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AngelNurse2b

AngelNurse2b

High-risk OB, Labor & Delivery
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AngelNurse2b has 5 years experience and specializes in High-risk OB, Labor & Delivery.

AngelNurse2b's Latest Activity

  1. Hi All, I was very excited to start L&D travel nursing at the beginning of the year. This has been my dream to do what I'm doing right now and I'm grateful for the experiences and opportunities I've had as a travel RN for the last 7 months. Now I'm having a tough time finding assignments because I don't have post-partum,PACU, and (most importantly) OR Circulation experience. At the hospital I was trained at, L&D nurses just did labor/delivery/recovery for vaginal deliveries and immediate care and resuscitation of the newborn, if necessary. I have found that this is NOT ENOUGH experience to maintain employment as an L&D travel RN. I've gotten lucky with the last few assignments because the hospital either worked with me by switching assignments if the patient turned into a c-section patient (and had the perm staff circulate OR and I would get the labor patient) or the hospital already had designated OR nurses/team. I'm learning that most hospitals don't operate this way. Lessons learned. I'm disappointed that I have to quit travel now. Plan is to find a permanent job that will train me how to circulate OR so I can travel again in the future. I've had two hospitals offer to train me to OR while on assignment, only to later change their minds because they don't want to train a traveler to a new skill, which is understandable. If you'reconsidering travel nursing as an L&D nurse, I would recommend training at a facility that let's the RN do everything (i.e.triage, resuscitation of the newborn, OR circulating, PACU,antepartum, and even couplet postpartum care- which is a bonus). You can go everywhere and anywhere you want with that kind of experience.
  2. AngelNurse2b

    Simple mask or NRBM?

    Hi Everyone! I've been to 3 different hospitals now as an L&D travel nurse and it's been interesting to see how different hospitals manage care. At my current hospital we use simple face masks instead of non-rebreather face masks for FHR decelerations and/or minimal/absent variability and I have never seen this type of mask used before for this purpose. The order at this hospital states "15L NRBM PRN for non-reassuring FHR tracing." Yet, we have no non-rebreather masks on the unit, only simple masks, which everyone uses. Does it matter which mask is used? It seems like 15L is too much. ACOG (2011) mentions that it should only be "8-10L/min" via 02 mask. AWHONN just mentions the use of the NRBM. The 2016 NCC Fetal Assessment and Safe Labor Management monograph indicates that 10L NRBM mask should be used. What do you think, are simple masks just as effective as NRBM for intrauterine resuscitative measures? Are they safe? If so, please site the evidence. Thanks for reading :)
  3. AngelNurse2b

    All dressed up, nowhere to go!

    I'm having the same experience as a first-time traveler. I have 7 years of experience, all my certifications, etc., but I know that I am competing with RNs with many years of travel experience. One thing that I have done that has gotten me 2 interviews this week and has worked for me is opening up to "less-desirable locations" and being open to doing nightshift for my first assignment. Now I have an offer and I'm just deciding if I want it or not! Best of luck to you on this journey!
  4. AngelNurse2b

    Labor and Delivery Travel Nursing

    I'm not at a teaching facility. We do cervical exams, place FSEs, IUPCs, Magnesium drips, Insulin drips, high-risk OB, etc. Since our OR and L&D are very busy all the time we have specialized OR and L&D staff for each area. Thanks for your thoughts! I will take a look at the thread you recommended.
  5. AngelNurse2b

    Labor and Delivery Travel Nursing

    After 7 years in nursing and 2 years in L&D, I have finally decided to pursue travel nursing in L&D. I have my ACLS, RNC-OB, BLS, NRP, and have taken AWHONN's Advanced Fetal Heart Monitoring class. My hospital delivers over 9000 babies per year, so I am experienced in L&D and high-risk antepartum. My concern: As an L&D RN, I have no OR or PACU skills. I have never been trained to Circulate OR and it seems like most hospitals require L&D RNs to Circulate OR. If you have experience with this specialty/situation, would you recommend: (a) getting another job at another facility to learn how to circulate OR or (b) learn how to circulate OR on a travel assignment? Any insight on this situation is greatly appreciated! Thanks for reading.
  6. AngelNurse2b

    How do you feel about having other nurses as patients?

