nurseob7

When babies stay with mom all night, how often are you required to document on baby? We are supposed to check that security device is intact every two hours. We are not required to document color or respiratory effort which I think is more important than documenting the security device. When applied properly, it would be almost impossible to come off. How often do you document on rooming in babies? Thanks!

Even though it is time consuming for the nurse to chart frequent assesments, many pts do not like bp's to be taken so frequently. Of course, once they have an epidural, I feel frequent bp's are evidence based, but not with pitocin. Many pts are induced with Pitocin and don't end up with an epidural for many hours. Many times Pitocin all day and a failed induction.

We currently are usually starting our pit inductions/augmentations at 1-2 mu/min and increasing by 1-2mu/min every 15 min . We have to document FHR and uterine activity every 15 minutes along with BP and pulse. The care of the pt is not difficult but the charting is ridiculous -- especially when you have two pit pts ! It is very easy to fall behing on the charting . During my 12 hr shift the pt gets 48 BP's which I think is not evidence based practice. I've never seen blood pressure effected by pitocin, even though I know it could happen. I would like to see 30 min bp's and 30 min fhr and ua documentation. How often do you take bp's with Pitocin? I am going to talk to some of the ob's and hopefully they will approve for this policy to be changed.

Just wondering if any units are able to use preprinted medication sheets? When a pt delivers, most docs routinely order 4 or 5 oral medications to be used prn, and a couple topicals prn. (With a cesearean, the number of routine prn meds increases) We have to hand write each medication on a med sheet AND only write generic name ........ this is so frustrating since it seems like a waste of precious time to me......... were told that preprinted med sheets are not acceptable due to increased possibility of med errors (nurses might forget to cross out a med from the sheet that was not ordered) I'd love to know what other units around the country are doing --- if it is not a Joint Commission requirement, I'm going to try hard to get this practice changed. Thanks !!

We must wait a minimum of 24 hours from birth (Illinois hospital)

I've never seen it before and it made me laugh -- I've been a nurse almost 25 years, and I honestly have to say, most of the things are so true..........Thanks ! Very cute --- I'm printing it and posting it at work. We have 3 new grads on my unit and lots of experienced nurses. I think they will like it!

Hello -- Wish I could help you ---I'd like to know the same thing. If you find out, I'd really appreciate if you would let me know....... I'll do the same. Thanks so much.....Tina

I agree with you totally --- I had a young patient last year that reported my comment to the nurse manager on her rounds the day after I talked with her. She was feeding her baby every 1-2 hours around the clock and baby was drinking way too much formula. I explained to the mother that many times baby cry for other reasons besides hunger and before a baby is given more formula within 1-2 hours after the last feeding, other comfort measures should be attempted, along with checking diaper, burping, etc. I told her that babies can be fed too much and this could later lead to obesity. She was offended -- my manager basically told me that I should not have told her that . I feel that I am a very good teacher and spend time with my patients informing them. It seems like most patients don't want that much information. They want us to wait on them and comfort them ---- I also had someone mad after I did my talk about second hand smoke around babies. It mad me want to stop teaching when management doesn't support the nurses. Customer satisfaction is all we hear about these days.

18 G are green -- 20 g Pink --- 22 g Blue I just find we rarely give blood anymore ---- delivering about 2,000 babies a year. In the last few years, I've given blood twice and that was the day after birth (not a true emergency situation) A few nurses on my unit just feel that if we start putting 20's in everyone routinely, our pts would be happier and a successful first stick would be increased. Blood can always be started with the 20 g angiocath and if you need to have a bigger one for faster infusion, why not start an 18 at that time? Of course, you could say that in a true emergency, time is precious, and what if you are unable to get an 18 in at that time? How about a pump for the blood to increase the rate? We usually use free flow tubing for IV solutions and blood. The anesthesiologist would normally be present during surgery of course and could do a second line ....... My unit wants to improve nursing care to reflect evidence based practice. I'd appreciate your input. Thanks!

My unit delivers almost 2,000 babies year year. We use use 40 as our low and then give the glucose and formula --- after feeding, if the sugar doesn't come up, we do a serum level. I would really appreciate if you can let me know the name of the lancet that you like. I want to see if our unit is following evidence based and best practice nursing. Thank you...

What device are you using to get blood from baby for glucose level? We are using the tenderfoot -- same device that we are using for metabolic screening (PKU's) -- I think with this device you usually get more blood than needed for a glucose test and am just starting to research and see if we should change our current practice. Thought maybe something different would be less painful also. Thanks!!

Curious.....what size angiocath is routinely used for your labor and antepartum patients? We are using 18 gauges but of course, if we can't get it after a couple attempts, will use a smaller size. Our unit is considering using 20 g routinely, since blood, if needed, can be given with a 20 gauge. I appreciate your feedback! Thanks

First day on my unit, 20 years ago, a doc delivered a baby by c-section with a nuchal cord X7 ! He was unwrapped the cord saying, one, two, three, etc. I've never seen anything close since! Thank goodness !!

Well, since I've work in L&D for app 20 years, I definitely do not feel there are alot of cons. I love labor and delivery but do not especially like postpartum. Labor and delivery is faster paced and anything can happen. Most shifts doing postpartum are pretty routine, which some nurses rather have. Can you talk to the nurse manager on the unit and see if you could job shadow a nurse for a few shifts? I would recommend that before you made the move. I think most managers would agree it is a good decision. Shouldn't be a problem at all, especially if you are possibly tranferring to that unit in the hospital you currently work at. What I can add, is that there are many nurses in my unit that have been there a long time and plan on retiring there. The turnover rate is not high at all, which I think says a lot for a unit. Of course, it is a little higher on the night shift. Currently my boss is trying to find an experienced night shift nurse, and is having no luck. Most want the day shift or afternoons. I would highly recommend OB nursing -- it is challenging but fun -- most of the time it is a happy environment. GOOD LUCK!

My unit now puts them everyone prior to the surgery and is supposed to use them until the pt is fully ambulatory. This is a fairly new policy -- the last year or two. Before that, we would only use them after the surgery when the doc ordered them (which they only did occasionally) -- Now, it is on our standing order sheet for c-sections. Of course, in an emergent case, we don't waste our time. Hope this helps! P.S. I also have never heard of Venodyne -- we just call them SCD's.