labordude

This is where I was going. The presentation screams this to me. AFE, especially the rapid cardiorespiratory collapse, neurologic symptoms, moving into DIC and left ventricular dysfunction. The low platelets and low fibrinogen are hallmark and I bet that EJ would high fibrin split products if that lab value was present too. The upside is that AOK is really effective IF AFE is recognized and the meds are given quickly. They are easy to keep available and can be kept together in an AFE kit.

I think I'm with you. If I'm right, we were just talking about this at work the other day and WAY too few people have ever heard of the acronym that helps both identify the condition and the initial treatment for it.

Woohoo! Let's go...I'm waiting for the promised later excitement too. Initial presentation is pretty much..hey I see this every day ?

They are incorrect and this will help you, especially if it's something of interest to you. I have the pocket guide, but I don't have or use any other books. For reference on medications I use Hale's Medications and Mother's Milk as well as LactMed. Get the apps (they're free!). Sidenote: What would they think of me? I'm a dude and I've been a CLC for 12 years!

They all have their ups and downs. The issues with the NOVII are independent of the system it is connected to. Placement, falling off, reactions, etc are more than likely user error or doing the prep incorrectly. There is a correct way to place it according to the vendor: http://www.monicahealthcare.com/Monica_Healthcare/media/Monica/Novii Support Material/107-PT-005-US-rev2_Novii-Operation-and-Maintenance-Manual-(DOC2111914).pdf The issues with connection (it's Bluetooth) are likely poor implementation of the antennas in the unit and too much interference. We have several rooms where it works great and others where we don't even both.

You have heard incorrectly about Houston. While Ben Taub & LBJ have midwives, they are part of the staff. The midwives at Texas Children's are part of the Women's Specialty group which is OB/GYNs, CNMs, and NPs. Methodist Willowbrook also has midwives (who are amazing by the way). Memorial Hermann also has at least 2 credentialed midwives who work as part of private practices but have delivery privileges. By and large the city is not CNM in hospital friendly, but that will likely change. More and more people want the combination of the CNM with hospital. I have no intention of doing out of hospital deliveries.

This will definitely fade over time, meaning how much it bugs you. Also "5 but I can stretch her to 6" is still a 5.

Artificial Rupture Of Membranes. In general terms, breaking the bag of water using a special tool.

Guttmacher has this up to date reference on minor's access to different kinds of care. The third column is prenatal care. 33 states allow minors to access prenatal care without parental involvement or notification. https://www.guttmacher.org/state-policy/explore/minors-access-prenatal-care I agree with the others who suggest looking for your particular state laws, but in the presence of ambiguity, I'm protecting my patient's confidentiality and supporting her choices.

There is a distinct difference between the skills necessary to place an IV or an NG tube and the assessment/knowledge/etc needed to titrate drips. It is this difference that forms the major gap between CNAs and RNs. Give me a new grad with a strong physiologic and a pharmacologic knowledge base any and every day and I can teach them physical skills like IVs, NGs, and Foleys. The opposite situation is much more difficult.

Yeah, I have that and my RNC-OB and AWHONN and CLC and whatever. Seriously, at some point it becomes RN, (insert alphabet soup) ?

I agree with Klone, though if the answer options don't have that it would just be prolonged because of the greater than 2 min but less than 10 minute long deceleration and return to baseline.

I made this switch 5 years ago after almost 10 years in Level III-IV NICU. I only wish I was able to switch sooner, but I knew exactly what I wanted and it wasn't a maybe situation for me. Since I didn't need as much (or really any) extra training on the baby side of the delivery, I was able to really focus on the mom and fetal side which was awesome. I was able to care for moms with likely NICU admitted babies really well and prepare them for what they might see/experience/etc. It was tough sometimes if my baby wasn't good at delivery not to jump over to the warmer because I was the mom nurse and not the baby nurse (though there was one time we did an "okay switch" because the mom was good and the baby needed help which was taking a while to get there). If you think you want to do L&D ask them to shadow. It shouldn't be an issue as a current employee, we do it all the time for people interest in internal transfers.

Well let's start Education: The nursing education system needs a revamp. We need a single defined educational entry that allows one to sit for licensure. More focus needs to be placed on pathophysiology and other science-based curriculum topics and not as much on theories (sorry Jean Watson) at the entry to practice level. Since clinical experiences with live patients can continue to be limited, maximize simulation while finding alternative experiences that practice application of knowledge. Interdisciplinary training/classes are incredibly important and the earlier in the educational program for every discipline the better off for future collaboration. The NCLEX needs to add a hard lifetime limit. Other professions have this. Standardization of curriculum across states will also help. Residency/preceptorship programs need to be improved and also standardized. There exists best practice for many of these programs, but they aren't always used. Nurses need to be more visible as community, organizational, and political leaders. Nursing is always considered one of the most trusted professions, but it's only recently we've started climbing up the list of most respected. When it comes to the future of care in the community and education to keep it that way, nursing must be on the forefront. Having representation at higher and higher levels of the government is necessary to have the voice heard. Very few members of Congress are nurses and as far as I can find, a nurse has never become a U.S. Senator (one from TN tried but she didn't win back in 2006). Also, did you know that in some states, in court a physician can be an expert witness on nursing standards of care? I won't argue that resources aren't an issue, but having seen this from the top down in several organizations, it has often come down to poor planning, budgeting, and forecasting. The organizations that handled this better were ones where nurses had voices higher up that were listened to. I have seen plenty of organizations where nurses are in visible positions of title that either have absolutely no business being there or are simply great "yes men/women" (although this happens in all industries). There is an experience/complexity gap with staff today. The "shortage" is because we have a glut of inexperience not a number deficit. Healthcare itself needs a gut check and must work on increased collaboration across disciplines which includes less improvement in silos and more truly impactful projects. This silo issue is a reason why many initiatives (in healthcare and outside) fail due to lack of actual stakeholder input. Since we know we are going toward a more electronic system and the ones we have now had nursing input...mainly after the fact, it's time to fix that for the next generation. Regulatory requirements put a huge damper on things, though if we stuck to one it would still be easier (e.g. something like using CMS rules for documentation and other insurers accept those). A lot of this is driven outside and away from the bedside BECAUSE there are no nurses there. I've worked for some amazing organizations who did so many things well and also for others where the left and right hand actively hid things from one another. I've worked in positions from bedside staff nurse to right-hand of the COO & CFO and many things in-between. I'm not trying to say all of this should/would/could/can be done, it's just things that I believe would help.

