LNDis4ME

ROTFLMAO! There's always one bad apple in the bin to screw up your teaching experience!

I had a somewhat similar situation on my unit last nite: G2P1 came in with c/o contractions. RN does exam and calls it 3-4 cms. This particular pt had been d/c'd earlier in the day for same complaint-she was checked by HO who called her a FT. Upon readmission, HO again checks pt and says 2 cms. Pt goes into jacuzzi, gets out, SROM and all hell breaks loose---she's pushy and just wild with 1-3 min contx. Another RN checks her and says 5-6cm. Attending and anesthesia is called in for epid. Attending comes in @2200, checks her and says 4cm. Thankfully there was no witch hunt or screaming involved blaming anyone for an inaccurate exam, but of course, everyone is kind of looking at each other trying to figure out WHO must have been off on their exam? FT...2cm...3-4cm...5-6 cm....4???? So, I come in at 2300, the delivery table is outside the door, pt has epidural on board, and we are all ready to have a baby. I assume care of the pt, pt is acting VERY transitiony...vomiting, sweating, shaking etc. I check her cervix at 2330 and what I found was the downright most weirdest thing I can recall...her cervix...bilaterally and posteriorly was about 4-5 cms, HOWEVER anteriorly there was this HUGE mass! I actually started to withdraw my hand and then rechecked thinking perhaps I was feeling a presenting fetal hand, but it was just soft swollen tissue. Very hard to describe, but that's the closest thing I can compare it to! Of course, I asked the pt if she'd ever had a procedure such as a leep or cervical lac with her last delivery (thinking scar tissue) but she denied. Anyhow, this ended up dragging on all nite...she did gradually progress slowly and was a rim when I left this am, I won't go into all the gory details about how her epid. didn't take and we repeated 2 more times. Her transition SX also continued until I gave her some stadol and phen @ 0230. I did have the attending check her behind me several times just to confirm what I was feeling...he did even try @ 0430 to slip it over, but to no avail, so we repeated the epid. a 3rd time with success. The OB, the HO and myself all kinda stood around all nite trying to figure out why we didn't have a baby yet? It was bizarre. And yes, we could have started pit, but she was contracting 1-3 on her own. So my gut feeling on this...I do think that the pt was indeed 5-6 cms at some point last evening, especially b/c of the symptoms she displayed....however, b/c she was involuntarily pushing too soon, this caused cervical edema, which caused the "backwards" progression" to 4 cm. I also had a suspicion that the baby may have been a bit acynclitic, but couldn't confirm this b/c she was so uncomfortable with exams and I didn't want to cause further edema. Once she was finally comfortable @ 05-0530, had a nap, she seemed to reach the point where the OB could finally slip the cervix @ 0730. I can't for the life of me figure out why it took this pt so long to progress, other then the edema and her pain level. It frustrated me to no end to not be able to deliver her, but it was a good learning experience...yes, pt's can actually go backward! I am also thankful, in light of the OP's post, that our docs are not the type to go screaming and crying to the NM or whoever b/c they didn't agree with an exam!

Hey hang in there! When I came to L&D 2 yrs ago, I had been an RN for 13 years. I had done a lot....I've also been a nursing sup, a DON, home health, a traveler (hit the floor running!). I had at least 10 years of acute med surg, and I STILL felt like a fish out of water!! My poor head literally SWAM with all the new info that I was trying to absorb while on orientation. I CRIED. I cried even tho I have always wanted to do L&D. The experience that I'd had before was what gave me the courage to go on....I knew what I knew and what I could handle, and there was no reason I couldn't handle what L&D threw my way. It took about a year to 18 months before I stopped having anxiety on my drive into work, about what COULD HAPPEN. I learned to reassure myself that I know what to do, I know the basics. There are still things that I have yet to experience, but I am not a mess of nerves as I am punching in anymore, b/c I let myself have confidence in what I know how to do and what I have experienced so far. L&D is tough, in ways that are too hard to explain. Just keep hanging in there!!! It IS like being a new grad all over again, but that's ok, b/c you have seen and done things a new grad hasn't experienced, and you just have to focus on the OB part of it! Because you know all the rest...just keep focusing on that and hang in there...it really does get better!!! I really hope this helps!!!

I am curious as to why you are not interested in becoming an RN?

