Buggs

Nothing is wrong with following orders, that is a basic role of the nurse. Just don't call me disobedient, like a child. Bad choice of words, in my opinion. To not follow MD orders is a serious issue, were you really saying that the nurses were busy fighting over their assignments that they were not doing their jobs? I have NEVER witnessed that. If there is proof that there are a significant number of errors with 12 hr shifts, I doubt any hospital would permit them in light of patient safety and lawsuits. I don't think any hospital would offer something to make a nuse happy with the possibility of compromising the patient in return. Not No way, not no how. I do agree that at times it is good to stir the pot :) .

I must say I found much of your post to be OFFENSIVE. Most of us don't refer to our patients as "hogs". I have found that my co-workers are eager to lend a hand to their peers if one nurse is having a more challenging assignment than others. We don't ignore "performing orders like you were told". It sounds like you think we are disobedient toddlers. Also, do you have evidence for bashing 12 hour shifts? Now, I do have to admit some belief in the "rainy day" theory. I don't believe the rain is the cause, it's the big change in the barometer that seems to make those babies want to come out and play. I suggest that you consider what you are hearing from your "girls nurse friends". Are you making judgements based on facts or on private venting sessions that many, in all walks of life, do? If you overheard a group of moms complaining about their children or husbands would you be quick to label them in a negative manner, or would you be able to see that many are loving, caring excellent wives/mothers just letting off a little steam and enjoying the comaraderie and humor together? Just a thought.

The only folks I have heard say "sonometer" were nurse midwives, thought it was maybe a "cultural" thing. Either way, we all know what is being referred to. Now to get off topic--what about the varying use of abbreviations--of course most not approved...sometimes we feel like Sherlock Holmes figuring what is being talked about. Any favorites out there? One we use is SOB, but the common folks would think we are being offensive

I'm in upstate NY. Worked in Delaware and NJ where the Mag seemed to more closely monitored. Thanks for the input. Creating change is not an easy task and I'm not really sure where to start. I just hate to not see it change til a bad outcome.

Did some checking...the bolus is done over a half hour (4gms) and vs are done q 15 min during bolus. fetal monitoring only if pt is contracting(Mag for PTL vs PIH) Seems no one but me is concerned with carrying a full M/B assignment and doing a Mag bolus. Also, do not have to stay in room for bolus. After bolus vs/assessment done q1hr and while we carry 3 other couplets. I seem to be alone in my concerns with this practice.

We don't do pulse ox routinely on Mag pts. We do check O2 sats on our C/S with all their VS. Seems our monitoring of C/S pts have become more frequent since there was a bad outcome with a surgical pt on another floor and since a c/s is post-op they have same VS checks as all the post-ops in the hospital. I am afraid the Mag checks and assignments won't change til there is a bad outcome. This is so frustrating!!! I think the double check for Mag is great, we do it for our PCA pumps. One would think Mag is just as potentially dangerous as Morphine/dilaudid. I will bring all this up with our Nurse educator for some clarrification. If the pt needs bolusing and they don't want to transfer her to L/D, maybe an L/D nurse can come and care for her on the floor til stable on the maintenance. What about fetal monitoring, is this needed during the bolus?

We do q 1hr VS, DTR's,I/O on PP pts, on AP PIH also Q1, FHR q 4. I think q4 for the "stable" PTL AP on Mag.

I work on a Mother/Baby Unit. We do take care of many Mag sulfate pts--usually PP with PIH. Very rarely AP's on Mag. The Mag is USUALLY started in L&D. But at least 2-3x in the last year I have heard co-workers who have bolused the pts on the floor. The other day an AP PIH was bolused on our unit then transferred to another hospital where they would probably deliver her d/t the PIH. To the best of my knowledge we have not been trained to bolus the Mag--it was not in MY orientation. We carry at least 4 couplets, even if one of the moms is on Mag. Sometimes we have 5 couplets, and some of us have even experienced carrying 6 couplets. Anyway the nurse caring for the patient had 3 other couplets, had to do the bolus and transfer. I think that is too much. They are setting the stage for a mag sulfate scare at our hospital. Wondering if any of you bolus Mag on the M/B unit, what monitoring is done on mom and if AP what, if any fetal monitoring? After reading the sad story of the maternal demise from Mag, I have to wonder why there are not National Standards for Mag? Why do some hospitals provide 1:1 nursing and others carry Full assignments? Why is there no JACHO standards for Mag or AWHONN standards for Mag? When there is such a range of how to care for these pts shouldn't someone narrow the gap as to what is SAFEST, not what works best for the staffing of the unit? And, back to fetal monitoring, should that be done during a bolus? We aren't trained in fetal monitoring....ARGGGG Thanks for listening.

In the past we always taught, and it was printed on most of the individualized MD instructions to avoid driving for 2 weeks. Verbally I reminded moms of their blood loss and changing body along with sleep deprivation, that MAY lead to an increased reaction time that COULD cause them to be MORE LIKELY to be involved in a car accident while driving. But...people do what works for them, my job is done when I've passed the info to them, what they do with it is their call. If a loved one of mine was injured/killed due to the carelessness of one of these compromised women, I certainly would be slow to forgive. When going against MD instructions and jepordizing other people on the road...well it's just irresposible and selfish. There are things called taxis and other possible avenues to exlore before endangering others. If the hospital/MD did not provide any education/restrictions regarding driving, then it is understandable. I honestly don't know if there is evidence available supporting any restrictions, just know what we taught.

