I finished NRP today!!

[Cindy-OB RN/CCE]

I'm so happy. I finished all of the NRP tests today and did the mega code. I hope I never have to use all of it. I start nights on Tuesday and have two more weeks of orientation left. Things are coming together and getting easier. I'm by no means proficient but not incompetent either. Today I checked a mom and she was 3cm. I felt really good that I knew her dilitation, effacement and presentation. Contractions were getting stronger so 1 hour later I checked again. She felt almost complete. I was surprised because she's a primip. I had another nurse check and she felt what I did but then quickly realized she wasn't at the cervix. I had forgot to put her head down. She was still a 3. OOPS! Oh well, thats how we learn.

Cindy

[mother/babyRN, RN]

Cindy,

Good for you and congratulations! Welcome to the special world of nights in labor and delivery. OF COURSE you KNOW it tends to be kooky on nights! You will be a lady partsl exam pro sooner than you know! Try letting the patients know that 1 2 0r 3 cms is the beginning, 8 9 and 10 are near the end and somewhere in the middle is epidural!:). Seriously, sometimes you have to remind them that each lady partsl exam might be slightly different because different people are doing them and having to estimate something they can't see. Remind them that if a patient is , say, 3 cms and then gets into or continues an active pattern in which things are obviously intensifying and you do an exam an hour later and she is still 3, that a lot of other things could be happening. For instance, perhaps the cervix has changed quite a bit, or the head has come down. Mention that just because the dilatation hasn't significantly changed doesn't mean a whole lot of progress hasn't happened.....

I use the time of early labor or labor checks to do some teaching for what is coming up, such as what I have described. I also make them aware that I am just touching base with them and don't expect them to recall it all.

And, if they are willing and eager to learn, I might also throw in that sometimes in labor, it is normal for the fh to go down, or for the baby to get tired. In that case, I ask, "Who do I put the oxygen on?" I tell them what is routine for us is anything but routine for them and that, if the fh should go down, even in the course of a normal event, such as head compression for instance, we might ask them to turn to their sides. Then I mention that if they are in the middle of a contraction, they might tell me "in a minute." And then I add, "We will simply put you there." not to scare them, but to let them know such things can occur. I then promise that does not necessarily mean there is a problem but with us it is all about preventing one....AND, if it does turn out to be more serious, I let them know we will be up front about it. That seems to calm a lot of fears.

As for neonatal, I have gone through that program at least 4 times now and it is STILL scary. When in doubt, do bag and mask...It is scary any time a baby is floppy ( we call them "bad babies), but you can do so much with just the initial ppv.

Good luck to you! Please feel free to ask any questions......