    Great topic! Yes, as I new grad I would feel anxious caring for nurses as patients. As an experience RN, I actually enjoy caring for fellow RNs! Since we both "speak the same language" I connect with them and find them great to work with in collaborating with their care.
  7. Klone, I have 4 years of inpatient high-risk antepartum experience.
  8. After much encouragement from this thread, I approached the union for advice. My union representative informed me that since a Performance Improvement Plan is not considered a formal disciplinary action, I don't necessarily need union representation. I now know where to turn when I have questions and am no longer afraid to involve the union if I need to. After reviewing my action steps and clarifying goals with my manager, she said that she thought that I would be "successful" with this Performance Improvement Plan. She apologized for the vague and disorganized fashion in which the plan was written. I only have 6 months of experience with this new speciality so I really want to make it on this unit until I at least have one year of experience (preferably 2-3 years). Otherwise, I'm not fully developed in this speciality and am therefore not as marketable if I want to go on with Labor and Delivery. I'm giving this plan 110% and watching my back at every turn. The morale on the unit is low, so I have to just keep quiet at work and just keep on working hard at this. I am still scared, but I am hopeful and determined. I have 30 days to prove myself.
  9. FlyingScot, I appreciate your thoughts. I have been keeping this to myself, wondering who I can trust/speak to in this situation. I am so glad I have not said a word to anyone yet, because upon further thought, I know you are right. Thanks for your insight on this!
  10. Thank you for your thoughts on this, Jadelpn. Yes, I do have a union, but I have been unsure about approaching them because I fear that it will create even more tension with management. As for certification, I already have my RNC-OB and I plan to start working on/studying for another certification (C-EFM). Speaking to my nurse educator is a great idea. I hadn't thought of that. I will ask her today about any classes on effective communication. I started updating my resume last night and posted it on Monster.com, for starters. Thanks again for your great ideas!!
  11. Hi Everyone, I'm an experienced RN who just recently changed to a new specialty 6 months ago. Everything has been going well until management put a Performance Improvement Plan (PIP) in place last week. My concern is that this PIP is partially potentially subjective and poorly supervised. The tone and the unorganized fashion in which it was constructed is concerning to me. I have attracted the management's attention, my performance and everything I do or say is under a microscope and I feel that they are waiting for a reason to terminate me. Here's the story: One day last month I got so caught up in charting that I did not look up at the monitor in time to recognize an electronic fetal heart rate tracing that needed interventions. Though the patient was not harmed, I recognized that I wasn't fast and vigilant enough in that particular clinical situation. Now, I watch my monitors like a HAWK and respond quickly when interventions are needed. I KNOW I messed up in that clinical situation and I have already started to implement and document change in my practice in a personal notebook. While I understand that I need improvement in this particular clinical area and that there is a bit of a learning curve going from a slow- to a fast-pace clinical setting, the other areas mentioned in the PIP are nondescript and potentially subjective. One point mentions that my communication style has been interpreted by some as being rude or condescending.” When I asked what I said or did that was rude or condescending” management said they could not give me any examples of this behavior. My manager just told me that someone had slipped a note under her door that informed her that I was rude to them. I have never been told that I have been rude or condescending in a professional setting in my life, so this was quite shocking to me, as it is not in my nature. What is most concerning is: how will management objectively measure improvement in this behavioral area when they can not even objectively inform me what I am doing or saying that constitutes as rude” behavior in the first place? For all I know, someone who just doesn't like me could be fabricating this. The rest of the PIP is a laundry list of points that I have not even had issues with, but they are listing them anyways (i.e. I will consistently exhibit professional and positive behavior with patients and families”). The management and my patients have never informed me that I was non-professional or not positive and I have had good interactions with patients and families, so I don't even know why points like this are even listed in my PIP if I don't need improvement in these areas. It seems to me that they are listing all of the areas that could potentially go wrong. My proposed solution: 1. Since the PIP does not mention a timeline (start or end date) or how my performance will be objectively measured, I am planning to find out what the expected timeline is and create a feedback tool/checklist to track and measure my progress and present it to my manager. I would like to take this tool to the charge or resource RN near the end of each shift to evaluate me on the points that I need improvement in. 2. I'm working on my resume and will start applying for a second job, just in case I lose this current position. My questions to those in this forum: 1. How do I address the perceived rude and condescending behavior? How do I improve is this area when I don't even know what I'm doing wrong? 2. Do you have any other ideas on what I should do in this situation? It seems to me that they are trying to find reasons to fire me. Should I just resign before they fire me? Your feedback and insight would be greatly appreciated. Thank you in advance for taking the time to read and help.
  12. AngelNurse2b

