feebebe23

Thanks for the ideas....I shouldn't have said "2 week stay." They actually said "in the hospital for Christmas, with the goal of being home by new years." Thanks to you all for the ideas!!

So my dad had a triple bypass yesterday and is doing very well!! YEAH!! So question to you cardiac nurses....any good gift ideas? I'm leaning towards both funny and/or useful. I looked all over the internet for a t-shirt that says "I had a triple bypass and all I got was this lousy t-shirt" but I couldn't find one. So of course I am going to get him all his favorite magazines, some books, ect. But certainly I could get some good gift ideas from you guys. He's looking at a minimum 2 week hospital stay. Thanks in advance.

Don't get me started on this one! GRRRRRR! Guess what happens when you start writing up, disiplining, firing nurses over med errors? They stop reporting med errors. Obviously, if you have the same nurse repeating certain errors (like not giving a vitamin) you have to address the problem. However, a supportive environment with proper education is much more likely to get the results you want.

Once had some EMT guys given a woman who was 10/10/2 50mics of fentanyl on the ambulance en route to the hospital.....she delivered 15 minutes later. What does the baby look like? Like it's talking to Jesus!

I have been an L&D nurse for 8 years. I have NEVER been forced to participate in an abortion. I simply make it known to my employer what my stance is and that's it. Done deal. Let's deal with some other issues. If a patient presented to the ER 24 hours post abortion with severe abdominal pain and fever of 103.4 you would have NO LEGAL grounds on which to refuse that patient assignment. None. If a nurse who works at an abortion clinic gets shot walking to her car after work and is brought to your ER. You would have no legal grounds to refuse to be her nurse. If you refuse either of these scenarios you would like be fired and possibly turned into the board. Next issue. You work in L&D and you happen to know that there is a patient on the unit who is terminating a pregnancy for trisomy 13. How do you treat your co-worker caring for that patient? Are you nice and friendly as always? What if that patient's spouse comes to the desk and asks for a blanket and pillow? Will you assist him in a friendly and professional manner? That same patient's husband comes to the desk an hour later and is frantic, "something's wrong with my wife, please help, we need some help!!" Do you go in the room and provide assistance. Same patient delivers and has a PPH....they need your help in the OR, they need you to draw labs or run and get blood from the blood bank. There are all very real scenarios that you need to think about. My stance is this....I will not personally give a medication that induces an abortion. That's it. All other scenarios that I have previously mentioned I would absolutely assist. You state that you are not against BC as long as it is not ab inducing. Does that mean you would not assist in an IUP placement immediately after delivery? Also, since you state that there are no catholic hospitals in your area you will also have to reconcile within your self the concept that you will work for an employer that generates an income from providing abortion services. I know of no hospital that is not church affiliated that does not provide terminations within the scope of the law for infants with non-compatible with life diagnosis. My point is you would really have to decide within yourself what your personal boundaries are.

So I am going to peer review! Yeah! I don't really want to go into specifics for obvious reasons. So I know that some of you out there on this board have served on peer review boards before. Here is my question.... What kind of things do you want to hear from a nurse to persuade you not to make a board report? I have lots of things on my side right now i.e. unsafe staffing, over AWHONN standards, letters of support from the MD, documentation of other nurses doing the same thing (my defense is that this is a system error not a ME error), reasons why I am not at risk for this infraction again, how I admitted my error instead of covering it up (which I could have easily done) ect Do peer review people want to hear remorse, excuses, suggestions on how to fix the issue. I am basically guilty of a documentation error. If anyone might have some detailed advice to offer I would be happy to PM more info. Just seeking advice.

I am not saying it's not possible. You just have to understand that you will be required by your license and legally to be "just as responsible" as a 20 year veteran L&D nurse. The most important issue to me in any job situation is "do you feel supported by the people around you." If in 8 weeks your gonna be on your own with a staff that doesn't support your learning curve....that's a recipe for disaster. Everyone told me it would take 2 years before I got confident in my skills and ability to handle emergencies. I didn't believe them, but they were right. Also....how many deliveries does this hospital do, do they do high risk, what is their staffing? I am so thankful for the training I received in a large facility where I got to see EVERYTHING. As a new grad you OWE IT TO YOURSELF to put yourself in the best position to learn as much as possible.

