adoptionacres

The best birth plan I ever saw was the one that went through all the preferences with the flexibility necessary for baby and mommy safety. The last item on the list was: And I would like the L&D to be over in 10 minutes! We all had a good laugh over that one!

Just got my RNC in Inpatient OB this last winter. I think the process of studying and taking the test made a difference in my knowledge base and I know the alphabet soup made a difference in how some of my colleagues view my skills. I think it was worth it. My hospital didn't give any extra pay for certification, I think our new contract included a periodic lump sum when recerting or getting the initial cert.

There are tons of things that are researchable, an easy one might be the value of a quick fetal fibronectin test for managing preterm labor patients. Good luck.

Anybody have a guideline on how soon cervidil can be repeated after it has been removed 12 hour after insert?

Small, rural hospital. We want two RNs, one competent in L&D, one in NRP. Respiratory comes in for mec, sections and if we are worried (GDM, decels, etc.)

One of our intensivists came to me one day laughing because she'd read this: "Dr. A popped by to see Baby J for a cuddle and a tickle." Another time I wrote in a teenage girls notes: "M engaged in spirited discussion with writer on merits of pink lip gloss over peach." The girl loved it. Don't know what our manager thought. One shift I had a 3 year old brought in to the ER for a tiny scratch on her elbow after a fall. I wrote the telephone order and charted for "a kiss and a band aid." Applied and followed by a response of "Patient tolerated well." The review committee loved it.

As a student, I was working on a med/surg floor when a very large, very drunk man was brought to the room. He had wet himself and for some passive aggressive reason, the ER doc :down:wanted a UA (can you say drunk and obnoxious, not infected?) The floor nurses all looked at each other and said, "So who's it gonna be?" I told them that as the stupid nursing student, I would be delighted to cath this unconscious gentleman:yeah:. 4 nurses, one on each corner, were there to assist as we all expected him to wake up swinging. I got all ready and prepped and we pulled back the cover and the room went silent. Everybody looked at each other with a "what now?" expression. The stupid nursing student gamely proceeded to 'firmly grasp' with the 2 fingers that would fit and start the cleaning and insertion process. The insertion didn't insert. I kept trying and we were all thinking that this was really going to burn the next time he had to pee. 4 RN's :heartbeat trying to give suggestions on how to do the cath (I mean, it's a guy-only one hole, right?) Only 1/2" in and it would stop! Finally, I start turning the p3nis over and looking at it more closely and realize that he has a hypospadies (if there's one anomaly, there's probably more than one!) At that point, seeing the size of the orofice, I gave up. We all decided that if the MD really needed a urine, he could cath the patient himself. Go figure, he didn't really need it! Once the guy sobered up and woke up, he went on his merry way, fortunately w/o burning from the somewhat abused false hole.

I finally called a coworker friend who happened to be a lactation consultant. She asked me "why are you doing this?" Well, I was doing it because I did not want to feel ashamed to tell people that I gave my baby formula. After about an hour and a TON of tears... I gave it up right after getting off the phone with her. I just needed someone to tell me that it was OK if I did not breastfeed. That I was NOT a bad mother for not feeling "natural". I was happy, my son was happy and FULL, and we bonded just fine!! He is the picture of health. When I had my daughter, I went through no guilt- just checked the box that said-"formula"! I do think that many moms are "guilted" into breastfeeding rather than doing it because it is what they really want to do. It is really hard work and it is not for everyone- doesn't mean that you are giving your child any less by not breastfeeding. :yeah:So true. Then you get the other kind of lactation consultant to whom BF is a religion influencing the management of the unit and insisting that we push our new moms to BF. I would rather have my new moms relax and learn to enjoy their babies than fight against the difficulties and expectations they are loaded with. I sent a link to the article to all our nursing staff, perhaps they will be slightly less dogmatic?

So I know that without an "active" herpes outbreak, a woman can deliver lady partslly w/o complications. How are y'all doing in your facilities with HPV? It has been shown to cause throat polyps in lady partslly birthed kids. One case I know of led to speech problems during the child's early developmental period and resulted in surgery to remove the polyps that can return at any time. I personally know of a man with throat cancer caused by HPV. Changing sexual practices mean this virus is no longer limited to causing just cervical cancer. I don't think we're going to get an "active" or "non-active" decision on this one. I have talked with my docs about this and we are thinking it's not going to be long before we are vaccinating both boys and girls against HPV. Any policies anywhere?

