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TammyWilson808

TammyWilson808

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13yr. RN vet w/ experience in LTC, ER, ACUTE and now Labor and Delivery

TammyWilson808's Latest Activity

  1. TammyWilson808

    Another Certification Question . . . 2 years?

    Aloha SmilingBluEyes, Awesome, congrats!!! I am just looking into it. I want to get certified in the same, inpatient obstetrics and even postpartum/newborn. There is alot of info just for applying for the exam. I need the study guides. Where did you get them? I need them ASAP. And also, how long did you study for to be ready for August? Please get back to me. Email me please at TammyWilson808@aol.com. Mahalo and Aloha (Thank you and Chow!) Tammy
  2. TammyWilson808

    No slamming me please!!!

    Aloha JKAEE, Congrats for recognizing what you need to do for your health and your baby's. Don't wait, go to your NP and tell her what you want to do. You've done the biggest step already by recognizing what you need to do. It is truly an addiction that you know you can't deal with alone. Go talk story with her---I really don't know what the best way to deal with quitting, so get back to me. Let me know how you're doing. Way to go! Aloha, Tammy
  3. TammyWilson808

    Pitocin protocol for Inductions

    Aloha Jemma, We do 20 units of it per 1000ml LR, concentration is 1mu=3cc/hr infusion rate. Augment protocol: 0.5 mu=1.5 cc/hr to start, and increase by 0.5 to 1 mu Q 30-60 minutes,titrating to a good labor pattern. If induction protocol: 1 mu=3cc to start, increase by 1-2mu Q 30-60 mins, titrate the same. Hope this answers your question. Aloha, Tammy
  4. TammyWilson808

    Level I Nursery

    Aloha, I am a L&D RN in Waimea, Hawaii and we have a level I nursery. If the OB-GYN knows it is a high risk patient they are sent and delivered at the tertiary care center on another island. If the patient comes in labor and high risk such as your case(which they sometimes do as we all know very well) they are delivered with RT and Peds present. Both of them, in addition to the OB-GYN or CNM, can intubate. We have an AWESOME group of Docs that are very dedicated to their craft and to their patients we have no problem having them in attendance. By the time the transport team from Oahu where the tertiary care center is, the babe is usually stabilized---usually! The transport team is awesome as well and the PEDs and OB are in constant communication by phone in anticipation of any problems during or after the delivery. Our RN team averages 20+ years experience with an NICU RN of greater than 20 years on staff. All RNs are NRP certified as you are. I am only the second RN with experience under 5 years. Sounds like you all have restructuring you all are adjusting to. I feel for you. Hang in there---find strength in your staff. Do you have Respiratory Therapy on staff readily available and experienced to intubate? What about your OB? Tammy
  5. Dear Kar212, I think we communicated through another thread. But I am an L&D RN from Hawaii and we, unfortunately, have our share of fetal demises. I can only imagine your pain and please do accept my sympathy. I am so very happy that nurses were excellent in their care of you and your family through your difficult time. I don't shy away from an important work that we do---our support through the actual labor and delivery, and even more important, during the immediate postpartum and thereafter makes our job more vital than ever. We observe the whole family unit to see that they appropriately grieve and support each other. We connect them with professionals in the community that can get further help. Even without life, our baby angels that we have the honor and privilege of receiving here have a reason for being here. They are perfect angels---please do not think of them as any less. I do hope in time your heart aches less, and I wish for you peace. Much Aloha, Tammy
  6. TammyWilson808

    We had a anencephalic baby born...

