LaborRN

It sounds cool!

I have used Phillips wireless monitoring system and I think it works great!

Anything over 100? Woah, I'm used to two over 120. Running an insulin drip with six patients sounds stressful! That sounds nice! We would use a chart and would need a double check from another RN if we maintained, increased or decreased.

If you want to get your foot in the door and get some experience working with babies L&D would be a good place. Depending on where you work you may get very little or a lot of experience. It depends on how many resources you have. It sounds like you are excited about both, so I say go for it!

This is from UptoDate: A presumptive diagnosis of IAI (suspected triple I) can be made in women with: ●Fever – ≥39.0°C [102.2°F] or 38.0°C [100.4°F] to 38.9°C [102.02°F] on two occasions 30 minutes apart, without another clear source PLUS one or more of the following [1]: •Baseline fetal heart rate >160 beats/min for ≥10 minutes, excluding accelerations, decelerations, and periods of marked variability •Maternal white cell count >15,000/mm3 in the absence of corticosteroids and ideally showing a left shift (bandemia) •Purulent-appearing fluid coming from the cervical os visualized by speculum examination For treatment purposes, ACOG suggests that patients with isolated fever ≥39.0°C (102.2°F) without another clear source should be managed as having suspected IAI, as they are at high risk of an adverse clinical infectious outcome [71].

What is a previn?

As a travel nurse, when I get my two or three days of orientation I take as many notes as I can during that time on what is required as far as charting, where to find emergency items (crash cart, precip kit, hemorrhage cart), where phone numbers are, and any other vital information I may need. I feel this helps a lot since it is impossible to remember everything! For my last assignment I kept a small notebook and for this assignment, since it is slower paced, I have a Google document. As far as creating a checklist, I think that would be very helpful and I would literally just do that! As you know, every charting system is different and every unit will have different things that they will be auditing for. Maybe make a heading for each tab you are required to chart under and then just list the items to chart. Maybe have several nurses review the checklist to get some input before giving it out to your travelers.

Thanks for your response and I agree with you. The fact that this is an expectation is ridiculous. Especially with no policy.

Not everywhere practices this way ?

It's all fun and games until something goes wrong and then the nurse is to blame. If I hook up to the patient I am the one administering when i wasnt involved in anything except pulling the med. Also, anesthesia refuses to review pump settings with me because they are preset?‍♀️☹ i have to have a nurse come in to the room but they "aren't allowed" to verify settings only verify correct med.

This is Florida. I havent seen any CRNAs but they have AAs that do spinals in the OR. I would be okay with doing it IF they had a policy or if I was backed up by the BON but when I called the BON they told me that they don't have guidelines on epidurals specifically. They told me to follow hospital policy. I told them there isn't one... I don't think I should be expecter to do something that there is no policy on if the BON has no support to provide for me either.

I guess I should clarify one thing. When anesthesia brings the pump and med into the room the pump is already running/medication started. So if I am the one hooking it up to the patient then i am administering the med is my thought on things. Thank you for responding ?

The hospital I came from had a goal of getting the baby skin to skin within 7 minutes of delivery for a c/s and immediatley for vag. We didnt use a pulse ox for monitoring. If the baby was looking blue or like it was having a hard time transitioning then we would take it over to the warmer and would have to write a note saying why we did so. We would get vital signs as soon as possible after delivery and then every 30 minutes until the first 2 hours of life. We would keep them skin to skin for a minimum of 1 hour. If we took them off sooner we would need to document why skin to skin was interrupted. Staff would not stay in the room at all times with mom and baby as long as the patient is alert and doing well. But would mention to visitors/family to keep a close eye and keep them in the loop if you as the nurse need to leave the room. It can be challenging when it is busy to follow these practices to a tee because you are tempted to want to get your assessment done but have to wait until the 1 hour mark since skin to skin time is supposed to be "uninterrupted" .

If you are initiating an infusion in my eyes you are the the one that is allowing the med to get to the patient. Initiating a med is giving a med and I am the one giving the med if I am hooking it up. The med would not reach the patient if I didnt hook it up to the patient so I am initiating it. No?

Murseman- Some of the anesthesiologists are extremely stubborn and just flat out refuse to do it and will say its not there job and we can do it. I talked to my director about it and she said that I can refuse doing it and notify my charge RN and director but I am hesistant to do that because I dont know if I want to cause a big scene. Other travel RN's have told me to just document it as a verbal order from the anesthesiologist to cover my butt if they refuse. I literally am handing them the line and they refuse. Alot of time they even have a tech with them that sets up everything for them so all they have to do is put the epidural in..

Hello, I am a travel nurse working in FL and at the hospital I work at the anesthesiologist wants you to hook up the epidural line to the patient after he places the epidural. I am uncomfortable doing this since they have no epidural policy and it is against Awhonn guidelines to initiate the epidural continuous infusion. Also, I called the board and they have no specific guidelines in the nurse practice act. A couple of them downright refuse to hook it up. What would you do?

So what I do right now is if I have decels that occur outside of that 10 min window I chart interventions on my strip but I don't say specifically what it was in a nursing note or anything like that. But I'm with you.. I think all decels should be recognized at that 30 minute mark.

Question: When charting heart tones you need a 10 minute window to determine baseline and variability.. "There must be 2 minutes of identifiable baseline segments (not necessarily contiguous in any 10 min window" "It may be necessary to refer to the previous 10 minute window for determination of the baseline". Variability is also "determined in a 10 minute window, excluding accels and decels". So lets just say I'm charting for 6:30- At my facility we chart based on the previous 10 minute window for all categories (baseline, variability, accels, and decels) so if I have a variable decel at 6:05 and I have no decels from 6:20-6:30 then I would chart absent for my decels. I see how we would look at the previous 10 mins for variability and baseline but I don't see why we only annotate for the 10 mins for decels and accels. Currently, I chart everything based off the previous 10 mins in our powerchart system. BUT, I always chart my position changes, IVF boluses, 02 and extra provider to the room on my strip which flows into my powerchart. But the way we have been taught is to still chart absent if decels don't occur in that 10 min window (6:20-6:30). There isn't anything concrete that we can find that you should chart accels and decels off this 10 min window and I feel that most facilities chart off the whole time period (6-6:30). The only thing we could find so far is from the AWHONN 5th ed. 2015 book FHR monitoring principles and practices book "Accelerations and decelerations are determined in reference to the adjacent baseline FHR." P.S what does this sentence tell you? What do you guys think? [TABLE] [TR] [TD][/TD] [/TR] [/TABLE]

My facility doesn't chart MVU's at all we just do the intensity and resting tone and try to get the contractions 2-3 mins apart. We do place IUPC's if pt is has a high BMI and it is difficult to pick them up externally.. also if they have been on Pitocin and their cervix hasn't changed (we will get a more accurate picture of true contraction strength)