debbiernbsn

At both L&Ds I've worked at the practice was to place an 18 gauge cath. This was requested mainly by anesthesia. Is everyone else doing this too as standard practice? If not, do you have any evidence to show that it's not necessary to have that big of a gauge? Thanks for any input!

Thank you that would be great!

Thank you. Do you know what reference they used to make that policy?

When do you draw the blood for a rhogam work up after delivery? Our facility states that it must be within an hour but I'm having a hard time finding evidence for that. Thanks for any help!

In both OB jobs that I have had there has been a call requirement. I worked 40 hours a week & took 5 8 hr calls in a 4 week period. Now I work 30 hours a week & take 3 8 hour calls in 6 weeks. It seems to be usual to have to take call with this job.

I think L&D is inherently a very difficult area to work in for several different reasons. 1) if you are a new grad then not only do you have to learn L&D info, but also basic med-surg skills and time-management. 2) we are worrying about not one patient at a time, but two. 3) we are hesitant to ask for help when we could really use it, because then we feel inadequate to handle our assignment. I went through all of this when I first started OB, had only worked a year in ER, straight from nursing school. Only time will help, I used to let other nurses dump on me, until I realized that I wasn't doing my license or my patient any favors! So now I ask for help. I have always said that the nurses that aren't at least a little afraid every shift they work, are the ones that really scare me. A little fear keeps you on your toes. Hopefully time and experience will help you, or perhaps you might look into postpartum. I work it mostly now, do L&D probably once a week and my stress level is much lower!

I have found that these duties are usually snuck in your hospital's nurse job description under the little phrase "job duties as assigned!" LOL

Yep, we give this before an epidural. We also give IV pepcid & reglan, the same exact meds we give for all of the c/sections also. Seems like overkill for an epidural to me.

I am also a nursing instructor and work on the unit where I have students. If the student is truly shadowing the nurse, following her and watching everything she does, then they should not miss anything. It is frustrating for me to check on my students and see them sitting there while the nurse is in the room doing something for the patient. Some responsibility needs to fall on the student to take every opportunity available to see/do whatever they can in such a short rotation. JMO!

Thank you for your input. Our minimum staffing for L&D is 2 RNs, so I feel that we cannot keep the triage open 24/7 because we can't have 1 RN in L&D and 1 RN clear on the other end in triage. That leads me to think that there should be designated hours like 7A-7P, or even 9A-9P. Our busiest triage times are from 2-9 or 10ish. I have made some calls to hospitals within the state and most all of them say that the triage area is within L&D. I think ours is slightly different as it is set apart from L&D. I am gathering my info in order to write a proposal, any suggestions on what to include in that would be helpful also!!

A little more info on the new triage area, it will have to be staffed separately from L&D because it is physically separated from it by a long hallway. Thanks for any and all input!

I work L&D/PP in a hospital that currently does approximately 1200-1300 deliveries a year. We are about to open a new unit with a 5 bed L&D triage area, which we had not had before. I would love input as to how those of you with L&D triage areas staff them, and what hours they are open. Any input at all would be greatly appreciated, as my manager has asked me to research this and write a proposal as to how we will manage this new area. Thanks!

I have worked in two different hospital's L&D's in Ohio and we could not place IUPCs in either one.

Procardia, when used with magnesium sulfate infusion, can cause a neuromuscular blockade (paralysis). I have heard it explained simply, that you don't use procardia when the patient is on magsulfate because the procardia is a calcium channel blocker, and what is the antidote to magsulfate toxicity? Yep, calcium gluconate. P.S. I work on an OB unit and that's how the docs explained it to us. Hope it makes a little sense!

I'm so sorry that you and the patient had to go through that. There are very few things harder than telling someone that their baby is gone. I have been through a similar situation years ago, twins, found one heartbeat, having a terrible time finding the second, had to chase the OB down as he was trying to go home to get him to order UTS. Baby A was great, baby B gone at 33 weeks. Such a shame and hard to deal with. But talking it out here and with your peers will help, as will the passing of time. Keep being compassionate and don't be afraid to feel with your patients. That's what makes a great nurse!

We currently handle Mag patients about like I have read here. My question is though, do you have your patients on telemetry? We do not currently do that, but have heard that the standard of care is going to continuous tele on Mag pts. Do you currently do that or are you thinking of doing that? And what would that entail as far as staffing goes? Any input would be appreciated

Yes, always before we got FHT's before and after the procedure. Now, a new anesthesiologist wants continous fetal monitoring due to legal risks, he says. But I have to wonder if this is really necessary or even possible sometimes....

Do any of you have to go to the OR and continously fetal monitor fetuses over the age of viability during routine surgical procedures? We have recently been asked to do that. My question is.... if the OB doc isn't rapidly available, what are we going to do with a fetal distress? Any comments on whether you do this, or how you do this will be greatly appreciated. And if you have any policies on this, I would love to hear what they are. Thanks!! Deb