I started in L&D as a new grad because I got into a formal 6 month training program that combined classroom and preceptor time. I have seen expereinced nurses try and cross train to L&D through a more "on the job" type of training. Seriously....L&D is the type of specialty where you really need formal education time with a nurse educator especially for a new grad.

I had the opposite experience of this. My daughter had a terrible case of swimmers ear. I took her to the pedi, got the drops, had been given her motrin, ect ect. She hadn't slept well in 2 days so I asked for something other than motrin. Pedi said no. Later that day she is bawling on the couch, laying on the heating pad, begging for me to "do something." The pain was radiating down her jaw....and this is a tough kid. It took me 3 calls to the doc's office before they would give me a script for tylenol with codiene. Finally I just had to say...."look we have been patients there for 11 years and I have NEVER asked for a narcotic before. NEVER....look at our records". I get that people have to deal with drug seekers and it's a hassle, but denying a child pain relief is just wrong! But I get what your saying....I think it is different in the ER.

Those are pretty awesome stories....my personal favorite. Had a patient go into the bathroom and sprinkles water on her IV site. Then she throws a hissy fit that her IV was "leaking" and she was not getting her PCA delaudid. So I tell her I am going to have to restart her IV in a different site if that site is leaking. (I checked it, I flushed it....it was not leaking) All the fluid was on top of the tegaderm...no fluid accumulated under the tegaderm. She again goes nuts and insists that the IV site is fine.....she just needs an additional dose. Some people's reasoning skills are just awesome.

If it was a true STAT and not just emergent then you wouldn't doppler for FHTs in the OR as long as you know you have a viable fetus. You can also skip the shave, the SCDs, surgical counts, ect....just spash and go. All other C-setions you should doppler fhts in the OR.

They are doing this at my facility also. The Labor Laws state that you are to get 30 min "away from your work area." So the hospital is just trying to inforce that. Which I get. But don't worry, one 20 million dollar lawsuit over lunch breaks and they will find a better solution to this. I hear that in Cali they have a nurse come in just to do lunch relief. I want to ask my CNO if a "reasonable and prudent nurse" would leave 9 sick babies with 1 nurse and leave the unit..... makes you wonder.

I was under the impression (I'm not sure why) that nurses had 24 hours to make/add comments to their nurses notes. It seamed reasonable that after you go home you might remember something that you didn't chart or think of something you might want to add. After a bad/emotional shift I went home got some sleep and did some thinking......went back to work the next day and added 1 short note. Now I am being told that I might be diciplined for this. It is a much longer story that I don't want to get into. But my question is this..... Is it wrong/against the rules to add a note with in 24 hours? ps this is computer charting so they can tell when the note was made.

6 milliunits Q15 is a bit much, I have a few MDs that like to start at 6 and go up by 6 q30, I will usually go 6-12-16-20 (every 30min), depending on what the baby/ctx pattern is doing. The important thing to remember is when it comes to pit the doctor can write whatever order they want and then the nurse decides what she is comfortable with. (remember the doc is at the office and the nurse is at the bedside) You do not "have" to go up by 6 just cuz that is what the doc ordered. If a patient comes in for induction and is already having some contractions I don't push the pit that hard....it all depends on the situation. And you can tell your friends on the other board....ask any L&D nurse or any OB/GYN people who are "fixated" on having a lady partsl delivery (no bashing here you just know who they are) always end up with complications....forceps, decels, mec, c-sections.....and people who come into the hospital relaxed and with the attitude of "hey I just want a healthy baby" and trust the RNs and docs...always have nice, normal, deliveries....just my opinion. It's like a self-fulfilling prophacy....the thing they fear the most is what happens.

Wierd question..... As RNs we know we have a duty to report violations of the law when we have reason to i.e child abuse, domestic violence ect... However, working in L&D what are the rules when you have a 15 year old mom and a 22 year old dad. Once had a 16 yo with a 45 yo dad (they were married) Had a 14 year old having her 2nd baby with a 19 yo. Obviously the law has been broken....but I perfer to stay out of the drama. Recently had a 28 yo mom and a 16 yo dad.... I like to follow the none of my business approach....but I don't want this to come back and bite later...but I also think that if they are filling out the birth certificite paper work honestly that is kinda like self reporting.... What do ya'll think.

