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

Thanks, Everyone. I would appreciate the information before our next OB Committee meeting. We are a small rural hospital and our OB/GYN is wondering if all of the docs should have a minimum number of deliveries per year to maintain competency.

Hi Everyone, Is there a certain number of deliveries per year that each of your physicians has to do annually in order to maintain OB delivery privileges? I am curious. Thanks! Layna

Thanks, Stormy That is a great idea! I will talk to my staff about this study. It is the only way to increase staffing. Administration bases decisions on numbers and they are interested in recruitment and retention. I will certainly take this path to improve staffing in our unit. I will keep you posted!

Thanks, Jill. I like your story of how an agency nurse stayed on as staff. I didn't think of that as a possible benefit of bringing agency nurses in. I was talking with one of the union reps last night and he told me that bringing in agency nurses may bring hard feelings. I don't know if that would be the case or not. My staff might be thankful for this as there would be less demands on them. We start our call schedule this month. I will see how it goes. Thanks for your support.

Hi Jill, Thanks for your response. I do only have one prn staff member right now, with one in training. I am always working on hiring staff, but due to our location, experienced staff are few and far between. The staff do not want to close the unit and they are willing to do what they need to until we build up our staff. I am here tonight working a night shift due to lack of staff. Yes, it is hard for me to do my manager job at 50 hours per week and then fill in as staff on top of it all. I decided to only cover nights and weekends with the call schedule which gives each staff person one to two 12 hour shifts every 2 weeks. I did't think it was too bad for a temporary fix until new staff is trained. Our full timers are scheduled for 36 hours per week. If they end up working one call shift, they work 48 hours total during the week. When they are on call, they make $3/hour and then time and a half with shift diff. for call back pay...more than what I get as a salaried employee. I just wish that there were nurses out there who want to live in this area. Please pass on any other ideas you may have. For my own FYI, I will be looking into travellers. Can anyone recommend a company to go with??

Thanks, Stormy and Canoehead. I appreciate the support and suggestions. My DON plans to address this issue as there is another manager in the hospital who has the same problem on her unit. We had a great brainstorming session yesterday. I am hoping that we come up with some more answers when we meet again. I am going ahead with the call schedule covering the nights and weekend days so that no one has to work more than 12 consecutive hours. We have discussed the possibility of closing the unit and no one wants to do that, so I think that the staff will pull together and do what they have to do to maintain their job security. I have thought of travellers, but I think that it is not just a money issue. My biggest problem with staffing occurs when there are sick calls. There is little staff to cover them. This is why we need the call coverage. I don't know if there is a way that I can get a traveller to be on standby for sick calls. I haven't used them before. Thanks again. If you think of any new ideas, please pass them along. Elena

Yes, Patience 911...I agree with you. The problem is that we have used all of the resources that I have. We staff with 2 nurses per shift and when one of them calls in sick, that leaves only one nurse and we cannot keep one nurse by herself. I felt that it was best to initiate a call schedule and to spread out the burden on the team as a whole instead of burning out the few nurses that are the only ones who ever come in to cover the unit. In time, I hope to get new staff so that the staff do not need to think of working more than 36 hours a week. I feel the same way you do. The tremendous responsibility that comes with managing the unit AND the added pressures of having to also be a staff nurse on call is beginning to make me have the same thoughts as you. After working 50 hours a week and then being expected to work as a staff nurse for free is depressing. I plan on talking with administration about this to see what they have to say. Please share any ideas on how to avoid using a call schedule. All I know is that our unit cannot continue to be covered by just a few nurses. We all need to share the burden and take care of each other until our unit is built up again. Thanks

