sweetcheekers

I have my review in a few days and at the facility I work for we are required to submit goals each year to be included in our review the following year. They must be measureable and fit under one of our five pillars which are quality, finance, growth, service, and people. I am an OB nurse with three years of experience and care for moms/babes postpartum and also care for labor patients. Any ideas?

Our CRNAs will do an epidural on a patient with a tattoo only if they can place it without going through the inked areas. Their reasoning is that some tattoos are done with ink that contains lead and this can be released into the system if punctured in that area. Don't know if this is one of those theories that we just avoid because it "could" be a problem or if it is evidence based?

I don't know about legal, but we're worse off than that where I work. The other night I was scheduled with another labor nurse but since we only had a mother who had a fetal demise the day before, and a cytotec induction that night, the plan was that I be there alone with both. The other nurse would be home, "on call" in case something else came up. Well, before the offgoing shift left an additional labor patient came in so she was there with me. It is a rural hospital that does about 30 or 35 babes per month. We routinely have only two RNs scheduled at night and usually only one is a labor nurse and the other a mom/babe nurse who does postpartum couplets. (The labor nurse also does mom/babe if there is no labor patient.) I think it is a poor idea to have a labor nurse in a unit alone with a patient when no one else in the facility knows labor at night. CHEAP, CHEAP, CHEAP! That is precisely the reason that even though I am newly oriented to labor I have refused to be scheduled as the labor nurse on my shifts. Not enough support or backup. In the event that we have no patients which has become a rare thing as of the last year or two, the unit is closed and the scheduled nurses are home "on call" or some who are willing float to med/surg if needed.

30-60 is what we consider normal in our OB unit. Not everyone though, is going to fit into the cookie cutter numbers that are laid out for us. Look at your patient and if he/she seems okay recheck in an hour. You'll probably get something closer the the "normal" range. We recently had a baby in our unit who had a heart rate in the 80s and respirs were low, too. The babies family practice doc called a neonatologist to consult, and he was told not to worry. He said if all else is normal including pulse oximetry and no signs of labored breathing (grunting, flaring, retractions) then that baby could tolerate it and it was not unheard of.

I've never seen the actual numbers used to determine the result, but we get a result listed as immune, equivocal, or non-immune. We vaccinate the equivocal and non-immune patients in our OB department before discharge.

If you believe in God, then know that what we do or don't do, or what we cannot get others to do when we know what needs done are irrelevant in the big scheme of things. I witnessed a stillborn birth a year ago in which we lost heart tones only a few minutes before birth, the code was not successful. In the midst of it all I heard God's voice inside my heart saying, " I am here, and I am in control." I knew then that I am never alone and that God's will prevails no matter what. I don't think we can ever understand the reasoning behind a lot of what we witness, but remember we don't have the full picture. We can't overcome what God has planned. We can only do what we know we should and then surrender control to the One most capable of deciding the outcome. Peace to you. I know it hurts. I still remember everything from that experience last year, the family, the babies name... I don't know that I'll ever forget.

Okay, now I'm LMAO! That is hilarious.

I'm orienting to L & D and have taken a class in fetal monitoring. I've been working with a L & D nurse in our unit taking care of labor patients for the past couple of weeks. The problem is that yesterday I had a decel at the end of my strip, mom was about 9 cm and delivered about 19 minutes later. There was a late and then a couple minutes later a decel that was shaped like a U and mirrored the contraction. One nurse told me it was a variable and another said it was an early. How do I decipher? I thought variables tended to be shaped like a V and I believed that earlies began before the contraction. This one was a mirror of the contraction. HELP! Differing opions among my experienced co-workers is not helping to build my confidence.

I began orientation to L & D this week after being a mom/babe nurse for the last 15 months. I was reluctant to learn this new role because I work in a small hospital on night shift which usually has only two nurses in OB, one L&D RN and one mom/babe RN. Occasionally both nurses are L & D trained, but not often. Anyway, I was worried about becoming a L&D nurse and then being "on my own" at night as a newer nurse, and not having any back up to rely on. I feel very anxious that this orientation is going to be rushed due to the fact that now, on my shifts we are going to have no L & D nurse because she took a weekend package shift. So next month, we'll have to fill those hours with PRN staff. I know this will get old and fear that I will pushed into taking those L & D hours so they are covered and meanwhile they will put a new nurse into my mom/babe hours so the nurse working with me will be inexperienced, too. (Much easier to find mom/babe nurses than experienced L & D nurses.) Anyway, I've oriented 3 days this week, and will again 3 days next week (for scheduled inductions/sections). Then, after only 6 days of orientation my manager would like me to take one on my own the next week. A co-worker told me she probably means as the primary caregiver with an experienced nurse following me. I still think that seems awfully fast considering all the different scenarios that can be involved and policies that are to be learned. I'm barely comfortable being involved as the secondary nurse at this point. I'm working on getting comfortable myself, and observing what all is involved and taking place around me. I think that it is really unfair to take a pregnant mom and her signifigant other who are already anxious and give them a nurse who is not confident or comfortable. I don't think that would be much comfort to them. I know I'll be anxious for a long time, maybe forever, but I think it would be better for myself and the patient to allow a little more time and a few more experiences before I am suppose to be running the show with or without a standby nurse. Any thoughts? Please, help!