Try to get CME like medscape so you can get some training at night. Those quiet shifts are absolutely the worst! Nancy

Libby, There is nothing better than rural nursing to get you experienced in all areas. Don't be afraid to ask for help and don't let them bully you into doing anything you don't feel comfortable with. Get ready for quite the experience. Nancy

I think one of the biggest things is communication: Clear, TRANSPARENTLY clear communication. Talk everything out loud. And make sure that you address the communication to a specific person and that there is an acknowledgement and response to that communication: i.e. Joan, get RT here. Joan: I am calling RT, RT is on their way. and so on... I believe this is called "closed loop communication"

Technically, we aren't the definition of rural, we are what is called Frontier Nursing. Our high desert county has 10,000 square miles and 7,000 residents. :penguin: We are moving into our NEW 25 bed critical care access hospital next month! :monkeydance: :w00t: We have 2 ICU beds, 3 ER beds, 3 OB beds, 1 (soon to be 2) OR suites. Our RNs need to be able to do everything. :pumpiron: We are 2 hours from a town of any size at all (75,000) and 6 hours from a big city (2 million). We do a lot of stabilization and transfer and a lot of cardiac drips. We won't do VBACs, but we will do L&D after 35-36 weeks and C-Sxns. Cradle to Grave, that's our range.

We had one of our ER docs bring his guitar and we went around and sang Christmas carols to our patients. :Melody:

I like the ICU patient's wife who took her AAA, AFib, chest pain husband's oxygen off so she could take some hits of it because she was a little sob. They are both on our frequent flyer list.

Suggestions: Get in touch with some reservation nurses, they run into the same main problems (i.e. ethanolism, diabetes, etc.) and the remoteness. I believe there is at least one post on this site from a rez nurse. Look her/him up. Also, get hold of a wilderness medicine or tropical medicine doc at a teaching hospital. The diseases won't be the same, but the isolation and dependence on your critical thinking skills will be. Get a PDA with a good all around program, one that can be updated from the bush. The other nurses at your clinic will have lots of info. Good luck and have fun! How long will you be there? Nancy

OK, one from my early days that my supervisor gave me heck about for months: ABNORMALS: Pt is obese. INTERVENTIONS: Will continue to monitor. Yup, she's still obese!

In rural hospitals we often have to admit our own patients into the computer system. A hospital employee came to the ER with a bite wound after she had, "Interfered in a family fight." The ER RN entered her diagnosis as 'human bite.' When I took over, I knew right away that this was incorrect, but asked anyway, "This is a dog bite, yes?" The patient, who lives alone with her sled dogs, and I both got a good laugh out of that one.

What's a "fry daddy?"

I tell my patient's that their gowns are open in back because they are I-C-U gowns. It takes someone pretty out of it to not giggle at that and they often end up repeating it to their families.

I started as a new grad at a rural/frontier hospital. It is the best for overall experience. Specialized RNs who work one area are horrified at the mere thought of doing everything we do. I will never be the awesome L&D nurse who delivers 20+ babies a month, but I don't cringe when I see male parts, a vented ICU patient with art lines and CVP lines or the major traumas that come in out of our ranches and rural highways. It keeps me learning and growing constantly, always questioning myself and expanding my skills. I love it!

This was always confusing to me, since we live two hours from anywhere. The next nearest large center is only 26,000 and may be considered rural itself. I have since been informed that we are not 'rural' we are 'frontier.' Seems a shame that cities of 100,000 can get the grants of 'real rural areas.'

Student. Huge, roaring drunk and aggressive patient comes in through the ER. Doc, who is known as a butt-head, wants a UA. RNs say, "Great, who wants this one?" Me, dumb student, says, "What the hey, I'll do it." 4 RNs in the room, one on each limb. I get ready to prep him (currently passed out) and pull down his pants and can barely find his equipment. The RNs by this time are snickering at the poor student. I manage to get hold of him by two fingers and attempt to cath him. Now how tough can it be, right? Guys only have one hole. Wrong! This cath won't go in. Everyone is giving me advice on how to do it while holding him down (actually, he never did wake up during this process). Finally, I turn the member over and find another (very small) hole on the ventral side. This guy had hypospadies. No one had ever seen it before. We told the B-H doctor that if he wanted a UA, he could do the cath job himself. For some reason, he didn't feel he needed it. :monkeydance: