Bessie

Thanks to you all for your reply's. After day 2 of her class I am feeling scared but empowered. They ask me questions about why I am not going up on their pitocin as ordered, and I say because. Now I can say, well if I want hyperstim and a hypoxic fetus I will go up. But since that leads to brain damage and CP I think every 2 minute contractions is just fine. Or when one doc wants us to check every other hour I can tell him. I won't be the reason she and baby get infected so I will use other measures to judge the labor progress. Research shows that after the 7th check you increase the risk of infection. Today I feel scared for my unit, because I want to know where the policy is and what it says and why everyone isn't following it. I want to stay there for at least a year, if I can, and that will be up in February Wish me luck, Bessie

I have just attended the first day of M. Murray's Advanced Fetal Monitoring class and I am scared to return to work. I am nauseated and unable to sleep tonight. I am new to L&D and have been on my own since August. Practices that I thought were scary; she has confirmed my suspicions. I work in a hospital that does 120 deliveries per month and that number has been rising. We are responsible for triage, antepartum, c-sections, recovery and sometimes pp if our pp floor is full. We have a room that we put PTL and PIH pt's on MgSO4 that doesn't have central monitoring. Then we are expected to manage them and a second pt who may be actively laboring or second stage. I have had these pt's and sometimes not been able to go into the room for 1 or more hours to view the strip! Our Docs don't stay in house and live 30 or more minutes away. We run pit on people at night without a doc immediately available. Docs miss deliveries and then tell us to deliver the placenta and write pp orders, and don't come to see the patient until the next day. Docs don't come to fetal demise deliveries unless fetus is term. We are the baby nurse and the mom nurse at delivery; sometimes we have a tech at delivery. The other day I had a mom hemorrhaging and a baby not crying and me and the secretary. The secretary can't hang my pit in the bag of LR or resus the baby so what good is she you say? She can dial the phone while I PPV the baby. The doc leaves the room to find help. I call help and don't leave either pt. He should have stayed. Our nurse manager is a pp nurse by training and a WHNP. I feel these docs get away with murder because she hasn't a clue as to how to labor a pt and how much staff is really needed. I work nights and hate the fact that I have to beg and plead for a doc to come in and they still don't. One night I had a patient who started having early decels at 6 cm, down to the 80's, on pit. Started calling first doc at 2300, care transferred to different doc at 0100. Called him all night and he didn't come. Convinced 16yo pt to get an epidural in prep for c-section. Pt doesn't progress past 7, doc finally comes at 0600 and sections her and then teases me for calling him all night. Doc speculates CPD at delivery. I called my the person who precepted me and she told me that there are hospitals that are worse then ours. I felt like she was telling me life is tough and then you die. I need to know that there are hospitals that support there nurses and practice within ACOG guidelines. Thanks for listening! Any suggestions are greatly appreciated. Bessie

Hey Dianah, Thanks for getting that article! I really appreciate your support! I have found out Ton's of information as well. There is a great website ( http://www.jonsplace.org/CHFjonsplace.htm) where I have found tremendous support and information. When I first posted life seemed bleak and limited. :) However I have since learned that I am not as bad off as I thought. :) I got caught believing that in 6 months this was all going to go away and my life would return to "normal." 50% of the people return to normal heart function within this time frame. When that didn't happen I was truly upset and angry. Well, I will just get to my new normal. I call it normal with a twist :) I am still a little in disbelief because I look fine and feel fine 90% of the time. Right now I am going to go into cardiac rehab which is a excersise program. If after 3 months I am doing well my md says that I can return to 12 hour shifts. He recommends 8 hours, but the unit I want to work doesn't offer 8's anymore. ;0 Plus I don't like people to tell me what I can't do. I think I am an awful patient! :roll Thanks, Bessie

Hi Dennie, Thanks for your prayers! And your response. Bessie

Hey all, I have been diagnosed with dilated cardiomyopathy following pregnancy. I am 33yo with 3 children. I just graduated from nursing school last May and was able to practice nursing for 6 months. I am looking for any support or info that anyone can provide. I just had my 6 month echo and my heart function has declined since first diagnosis. My EF is around 40% according to my echo. My entire heart is enlarged. My tricuspid valve has a moderate to severe "leak" and my mitral valve has a mild "leak." Leak is the term my cardio doc uses. I imagine he means insufficiency. I also have some pulmonary hypertension according to my echo and he is sending me to a pulmonologist. At the time of diagnoses I had a Left calf DVT and suspected PE with the vq scan being inconclusive of the PE but my d dimer was over 2000. I am asymptomatic 90% of the time. However, I have read everything that I can get my hands on and prognosis says 20-50% of patients die within 1-5 years and another 25% die within 10 years. My cardio doc says that I have mild heart failure and makes me feel like this isn't a big deal. However it feels like a way big deal to me. I thought I was going to be able to return to work. He says that I can work 8 hour shifts and he would like me to start with 3. However before my 6 month echo, he kept telling me that I could return to work whenever I wanted with no restrictions. I am feeling a little angry, confused and sad. Thats all for now, Bessie

Fergus51 and TennRN, Thank you for all the detail you have given me. TennRN that was not too long. I soaked up that post like a sponge. I am an information fiend! :) I like to know what to expect. I now know how to direct my self study before I start work. Someone mentioned the Dubowitz. I only briefly remember that from school. Perhaps there is a website?! I am getting excited about this new adventure. At first I was just nervous. Now I am nervous and excited.

