AishaRN

Detra, So, I am on of those people who list to check things off as I complete them. And when I was in residency, I made out a check list ... broke it all down. You might not need this much detail or "reminders" but it worked for me until things became more fluid :) This is for an admission through a lady partsl delivery. Obviously, there will always be things that don't fit with these checklists ... epidurals that don't "work" the first time, BPs that plummet after an epidural, abruptions, postpartum hemorrhages, etc. I have it saved in Excel, but I can't seem to just attach the file here ... so I apologize for the formatting below. Hope this helps you in the beginning though :) Aisha ----------------------------------------------- Gather paperwork and ID bands Look over charts - maternal risk factors? EDC G P Allergies Blood GBS? Hep B Herpes Pull IV start supplies Go to room Put on ID band Mom on monitors (FHR, contrx, V/S) Verify allergy status/safety check Get mom to sign consents Start IV - start meds if GBS + SVE if intact (unless contraindicated) and before Pitocin Chart Do full admission charting exam, assessment, note and problem chart fluids, meds, and charges Call for epidural when needed (ordered) Insert foley after epidural Set up delivery table FHR/VS/Pain/Dermatome Chart when complete and ready to push Delivery > Pull foley > Position patient and annotate > Document when Dr arrives and that pt is pushing, etc > Assist with pushing > Document time of birth > Document any complications > Start pitocin when placenta is delivered > Document placenta delivery time Dr Leaves > Remove sharps from delivery table > Clean up mom, apply ice/pad, fix bed > Clean up table and room > Put bands on baby, mom, and dad > VS/ Fundal checks/Pain/ Dermatomes Mom Q 15 x 4 Baby Q30 X 4 Q 30 X 2 Q 1hr X 2 > Mom up to void at 1 1/2 to 2 hrs post delivery or when fundus displaced >> or do in/out catheter > Baby bath after 1 hr or 1 1/4 hr - retake temp > Footprints > Chart - fluids, meds, and CHARGES > Do ballard, delivery charting, birth certificate > Security Band > Call Pedi

Here are some of my suggestions on what to do to prepare for residency in L&D: - show up 10 to 15 minutes early! - leave your jewelry at home (except wedding ring perhaps) - Get and read a copy of the NRP guidelines at http://pediatrics.aappublications.org/cgi/content/full/117/5/e1029 http://www.aap.org/nrp/science/science_evidenceguide.html - have a small notebook and pen to take notes - there will be LOTS to keep track of - once you get the idea of how your day is supposed to go, make a check list for yourself to make sure you get things done in an organized way including admitting a patient and paperwork for after a delivery(I made up a checklist for lady partsl deliveries and then one for c-section deliveries and used them until I had it down - ask if you don't understand - be patient with yourself - it takes time Okay, hope these help :)

Hi Detra - First, let me tell that it definitely gets easier to do SVE's (sterile lady partsl exams) for dilation/effacement/station. My first suggestion is to take a tape measure and measure out common household things ... glasses, measuring cups, shampoo bottles, etc. Then once you know how many centimeters they each measure, get practice measuring them with your fingers. Then find new things to measure :). This won't help with effacement and station though. That is something you just have to "get the feel" of during actual SVEs. You will totally know when something is 100% effaced .. the cervix will feel like a sheet of paper. The extreme opposite (0% effaced) is pretty easy ... really thick. In time, you will be able to call it 0% - 50% - 100% with some certainty :) And this will work for the most part :) Another suggestion, if at all possible, try to check women who have an epidural so you can really take your time and not worry about her being uncomfortable. Always make sure to let the mom know what you are going to do and try to be specific ... instead of saying "I am going to check you" you could try and say "I need to check how far dilated you are, okay?" or "let's see how far dilated your cervix is now" I am happy to share information :) Aisha

Welcome to Washington! For NICU, Madigan has a level III and is the closest to Dupont. St. Pete's in Olympia has a NICU. Tacoma General has a level III and is a short drive from Dupont; just down the road is St. Joseph (St Joes) which has a level 2b (shares the same NNPs and neonatologists with Tacoma General). If you let me know if you are more interested in level 2 or level 3, I can point you in the right direction. St. Claire's does not have OB or NICU (they are part of the Franciscan group and St. Joes and St. Francis have OB).

Purpsurfer ~ you can not believe how relieved I am to read your post, just to know that I am not alone. The whole reason I went into nursing was to do L&D and eventually midwifery. But after a year as a L&D nurse, I literally have days that I panic on the way to work ... just reliving various horrible nights at work. On our floor, there is a mix of L&D nurses and postpartum nurses. When there are no laboring patients or more L&D nurses than laboring patients, then L&D nurses get to do postpartum. I actually am volunteering to do postpartum ... I am wishing for postpartum ... just because of the incredible stress of it all. For all the experienced L&D nurses out there, does there come a day when you stop worrying so much? I have been told by many experienced L&D nurses on my floor that I am good at it and I try to keep getting more knowledge in the field and doing the best I can. Does it ever become less stressful? I know, sounds like I have no confidence ... it isn't that I don't know what to do in a bad situation ... I do and things have always turned out well thank God. But the stress! Please tell me it gets better! I am seriously considering changing my focus for graduate school Again, I am just happy that I am not the only new L&D nurse that has doubts!

"Aisha, I would be interested in and appreciate of both of those resources!!! :)" Hi ... if you send me your email address I can email you the worksheet in MS Excel or MS Word :) I tried to cut and paste here, the formatting doesn't come through Bye for now!

Shannon - are you still looking for a "worksheet" ... I have one that helps with making sure things get done during a lady partsl delivery and would be happy to develop one for c/s as well. When I was in orientation and then first on my own, it totally helped to have a "checklist." Just let me know.

I just graduated from nursing school December 2006. I started a residency program for L&D/special care nursery in January and starting IVs is a skill that is needed fairly regularly. We were not given much instruction in school beyond practicing on a rubber arm and the rare opportunity to start a real IV on a real patient during clinicals. Sadly, I have a variety of preceptors and one of the preceptors was stunned that I had not come out of nursing school will a solid knowledge of this skill and made me feel absolutely ignorant . While I have had good success with other preceptors starting IVs and drawing blood, every time I attempt a start with this particular preceptor, I miss ... probably from her initial negativity. Please keep this in mind if you ever have to precept

This thread has been so wonderful to read!!! Thank you to everyone for your stories I am a new RN having just graduated in December and actually just finished working my first week as a RN on a L&D floor. It has been amazing! On my first day, my first patient ever as RN was a beautiful Hispanic woman giving birth to her fifth child without any support person or family whatsoever. I have not mastered Spanish yet (but working on it) but I tried very hard to use what I knew even though there was in interpreter in the room. Anyway, the birth went so smoothly and mother and baby came through happy and healthy. After completing the newborn assessment and getting mom cleaned up and helping them bond, I started working to fill out the birth certificate paperwork with the help of my preceptor. When we had the interpreter ask the new mom what she wanted to name her daughter, the mom looked directly at me and said my name!!! My first thought was maybe she was asking for my suggestion, so we had the interpreter ask her more specifically. But she said that she wanted to name her daughter after me because I had made this birth wonderful for her. I almost cried right there! So, that's my "memorable" thank you ... there is a little girl out there who was named after me