BirthCenterRN

I don't have an answer but congratulations on your new adventure!

I am going through the same thing right now. Only the nurses invade my home time too by calling me at 9 or 10 am right after the night shift and asking stuff that could easily be looked up in the computer. It has been 3 months for me and I am not sure how much longer I can deal with it. I hope it gets better for you.

Same as smiling blue eyes

I graduated in May 2007 from FVTC. Most of the clinicals were 7-11 in the first year and 6 or 7-1 or 2 in the second year. There was a few that had afternoon clinical but you took a chance on if you would get into that one or not. I worked a part time day job but I had a very flexible schedule. I could work whenever.

I hate floating.

Unfortunately I am stuck wearing those horrible ceil blue surgical scrubs:(

My unit does everything but I just wanted to say that caring for the "undelivered" patients can be very rewarding. They are long term and you get a chance to know them and their families better. We end up crying all the time when they leave after 2-3 months. We become extended family. When we staff for "undelivered" pt's we are 1:1 for unstable (usually the first 24-48 hours, 1:2 for stable but frequent/cont efm, 1:3 for very stable nst q4 or qshift. Good luck

same as hoppermom the only etc is pt that weigh >300lbs or reluctant(non compliant) fo ambulation I make the effort to get my c/s patients up within the 4 hour window. Definitely by the 6-8h mark.

Our patients do not go to PACU we are the PACU on the unit. Pt arrives on unit loc and reflexes, lungs, aldrete score, skin, incision, breasts, heart, calf tenderness, bowels sounds, urinary (foley), fundus/lochia, perineum if pt pushed before c/s, coping/bonding Then q15x4, q30 x2, q1h x2 with vitals loc, lungs, inc, foley, fundus. lochia, perineum Then q4 until 24 hours out with vitals loc and reflexes, lungs, ability to move/ambulate, skin, incision, breasts, heart, calf tenderness, bowels sounds, urinary (foley), fundus/lochia, perineum if pt pushed before c/s, coping/bonding The patient is on continuous pulse ox for 24hours documentedd q1/2h x12h and then q1h x 12.

I work at two different birth centers. The first one the RN does everything except place the catheter. However, we have additional training on orientation on how to manage the epidural and the pump as well as mom and baby. The anesthesiologist stays in the room for the first 10-15 minutes and on the unit until the mom is completely satisfied with her pain relief and both mom and baby are stable. They then leave with the expectation that they will return for any complications and administer the appropriate meds ie ephedrine etc. We only do IV bolus and in rare circumstances ephedrine if it is an extreme case and they are tied up in trauma and the back up is in route. They don't get mad about you calling and one night I called 5+ times about a patient's BP and he returned each and every time to assess her and give meds. The second place I have just started and haven't gotten all of the logistics but I did have epidural pump orientation today so I am assuming that prime/program is the RN job. Both of these places require 2 RN's to be at the bedside during programming, connection, and initiation of the infusion. The med must then be signed in the EMAR by both RN's. I am comfortable with this and couldn't imagine waiting on the anes. provider for everything and having patients in pain while waiting. Our nurse practice act covers these actions because you have additional training in the programming and maintenance. Kind of along the lines of a nurse specially trained in iv sedation or other specialties. my 2 cents

I think that the "what is it" in the report is referring to the affliction not the person. The use of room numbers and "it" could be a result of HIPPA laws. Just a possibility. As for the baby, I think it is a little over the edge to get upset about this. I personally call "it" my it's name if the parents have one or baby if not.

We use it. The routine is to do it at 5am on the day of discharge and PRN. If the level is high risk for age, gestation, and risk factors then we get a serum within one hour. (http://www.bilitool.com is a great resource if you don't want to do the math on your 11th hour of working:)). We then call the MD with the serum results if they are still high. If the serum is lower we just leave a message for the MD because they come at 7am anyway. I love the TCB. It saves alot of pokes to those tiny feet.

Our orders used to say cervical exam by MD within the last 24 hours. They now extended it to 72hours (ie seen on friday and induced on monday). The nurse does the initial exam right before the pitocin is started. This is the same policy for cytotec/gel. In the ripening scenario, when the nurse does the sve and the patient is >3cm or Ruptured we go straight to pit. Hope this helps

I am a new LD RN (1y) and I often get called in a room by experienced nurses because I have longer fingers. I used to think "you want the newbie to check someone" but I was always accurate and they trusted me.

Our docs vary in what they do. It also depends on the things that others have already listed. I have seen a doc let a term, gbs- pt gp 3 days but she started antibiotics after 24 hours and let us do the pit really slow. We had it on for a while then rest at night then back on in am. I had her all three nights and she got to about 4cm at 5am and delivered at 8. She was also a prime. My personal experience was that I was a g6p3 with pg#1 PCS pg#2 RCS pg #3 VBAC. I prom at 37weeks, gbs-, hx of large babies. I had midwives and I was previously 2cm/50/-2 on monday and prom on wednesday 1pm. I went in and my midwife said that she wouldnt check me b/c she already knew where I was 2 days ago and she let me go home. I slept all night and she called in the am. I hadnt had one single ctx (ironic given that I had been in preterm labor 3 weeks prior). I cam in at 11am on Thursday started pit at 2mu and delivered at 7:59pm with one push. Healthy baby and healthy mom. I wasnt a nurse back then and now that I am, I am glad that she didnt start "checking" me and gave me a chance before intervention.