:yeahthat: Seriously, is this a Nursing Home or a Hospital and where are you located??? I do agree with above poster....my understanding was that if you did wear a cap, you always wore your own school's cap, not the hospital's or a generic one. I hope this is just a nursing home who is trying to please residents, and not some crazy new trend. If I were you I'd tell them "Let me welcome you to the year 2007"!!!!

Are you generalizing "OB" as L&D, PostPartum and/or Nursery? If you are referring to L&D specifically, I have to say that I very STRONGLY recommend getting at least a year or 2 of Med Surg first. Here's why: There are no nursing schools that I am aware of that really adequately prepares their students with the time management, organization and critical thinking skills that L&D requires. I know this from my own personal experience and from a situation that I observed over the past few weeks. From my own experience: I have been an RN for 15 years. Two years ago, I FINALLY landed my dream job in L&D, which I really and truly love. My work history prior to L&D since graduation: 5 years acute adult med-surg, 1.5 years NM in LTC, 1.5 years DON in LTC, 2 years part time Nursing Supervisor in LTC and part time caseworker in Home health ( had small children/newborn at home), then 4 years Adult Med Surg/Tele/Ortho as a travel RN, in which you can and will be expected to hit the floor running, with little or no orientation. So, all in all, I walked into this wonderful job with 13 pretty solid years of experience in many different areas. I had wonderful recommendations from supervisors and coworkers alike about how excellent and organized I am, yadda, yadda. So what happened? Well, I did fine....I'm still here. But in the beginning, my head literally SWAM with all the new info I was trying to learn and absorb and try to put into practice. I cried...several times. I questioned myself as to what the heck I thought I was getting myself into. And I had all the basics....how to stay on top of things, how to be organized, I've had 4 children, I've read from cover to cover every OB textbook I've ever laid my hands on. But real life OB is a whole new ball game! It was a long time b4 I could go to work without some sense of anxiety about what might happen. I still ask questions and consult with the more experienced nurses I work with. I still self examine and think about how I could've/would've/should've done this or that differentally. There are still so many things that I have not yet experienced and can only pray that I can handle them when they happen. The situation that I observed: We had an RN start orientation in the middle of August. She came to us with about 1.5 years experience in a sub acute rehab unit. There were rumblings on the unit that she was basically a new grad as far as skills went...IV's, foley's, vag. exams, time management, organization, critical thinking etc. Last week, during a C section, she completely fell apart and the next day, relinquished her position, b/c by her own admission, she needs MORE experience. I feel so badly for this girl b/c I know she tried so hard, but even tho she had "experience" and wasn't technically a new grad, she lacked the experience that she needed. I hope that she gets her experience and comes back b/c she will be excellent! I really honestly believe that having a year or two in Med Surg can make all the difference in survival in L&D. On my unit, we do have RN's who have only ever done OB, but they started 20-30 years ago, when I think things were much different. The newer girls have all had other experiences before starting, and we have one RN, who came to L &D from Postpartum (as a new grad) and went back to PP to gain more experience. And then came back, and she IS WONDERFUL! L&D is just so fast paced and changing all the time....it's very hard to explain how things can be status quo one minute and fall apart the next. In my opinion, you really have to have your head in the game and a handle on things from one moment to the next, and be able to deal with whatever life throws at you next...you can't be struggling with throwing in the IV or the foley or what to do when the baby is not breathing....Med Surg is what gives you those skills, and is really and truly necessary! Speaking for myself, I know that I never would have made it this far, without my years elsewhere! Sorry so long!