Hello Everyone, I work about 50-55 hours a week (not incuding work related reading done at home). I have been in this job 6 months- was a staff nurse on the unit prior to this. My staff are unionized and there are provisions made in their contract to be compensated for each hour they work and for overtime they incur. Recently we have lost a few core staff members due to increased job opportunities in the OR that has recently become busier. It is difficult to get staff to cover sick calls as we have very little extra staff right now and a lot of them are new to the unit and nursing. We are not allowed to mandate staff to come in and I am not sure that mandation would work as people would get good at ignoring their phones. Since Sept. 11, I have noticed a dramatic difference in the number of times people will actually come in at the drop of a hat to cover a sick call. The burden has been falling on me and a couple of wonderful staff nurses. I am paid a straight salary and with the hours I work, I make less than my staff. On evenings, nights and weekends, there are nursing supervisors who are supposed to take care of things like staffing and other managerial issues when I am not at work. I really like my managerial job, but I have been called by these supervisors at least once per week to cover the unit in some way. I don't mind doing patient care (in fact, I miss it), but I feel as if these supervisors feel that I am supposed to "live" for the hospital 24 hours a day and to come in for free. One "supervisor" called me last Saturday to come in to work 7p to 9p since the day girls did not want to stay 2 hours past their shift while waiting for the 9pm person. So...the expectation is there- that I should come in on my weekend off to work 2 hours for free. Managers at this hospital are not compensated for coming in like the staff are. My boss says that I can take compensatory time..."Comp time" is an illusion as the pile of work is always there waiting for you no matter what comp time you take. No one does it for you while you are gone. There are times I have wished for a fairy godmother!! Sometimes, my working as a staff nurse shows that I care about patients and staff and I feel like a team player when I do it, BUT for the most part- I feel that some of the staff really do not care if I have family life as long as they are getting their 4 days off per week. I also feel that some of them may secretly have some satisfaction in seeing me work all kinds of odd hours. Most of my staff members have the this lack of understanding regarding the "life" of a manager with the exception of a few. One of my staff members was a manager not too long ago and one of my most helpful staff. Thank God for her and her sense of humor! I need to be careful not to tire her out! :kiss :roll Due to the difficulties in covering the unit and for patient safety reasons, I felt the need to initiate a call schedule. I do not think it is much to ask the nurses working three 12 hour shifts/wk to take a shift of call every week or two. They get paid for every hour they work and paid to be on call. When they are called in, they get time and one half for each hour worked. Some of my staff feel that I am expecting a lot- and one member verbalized that I should make myself a part of the call group in addition to my managerial job and responsibilities. She didn't say much more after I told her that my being on call and working the unit thereafter is a "freebie". For those of you who may be thinking that I should hire more staff: the people are NOT there. I have "stolen" as many of the med/surg nurses as I can and I continue to look for new nurses everyday. On one hand, my staff say that they are "burning out" due to orienting new people to the unit and on the other hand, they ask me to hire more people. I could use per diem nurses, but my some of my unionized staff do not want them in our unit. Administration has also discouraged us from using per diems to cover for vacations this summer. In light of the national nursing shortage, lack of extra staff in my unit, and the fact that we already have so many new nurses on nights, do you think that I am asking too much with having a call schedule to cover our unit? I feel that the burden of staffing should be shared by the whole team until we hire more staff. I would like to know what the rest of you are doing out there and if you have a problem with having a couple of days off to yourself or any part of "a life"?? Are you expected to be at the beck and call of the hospital 24 hours a day? How are you handling the nursing shortage? I am new at this and welcome any comments. Thanks!

Hi Everyone, Thanks so much for the replies. I appreciate it. Wish me luck! I am looking forward to having this nurse in our unit. His attitude and skills will make him an asset in our department.

HI Everyone, I am a nurse manager in a small OB unit. There is this male med/ surg night nurse who I think would do well to be trained as a postpartum/nursery nurse. He said that he would like to learn more so that he could help out if we ever needed it. My problem is dealing with the rest of the staff. Some of my nurses say NO WAY! I told them that it is discrimination. Please share some tips on how to deal with the attitudes...OR am I way off base here? :confused: