GailWHNP

Where I work in Florida, if you attend the hospitals' school for nursing, they will cover your expenses when you contract for 2 yrs with them. If you quit before the 2 yrs, they prorate what you owe them. When I graduated with a BSN, I went to work with a health department as the hours were more accommodating to a single parent with two preschoolers. I contracted for 2 years and all my loans were paid off. Then, the health dept asked if I would consider going to Emory U to study as Ob-Gyn nurse practitioner. (Talk about a hard decision--not!) I was paid my full RN pay check, all expenses were covered including books, tuition, housing, travel pay, and even per-diem. Take advantage of "the nursing shortage" now while you can! Gail

Yeah, I'm trying to get feedback on how to raise the flag, particularly *before* I have been assigned such a patient and preferably without being fired! Gail

It *is* reverse floating. When the nurse with the med-surg experience stated the woman belonged in PCU and here she is on our OB unit, I wondered what the heck the nsg super was thinking of in allowing the woman on our floor. The two nights I worked postpartum, I took care of all the OB patients and let the other nurse with med-surg experience deal just with that one patient. It took all of her time. She was in the room every hour. I was hired with the understanding that my main area would be L&D. I would float to post-partum. So far, I've been floated to nursery and GYN. I don't mind that; it's still within my realm of experience. But this? It's starting to be a more common occurrence. If the other nurse had called in sick, I may well have been stuck with this lady. It is most unfair to her. It seems there is no way out of my accepting her care except to abandon my duties. This is so not right! I am hoping that if I present the statement in the nursing practice act, whoever assigns this pt to me will reconsider. And they talk of nursing shortage. I think I'll go back to being a nurse practitioner . . . at least no one told me I had to take care of anyone but well women! Thanks, guys. Gail . . . somewhat new to all this hospital stuff

Thank you both for responding. I looked up the FL nursing practice act last night to see what might cause reprimand. One of the infractions was . . . "delegating or contracting for the performance of professional responsibilities by a person when the licensee delegating or contracting for performance of such responsibilities knows, or has reason to know, such person is not qualified by training, experience, and authorization when required to perform them. This sounds like to me that if I inform the nursing super, should she assign such a case to me, that I am not trained nor do I have the experience required to care for such a patient, *she* could be in deep do-do if I reported this. I'd feel better if she would sign a paper stating that she is indeed aware that I do not have the med-surg experience required to care for such patients. The nurses with med-surg experience who have taken care of this woman on our OB unit have stated the lady belonged in PCU. I also have a lot of questions about the wisdom of putting a lady with muscle abcess and septicemnia on a floor with newborns. In clinics where I have worked, pregnant women were well separated from the general population. Gail

I work L&D. I worked as a health department nurse in high-risk obstetrics after graduation then as an Ob-Gyn nurse practitioner. I have *never* worked med-surg or in anything *but* OB. On my floor, I can "float" to postpartum where we also manage GYN surgical patients. This is still in my area of expertise, and I feel confident delivering quality care to these surgical patients. BUT . . . lately we've been having more and more med-surg patients assigned to our floor due to lack of beds on that floor. Caring for patients with ng tubes, hyperal, central lines, etc is out of my experience. Sure, I learned about all that around 18 years ago in school but have never used it. It would take all night for me just to cipher the all the protocols for some of the patients that appear on our floor. Fortunately, I have not been assigned one of these patients as I frequently work with another nurse who has med-surg background. I will take all the OB/GYN patients and leave her with that one patient just to avoid the responsibility. I fear the night when I will be assigned such a patient. Before this happens, please, please . . . what would be an appropriate response to my nurse manager should she assign such a patient to me? I can easily learn the technical stuff but lack the experience in caring for such patients and in recognizing subtle signs that the patient is going down hill. I truly do not feel that it would be in that patient's best interest to have me as their nurse! Now, if she were in labor or with a high-risk pregnancy, I would have no problems caring for her and another patient or two. Thanks for your responses! Gail

When I worked in high-risk obstetrics, I would attend the funeral of the babies that did not make it. I felt the parents needed to know that I was still there for them. Gail

Re social inductions . . . There *is* something we can help do about that. You know there are a lot of women who come into Triage not in labor and are not happy to be sent back home. Comments are usually, "I'm so tired of being pregnant, can't something be done to start my labor?" Some even say they are being induced "next week" (at 39 wks with no risks). BIG teaching opportunity here! You know the docs don't do it, so it's up to us nurses not to let these comments go by unaddressed. Re EFM . . . Once the patient is hooked up, I always pull a rocking chair or other chair next to the bed and encourage her to get out of bed. We also have the birthing balls which they enjoy sitting on as well. Gail