heartbeat2

There maybe reasons as to why she is acting this way, sounds unprofessional to me and not a way to be an effective leader. You may want to meet with her prior to your evaluation and ask directly for feedback. A good technique to use is after you listen to what is said, summarize what you understand has been said to decrease miscommunication. She may feel like she's not been welcomed or may be used to a different style of interaction... It depends on what your goals are as to how to procede. Your job is stressful enough without the added stress of a negative nurse manager. Good luck to you and your co-workers.

I was a labor and delivery nurse that due to a broken knee could no longer work in my area. My hospital now lets me work as a monitor tech where I watch many patients on several floors: up to 48 patients at a time. I have asked in the past what other hospitals do, and what their policies are. I know I look at things a bit differently because I am a nurse and have the liability so engrained in my mind, to do what's best for the patient and then myself. I teach BLS, am ACLS certified even when I was working labor and delivery. Also, does anyone have any suggestions on where/how to become certified in telemetry? Thanks:redbeathe

Sometimes pauses are a result of medication and may need to be adjusted. If undermedicated, the rate can become quite rapid, overmedicated, very slow. Also, is this a new onset of A-fib or chronic? A-fib has the increased risk of blood clots forming in the atria since they aren't emptying fully. If the patient converts to a sinus rhythm watch for signs of stroke, MI, PE. Hope this helps.:redbeathe

I am very interested in becoming certified in telemetry. Is there anyone that can recommend an on-line or correspondence course? Thank you.:redbeathe

My first impression of the tracing you mention is IVR...idioventricual rhythm. The first time I saw this it was like my P wave just melted into my QRS and it had gotten wider then my P wave just emerged out of my QRS and had returned to it's normal morphology. AIVR is accelerated idioventricual rhythm: a rate above 40. Hope this helps.:redbeathe

I had a TEE done to see if I had a defect. The bubble went from the right atrium to the left atrium. A clot could do the same thing. I don't know if this is the only reason it is done.

I would love to speak with anyone here re: telemetry, I went from L&D to telemetry after breaking a knee and am having a few BIG issues. I would love to have someone tell me how their hospital handles issues like "how long is too long" for a pt. to be off their telemetry monitor and things like this. Who is over you telemetry units. How many patients does one person monitor. What is the layout of your telemetry department. I don't mind helping anyone with ?'s re: going to mother/baby, post partum, or L&D:balloons:

I would love to speak with you. I worked labor and delivery for over 20 years and dearly love it. I broke a knee 2 1/2 years ago and couldn't work l/d since but am trying hard to get back if my knee one day will let me. My hospital placed me in telemetry for recovery time. They didn't have to do it but I'm forever grateful that they did.

Have you ever worked with a Dr. that goes into the patients room and talks a great deal.... and usually in circles, and actually says NOTHING! When the Dr. leaves and you are standing there...the patient and or family will ask, "what did he say". lol...I go get him or beep him and tell him the patient has ?'s for him. We had Dr.s give their patients our L&D unit number for them to call us with their ?'s. One dr. said he wasn't going to return this one patients call. I called her back to let her know that I had spoken with her Dr. and had not received any orders. That if she felt like she needed to be seen to come to the hospital. Boy was he upset with me. (I think he was going to tell the patient that I'd not given him the message) One Dr. would have a number of patients in labor, and we were busting our britches to care for them, IN he walks and breaks everyones water, orders a ton of epidurals, and pitocin augmentations!...now a once managable situation is no longer...oh and I would be the one following him room to room doing this and he would be upset that I'd not gotten the first patient admitted by the time WE had seen his last patient. Sorry but it does take about as much time for him to chart what he did as it does for me to clean up after what he did, and on to the next patient.

To me, I see a difference in the way the public perceives nursing since they have become customers instead of patients. May account for the number of years passed and the increase demand on what nurses do. To be fair, what most have seen nurses do is from TV shows. Not sure how much people get from even the higher tech shows, and always a dr around like in ER. (some of those shows are so way over the top we know they aren't true) Also, from the patients point of view, We are both (waitress and nurse) in the field of service. My response would depend upon how the patient said what he did: smarty or ignorant.

This is one of the hardest things to deal with, how much is too much and how do you know it. First, you want to make sure the fundus is firm. There are times when you massage, yes the fundus is firm, but does it get firmer when you massage. This will usually decrease the "trickle" you may easily see. We would do pad counts and we kept the same one under the patient until it is about soaked if the patient has heavy bleeding or if we are concerned about the amount of blood loss. You will be able to tell the difference just by how heavy the pad is. When in doubt and a more experience nurse isn't available right away, keep the pads laid out on a chuck in the recovery room area, or in the tub if you are in the patients room. Let the nurse in charge know what's going on. Keep a watch on the patients bladder. A full bladder will not let a uterus contract as needed. If the fundus is firm, and the bladder empty, then you are usually looking for lacerations or possible retained placenta. The doctors I've worked with would have standing orders about catherizations and pitocin. If this doesn't correct the situation, call the Dr. It's normal that when the patient first gets up, the pooled blood in the lady parts will pass and be a large amount, but it doesn't continue. Keep a check on the vital signs, but moms can lose a good bit of blood before vitals will change. We had a doctor that collected cord blood after deliveries, heparinized it, and then used it in an inservice. Measured out in ML.s what 50ml, 100ml, 200ml, and 250 ml would look like on a pad. If you have baby scales available, you can weigh the pads also when you are concerned. You can also describe the amount in sizes of softball, cantaloupe, basketball....especially when it's "congealed" and you don't have individual clots. I hope this helps.

I've posted this before, but it has and will always remain one of my best thank you's. Got a call and the woman was asking me "what do I need to do to be able to do what you do"..(education wise that is). So I spoke with her about her options. She told me that I didn't remember her but that she would never forget me. I took care of her through her labor and delivery. I had made such an impact on her life, she was wanting to follow in my footsteps and make an impact on someone else and become a nurse....wow.

I've been a nurse for 24 years. The insurance the nursing school carried on the students wouldn't allow for the students to do IV's. Even though our instuctors didn't agree with this, we wouldn't have been covered if something were to happen.

Wow...talk about a common thread woven throughout. Sounds like you already know your answer. You have been through so much already. There are many opportunities out there. Wait until you have a fit for you and your injury if you can. Hang in there.