    Poll: Nurse and law enforcement couples

    I'm in San Diego and my last two boyfriends were Navy SEALS. There are a few military bases here so SEAL/RN and Navy/Marine and RN couples are common. We actually have a huge statue of a salior kissing a nurse here too by the bay! Not sure where ya'll are meeting these cops though.
  13. AngelNurse2b

    Cervical Exams- locating the cervix

    Hi everyone, I just recently transitioned into L&D from 4 years of high-risk antepartum nursing and I absolutely LOVE it on L&D! I've been doing L&D for two months now and I am still not 100% accurate with my cervical exams. I have read almost all of the threads on cervical exams in this forum. But I have a few specific questions. Sometimes when I go in to do my cervical exams it just feels like vaginal "mush." Its like I get lost in the vagina and just can't seem to find the cervix sometimes, especially when my patient is 100% effaced. Should I just search right, left, up, far posterior? What do YOU do when you can not find the cervix after searching for a minute or two? Should I elevate my patient's hips to raise the pelvis? Would that make it easier? Please share your thoughts, tips, and answers. Thank you very much :-)
  14. AngelNurse2b

    ER nurse to L&D

    Welcome to the amazing world of L&D! I've been an OB RN for 4 years and new to L&D as of this year. I did ER for a few months and can tell you that the pace is similar on L&D -fast-. One word: NRP. Know it, know it, know it, and know it well. When you see your first blue baby with an Apgar of 1, you need to act fast and know what do to. If you're in California, take the Regional Perinatal Program. It's great, formal training. Other than that, just study your EFM interpretations and what to do for the various FHR decelerations. I studied for my RNC-OB and that helped me transition to this role. But you need 2 years of OB RN experience before taking your RNC-OB exam (just something to look forward to). Anyhow, I hope you like OB! I cried at my first delivery, it was so incredibly beautiful, and I'm constantly amazed by birth!
  15. AngelNurse2b

    Floor-nursing-to-ED: lessons learned

    I once read another poster in this forum state that the "ED can break you down, chew you up, and spit you back out." I was recently spit back out after being broken down and chewed up and I would like to take the time to share my lessons learned. I think PCU or med-surg tele at the very least would be a good background to have when looking to transition to the ED. The ICU would be appropriate too because I know ICU nurses have a lot of knowledge and skills that are applicable to the ED. I think that PCU is great experience to have because you are dealing with at least 3-4 high-acuity patients at a time, which is similar to the acuity and RN-to-patient ratio of the ED. I recently transferred to the ED from an OB floor and that was a bad idea, given the type of training program and it was (mostly on-the-job training within an ED with a high turn-over rate). I have done PCU/tele nursing before in the past and it would have been the best launching point to transfer to the ED, rather than from my OB floor. Lessons learned if you want to transition to the ED from the floor: - Make sure you have current tele skills - Get your PALS, ACLS - Study up on how to do focused assessments, but know that they come with time - Try taking an ED nursing course to fill-in knowledge gaps. I found a local one through a university, but there's one through ENA too. - Be reassured that it is a tough transition; you won't feel "fast enough" in the beginning, but keep at it. - Don't worry that you don't have "good IV skills." I understand that we don't start IVs on every single one of our patients on the floor. In the ED, pretty much everyone gets an IV. Surprisingly, your IV skills come with weekly practice and confidence. - Find a mentor, a confidant. - Find out if the preceptors are trained and what the expectations are for each week, to make sure you are on track. - Identify your resources at the beginning of your shift. You won't know everything when you come off orientation and this is normal; know who you can turn to. The ED is like floor-nursing at hyper-speed. I was there for a little over a month and it was awesome. I have a lot of respect for ED nurses and look forward going back one day in the future.
  16. AngelNurse2b

    Do Med Surg / Tele RNs still get hired into ER?

    I think PCU, ICU, or med-surg tele at the very least would be a good background to have when looking to transition to the ED. I recently transferred to the ED from an OB floor and that was a bad idea. I have done PCU/tele nursing before and it would have made a lot more sense to transfer to the ED from the PCU, rather than from my OB floor. The ED took a chance with me and it didn't work out so I'm back to OB. Lessons learned if you want to transition to the ED from the floor: - make sure you have good current tele skills - get your PALS, ACLS before applying - learn how to do focused assessments - try taking an ED nursing course (I found a local one through a university) This is what I learned that would have been helpful for me when transitioning. These preparatory steps would have helped me transition faster. The ED is like floor nursing at hyper-speed. Best of luck to you on your road to the ED. I was there for a little over a month and it was awesome.