redhedgoddess

Thanks for the replies so far. To give a bit more background, we are a 13 bed LDRP unit with 4 teams of 4 full-time staff working 12 hour shifts, 36 hours one week, 48 the next. All of our other travelers have worked as a team member on a specific team for the duration of the contract. They've often had vacation time scheduled in the middle, but nobody has had a specific day off every week, certainly not our busiest day of the week! This particular nurse is working her first traveling assignment. She is needed to cover a leave of absence and is one of 3 L&D nurses on the team. Fridays are very busy for scheduled C sections and we do alot of triaging (labor checks, NSTs, etc) for the coming weekend which requires an L&D nurse. She's a nice person and a good nurse but she isn't making friends because she knows how slammed our Fridays are without her and laughs and tells us what she was doing while we were running our butts off (Ladies' night is Thursday and she likes to dance then recover slowly Friday as a sun worshiper by her pool). Then, if we have a "quiet" *knocking on wood* day, she wants to be sent home early or called off because she gets paid even if she doesn't work, again, not making points with the rest of us... If she weren't such an overall likeable person, we'd have probably had to reaaalllyyy hate her! There is no staff to pull in to help on the busy days. We'll float med/surg nurses over who care for mother/baby couplets, but no other L&D nurses are available. She says she's going to renew for another 13 weeks but is going to stipulate having even more days off next time. Under other circumstances, in other units, I don't suppose that would be a problem. I agree that it isn't a mark against her that admin signed her contract with her concessions. The new administrator, thankfully, is taking the time to research our needs a bit more. I just was wondering if this is common practice with travelers as a whole.

Greetings, All I'm currently working with a traveler who stipulated in contract that she will not work Fridays. This makes our Fridays awful as she is a specialized nurse and there is no replacement for her from within the facility. She's talking about renewing her contract but making arrangements for even more time off. I know that our travelers will often schedule a vacation during the contract period, but haven't had one before who refused to work a certain day of the week, every week. Is this common practice? The Director who signed her contract was interim and had no real clue as to the needs of our unit. I'm pretty sure that the new Director will not renew her under the circumstances. Kind of sad: she's competent and likeable. This was her first traveling assignment. Is she being too picky or are we expecting too much?

Warning: I'm venting about a fetal demise, my first, of a full-term, beautiful baby girl. Here goes the story... Had a pt admitted to the hospital at 35+ weeks gestation for diabetic teaching and management of gestational diabetes, usual workup: NST, BPP c EFW... Neither she nor her husband speak English. G3P2. According to prenatal, had rec'd diabetic couseling as outpt since diagnosis with repeated notations of non-compliance with diet, refusal of insulin. I was her nurse that day. She showed up 6 hours late and, even though MD had told her to be prepared to spend at least 24 hours, up to 5 days as inpatient, had brought her two children and husband with her. She had never planned on staying even overnite, lied about her blood sugars, dietary intake... everything. She did have a reactive NST and 8/8 BPP. I heard the MD telling her that if she continued as she had been, the baby could very well die. She obviously didn't believe him. After the MD left, she was ready to walk out AMA. I, through a translator, asked her if she was prepared to trade her daughter's life for the inconvenience of staying for a few days in the hospital? She stayed overnite but walked out early the next a.m. before the MD returned. Our hospital has started admitting scheduled C/S straight to pre-op holding (I won't even go into how we feel about that) and the OB nurse goes down, does FHTs by doppler just prior to delivery. She was sceduled for PC/S for breech presentation 37 wks gestation. So... down I go to pre-op with my trusty little doppler... can't find the tones... go get the MD... no tones... When was the last time she felt the baby move? "This morning." He asked her 4 times, in front of me, when she last felt the baby move... all 4 answers: "This morning." Stat US... dead baby. The decision is made to deliver by C/S. Out comes a beautiful, perfect baby girl, 9-10, no cord, no visible anomalies, not recently dead. The last NST c BPP had been a week before, reactive and 8/8. The MD had tears in his eyes and closeted himself in the dictation room for awhile by himself. When she came up to the unit, I was passing in the hall. We made eye contact, briefly. I touched her arm, said "I'm sorry." She started sobbing. Daddy held his dead daughter briefly, Mom refused. I collected a lock of hair, took pictures and put together a bereavement package for the family. I don't know that I'll ever forget that baby's face. I have mixed feelings toward the parents. They definitley were made aware of the risks of gestational diabetes and the possible outcomes. I'm angry that she could blithely lie, while looking so earnest, about her compliance with treatment. I'm sorry that they lost their daughter. I'm so very sorry that a baby girl died because Mom and Dad couldn't be convinced of their responsibility to their unborn child. I think I'm done venting. Thanks for reading. Thoughts are welcome.

I got 6 months on a 13 bed LDRP unit. I had already been doing mother/baby because of floating over from med/surg for about 3 months before formally transferring so my entire 6 months of orientation has been L&D. We work on 4 person teams and we do not circulate for our own sections: we have an OR on the unit but not enough staff to cover the floor and the OR & PACU. I think its important to keep in mind when you are considering length of orientation how big the unit is and how many births you have per month. There are two LDRPs in my county: ours is 13 beds, the other is 7 beds. We average around 65 births per month, the other is less than 30. They can't afford to hire anyone without experience because it would take too long to orient to L&D. That's why we do 6 months on our small catch-all unit as oppposed to a shorter, more intense L&D orientation on a separated unit. The most births we've had in a period of time was 6 between 0800 and 1430: 4 scheduled sections, including one set of twins, and one NVD. Quite a lot for a small unit! Then I'll go days without having even one active labor pt...

Planning ahead is, of course, great. Prioritizing is a must... however, what makes floor nursing (med-surg in particular) so challenging is that for which you can never plan. Stay loose and flexible: don't be rigid in your plan for the day. Here's a few things I've learned along the way that have helped me. 1. Beds don't have to be changed to the mattress every single day. Change what needs it. 2. Don't fudge on vitals: they're often your first sign of something bad coming. 3. Let those who can, do. Delegate to other staff as appropriate and available, let your patients do for themselves what they can. 4. Your patients will forgive you much if you get them their trays while they're still warm (hot is probably impossible =)! 5. Always find time to medicate for pain. 6. When you have a pt go bad, let your other pts know, as appropriate, that you have a situation that will require your full attention for awhile and that you will provide for them in the best way you are able. I've found most people to be very understanding. 7. When at all possible, answer your call lights quickly. If often saves several minutes worth of complaining about how nobody ever comes when they call!! There will be days from... heck. No way to totally avoid them. The best way to make it through is to develop your method of delivering care and stick to it. You learn thru experience safe time-saving methods. Learn from your mistakes and move on. Enjoy your career, Tracy