layna

Wow, BBnurse...what a very tragic case. :-( I would really like to see your protocol. It sounds pretty comprehensive. We don't do the neonatal urine screens here. The MDS is ordered by the physician upon communication with CPS. The reason why we are working on a protocol is to hopefully avoid tragedies as described above. I also want to see better communication between CPS and the primary care physician BEFORE delivery. What prompted this review was CPS requests for MDSs that were being done by the nurses without an order and the test not getting paid for by CPS who were the ones requesting the test. Now, by the looks of this post, it looks like it may be a more thorough process if we include the UDS as well. Thanks so much for the info. I would love to see the policy you have, BBnurse. Layna

Meconium is the first stool that a newborn baby passes. If the mother has taken drugs during her pregnancy, it may show up in the meconium and be used as evidence in a protective services case.

When and FIA caseworker requests a meconium collection on newborn of a mother with a drug history, do your docs order this? What do you tell the mother? Just curious. We are working on a protocol for this. I would appreciate any input. Thanks for your help, Layna

We triage our own labor patients as well. The only problem we have is with patients walking directly up to OB needing an evaluation. There are times when the two RN's on are in the delivery room while this patient is waiting. I would like all pregnant patients to see the ER triage nurse first before coming up to OB so that we receive a call and can attend to a patient right away without making her wait. The other thing this would eliminate are pregnant women in need of ER care verses OB care. There are times when patients experiencing exacerbation of asthma etc. are sent to us just because they are pregnant. Our pregnant patients in need of an OB eval are usually with us anywhere from one to six hours depending on what is going on. After that, the doc has to decide if the patient should be made a 23 hour admit or if she should be fully admitted.

Very nicely said, Mother/baby RN.

Sorry if there are some who perceived that this was heating up into a big debate. This was not the intention of my post, however, I do frequently encounter moms who need to know that it is ok for them to let their babies receive nns at the breast if THEY want to within their own limits. Every person has to strike their own individual balance. I firmly believe that we should never judge a mom and that we are vessels of information for them in the decision making process. As professionals, we need to be aware that we are living in a predominately "rubber nipple" culture. I don't see nns at the breast as something that is always presented well to bf patients. I also hear moms say that they quit breastfeeding because they couldn't get enough done around the house. Perhaps these moms may have benefitted from a consultation with a nonjudgemental lactation consultant. To practice effectively as professionals, we need to be aware of the culture we are living in and the individual needs of our families. Thanks to all of you who were kind enough to reply to this post. I have learned so much from you all!

"Browneyedgirl, you sound like a very caring and conscientious mommy. Your children are very, very, VERY lucky to have had such a nurturing person to take care of them." You are absolutely right. In this materialistic culture, I know very few moms who will take the time to allow their babies to experience NNS at the breast for long periods of time. Most women won't tolerate it because they want their "freedom" and a clean house all the time. My fourth child enjoyed as much NNS as he wanted. I figured that there was plenty of time later on in life to be "free" and have a clean house when he is grown and then gone. No regrets. :-) As far as pacis- my first three children used them. Yes- easy to take away compared to thumbs and fingers! :-)

A very valid point and observation made by imenid37! I still have fond memories of watching my son on ultrasound at 26 weeks sucking his thumb. :-)

Thank-you, Jolie. I will have my assistant contact the formula company about this.

To try to cut costs, one of my staff members suggested making pacifiers a chargeable item. They are about 1-2$ a piece and sometimes patients end up with 3 or 4 of them. Some other people I work with consider pacifiers a standard of care and patient should not be charged. What do you do at your facilities and what do you think?

Thanks to everyone for input on this subject! I am currently involved in the development of a float policy for our OB nurses. I do believe that floating guidelines need to be in place for the patients' sake. Nurses floating to other units should NOT be given an assignment unless they are currently practicing as a primary nurse in that unit (some of the nurses here do work in more than one unit on a regular basis). I also believe that with the help of the staff, there needs to be a clear guideline in place for the RN's who are floated related to what they can and cannot do- I found a great list of things like this in a Perinatal Compliance book I recently bought. We need to address the "floating fears" as mature adult professionals so that the needs of patient, unit and RN are met as best as possible. If any of you have some written floating guidelines and want to share, please PM me. I would appreciate it. Thank-you!

At my last place of employment, I was doing pericare on an 18 year old girl who had just had a precipitous delivery 10 minutes after her admission. While I was cleaning her up, I found a wad of blue bubble gum stuck in her pubic hair!! She also had crabs and lice....Needless to say, my co-workers didn't let me live it down! When I left the unit to move to another city, guess what they gave me....yup, you guessed it- bubble gum and a cake decorated with plastic black bugs!!! LOL...

Chris B gives good advice. I have been a manager for 9 months now. I love the challenges. There are more "peaks and valleys" in management though. You have to make decisions that are not going to please everyone all of the time. There is also a big difference in having a desk where the work waits for you verses punching in and out of a shift where someone takes over your work. Good luck with your decision! If the politics are not good, this may be your chance to make a difference!

I think that moonshadeau says it all. It took me 10 years to finally convince myself that I deserved a break and to quit working through lunches and suppers. With the exception of an emergency taking place on the unit, since then, I have made time to take a lunch break. The amazing thing is that after I took my break, I was refreshed and did my work much more efficiently. Those people who feel that they "cannot" ever take a decent lunch break need to reexamine their patterns of practice. There are solutions out there if you are willing to take them. You can have the best union in the world but no one can "make" you take a break unless you feel like you deserve it. There is always plenty of work that can keep you working well through breaks and dinners...Good luck to those of you who are looking at ways to see that you get your well needed breaks! Peace to you all.

HI BadBird, Thank-you for your reply. I appreciate it. I have considered agency nurses, but the staff feel that this may create more problems such as resentment over wage disparity, and having to take the time to orient these higher paid staff members. I have instituted an on call schedule which seems to be working well. It spreads the burden on all so that a select few avoid burnout. I am continually looking for new reserve staff as that is where I need help for sick calls and vacation coverage. My core positions are full, thank goodness. Administration has supported me in attaining almost a full FTE to cover nonproductive time. Overall, life is getting better. If anyone has any other ideas, please let me know. Our unit is an OB unit staffed with 2 RN's per shift (core) with help added as needed. I am trying to avoid closure of the unit. Hopefully we get through the summer without any major problems. Layna