Our OB unit has recently begun giving the hep B vaccine to our newborns prior to discharge if the parents elect to have it. We recently discovered that we are not all administering it with the same size needle. What do you feel is appropriate for an IM injection in a newborn, both guage and length? The research I've done states 7/8 to 1 inch in length but all the nurses I work with are shocked at this, and it does seem kind of long, however some are giving it with a TB syringe which I think is way to short for IM. Any thoughts?

No, I'm your nurse. You must be disoriented because you are at a hospital not a restaraunt.

We were taught that the "old school" of thought was to clamp at 1000ml of output, but no one could justify why so it was not considered to be knowledge based practice so we did not abide by it. I don't see the issue with it. If a person were to sit and void, their bladder would empty itself of whatever volume is present without any harm.

GREAT NEWS! The baby in my post had open heart surgery yesterday and did well. He may only need one more surgery instead of two more like they originally were thinking and he goes home this coming week if all goes well. (To wait for his next procedure.) I am sooo thrilled. Thanks for all your support.

Holy cow! What a night. I'm a newer nurse working in OB. I earned my RN license last October and have learned a lot since then, but I work in a small hospital so even in the time I've been there have not seen what many see in only a few weeks in larger hospitals. Anyway, last night I take report on a new mommy and babe just about 4 hours old. Beautiful story of an ideal labor and delivery with this wonderful babe who nursed within an hour, like a champ I might add. So we are all in awe of this mom who delivered a nine pound baby quickly, no intrathecal, (no side effects) and this baby who is a dream to feed. I was told in report he did have some facial bruising from coming down so fast so not to be alarmed when I see him. I go to retrieve this baby from mommy, notice that he does indeed look bruised, and proceed to the nursery to assess him. I immediately notice his little feet are pale, he has acrocyanosis of hands, and I think, "okay well I don't see this a lot, but he's only a few hours old so acrocyanosis is WNL for his age." I take his temp and he is 98.8 axillary. I then think, "no, babe's I've cared for who are still having acrocyanosis are not usually this warm. Something is not right." I do a pulse ox and get 66%. I about $%#@. I pulled aside the other nurse working with me and said, "That number better be wrong." She said that it HAD to be. He looked totally relaxed, breathing normally with NO signs of respiratory distress. I changed probe location several times, changed probes, change oximetry machines, and promptly placed blow by to his nares. He pinked up (in his "bruised" face) and hands very slowly and his pulse ox rose VERY slowly. I then placed him under oxyhood since oxygen was what he apparently needed. I was not impressed with the slow response to O2, and the fact that he never got in high 90's like most babies. I called his doctor, informed him of the situation which he had a difficult time believing. He gave orders for a chest x-ray and said he'd be in. It turns out this kid has cyanotic heart disease and was shipped by transport team to a children's hospital to see a specialist. I got a call later in the shift from the transport nurse saying that if I had not detected the problem, acted when I did, that baby would have died in our nursery. She said that when he was declining when she and her team were there it was due to his ductous arteriosis (ductous venosis?), I can't even keep my terminology straight at this point, closing. This was the only way his lungs were getting any oxygenated blood so if it had closed he would have died. Since the transport team was there and had time to confer with the neonatologist they had determined what the suspected diagnosis was, had a drug available to open that back up, and had placed the UVC and UAC. They pushed the drug, which slowly worked, stabilized him and transported him. I was the hero of the unit with all singing my praises. I was flattered and appreciated the recognition. I even felt a surge in confidence that I met the challenge and made the right call with a baby that needed more than routine care. So, now that it has all sunk in, why do I feel so bad. By the time I had been patted on the back for what seemed like the hundredth time I wanted to scream, "what the &%#$ does it matter, the kid may die anyway!" I didn't feel like I saved his life, if anyone did him any favors it was his doctor who doesn't have one of those big egos that make them decide that they are going to keep the kid here and provide care themselves, or "watch them" for awhile. It was the transport nurse who was a pro at what she does. She was so calm, methodical, and reassuring to the parents. She's the hero. The call we got back says this kids heart is a piece of junk. He's got multiple defects that make it a very complex case. If they can save him he will have to survive at least 2 or 3 surgeries which are risky at best. So, everything that was done may be worth nothing. I'm sorry, I know I did my job and I have nothing to feel guilty about if he doesn't survive, but my efforts are worthless to his parents if that boy dies. They aren't going to be comforted by the fact that "that nurse made a good call, she caught on early on that something was not right. " Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?

I love the name Sawyer for a little boy or Kaden. If there are any more little girls in my future I plan to use Karson or Kamden. I have two daughters Kaitlyn and Kennedy.