>>>>>>

Well, to be honest, I think you are splitting hairs here. All of the above scenarios you described above could potentially be interpreted by a pt as being bullied or intimidated. The quickest, easiest and most efficient way to deal with a situation is for a staff person to inform the pt that the behavior is inappropriate and won't be tolerated. Your issue with the staff person being 6'7 and 400 lbs and "intimidating" or "bullying" is unrealistic in my opinion. Reality is that I don't have time to deal with outside agencies and/or mountains of paperwork just to get thru my shift and deal with an unruly pt b/c god forbid, he acts like a jerk, but I don't want HIM to feel INTIMIDATED? Please, GET REAL! Let me give an example: I have an 80 yr old male who is confused, has dementia and everytime a female nurse is within his reach, he acts like an 18 yr old on hormones.....what do I do? First, I laugh. Second, I learn how to dodge him and be quick. 3rd, I tell him no, he can't do whatever it is he is doing. Do I ever even entertain the thought of calling security on him? Nope, probably not...because, no matter what I do, he won't recall it 5 minutes later. That is the reality of being a nurse. Second scenario: I have an alert and oriented 35 year old. Every time I enter his room, he makes inappropriate comments about me, my appearance etc. Whenever I am within his reach, he gropes me, tries to pull down my scrub top etc. What do I do? Well, I am 5'3 and 140 lbs. Sure, I can the local police and file a complaint. I can call for a psyche and social services consult. I can establish "limits". If the pt is A&O x3, and acting in his right mind, then he is behaving in his right mind and knows very well what he is doing, so "establishing limits" is probably useless. In the meantime, I still need to take care of this pt., give him his meds, do his treatments etc. In my opinion, the quickest, easiest and most efficient way for me to care for this pt, is to call any and everyone in the immediate area to help me deal with this pt. If the pt is "intimidated" or feels "bullied" by the security guards, 6'7 male nurses etc in his room, that's his problem. If he doesn't want to feel "bullied" or "intimidated" he shouldn't have acted that way in the first place!!!!!!!! In my opinion. "bullying" would be say, calling security on an 80 yr old confused pt who does not understand or remember what happened 5 minutes ago....NOT trying to reign in an a&0 x3 pt who wants to be a jerk!!

At my hospital, we hire LPNs as scrub techs in L&D. They are trained to scrub in on procedures and C sections. They also attend the lady partsl deliveries as the "writer", and have specific duties related to that..setting up delivery tables etc. They also restock rooms, clean the equipment, do the ordering, put pt's on the monitor, obtain vs. In a pinch, they can do a recovery on a lady partsl delivery. They are all trained in neonatal resuscitation. They can float out to post partum or nursery and take an assignment. We have in the past had a few techs that were not LPNs, but our NM has said in the future she will only hire LPNs as techs. We have an LPN who has worked here since the hospital doors opened in the 1960's and she is fabulous and can run circles around most of the RNs in the unit!!!! Back in her day, an LPN could do anything and everything related to patient care, so she really knows her stuff and has seen and done it ALL. She is one of the most respected employees in the hospital and still going strong, in her 70's!! We love her to pieces. Good luck to you! Definitely finish up your schooling to get your RN. In the meantime, call around and ask to see what it's like in your area. You may wait quite sometime for an opening, as L&D is pretty tough to get into sometimes, cuz ppl don't leave until they die or retire. I waited 13 years for my dream job in L&D. When it came, it practically fell into my lap, but it took a long long time for me to get here. Be patient, but be persistent. One thing I can't stress enough tho, once you get your RN, you really will need to get some Med-Surg experience under your belt, even if you do luck out and work as an LPN in the area in the meantime. We just had an RN drop out of her orientation b/c she needed more experience. She has been out of school about a year and half, however her first job as an RN was on a sub acute rehab unit. The poor girl fell apart about 8 weeks into her orientation and I felt so bad for her. I think the thing that most nurses don't realize is that L&D is a whole new ballgame. Even as a nurse with 13 years of solid experience in many different areas, my head was swimming with all I had to learn when I first started. Based on my own experiences I feel very strongly that any nurse who wants to work in L&D should have some very solid Med surg experience first. The reason being that Med surg gives you the time management, organization and critical thinking skills that are necessary to survive in L&D. I know there are some nurses out there who will disagree and I do work with some RNs who have always worked L&D and they do fine, but that is the exception rather than the rule, and when they started 20-30 years ago, things were a lot different then they are now. Another reason: sometime in the future, you may find yourself in a position where you don't have an L&d position. Without any other experience, your options can be pretty limited. This just happened to our former asst NM. Her position was "eliminated". She had never worked anything other than L&D. She definitely felt like her options were pretty limited and definitely regretted not having gained other experiences. Just my opinion. Hope this helps you! Good luck! Erin

By that token, then calling Security up to deal with a pt could also be considered bullying...3 guys in uniform with night sticks etc. The line has to be drawn somewhere. The patient was inappropriate and needed to be told his behavior was inappropriate. Being a patient and sick does not entitle you to sexually harass the staff or violate their personal space by groping them etc. So, if it's considered bullying or intimidation to have someone quite large inform him that his behavior is inappropriate and won't be tolerated, then so be it. If the pt walked up to someone on the street and groped them, he would be arrested. Being a pt does not entitle you to behave anyway you want. Violent or inappropriate behavior is unacceptable. Remember, our workplace is supposed to be violence free. Exactly how should a situation like this be handled if the patient can't perceive it as being bullied or intimidated?