"pit to distress" is not a real order that you are going to see written on a chart. It is a slang term used by L&D nurses and docs. The other more commonly used phrase is "pit'em and commit'em" What it really means is if someone needs to be delivered 1 of 2 things is going to happen.....the baby is going to tolerate labor or it's not. The only way to tell is to run the pit. Once cervical change is established you stop upping the pit. I'm not saying pitting someone to distress is never done.....we have all seen it done under certain circumstances....but it is not good practice and can backfire on you real quick! High-dose pit is an entirely different thing and is only used in cases of fetal demise.

You did fine....water breaks all the time......

When they call and say that I want to say "When was the last time you saw it?" "Good luck finding it" I even had a lady bring it in a plastic baggie......i wanted to ask if she was saving it for the baby book.....

my hospital has a policy that states if a doc wants to go against hospital policy he/she has to notify the pt that the order is againts hospital policy and have a consent signed by the pt stating as such....... whenever this has been brought up.....i have never had a doc go and tell the pt he/she wants to violate hospital policy works like a charm

I just don't understand this. I am a labor and delivery nurse and I refuse to do abortions. (the only abortions my facility will perform is non compatable with life/quality of life babies) We don't do "convience" abortions. This has NEVER been an issue for me as my employer knows I won't be the primary nurse for these pateints. However, if this pt has a retained placenta and needs to go to the OR for a D&C I DO NOT believe I have the right not to help. If the nurse calls out and asks for someone to being something into the room i.e. a bag of fluid or meds.....or whatever. I would never NOT HELP.... Just my 2 cents

I here what ya'll are saying. However, I have talked to some med-surge and ER nurses at this hospital (I work in L&D) They seem to think that if I do have gallstones that they will take my gallbladder out same day/next day(because I have insurance) This is a smaller hospital and if you were the gernal surgon on call and could take out a gallbladder from an insured/willing patient. Would you send her away??? The PCP vs ER route would cost me about $800-$1000. That is why I hesitate to do it that way. That's why I posted....I don't want to abuse the ER. I would hope my fellow nurses whould undersand. I am just trying to make the most of my insurace benefits.

OK....so here's the deal. I have self diagnosed my self as having gallstones. I know! I know! But you know how we nurses are. It has gotton worse over the last month and I know I need to do something about it. So here is my question. Option #1 If I do this the way I am supposed too.... go to my famiy practice MD-co pay out patient labs/testing-co pay general surgon consult-co pay out patient surgery-20% to the surgeon and anesthesia Option #2 Go to the ER, get tests, get admitted, get surgery, covered 100% out of pocket-0 sounds like a no brainer....however, going to the ER and saying "I was having this pain yesterday, it's better now, but I want to get it checked out" or faking the pain......these options go against all my nursing morals, values, ethics....I would feel like such a smhuck going into the ER like this....I need advice.

IN ADDITION!!!! Babies come out the lady parts!!! If you don't want to see a lady parts!!!! Then don't come into the room titled "labor and delivery"!!! If you ever find your self standing in a room titled "labor and delivery" and a nurse asks you to leave and you don't......don't be supprised if you see a lady parts! my 2 cents

ok.....dental pain......let me tell you!!! My husband had a hack dentist start a tooth extraction.....couldn't get it out....referred to an oral surgon. But guess what...it's 4:00 so he can't been seen until tomorrow. When the numbing wore off at 2100 he was DYING!!! My husband is not a wimp! I work labor and delivery and he was hurting more that any natural delivery I have ever seen. Naturally.....the dentist didn't give him any pain meds....didn't answer his pager.....so off to the ER. THE ER WAS FABULOUS!!! Not only did they given him something IM ( I forgot what it was) but the ER doc put in a 12 hour dental block that got him through until he got to the oral surgon the next morning. No you shouldn't go to the ER everytime you have a toothache....but this was an EMERGENCY!!!

I wouldn't even worry about it..... It's not your job to give the family updates.....infact I think it would be a HIPPA violation to do so. If it wasn't a stat case then the husband/SO/FOB could have gone and told the family what the deal was. Also.....you don't need to call the supervisor prior to calling security. If you told the family once to leave the hallway and they didn't......then make security deal with it.....that's their job. I am so sick of running into a room and telling the family to leave and they all just stare at you like your an alien.....if I have an emergency....I say "if you don't want to see too much....leave now" then I do what I have to do... I care more about oxygenating my baby then if the patient's father-in-law sees all her business.....