Going to an interview as a rural OB nurse, have QUESTIONS!!

Snugglibumkins · Mar 31, 2007

I live in a rural area. Anything that gets complicated gets flown off the island immeadiately.

I am unsure about your background - do you have a strong OB background? I would ask about orientation - will you know when things are starting to go bad?

Does the hospital have a NICU? (probably not)

I'm usually interested in the stats - how many deliveries. How many have been 'caught' by the staff nurses lately?

At first I was terrified of living in a remote area. I now love it. I've learned so much.

Good luck in your new adventure.:monkeydance:

NPinWCH · Mar 31, 2007

Questions:

How many RNs/shift in OB?

How many NRP certified people attend each delivery? (standard of care is at least 1 person completely capable of ALL the NRP skills just for the baby)

How long does it take for transfer to arrive?

How far out are the docs/midwives?

Where will you spend your downtime? (you will most likely be floated off the unit when it is empty)

My only concern is that you say you have no OB experience. You stated that they only do 80 deliveries/year thats roughly 6-7 a month, and you will only get 2-3 months of orientation. I'm not sure 12-21 deliveries/labors in 3 months is enouth for a good orientation, and of course you wouldn't personally be involved with every one of them.

Orientation for RNs with no OB experience lasts up to 6 months at our small rural hospital (370 deliveries/yr), and even after that the new RN is always scheduled with an experienced RN. I am going to assume that you WILL be the only OB RN there after orientation. I still consult with my fellow RNs when I have a question about something, even after 12 years in OB.

You may do better to get some good experience in OB before considering a job like this. I've found that you never quite know certain things in OB until you have one walk in the door. Just like in any other area of nursing you need to learn the nuance that is labor and delivery as well as how to spot that one kid who is going to need help.

Good Luck!

cisco · Mar 31, 2007

sugglibumkins and rninwch, thank you for your great suggestions. Part of the orientation would be at a larger hospital with a much busier OB dept. I do have concerns about the patient safety under these circumstances, so thanks again for your input!

mitchsmom · Mar 31, 2007

How many RNs/shift in OB?
How many NRP certified people attend each delivery? (standard of care is at least 1 person completely capable of ALL the NRP skills just for the baby)
How long does it take for transfer to arrive?
How far out are the docs/midwives?
Where will you spend your downtime? (you will most likely be floated off the unit when it is empty)

I agree that these are all good questions! I would NOT want to be the only OB nurse on a unit... well, ever... but especially not without a lot of experience. And that is hard to even quantify...

I would ask about getting STABLE training (and absolutely NRP and Fetal Monitoring - BEFORE you are off orientation, preferably before orientation starts or before midway in any case!). Even if you transfer out sick babies (as we do in my community hospital), you will still have to stablize babies and will need to know what to do with them. Sometimes this can be for numerous hours until NICU teams arrive, especially when bad weather precludes quick transport.

High risk mothers also don't always end up getting to the high risk centers either, sometimes they jsut show up - with no prenatal care (especially in a lower socioeconomic/rural/migrant worker area) (add in a positive drug screen for half of those), just come because they can't make it to the other place in time, just come to get checked and it ends up being something bad, are here on vacation and something happened, etc. etc.

And then it's an even bigger deal because you are less equipped for it and less experienced with it. And you won't be able to transfer this pregnant person if she's progressing too quickly, which happens fairly often.

In the "stickies" at the top of this forum there is a thread on AWHONN staffing ratios - print it and find out if they are fairly in line with those guidelines. Do they keep mag patients? Do they maintain them at 1:1 ratio?

Will I be expected to work as the sole OB nurse and when would I have to start being alone?

Will I take postpartum pts too?

Is postpartum and sick baby training included in orientation?

Can I look at your orientation training schedule/materials/competencies?

Who covers my other pts when someone gets an epidural or delivers (remember that someone will already be in the room with you to be the baby nurse)?

What if three people walk in the door at once to deliver?

Do I have to take call? (how's it done if so?)

What anesthesia (epidurals) is used there and what kind of night and weekend coverage and procedures do you have for anesthesia (and OB providers)? What is the OR team resonse time for emergent night/weekend c/s?

Can I look at your policies and procedures?

Do you scrub and circulate your c-sections and how does coverage work for my other pts if so? (Likewise, do you do OB PACU for your c/s?)

What is your c/s rate?

What is your epidural rate?

Do you do VBACS?

Are births here highly managed or more hands-off?

What fetal monitoring program do you use? If you use computer patient charting, does the fetal monitoring program communicate with it?

Does our unit take gyn patients? Do we take med-surg or any other patients than L&D?

What OB providers deliver here? (try to check them out - do the nurses get along with them, do they have a million lawsuits, board certified, whatever - same with the pediatricians)

How much time do the OB MDs/CNM's spend on the unit? At what point do they come for a delivery (complete, on the perineum, whatever)

How many precips (deliveries unattended by an MD/CNM) do you have? (we have to note this in our delivery record book... that might be interesting to look at if you can... we note that and all the other basic stats and complications).

Is there a unit CNA? Unit clerk? If so, what shifts do they cover?

Can I shadow someone for a day or two? before I make a decision about this job?

Some off the top of my head! And all of the applicable parts in writing in my contract!!

cisco · Mar 31, 2007

mitchsmom, excellent suggestions! I checked out STABLE and printed it out along with all these concerns/ideas. All this info is definitely validating my concerns...I'm excellent at med/surg, home health nursing...however OB is a horse of a different color...and God forbid if anything went bad for a mom or babe because I wasn't fully trained and competent in this specialty. So, thank you all again for your valuble help.

SmilingBluEyes · Mar 31, 2007

Good input from everyone. Just remember, in the rural setting, YOU are often "it" in places like OB. I would want my skills to be very strong, and not be afraid to act very independently and autonomously as a rural nurse of any specialty, especially in OB. I know, as I have experience in rural Oklahoma as an OB nurse. You can't always "ship em" when there is a problem. We saw plenty of 28-weekers born that we could not get out for hours due to bad weather or other problems. Your skills (and those of your colleagues) need to be top-notch. It's not for sissies! GOOD LUCK to you and let us know how it goes when you are done with the interview.

cisco · Apr 1, 2007

smilingblueyes, I completely agree with you. I'll let you all know how the interview goes. I feel forarmed now more completely to ask key questions and to request a much longer orientation period...along with other requests/question to cover patient safety and protect my own licensure. Thanks again for all the input...I will let you know how the interview goes and my decision by the end of April. Thanks again!!!