I agree. I was wondering about this today: I can recall back to my first couple years as a nurse, and my hands being chapped/raw a lot of the time, especially in the winter. But over the years, that seems to have occurred less and less. Is it possible that our hands do toughen up over time, in the absence of an allergy or sensitivity? Has anyone else experienced this? Of course, my hands are usually pretty dry, and I lotion up all the time, but I can't recall the last time that they were chapped, raw or cracking. So I wonder if eventually, your hands get used to the harsh soap and frequent washing, to some degree.

I worked there on a couple different occasions as a traveler on an Ortho unit. The pay was about $24-25/hr for a traveler plus I got a housing stipend. This was 3-4 years ago. I'm sorry that I don't know what the house staff got paid, but I don't recall hearing many gripes about low pay. Strong is absolutely huge...the campus itself has it's own zip code. It is a magnet hospital or was in the process of becoming one while I was there. The staff I had the pleasure of working with was very friendly. The pt acuity was fairly high as it is a major trauma center. The nurse/pt ratio on the night shift on the unit I was on was 1:8 usually. We had a PCT who did all vitals and lab draws. The care was decent. Of course, as a teaching hosp. you mainly work with residents, so try not to have to work on July 1 :). They use a computerized order entry system that the docs use, and can enter their orders anywhere on campus and then it spits out the orders on the printer at the nurse's station, and then the orders go directly into the chart, which was kinda nice. One thing tho was it took a lot of time to figure out who to call when you needed something....they had a very complicated system of teams for this or for that and it really was a pain trying to learn it in the short time I was there. Easier to just ask the charge nurse. If you have a code, 40 people will come, 35 just to watch, even in the middle of the night. Overall, it was a great learning experience for me. I had no ortho experience when I first went there and altho I didn't fall in love with it, it did kinda grow on me. I went back for a couple more assignments. And I did like the staff for the most part. Oh and the cafeteria food was pretty decent, but expensive. When I was there, a lot of units were sorely in need of a remodel tho, including mine. Not sure if you are interested, but I also worked at Highland hospital which is affiliated with Strong, so we had a lot of residents there too. It's a smaller hospital, it was nice. I worked on a unit which was basically an acute care for the elderly type unit...meaning if the pt came from a nursing home, or was over 70, they all went to this unit for their acute stay. Let me just say, I absolutely HATED it. It's bad enough on a nite shift to have one or two LOLs or LOMs trying to climb out of bed, but it absolutely sucks when your whole 8 pt assignment is doing it!!!!! Bad idea...whoever thought of it should be shot. Anyhow, even tho I didn't care too much for the pt demographics, I worked with a pretty good staff, gave decent care. I did have a bit of an issue with the evening staff (I worked 7p-7a) trying to dump on me cuz I was the traveler, but a chat with the night charge RN took care of it. The orientation process was a bit disorganized in my opinion. But overall, I thought it was a decent hospital. Whatever you do, steer lear of Rochester General. A few of the girls I worked with at Strong had also worked at RGH in the past and said it was an awful place to work. Hope this helps! Erin

Another thing that may help is to not use HOT/WARM water to wash and rinse...should be cool to lukewarm at the most. I don't recall where I learned that little tidbit from, but I have tried it and it does seem to make a difference in keeping them from getting raw/chapped.

Hi all! For those of you out there who draw your own labs, do you use butterflies? We are now being told not to use them when possible b/c they supposedly cause hemolysis. Generally in L & D, we try to draw labs when starting our IV's, but there's always patients that need labs drawn later, and I always use a butterfly. I LIKE butterflies, they are what I learned on, and it's my preference. I'm having trouble buying into the whole hemolysis thing, b/c I can't remember the last time I had a draw of mine come back hemolyzed. I meant to check with our phleb this am to see what she uses, but didn't get a chance. Every other place I have worked where they have techs drawing labs, they have used butterflies. Any thoughts? Thanks!

I'm sorry that I don't know the answer to your question, but did you mean MEDICAID? Medicare is for the elderly and/or severely disabled. I just wanted to clarify..... As far as your question goes, the only thing I can think of is that the hospital may be able to bill MEDICAID at a higher rate if the L&D is considered a "stand alone birth center"? I'm grasping at straws here, but it's a thought.