dawnbee

I work in a 40 bed rural hospital as a Perinatal RN. We have a three bed ward, with two delivery rooms. There is one Perinatal RN in the hospital 24/7, and since provincial protocol demands that there be two qualified assistants at each delivery, our Shift Coordinator is the designated second. We deliver approximately 200 low risk pregnancies per year and do antenatal care on many more high risk pregnancies who are slated to deliver in centres with available nurseries. Our unit is linked to a 18 bed Med/Surg unit and a 3 bed ICU. We are expected to help on the floor, relieve ICU and other RN breaks. and receive admissions of male and female cardiac and surgical postop patients to Maternity when we don't have active labouring patients. We have had as many as 5 off-service patients crammed into our four rooms (one "assessment room"). If a labouring woman comes in, the off-service patients are handed off to the already overburdened Med/Surg staff, while we provide 1-1 to our priority patient. If it's after hours or weekend, we have had to deny our patients epidurals, or offer them transfer to a larger facility, as we didn't have enough staff to monitor the infusion. Oxytocin drip, same thing. Two of our 4 docs also do circumcision in the hospital, and we assist with that and postop observation of the child. And of course, the prebooked and surprise NST's, well baby weights, breastfeeding problems etc. For the past several years, we have had few if any casuals, and we have all logged many hours of overtime and on call hours. We must take on call because the Shift Coordinator is often too busy in Emerg to help with deliveries. In 2006 alone we had 3 time loss injuries in a permanent staff of six, which caused more overtime, exhaustion, etc. Our hospital Maternity service has been closed due to staffing shortage at least ten times in the past year. The next nearest hospital is 100 km away from ours, and well over 200 km from our outlying cachement area. Our Obs GP's have been incredibly supportive of us, and very vocal in trying to obtain the resources we need to practice safely, and we have had several meetings with upper management about the issue. The upshot of the most recent meeting was that there is not a nickel to spare, and we just have to move human resources around to meet the need. So now, there will be 2 trained Mat nurses per shift (several have been trained but are not comfortable working alone so soon...). Our assignment will now include part of the Med/Surg floor. The senior, experienced Mat nurse will work the Med/Surg patients and the learner will take the Maternity patients. Then, if a second is needed at a delivery, the experienced RN will be the back up, while the Shift Coordinator covers her assignment. Basically, I have been pulled out of my position and put on Med/Surg while the new kid practices my specialty. I'm all for mentoring, but this goes too far for me.... So, one of our docs and myself have been appointed to a sub-committee to find ways to bring our concerns to a higher level of management. We have already obtained stats from 2004/5 regarding workload, patient acuity, ward closures, etc., and 2006 stats are just around the corner. We could use any advice or input anybody has to offer. Thanks.

Syncronicity! I nurse in a small Canadian hospital. Just two weeks ago I struggled with the same ethical dilemma as the original poster. My patient on Med/Surg was a 94 year old gentleman who had lived in a small apartment in his daughter's home, independent except for the supper meal his daughter prepared and brought to him, until a fall brought him to us. No major injuries apparent at first, a couple lacs and contusions, a bump on the head. He was awake and alert. During the days before he died, I watched his loving and attentive family, who never left his side, gradually request withdrawal of treatment. They seemed convinced that this was to be his last illness, although he didn't seem to think so. Instead of mobilizing him, he was kept in bed, because it was "unsafe" for him to get up. We started using pshycotropic meds to calm him as he struggled to regain independence. And morphine for the pain from the fall. Then, eventually, he gave in to the "inevitable." This whole scenario troubled me at a deep level, yet I felt powerless to intervene, and then guilty because I hadn't, and what was the best outcome I could hope for anyway? It would be so easy if everything was white or black, wrong or right. But it's the grey areas that keep us up at night.

Anyone else been thought of as a superhero on duty 24/7? As always, looking for another nurse to lean on. JacelRN Just a couple of weeks ago, my son and I were driving into town to run some errands. As we came to the corner outside of town, an SUV was stopped in the middle of the road in front of us, and a man was pulling a woman out of the vehicle. No other cars around. He dumped her unceremoniously at the side of the road and drove off. How could I not help her? She was pretty scraped up, and her arm seemed to be troubling her, so we piled her into my car. She begged me not to call the police. Turns out they had been partying all night, and she was very drunk. I told her that I was a nurse at the local hospital, and I would take her somewhere safe, either to the hospital for asssessment, or her doctor's office. Long story short, we drove her to her parents' home, 30 miles away. It was an awful ride, she was all over my son, and at one point pulled out a bottle of gin and took a swig. I was tempted to pull her out of the car and leave her at the side of the road myself. The arm, by the way turned out to be fine, because she had no trouble using it to grab my son from the back seat. When we told my husband the story later, he thought that I had been foolish, and should have stayed in the locked car, written down the licence plate (we did do that, although didn't call it in..she wasn't going to press charges, anyway) and wait at a safe distance for help to arrive. We live in a rural area in British Columbia, and even an ambulance would take at least 1/2 hour to arrive. I couldn't have left her lying on the road that long. I don't know what the moral of this story is, but even though it didn't turn out very well, I still think I did the right thing.

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?