NJNursing

The whole tri-state area is a hot mess for new grads despite their degrees. I have heard a lot of people who settled for nursing home jobs and doctors offices. I know with Virtua, the squeaky wheel gets the grease and their HR peeps are notoriously slow. Keep plugging!

That is a pretty complicated case. I have seen the stringy discharge with some pts with std's. She may have a small bit of retained placenta but she would normally just have a steady, continual bleed, not the heavy/light cycle. If the cervix is closed, its not incompetent. She probably needs an exploratory d&c just to make sure, The thing seen at the top of the cervix on the ultrasound could of been a clot that needs to be expressed.

I had a pt like this recently. Iupc put in, pit turned off O2 applied, pt turned in L lateral position with a knee up to try to help the baby descend. Mom was very slow to go from 2-4 cm dil. This went on for hours, at least 5-6. Iv fluid bolus. She I sat her up in a modified indian style, bottom of the bed down. Sht turned a corner and was 6 then 8 and then complete. Once the baby was past 0 station, the variables let up and were more like earlies. Baby delivered fine, nuchal x 1, mild terminal mec, 8,9 apgars. I thought she was going to be sectioned but she made change and the baby had good variability.

Lab gas never been able to access any central line for draws thus needing a Dr order to be able to get labs out. At the beginning of the year we stopped this practice at all from evidence based practice on infections. All labs must be drawn peripherally.

We currently use Hugs tags on the ankle right now. Where I used to work had the clamps on the cord. They stayed on until right at discharge. No problems.

We keep babies in L&D for 1-2 hours before going to the newborn nursery. They are bathed within an hour of getting there and gets the full head to toe assessment.

I work in a community hoapital. We only 6 labor rooms, 2 antenatal / mag recovery rooms, but in a squeeze, we can deliver in them. 2 or's/pacu beds, 5 triage beds. We can have 1 patient all night, we can have 13. There is usually at least one section a night, most was 7. We always have 2 docs in house but we have 4 ob groups who like to do their own deliveries, but if they don't make it to the hospital in time, the laborist will do the delivery. I don't mind doing vag exams, but if they are complete with pressure, i get a doc to double check. It's about learning a new skill and bringing the knowledge with you.

When I graduated in '06 we had to have our fingerprints done prior to the ATT. Good luck!

We are ortho-neuro and it can be 1:4-6 on days, 1:5-7 on nights. Aides depends on staffing and 1:1s throughout the house. We always have 1-3 aides for a 35 bed unit. We nearly always have a secretary and have mobile phones. However the acuity is high and even with great staffing, it can be rough.

I agree, avoid all isolation patients. We just do it as a courtesy to the preggos on our floor anyway.

Sx = surgery

It all depends. If they are a multip, I may have them push at 10 cm. It also depends on the station. I like to wait until they are +2 to push. If they have no epidural or not a well functioning one, I will push at 10/100/+1. If they are a prime with a good epidural, I may do some test pushes. If they can push well, I will let them push. If not, I will labor down an hour and reassess. Many of our doctors trust us to push with the pts until nearly crowning. There are a few who will actually stay for however long it takes because they want their own pushing assessments. The more you do it, the more comfortable it will become. Have a senior nurse in with you to give you help and guidance for your first few times.

We are an all female unit with the female to male doctor ratio being 3:1. There are cultures that insist on being female only and I know when I was in nursing school there were 2 male students and during ob rotation, patients would refuse them. I know myself, I was uncomfortable with a male residents checking me.

I agree, there can be genes on either side that can show up at delivery. I had 2 brunettes have a baby with shocking red hair, but apparently there was a great aunt with red hair and she was the only one in the family who had it. Both lineages were Irish as well.

We don't routinely do Leopold's other than to try to figure out if the baby is vertex and where we think FHT's will be. We have several rolling ultrasounds for the doctors to get a quick eye on the baby when they first get to the unit.