My 2 cents....We have one large unit that cares for women from antenatal to postpartum including babies. We are not able to transfer our patients anywhere. That being said...we are all trained in dealing with a loss and pt's with a loss are 2 nurses to 1 pt until all of their recovery is done and pics, momentos, etc. Then they go in with the normal assignments and are counted the same a NICU moms for staffing purposes. We get alot of feedback b/c we also run a support group and we do not have complaints. Like someone said before..we keep them away from the nursery, there is a white rose on their door so everyone knows and we make every attempt to keep them away from laboring moms also. I understand your issue but there are units that dont have a choice and are able to make it work with some adjustments. I realize that your loss makes it a little more personal and I have had 2 myself. Maybe you would like to start some type of program or protocol. I joined our RTS (Remember Through Sharing) coordinator to provide services and do the support group and it really does help with healing and you have a personal understanding of what the families are going through.

hope this helps

I work on a unit where we have one unit. Everyone that is 20weeks and up is admitted to our unit. We have a variety of monitoring based on MD preference and reason for admission. The most common are... 1. Continuous (usually only for PTL or an issue with baby if bay looks ok we may due continuous toco and spot check FHR with an NST at one of the intervals below. 2. NST q4 3. NST q8 4. NST qd 5. 2 out of every four hours Now given this info...it never seems that we can get the meds, vitals, and labs to match with the monitoring. Basically the patients get awaken often anyway:(

Hello all! I had an interview today for a Clinic RN in an OB/GYN office that has doctors and midwives. I currently work in a high risk birth center and provide all care for mothers and babies from admission to discharge including antepartums, pregnant surgicals, and gyns. I want to become a CNM and I am wondering if I should take the clinic job to get some office experience. Has anyone been a Clinic RN before or after inpatient? How different is it?

I had a teenage patient in labor that had her mom, her mom's boyfriend, her own boyfriend(teen), the baby's father (teen), her baby's father's girlfriend (teen), her baby's father's mom, her own 2 sisters, and her grandmother with her. There wasn't room to move in that room.

I graduated May 07 from an ADN program and I did my final internship on the unit where I work now. I was hired before school ended and started 3 days after graduation... Anyway, I work in Birth Center and my job includes High Risk antenatal care (ie severe preterm labor, prolonged rupture, cerclages, hypertensive disorders, magnesium sulfate admin and care) then there is L/D of any pt 20-42 weeks along, I circulate for c/s and provide PACU care afterwards, Mom/Baby including late preterm 35-37 week baby care, PP readmits, and post surgical care of pregnant moms. It was alot to learn but I have been on this unit for 9 months and feel pretty comfortable with all of these things. It was overwhelming at first and we get 12 weeks of one to one orientation. I actually got 16 because of my internship. We started with 4 weeks of M/B, and 8 weeks of L/D. The rest you learn at a later date once you have got the basics down. My point of this is that I can now go anywhere I want to go that has to do with moms and babies. I have some experience in every area and only need to expand knowledge. I also want to be a midwife and was previously a doula as well as a lactation consultant. Edited to add: I agree that the first year is tough. I didn't agree with the "wait 1 year before moving on" thing either but I certainly do now. But that is just me. I have 4 children 5-13y old. I felt that I shouldn't have been working/orienting while trying to study for boards either but I pushed myself and it worked out. Passed the first time with the minimum questions. I also start a rn-bsn program this fall 2008. Good Luck! Follow your heart!

I haven't found this to be true...some people do feel the pressure but that is a good thing. It makes pushing better. In my personal experience I did not feel anything with my epidural and only pushed 3 times with my first vag delivery (9lbs 7oz and intact perineum) and not at all with the 2nd vag delivery (8lbs 8oz and intact perineum). ps my first two children were c/s and the second 2 were vbacs

We do the bath in the room usually within 2 hours after delivery but it can be done after that. The only thing we are required to do within 2 hours is give the Vit K and Eye ointment. This can be done while the baby is with mom. We also do the immediate skin to skin and skin to skin for rewarming after the bath. I really try to encourage the first breastfeeding ASAP after delivery and before either mom or baby get a bath. I did have a baby 2 nights ago that despite all of my efforts he did not nurse and still hasn't. But myself as the nurse and the pt as the mom can both say that we did everything possible to make it happen. This is the first time that this has happened to me but I feel that my efforts still make the experience a good one.

We also have computer charting and I love it. We are only half way there though. We still do the qshift assessment and labor notes on paper but everything else is computer. We have laptops for each L&D nurse. You can move the laptop from the nurse alcove outside of the room to a pull down desk inside of the room next to the monitor.

I work in a pretty busy birthcenter also. I would say 1/2 hour- 45 minutes. We do have to do all the paperwork too but I would have them sign the epidural consents first, get them on the monitor and start the auto vitals, get the IV started and start the bolus, check her cervix, page anesthesia (their eta is usually I have to add that most of our admission paperwork is done prior to arrival *profile, birthplan, consents for baby, acog* Our doctors use the same computer system that we do so we just update any allergies and current meds if needed. Most of the time anesthesia asks these questions and I record at that time. The H&P is in the computer form their last OB visit which is typically within the last 7 days as our standing orders require. We have standing orders for admission from our OB doctors and we just page them to let them know that the patient is on the unit. We also have all of the supplies for epidural, delivery table, and baby warmer in every room prior to arrival. These items are in a locked closet in between 2 LDRP rooms. If I had a patient who was new to our system and did not have anything done prior and nothing in the computer, it would take alot longer. But we do have orders for nubain IV and I would get the that because it last 1-2 hours and takes the edge off while they wait. Hope this helps.