rnWinn

No, it's longer but only 12 weeks left. I have enjoyed it otherwise and the nurses seems to like me, and I them! Thanks for the response:)

Hello all I just felt the need to vent in an anonymous forum about an experience the other night... I work on L&D as a travel RN. The other night I had my first delivery with a notoriously picky Ob doc but thought everything with the delivery went fairly well. If you are interested, it was a lady partsl delivery, and this doc likes things done her way, and is persistent about it but not what I would call overtly rude or anything. She requested "20 units in a bottle" for after the delivery, which is not the norm at that hospital, so I and another nurse figured she just meant 2 fresh bags of Pitocin, and to discontinue the currently infusing one at delivery, which was only half full (which I did - that is what we do here). Anyway it was an unnecessary vac delivery (I've been at this for almost 8 years and know when a vac is warranted), and had me running to get a delivery table that was more fully set up (we don't set them up, and don't see what's under the sterile sheet until the doc removes it), then mineral oil for the perineum, all fine and dandy and done quickly by me. She wanted to straight cath the pt because she thought "there was a bladder" - which I palpated and said "no, it doesn't feel like it" (and I had just removed the foley about 15 mins before). But she insisted, and I got the straight cath and sure enough, no urine return. Anyway she did the delivery, I had my 2nd nurse in to assist with the baby (weight, etc) also assisting to hold mom's legs, and the charge RN there as well (I guess this doc didn't know me from Adam and wanted more people, I don't know). I had called peds for the delivery and they were there as well. Anyway, baby delivers, everything going well, then she starts complaining that I had the wrong Pitocin, so I sent the charge to grab it for me, had the 20 units in a litre up in no time, dripping slowly while awaiting the placenta (as we always do at this hospital). She says - "Why do you have the Pit bolusing? It make the uterus clamp down so I can't deliver the placenta" and I responded "I have it dripping slowly". That's it - no argument or rudeness from either of us. The placenta delivered about 3 minutes after delivery with no problem. Anyway, I get the pt recovered, she had the shakes, that settled down, was obstetrically stable; gave her Fentanyl which the doc ordered for abdominal cramping/peripain, replaced her 1st ice pack with a fresh one after removing the epidural catheter, washing her back, doing pericare and changing her gown. Pain went from 8 to 4 which was within pt's tolerance level. Sat up pt to get in wheelchair (90 mins after delivery) and she vomited everywhere, so I cleaned her up, changed her gown again and pt was feeling better. Got a wheelchair, assisted her to it, pt feeling some peripain which would be best treated with Motrin (which is given on pp unit, not L&D unless truly needed and then you need a special written one-time order). All ready to go, pt discharged from computer system and transferred in other computer system, all ready to go out the door. About to back out, Doc comes in room, says "oh she threw up? Give her Zofran IVP now, and Morphine 10 mg". So I give it, very upset because this was not necessary at this point, but she is not one to be questioned, explained it all to pt and pt agreeable. Then I gathered her stuff and the doc says "get her on a gurney for transfer". I call for a gurney, and it's in the room within 2 mins, but doc wants pt to lie in bed while waiting, so pt had to stand up, get off the wheelchair, lie down in bed, (she was not particularly groggy believe it or not) then immediately transfer to the gurney. We all said goodbye and thanked the doc, then left for the pp unit. Pt remained stable there although was complaining of cramping. I suggested Motrin for the cramping. Doc was back on L&D. Pt and family were very thankful to doc and me. Anyway, today I am pulled aside but the charge RN and told that the Doc was complaining a mile a minute about me, saying I didn't know how to hang Pitocin, was running it before the placenta came out which would make the uterus clamp down and make the placenta hard to deliver (I know my third stage mgmt, and that is old school), stated I had no help in the room, didn't I have any friends on the unit to help (I have 2 extra nurses in there at delivery), etc. etc. etc. I was so upset I almost cried. Oh she (doc) did say one thing which was true, that I should have kept the pt there for 15 minutes after administering the Morphine and "shouldn't I know the hospital protocol"???? I concede her that point, but at the same time I was accompanying the pt down the hall to postpartum (we always do, and help settle them in and give full bedside report, which can take a good 15-20 mins), and mind you the meds were delivered while the pt was leaving the unit and discharged, and Morphine - a total overkill. I felt like the worst nurse in the world, because overall even with all the aggravation and pickiness, everything went well and the doctor did not confront at all and was fairly decent to me, and I to her. Thankfully the charge nurse told me to take it with a grain of salt (due to the doc's reputation, but it makes even an experience nurse like me feel like a big nothing, even knowing this doc's practise, while safe, is not usually "best practise" or research-based, although I won't go into detail. Anyway, thanks for letting me vent, I just hope I don't have to experience anything like this anytime soon, and hope I can feel forgiveness and friendliness towards this doc from now on.:)

It depends on the situation. You d/c pitocin in case of bradycardia or tachsystole (more than 5 contractions in 10 mins) in cases of nonreassuring tracing. If the tracing is reassuring (which our policy states is moderate variability and/or accels present in the past 30 mins with no more than 2 late decels in the past 15 mins I believe) and there is evidence of tachysystole, you decrease the rate by 2 mu/min. Hope this helps. A lot of it is a judgment call.