    We had a anencephalic baby born yesterday. This was my second one in my career and you never get used to it. Baby's face was macrosomic, distorted. Their precious angel had a heartrate for about 4-5 minutes and then passed. I labored mom all night then the floor got real busy real fast (if you're a L&D nurse, you know what I mean). She was on a PCA to alleviate the labor pain and discomfort. I know it was my duty and honor to provide emotional support and medical support for mom and her family. Everyone in that room, familywise, was hoping for a miracle. Although their miracle didn't happen on that day, I told them that their miracle was going to be in another form somehow, somewhere. I have been a L&D RN for 3 1/2 years. As time passes I know I will have the right things to say and to be more comforting to my patients. It's only now I conflict within myself to know if I'm being comforting to my patients. It'll come with experience. If anyone has some insights that you'd like to share with me I would be obliged. I have taken couple of classes on fetal bereavement, it just takes getting used to. Aloha, Tammy
  7. TammyWilson808

    Pros and Cons of L & D Nursing

    Aloha, I totally agree with your assessment! I am an L&D RN and proud of it! An old timer RN told me once dealing with fetal demises is the price we pay for the most awesome job in the world we have to do. I had to think about that one, and am inclined to agree. Aloha, Tammy
  8. TammyWilson808

    Labeling Pitocin

    Aloha, We also have to label our bag containing Pit (usually 20 units titrate per protocol), our line and the pump. We are being JACHO surveyed in June---those are the standards of practice we are held to. Personally I think having to annotate titrate changes on bag is not necessary but it is dependentupon your facility's dictates--- Aloha!
  9. TammyWilson808

    L & D nurses routinely deliver babies?

    Aloha Midwife Sarah, It is true on a very rare occasion RNs deliver babes when MDs cannot get there in time. It is unforseen and can't be helped but it is routine for the MDs and Certified Nurse Midwives we have to deliver our babes. Please get in touch with me and I could hook you up with the midwives here as one of them just came from Florida where she was practicing! I have had the pleasure of working with RNs who've been midwives before and the transition from midwife to RN is extremely difficult. As a midwife, they are in charge and make the decisions for labor and delivery of their patients. As RNs they take orders and are not autonomous with decision-making. (You must have lots of birthing experience and you will be such an asset to whoever is lucky enough to have you!) I have not seen one midwife make the transition successfully. The only one that was successful was my girlfriend who was a midwife then became an OB MD. But I want to stress that it is not impossible--nothing is! I also saw in this thread later that you passed your boards! CONGRATULATIONS! :rotfl: :balloons: Be deligent and you can do it! Tammy
  10. TammyWilson808

    Episiotomy vs. Spontaneous laceration?

    Palesarah, AMEN! :rotfl: Where I work as a L&D RN, episiotomies are NOT routine. The doctors and midwives speak with the mom BEFOREHAND and ask what are the specifics of their labor. It gives the patient control and allows them to choose! But in my short three year experience as an L&D RN, I have seen where the patients insists without some flexabiliity on not having an episiotomy and they would tear ugly fourth degrees like you would not believe. The doctors and midwives would ask as the babes are crowning (the mom perineal tissue around babe's head would whiten thus a sign that the tissue's gonna tear) if they would like a little cut. I read in this thread earlier that it is wise not to have any routine things done just because they are routine, but it is smart as well not to ignore and refuse a necessary intervention when it is offered. I work with OBs/CNMs who do warm water soaked cloths on the perineum as babe nears delivery and that helps the perineum to stretch as well. I like that! It's comforting to our moms at a time when alot is going on and uncomfortable--- :)
  11. TammyWilson808

    tubs in LDRs- need advice for new hospital

    I work on the Big Island In Waimea, Hawaii and we have five LDRPs and a tub room which includes a laboring tub/jacuzzi. I wish we had a tub in each of the five rooms but space is pretty scarce. We make do---and couple of the nurses are in the middle of redecorating it.
  12. Aloha Kyriaka, We have a beautiful five labor/delivery/recovery/postpartum rooms. My patient was put in one of the five rooms most separate from the two postpartum couplets we had that night. I have not seen a more protective bunch of nurses (I call sisters) of their patients than whom I work with now. They are my mentors and teachers. They have taught me how to cherish and hold sacred the women we care for. Really! Visitors are screened and only allowed by whom the patient chooses. She was craving chocolate and I was able to find some chocolate ice cream with chocolate syrup for her. Just spoil her rotten. And encouraged her to spoil herself when she got home and cradle herself with her very attentive family's love. I think the best came from that very sad situation. Aloha! Tammy
  13. TammyWilson808