Thanks for everyone's thoughtful replies. I am sure I will be back to ask more questions when I accept the position and start work. Any suggestions for a smooth transition are appreciated. I have already committed to memory the info about the bg of 40. Anyone care to give me a rundown on what it's like to receive a new mom and baby from L&D. I imagine baby doesn't come directly with mom. I imagine mom needs breast checks, fundal checks, lochia checks, perineal checks, vital signs, possible antibiotics, possible rhogam, pain meds. Baby: vs, bg, possible antibiotics, bili check, direct coombs? (don't get it),all those metabolic tests, I&O, and other stuff I am unaware of. How close to the mark am I?

Thanks for everyone's helpful info. I have not had experience in this area so I didn't know what the norm was. I knew I could come to the message board for honest opinions and accurate up to date info. :) I am sure the five couplets depends on census and staff on duty. How is couplet care more rewarding, harder or easier then working with just babies or just mom's? Any info you can provide will be helpful. I was thinking of another position that is only mom's or babies and not both. Just trying to weigh my options on the best place to get my feet wet in women's health. Bessie

Hi all, I have a question about patient ratios for postpartum mother/baby units that have one nurse for the mother and baby. I recently interviewed for a position that assigns 5 couplets to each nurse. 5 mothers and 5 babies. That is 10 patients total and seems like a lot to me. Is this the norm? Tell me what you guys think about this. Bessie

You all have posted such thoughtful replies and I really appreciate each and every one of them! It seems to me that I will have to find the place, team of people and position that brings me enjoyment and Fun! I think this is inevitable because I have never been able to work any place that made me unhappy so why would I start now. The funny thing is that I have interviewed on a Peds oncology floor and I think I want to work there. Talk about finding the fun!? I know that this is going to be challenging work!! But I think enough challenge so I won't get bored along with pt and family education and support. This may sound weird but they don't have pt care techs so I get to do all my own work! I actually look forward to doing everything. Perhaps this is my ignorance coming through. :) These kids generally have their parents at their side and they want to help so I won't always have to do everything. Anyway, I will report back Bessie

You all have posted such thoughtful replies and I really appreciate each and every one of them! It seems to me that I will have to find the place, team of people and position that brings me enjoyment and Fun! I think this is inevitable because I have never been able to work any place that made me unhappy so why would I start now. The funny thing is that I have interviewed on a Peds oncology floor and I think I want to work there. Talk about finding the fun!? I know that this is going to be challenging work!! But I think enough challenge so I won't get bored along with pt and family education and support. This may sound weird but they don't have pt care techs so I get to do all my own work! I actually look forward to doing everything. Perhaps this is my ignorance coming through. :) These kids generally have their parents at their side and they want to help so I won't always have to do everything. Anyway, I will report back Bessie

Molly J What a thoughtful response. That had to take you a while to type! :) I really appreciate the indepth information. You pointed out some good key points. I am young, 32 with 2 kids (5&3) and a wonderful husband. I have seen some yicky stuff in my own life...incest,physical abuse, abandonment, foster care, family members on drugs and the list does continue. Even though I have survived this "stuff" I am not hardened and am still quite sensitive. I want to help everyone...I know, I know I need to get over it! Helping everyone is impossible. I just feel so much for the people I meet in the hospital. Like the double bka, end stage renal failure with no family; or the 18 month near drowing x's 2 who is now a vegetable; or the Mom who has had 4 PROM resulting in delivery and death and who desparately wants children. I think I just need to jump in, do what I can and enjoy the people that I do have something to offer too. Where ever I work is going to have to been fun because I am a FUN person! Perhaps I gave you all too much info. Sorry! Thanks for the positive responses! Bessie

Molly J What a thoughtful response. That had to take you a while to type! :) I really appreciate the indepth information. You pointed out some good key points. I am young, 32 with 2 kids (5&3) and a wonderful husband. I have seen some yicky stuff in my own life...incest,physical abuse, abandonment, foster care, family members on drugs and the list does continue. Even though I have survived this "stuff" I am not hardened and am still quite sensitive. I want to help everyone...I know, I know I need to get over it! Helping everyone is impossible. I just feel so much for the people I meet in the hospital. Like the double bka, end stage renal failure with no family; or the 18 month near drowing x's 2 who is now a vegetable; or the Mom who has had 4 PROM resulting in delivery and death and who desparately wants children. I think I just need to jump in, do what I can and enjoy the people that I do have something to offer too. Where ever I work is going to have to been fun because I am a FUN person! Perhaps I gave you all too much info. Sorry! Thanks for the positive responses! Bessie

Thanks for all the responses! I can take the good with the bad in any job. However, the bad in nursing can be soooo bad...death, dismemberment, abuse...and on and on. I do need to develop some resistance to the bad, so I don't cry so much. Every clinical rotation I had, I encountered some patient situation that made me cry. My instructors all tell me that I will not cry so much after a while and that my sensitivity will make me a good nurse. I hope they are right! I just wanted to be assured that people goof off and have a good time at work sometimes. I also wanted to know what type of nursing you do. I am still trying to decide in what area I want my first job. And to be quite honest...I am little SCARED! Not of the Docs or other nurses. I don't want to harm any patient. Bessie