaa gaa? WRONG. they suck you in, thinking it's all hearts and flowers but all it really is is 12+ hours of HELL. I wish I had never become a nurse, cuz it SUCKS...but, good luck to ya hope you do better than I did

[HappyNurse2005, RN]

feel like i have to add my two cents. i am a mom/baby/gyn nurse. i do everything BUt labor and delivery. just want to tell you: in my facility (an HCA facility) I am expected to do EVERYTHING but deliver the baby. I am supposed to be a mom/baby/postpartum nurse and I get everything BUT the actively laboring patient. I get antepartum, even though I am NOT qualified to read a strip, I get gyn patients with multiple issues, to include bilateral PE, hx of DVT, patients withdrawing from drugs, with b/ps 212/119, where I am required to sit one on one at bedside pushing apresoline, I have gottenn patients with thrombocytosis who require special care, can't even begin to describe the patients I have gotten with extraordinary issues that come to my floor, all because their primary doctor is a OB dr. Should I as OB nurse, get lap chole patients? I think not. Should I get patients that require one on one care, sitting at the bedside pushing apresoline, meanwhile I have 3 other patients who require my care, with no tech and no secretary? NO Not only is that unsafe, but it is ABUSIVE. I have been so totally abused to the point where it is dangerously unsafe. All in the name of saving a few dollars.

how can you have antepartum patients but you can't read a strip? who does their fetal monitoring and interprets it?

i am an antepartum/l&d nurse (no postpartum) and we have gotten women with medical issues as well. if it can happen to a woman, it can happen to a pregnant woman. heroin withdrawal on methadone, hip fractures s/p mva, appendectomy post appendix rupture, recently, a sickle cell crisis on pca pump, etc. it is something that isn't always known by new nurses-if you do antepartum, you will have pregnant patients hospitalized for non pregnant medical issues.

i though, think its interesting.

[mamababynurse]

I have to call downstairs to L&D to ask someone to come read the strip for me. If they are busy, it can take quite a while until someone gets to it. Pretty unsafe. Besides, I don't like antepartum. If I had wanted to do that, I would have been a L&D nurse. It's not just pregnant people with issues, it's pretty much anybody with a lady parts. Got one last month who came in to the ER with "numb legs". I got her because she had a hysterectomy about a month previously. I am the dumping ground for all the stuff other floors don't have room for. The only thing I have yet to see is a patient with a member, but I'm sure that's next. And THAT's when I say "goodbye"