Those things don't fix the profession, they fix the job. I'll admit my wording could have been better.

TL;Dr: Nursing needs some help. What do you think will help improve the profession? Nursing as a profession is in definite need of improvement as we go forward into the future. Many additional tasks are thrown at us, sicker patients are assigned to us, and we’re always asked to do more with less and do it faster. There has been a palpable push toward tasks over people, a decidedly different path than historically and from what is taught as nursing in schools. Based on your experience, what would you change or do to improve the profession? I’m going to preempt some answers here and say go beyond better staffing/ratios, higher pay, ancillary staff, unionizing, etc. Think about the profession itself and how you think nursing fits within healthcare as a whole now and five years from now.

You must not have worked somewhere where if you don't address a provider as "Doctor" you get a talking to from the leadership. Though in my experience, it's been very regional, particularly the south. I agree that in and of itself, it's not an issue, it's a symptom of a larger problem within the system.

This is sort of moving away from my original line of questioning but I do understand that patients need to know what role each person plays. That being said, this information can be conveyed in multiple ways. "This is Dr. Jane Smith" and "This is Jane Smith, your Doctor" are equally as effective, but multiple factors influence what language we use particularly with patients. I was focusing more on a 1:1 discussion with a provider and how your local environment impacts what you may call them.

Seems to be some commonality that attendings are called "Dr" and residents and everyone else is often first name basis. I'm going to ask the providers around if they think it's cultural, regional, organizational, or their personal preference. There was a time when everyone was Title Last Name including nurses, but we strayed from that in most places accept for attending physicians (in general). Boggles my mind. @Tegridy Why do you think it's important in front of a patient? In the words of Robin Williams as Patch Adams, "When did the term "doctor" get treated with such reverence, as, "Right this way, Doctor Smith"... or, "Excuse me, Dr. Scholl, what wonderful footpads"... or, "Pardon me, Dr. Patterson, but your flatulence has no odor"? At what point in history did a doctor become more... than a trusted and learned friend who visited and treated the ill?"

TL;DR: Have experienced huge differences in organizational and regional cultural expectations as I've traveled across the country. What's been your experience? For those of you who've worked in different locations around the US, how has your interaction with the physicians changed? Are there different unwritten (or written) rules on how to communicate with them? I've worked in 7 different states in several regions of the country and have seen a huge difference in cultural expectations of RN interaction with physicians. Back in the northeast, it was very common to be on a first name basis with the providers. Having moved down south and ended up in TX, it's a night and day difference with a very demonstrated expectation that it will always be Dr X regardless of the situation. Even had the chief of service verbally correct a first year resident who was talking with a colleague of mine on a first-name basis. They were told to make sure they were always called Dr Y. What are your experiences? How do you choose to interact/are encouraged to interact with the providers? If you choose to call someone Dr X out of respect, do you not ask the same from them for your given title?

Oh I'm well aware of the legal aspects and also aware that no hospital in their right mind would take me on in court, I'd win. I was mostly annoyed they were so flagrant about it. I mean, at least discriminate discretely like the rest of us.

I'd like to see this data. My hospital system can attest to higher satisfaction with many positive comments since hiring myself and 3 other guys across the different locations. I haven't been at one of the locations for about 6 months and patients still ask for me to be their nurse because of their friend or provider recommending me. I hope that if we ever work together as CNMs that your preference doesn't translate to the patients we care for. In fact, ACNM recently came out saying they want to be more supportive of men going into midwifery.

I haven't seen anyone trying to say that individuals shouldn't have their preferences respected. My (the OP) argument is that while individual preferences exist and are respected, hospitals can't use gender as a hiring criteria. Interestingly enough, the hospital I was speaking about never gave a reason for their hiring practices, which were odd considering that male physicians and surgical technicians were fine but men as nurses were not to be hired into obstetrics or even the nursery. I always honor my patients caregiver requests, it's really easy to do that. It just doesn't occur that often and when it does, it's usually a blanket "no male providers" which is of course honored as well. I suppose if we want to focus on whether men should be allowed to work as nurses in all specialty areas, the answer must be an unqualified yes. I am only making the statement that gender not be used as a hiring factor. Like anything else, individual patient preferences dictate sometimes that they want a specific gender caring for them, but that is not unique to the obstetric area.

Tons of my colleagues have done/are doing their FNP because of the flexibility it offers them. Fewer people are doing WHNP because CNM covers that AND more. If you want to do CNM, L&D is very helpful. I have gone back and forth between CNM and MD and after trying out school for both, landed on CNM.

I used MedEdSeminars online class, but I did some review in the books too. Simpson's Perinatal is good, but it's outdated in some areas and there is a new version coming out in March. Gabbe's Obstetrics Normal and Problem Pregnancies Essentials is excellent. I didn't use the AWHONN High Risk and Critical Care one much though. I took the test today and passed.