What..work with NO residents??

  1. Ok question. I have only worked in L&D in teaching hospitals..and am not considering taking a position at a small hospital with No residents. No 24hr anesthesia...but an OB in the house.
    The RNs do all assessments concerning admissions..verify ruptured membranes ect themselves. No NICU..so if baby comes out bad I will be doing the resusitation..and then shipping that baby Out.
    No high risk..but we have all had perfect labors go bad at delivery..

    Its alot of responsiblity to Not have that back up..and I'm a little nervous. Should I be?
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    About jodyangel

    Joined: Aug '04; Posts: 642; Likes: 67
    Specialty: L&D


  3. by   Fyreflie
    My last job was pretty much exactly that and after the first few months, when I was learning to do specs, honing my judgement skills and learning to Triage in a whole new way--I loved it!! I was always a little nervous but I think that's healthy no matter how long you've been working. My assessment skills were waaaay better in all areas by the time I left and I quite honestly miss the independence now.
  4. by   monkeybug
    That sounds exactly like the first hospital I worked at. You will adjust. And you will be amazed at what you can do! As for the lack of a NICU, if we had a baby go bad and the pediatrician wasn't there, our OBs would step in and help, and our CRNAs would intubate if needed. I felt like I could handle just about anything after several years of that. I did end up at a teaching hospital as a travel nurse, and I HATED it. I missed my independence and autonomy. The hospital I'm at now has family practice residents, but most of our patients belong to the private docs so I get to be my independent self most of the time. Once you get used to it, you will probably like it. L&D tends to attract independent people. I can't speak for all small hospitals, but when I worked at one, it was not unusual to hear the doctor say, "I've been up for 2 straight days. If you really need me, call me. If you can handle it, write the order and I'll sign it in the morning." Or, if the MD found out that a med/surg nurse was being pulled to take care of postpartum patients, I've seen this order in every postpartum chart before he went to bed: "Consult with L&D nurse BEFORE calling doctor."

    We really worked as a team there, the doctors respected each of us (once they got to know us) and trusted our assessments and opinions. I remember seeing one of the OBs mop the OR when we were crazy busy, had no housekeeper, and needed to do a c-section. I miss those days!
  5. by   MamaMadge
    I work for a small hospital and we do not have docs or anesthesia in-house. Yes, it can be challenging, but all of our docs live close by and in an emergency, we can have a doc and CRNA there within a few minutes. Conversely, we have had nurses who came from teaching hospitals and they did not know how to to a cervical exam correctly. It really makes you hone those assessment skills!!
  6. by   Honeychild
    I work in a similar setting. It can be a little intimidating, but I think the atmosphere really depends on the team you are working with. I work with wonderful nurses and doctors that I trust. Work for me is exciting. I used to work in a NICU and loved it there too, but I really enjoy my independence.
  7. by   HeartsOpenWide
    I work in s hospital like this, plus no MD on site. All of the clinics are close by, but at night you are on your own. You really have to know your EMTALA stuff, we see, assess, and discharge labor checks without the doctor ever seeing the patient. We basically do it all. I have been at RN deliveries when the doc has not gotten there in time and the woman has bombed. You really have to be good at your assessment skills, your docs not right there. I think it would be hard to give up so many skills to a resident, I really enjoy my scope of practice.
  8. by   jodyangel
  9. by   HeartsOpenWide
    Quote from jodyangel
    It's not EMTELA. It's EMTALA= Emergency Medical Treatment Active Labor Act

  10. by   jodyangel
    Never heard of it!! Off to read..
  11. by   jodyangel
    Ok read it..but just seemed like alot of legal mumbo jumbo..what and how does this act apply to Me??
  12. by   HeartsOpenWide
    Quote from jodyangel
    Ok read it..but just seemed like alot of legal mumbo jumbo..what and how does this act apply to Me??
    If you work in a small hospital, where you assess pts in possible labor, and send them home based on your assessment, or are involved in transporting a patient to a higher level hospital (either a laboring mother or a sick newborn) you need to know. EMTALA violations cost the hospital tens of thousands of thousands of dollars. If the ambulance arrives to transport your patient and you checked her an hour ago, you better check her in the stretcher before she rolls out, if she becomes complete or arrives pushing at the next facility...your name was on the chart that the woman was stable when in fact she wasn't. We got an early labor patient from an hour and a half away from another hospital (which was VERY rural and had no L&D) who came in private car; big no no. The list goes on of stuff you have to know. In a rural level one hospital, EMTALA is a word we all know.
  13. by   passionflower
    That's a tricky scenario especially when I have seen patient's stay at 2-3 cm and then change pretty quickly from 4-10. Labor is so unpredictable. Charting and more charting before discharge to r/o labor. I'm always terrified I will send someone home that ends up delivering in the parking lot.
  14. by   MKPRN
    I work at a hospital exactly like the one you describe except no OB in house. I work nights and the only doctor in house is the one in the ER. However, when things are going down we don't call the ER MD. All of our OBs are 5-10 minutes from the hospital and I work with and amazing staff of nurses. I love where I work and have great nursing skills. I feel like I get to use my judgement and experience better here than I would at a big hospital. All the nurses in my department do l&d, postpartum and nursery. We all stabilize infants if they need a transfer to NICU. Many of my doctors have told us in an emergency they would rather have one of us as a nurse with them than at the big hospital nurses with a NICU because we have such versatile skills.

    Is it scary as hell? Sometimes. But I don't try to avoid the idea of something bad happening. I just try to make sure we are always prepared for worst case scenarios walking in the door. During down times I am checking and stocking rooms, making sure everything is ready to go. I can go through our infant crash cart in my sleep. I try to keep myself educated and up to date. I always end up doing quadruple if not more than my required CEUs. We also do lots of drills and scenarios.

    I firmly believe that God watches over us here at my little hospital. It seems like the worst always happens at shift change so there are extra hands on deck. We have delivered as early as a 29 weeker here. The down side is there are somethings I will never see (and hope never to see) here because those high risk patients are taken to the big city hospital. I have bagged lots of babies and had some pretty serious situations in l&d. In my 10 1/2 years here I still have never delivered a baby, lots of my coworkers have though. But if it happens I will be able to handle it because I am ready.