Novice RN asking if there are checklists for Delivery, Recovery, C-section?

[SpudID]

Dear All,

I wrote once before about my precepting difficulties. Just to update, things are going better. My preceptor is a global thinker and I am linear. Communication/teaching is still difficult. As a novice nurse, I need a timeline and direct steps. I hope with experience I will be able to add intuition that allows me to see the bigger picture.

Having said that, I was wondering if anyone had any direct steps out there for Labor, Delivery, Recovery, and Cesarean birth? I am missing things with each birth and would love to have have some 3 x 5 cards that could serve as a reminder when I feel lost/frozen.

Does anyone have anything like this or could recommend some? I am trying to make my own.

Here is an example that I prepared for cesarean birth:

Cesarean birth checklist

1) Declare C-Section to Unit Secretary and state: We are going for a C section, can you page peds, anesthes, the surgical tech and send the type and screen.

2) Raise bed to hip level, unplug the bed, unplug the computer cord and put in dummy plug, switch over IV bags, unlock bed, off steer and pull bed from wall. Steer back on for going straight.

3) Cover mom's hair, my hair, shoe covers, mask, no coat.

4) In OR, TIME IN, transfer mom to OR table assuring mom does not fall off the other side

5) place bump, attach arm of OR table, hook up monitor for FHTs, check suction

6) place ground pad (not on bone) on upper left thigh, plug into cautery machine

7) Place foley catheter, shave hair from incision site, state FHTs, remove FSE.

8) prep belly: open white package to flat, open blue packet holding flaps back and drop onto white, pick up glove package and open on top of pt., pick up other glove packet and unfold and drop onto other glove.

9) glove, pour 1/2 betadine on gauze, turn over and pour rest of betadine on gauze. wipe starting under incision and horizontally to Mons/labia 3X, wipe inguinal folds starting with farthest away not going over previous area 1X and then closet inguinal 1X.

10) Pop Duraprep in container on top of swabs making sure to saturate swabs and Duraprep sponge. Use swabs (1 @ a time) to clean belly button. Use Duraprep in LEFT hand and start 2/3 of sponge below incision line and go up the belly to fundus horizontally. Use RIGHT hand to vertically sponge from farthest hip to inguinal and closest hip to inguinal.

11) Ask if the prep is adequate. Count w/ surgical tech. Do PAUSE.

12) Plug in cautery and suction tube.

13) Drag out big Biohazard Can, get small can and put chux on floor for sponges.

14) Note incision time and page peds to delivery.

15) Begin charting.

16) Note birth of baby/placenta, 2nd count at uterus closure, 3rd count at skin closure. Note surgery finish.

17) Get OR bed.

18) Assist with lotion to remove Duraprep, transfer pt using roller board to OR bed.

19) In PACU, 15 min VS checks, dressing check with fundals/lochia flow, 2 baby VS, ice chips after 30 minutes of stable approx. Fill out paperwork, help with BF if approp. Empty foley. Take up to MBU.

Sorry if it is too detailed. Thanks for your help. Each day I go to work I stressed. I leave so drained. Although everyone assures me I will make it, I can't tell you how burdened I am with my inadequacies. Any help would be greatly appreciated.

Respectfully,

SpudID

[kimrncnm, RN, CNM]

Hey, don't be hard on yourself, I can tell from the list you made for yourself ( and the fact that you cared enough to make one ) that you are a good nurse and doing your utmost to provide quality care. Hang in there ;-) I work at such a small place that we don't get to do our own c/sections..your list may help me someday!

Kim

[RaeT,RN]

I definately agree: DON'T BE SO HARD ON YOURSELF. Give yourself time to learn. No one expects you to learn how to be an L&D nurse overnight. From what I can tell so far, there is no one model for L&D nursing. Just think about each preceptor you have been with - I'm sure each of them had their own ways of doing certain things. Some things are routine, yes, but other things you've just got to get down with practice and finding out what works for you.

I know where you're at right now - it's terrifying. Just keep going to work everyday, have patience with yourself, and one day you'll suddenly realize "Hey, maybe I CAN do this afterall!"

Please feel free to email or PM me.

[imenid37]

It sounds like you're trying hard and doing a good job. We do bench-marking and have a set of checklist type papers for each area L/D, NSY, and PP/GYN for our orientees. At certain points in the orientation process and in the first year on the unit, we have goals outlined re. what the orientee will be able to do independently, with assistance, etc. I made up pneumonics for my self for multi-step things like C/S. I wasn't a new grad when I started my present job. Only L/D was new for me and no OR stuff to remember either (it's a small hospital). I had done M/B and some med-surg/cardiac right out of school, so some things weren't too bad for me to pick up. You know you are only human. Inevitably, you will make a mistake once in awhile. You don't have to be perfect. If you slow down to notice one day, you'll see that your colleagues are not perfect either. When I first started doing L/D, I lost the patient's chart. Physician thought maybe she lost it too and was looking all over. Right as the OR team arrived, I found it on the shelf where the foleys were kept in the supply room. Now I can laugh. Then I was pretty mortified. We were all new once, sometimes unfortunately we forget that. Good luck Spud. I think you will do well.

[Mrs.S]

I think as new nurses we get really task-oriented. I loved making lists when I was just off orientation; simply thinking the processes through and writing them down helped tremendously. it's easy to get overwhelmed with all this "stuff" you are responsible for, but if you have steps in your mind it helps make things seem less chaotic I think.

[SpudID]

Thanks so much for your help. I know that in my reading of Benner that novice nurses are obssessed about time organization and management. So much so, that they can lose sight of the bigger picture. Thank you for your encouragement and support of myself. I hope that I will make it through all of this. I keep looking forward to July and Jan (the benchmarks of 6 and 12 mo for me)

Warmly,

Spud