We use the TCB on all our babies at the time we draw their newborn screenings. The babies of vag deliveries are usually 24-36 hrs old, and the c/s babes are usu. @ 48hrs old. (We do the screens on night shift just before their discharge in the am. If the TCB is 2 or closer points to light level (we have a graph to plot them on as part of the documentation) we must draw a serum level. Of course, if our nursing judgement indicates that we think the baby needs a serum at ANY time, we have a standing order to draw one. Sometimes a serum is sent with the newborn screen because the parents want it checked. So far I have not personally found any huge discrepancies. But, I do keep in mind that it is a SCREENING tool, and my judgement can be more reliable at times, so I send a serum if I doubt the TCB. The way I look at it is the TCB is a ballpark number, but if it's close or in question, send the serum. Hope this helps.

On the PP unit we do hourly checks on our Mag pts including VS, DTR's, UO. They are not on any monitors. If they are an AP pt w/PTL on Mag vs PIH, on the PP unit, the MD's sometime order q4hr VS. Against my better judgement nurses w/ pts on Mag on the PP unit still carry full assignments of usually 4 couplets. In the good ol' days(80's) we did 1:1 or 1:2 when pts were on Mag. And remember, we do not have any ancillary help! The thought of a Labetalol drip scares me-that will be the next in the latest of scary practices on the PP unit. It used to be that Mag was started in L&D, now "they" have actually had us initiate Mag onthe floor with the loading dose-and remember, the nurse STILL has a 4 couplet assignment! Are there guidelines in existance from AWHONN for Mag pts? I would doubt they want us loading a Mag pt on the floor with no monitoring and full assignments. What info did you have to share at the class?

Coop, I feel your pain--I am your co-worker. Thank you for bringing our issues for input on a larger scale. We must take action together. Collecting data from others gives us support in our quest for improved conditions. Please don't give up yet. Some of us are trying to provide those in power with standards of care that are used nationally. The idea of involving "Risk Management" is also being considered. Besides the nurse-patient ratio, we are trying to provide written reasons for increasing ancillary staff. "Coop" briefly mentioned our lack of ancillary staff. What kind/number of ancillary staff do the rest of the OB units have? The majority of nights we "share" a secretary, and a tech between L&D and the 30 bed PP unit. Most, if not all, their time is spent in L&D, which is understandable. But one nurse in the nursery with 14+ newborns is a bit of a challenge. (We are talking about night shift). And yes, we take care of Mag patients, their baby, and three other couplets. We answer the phone, all call lights, do all bloodwork on moms/babies, do all our vitals, and of course tend to all the needs of the family unit--juice, pillows, snacks,make the bed for dad... Again, receive little to no help from any ancillary staff. Hard to believe a unit our size has noone at the desk. Any suggestions or support from our peers is greatly appreciated. Have any of you seen positive impact from "Magnet"?

mjlrn97, I want to work where you do. How come your hospital can support staffing like that and not go under, and mine can't? Maybe my management is to blame. Imagine that! I think I want to move to your town. If anyone from your board of directors wants a challenge, maybe they could fix us up. We now are being mandated to attend a team building class. They just don't get it. We need more players, and less coaches.

I am sorry for you, unfortunately sounds like the nightmare around here. I feel like nothing will change untill something bad happens. The government needs to step up and make more laws to protect the patients because the hospitals are not doing it. I was pleased to see the Reader's Digest writing about the nursing shortage. We need to speak out more. Easier said than done as we all need our jobs to feed our families. Get out of there if you can and keep some account of what's going on. We all need to bombard the press and governing officials with the reality we face everyday at the hospitals. The hospitals will keep things as they are if we don't make a stand, and surely they won't stand behing us when that awful thing happens, and we will have to live with it forever. Good luck!

Unfortunately there is no law in NY regarding nurse-pt ratio numbers. On our 16 bed LDRP wing the typical assignment is 6-7 couplets, if you only have 4, you ususally have a cytotec pt that is awaiting induction, or an early labor. The techs don't do pt care, just stock and do paperwork if have time. On the 18 bed c\s, gyn/AP wing our assignments are usually5 "grown-ups", some being sick gyns (if you have a lady parts you can be put on this wing as the goal of the hospital is to keep those beds full), AP's or C/s on Mag we aren't supposed to bolus mag on the unit but always have those exceptions..Our gyn's may be 109 yrs old with bed alarms, sundowners, stage 3 or 4 CA, you name it, central lines, NG's,...and don't forget to find time to help the other moms breastfeed. We also have the babies of the c/s pts. We have a secretary OR a tech only maybe 25% of the time. They never do patient care, although if it's your lucky day a couple times a month someone may do vitals, but only once, they don't do them at second rounds. If I sound frustrated, I am. All our experienced nurses have done their best to get out of the mess. Our new nurse manager and her superior don't have any OB experience and want the place to fit into some mold of what they think a hospital unit should be. I pray on the way to work, and give thanks on my way home. Hope you never have to work under these conditions. I can't believe this is the USA!