I hear there is a hospital-wide change to Epic charting...they are hiring travellers to fill in while the staff in in training. Anyone know what charting system they use now? More specifically in the Family Birth Center?

Hello Well I just arrived home after a 4-hour drive. I was on my way to my new job, and had my contract in hand but had to fax it to my recruiter, signed, when I arrived in the first city enroute. I had packed up the car, make a million arrangements, and was on my way when my recruiter called with terrible news. The hospital that offered me a job withdrew their offer, stating they didn't feel I had enough postpartum experience based on my resume (the job was for an LDRP unit). It is true, the majority of my experience (6.5 years) is L&D/antepartum. But I was quite hurt and upset that they felt it was okay to make the offer, I accepted (verbally) and then just take it away. They did the same thing to another traveller, but didn't offer her the job first. They just said they would prefer her (and me) to have "more" pp experience. In any case, I am still annoyed but it is what it is. I just wish the job market wasn't so bad! I will say that it sounds like this manager either a) is expecting Florence Nightingale, or b) maybe a friend or something needed the job so she "took it back". I have great references, so other than my not having extensive pp experience (I do have some) I cannot think of any other reason for her to withdraw the other. My recruiter and my friend's recruiter were shocked. I've been travelling for over a year. The moral of the story - get it in writing! In my case, I think this may have been a blessing in disguise (although I'm still disappointed).

I worked antepartum at Cedars last year and absolutely loved it. I was housed in Playa del Rey, which was a 35-min drive but worth it because Playa and Marina del Rey are such great places. I would love to go back if they ever need travellers again! A lot of the travellers were housed in West Hollywood very close to the hospital. But I would choose the beach communities, hands down!

Hello I am a travel nurse and have applied for a position at Texas Children's hospital on their L&D unit. I am wondering if this is a descent place to work or if I should avoid it...any info would be greatly appreciated!:nuke:

Thanks for your quick response...postpartum I would certainly be more willing to float to, but NOT antepartum/gyne (in my hosp they have 10 patients each with no aide a lot of the time and these patients are fresh post ops on PCAs, palliative onc patients etc as well as the antepartums - no way would I float there!!) I would float only IF I was given a good week's orientation to postpartum, because while I know the basics of babycare, assessment and especially breastfeeding, it's the other stuff like bilirubin and wbc shifts and stuff that I'm like *duh* I'm an L&D nurse! But thanks for your input!!

Hi, I have been looking for a travel nursing position in California. I am getting really frustrated though, because my experience is totally in high risk L&D - no LDRP/postpartum experience. I would have thought it would be easy to get a job...but so far the jobs all call for floating to postpartum and gyne. Is it possible to just work on L&D alone? I have spoken with 3 nurses that I know who have travelled and they never floated (2 worked in California). I don't know why I'm having such a problem! Thoughts?

With the central monitors, do they print out a continuous hard copy at the front desk, or are the hard copies in the room (ie. so you can quickly write things down on them you've done)?

Hi, I am about to move to California to nurse (hopefully in San Diego, or Lompoc, Encinatas, Santa Barbara or nearby). I am used to 1:1 nursing (usually) with continuous EFM, and I am with the patient the whole time. How does it work when you have central monitoring? I guess you can have 3 or so labor patients, but how do you provide any support? Is there anybody in the room with them all the time? Or is it just their husbands/friends or whatever? I'm really curious.

Hi, I am hoping to travel nurse in November, and I spoke with a recruiter at Nurses in Partnership. She told me that in California, as a travel nurse, I am not entitled to any shift differential. I am also going to speak to a recruiter from On Assignment Nurse Travel, and ask them about shift diff. Is it true that you don't get shift diff as a travel nurse? That really sucks, because I heard you can get up to $5/hr if you work nights in California, but maybe that's only if you're not a travel nurse.

Do you have computers in all the rooms? That is, on the labor units?

Wow that's taking the privacy act a little far if you ask me, some may say the patients/clients are "more than just a number" - ie. you can't please everyone. "Hippa guru" that sounds facetious, although I have no idea what it means:)

I'm from Manitoba, working in Winnipeg.