tdr61

Los Robles Hospital and Medical Center in Thousand Oaks

Come on out...you'll love it!!!! I moved out here 4 years ago and don't have any plans of leaving for the simple fact that California is a safe place to practice. I've been from New York to California as a traveler and can say that until other states adopt the staffing ratios as California has done, this is the only place I will practice. Yes the cost of living is higher than in other areas of the country. However, the San Diego and OC areas aren't as bad as the areas further north. I will say that the only way I can stay here (being single) is to do so as a travel nurse but then I have other bills to pay aside from daily living expenses. If you don't have much to pay out, you should do just fine! Good luck! Tenesa

Thousand Oaks is in southern Ventura County...very, very nice community. The cost of living is about the same as LA county. I am currently a travel nurse at that facility and the unit I work in is great (L&D). The hospital is a HCA facility and is union which I know can be a huge deterrant for many nurses. Working for HCA was a concern when I took the contract but I will admit the only issues I've had was not with the hospital itself but with their own travel agency (All About Staffing). Feel free to PM me if you have any other questions. Tenesa

The hospital in Thousand Oaks is offering a $10,000 sign-on bonus for full-time RN's...not sure about the relocation assistance though.

At the hospital I'm currently at there is a policy in place that states there is no videotaping in the L&D or C/S rooms. With that being said, I will say that it is not often enforced. The majority of the nurses could care less if there is a video running or not as long as the person doing the recording is out of everyone's way. I will also add that we don't get many patients who want to video tape the birth so it's never been an issue. Tenesa

Welcome to CA! If you decide to live in Arcadia you'll be looking at a minimum of 45 mins to an hour drive if the traffic isn't bad. If it is, you can double that time. Arcadia is about 30 miles or so from the hospital and that time of the night can prove to be very busy. The morning time probably wouldn't be as bad once you get through the Burbank area. Does your company not offer housing? If they do I would definitely take the housing and get closer to the hospital. However, I wouldn't recommend the Van Nuys area. When I did an assignment at Valley Pres. I took housing in Woodland Hills...it's about 13 miles away and took me 25-30 minutes to get there. I'm still in Woodland Hills so if you have any questions about how to get around or the area...drop me a line! Tenesa

In my 16 years of L&D nursing I have seen two uterine ruptures (neither were my patients). One was a VBAC attempt, not induced or augmented, delivered lady partslly and ruptured during the immediate recovery phase. The patient was sent to the OR twice and received close to 100 units of different blood products and a hysterectomy. She spent several months in rehab to learn to walk and talk again but did survive. The other was a previous c/s who presented with contractions, non-english speaking, no prenatal care, previous c/s in Mexico with a vertical skin incision. The MD on-call took a "wait and see" attitude, the patient contracted irregularly for about 4 hours, got up to go to the bathroom and on the way back to bed the patient went to her knees doubled over, the staff got her to bed and on the EFM, FHR flat and in the 50's, rushed to the OR where she had ruptured, delivered an 8 lb girl with no EEG activity and kept alive on a vent, mom ended up with a hysterectomy at 20 years old. Upon mom's discharge the vent was turned off and the baby died. Just last week I had another non-english speaking patient who presented to L&D with c/o lady partsl bleeding and abdominal pain. Prenatal care was through a local clinic so she was assigned to the ER OB doc on call. Through a translater I found she was a previous c/s x2, she had a moderate amount of bright red lady partsl bleeding, severe abdominal tenderness, uterine hyperstimulation and a maternal HR in the 120's. A stat c/s was called and when they opened her up they found her lower uterine incision was rupturing and she was bleeding into the myometrium...the entire uterus was mottled. She was also abrupting. Mom and baby came through without incident. Good luck with your research!

I have worked in both scenarios and when I am at a place that uses a regular infusion pump for the IV there are some safety precautions that I utilize. I make sure the pump for the epidural is on the opposite of the bed from my other pump. I label the epidural pump with tape stating "EPIDURAL" and place the tape across the pad so that if anyone walks in and tries to change the settings they will see the tape. If the tubing is not epidural tubing (which unfortunately does happen), I asked the anesthesiest or CRNA to tape the injection ports or I will do it myself to ensure that nobody inadvertantly tries to inject something into them. I do the same thing when I'm doing an amnioinfusion. Just some thoughts on how to keep the patient safe...hope they help!

Hmmm, let's see...aside from making that list, think about what size hopsital you want to work in and what shift you are willing to work. Obviously there will be more night shifts available than day shifts which, if you're willing to do nights, will open up alot more opportunities for you. Make sure you find out up front if the housing is private or shared and find out if benefits start on day one or if there is a 30 day waiting period. Find out about the orientation schedule and if you will be paid at a different rate for orientation. Some agencies don't pay your regular rate for orientation. Ask how the paydays work...when and how are they paid...are you responsible for your timesheet or is the facility. Will you be required to float to other areas and if so will you be given an orientation to those areas. Find out if the facility requires mandatory call shifts and what the pay is for those. Also, ask if you are guaranteed 36 hours a week or not...some agencies don't offer that. I'm sure there's a ton more but my brain is dead about now...lol

Don't let the recruiter's get to you...some of them can be overbearing and bordering on rude. It helps if you have a list of what is important to you in a contract, benefits, payrate, housing, bonuses, etc. When you're talking to the recruiter's just put it all out there, tell them where your looking, the shift you want, the pay you want and the benefits you want. Alot of recruiters will try and sway you to other places or shifts...if those things are non-negotiable, let them know in the beginning and don't waiver on it. Because like dpipes44 said, they are just like used car dealers and will try and talk you out of alot of things so their commission is bigger...stand your ground and that won't happen. As far as the companies go, for me it comes down to the recruiter I have...if he/she is not willing to listen to what I am looking for and is more interested in trying to talk to me into something else...well, I cut my losses and move onto the next company. A good recruiter is probably the most valuable tool you will have as a traveler. Feel free to PM if you have any other questions....good luck!!!

I've worked in some facilities that still practice that way but I've noticed that many are moving away from that. Currently where I'm at, if the mom does not get at least 2 doses of antibiotics the peds will do a CBC, CRP and blood culture. No treatment is given unless the results are suspicious. They still keep the babies 48 hours or until they get the blood culture results back.

I would definitely check with your BON on this one. If you are one of the nurses who is performing a bedside US for whatever reason, make sure you have a documented competency showing that you have been trained to perform that duty and make sure your policy covers it. Otherwise you're setting yourself up for problems. Personally, while I am capable of doing them and have in the past...I don't any longer and wouldn't do so without attending an OB US certification class. If I can locate the literature from AWHONN about RN's performing bedside US's I'll pass it on.

I believe the ACOG literature states that Pitocin can be titrated as high as either 40 or 40 mU...I will have to find the exact article that addresses it. I'll pass it along when I find it.

Yes it's possible...I have an ADN and have been in OB nursing for 15 years...have decided to take the big LEAP and go for my Master's this year. Good luck!

That is exactly what the AWHONN guidelines states. I too worked at a hospital where the nurses placed the epidural bags in the pump, programmed it and started it as well we turned it up or down....the anesthesiologist had no idea how to run the pumps either. The staff nurses there had no problems disregarding guidelines but I refused to...needless to say I don't work there anymore. I would caution any OB nurse to think twice before touching an epidural infusion other than to turn it off...if something were to happen, in most cases you would stand alone in a court of law.