    We had an OB patient die today

    I'm so sorry. I work in a family birthing unit in Hawaii and when we lose a baby the whole team, doctors and nurses alike, feel that loss. The unit is quiet and goings on keep going on but the hum of the place is just very sad. We weep behind closed doors, and comfort one another. We depend on each other; we are a team! You are in my thoughts and prayers. Tammy
  14. I have been an L&D RN for nearly three years and for the first time I cared for a woman whose baby died in utero at 24 weeks gestation. There was a large part of me to be busy with the paperwork and the necessary function of the process. That is the "nurse" part of me. My heart was another story... I initially walked into the room, introduced myself to my patient and the family and established a rapoir (sp?) with them. As my night progressed, in relating to this grieving woman, I understood my role clearly. I am there to provide emotional support, present both woman and father of the child with labor options and give them what they need---space to feel their loss. I felt my role is and always will be to these aching souls is to focus on this: their angel's presence, though brief with us, had a definite purpose. We not always aware of their purpose, but they are gifts to us just the same. And these precious babies are perfection, their physical bodies might not be, but their essence of who they are is perfection. I did share this with my patient that night---and I did share my tears of sorrow with both parents. I told her that the whole night I had a knot in my stomach and a lump in my throat and I felt her pain. But what I was feeling paled in comparison to what she was feeling and how her heart ached. I felt I needed to be professional in dealing with my patients and I know I am a good RN. But I also was dealing with another human being whose heart was full of pain. My gut told me that spilling tears with my patient was a good and empathetic thing to do. Not losing control kind of crying, but tearing is ok! And as an L&D RN, we are taught to trust our gut, our intuition---because it is usually the right thing to do. I did encourage my patient to have an epidural to diminish the labor pain after she decided to deliver baby vaginally. Also I did encourage the family to hold baby after being cleaned up and placed in a soft cotton flannel baby blanket. We have a friend of an RN I work with make baskets that baby's nameband, lock of hair, and clothing, etc. go into and the family can take home. We do footprint and provide the family with our unique baby birth certificate. The baby's cribcard with its footprints will in the basket as well. I have the best job in the world---and for the most part it's happy. And for the other, it's still very satisfying and rewarding. I wouldn't do anything else. Aloha, Tammy
  15. TammyWilson808

    What is it about Med-Surg?

    Med/Surg is one of the hardest jobs a nurse will ever have. I was one for ten years and you were either a well organized, efficient Med/Surg. RN or you weren't. And it is that simple. It is the catch all of most hospitals, and the destination of patients the other units decline for whatever reason. The knowledge base possessed by a Med/Surg. nurse has to be a solid, diversified one. A good Med/Surg. nurse is worth her or his weight is gold. It is one of the toughest jobs that I have ever loved. I am a labor and delivery RN now and will never regret my experience as a Med/Surg. nurse. It is the best stepping-off point, working my way through to another form of nursing and paying my dues. "A truly good Med/Surg nurse is worth his or her weight in gold"...
  16. TammyWilson808

    What is it about Med-Surg?

    Med/Surg is one of the hardest jobs a nurse will ever have. I was one for ten years and you were either a well organized, efficient Med/Surg. RN or you weren't. And it is that simple. It is the catch all of most hospitals, and the destination of patients the other units decline for whatever reason. The knowledge base possessed by a Med/Surg. nurse has to be a solid, diversified one. A good Med/Surg. nurse is worth her or his weight is gold. It is one of the toughest jobs that I have ever loved. I am a labor and delivery RN now and will never regret my experience as a Med/Surg. nurse. It is the best stepping-off point, working my way through to another form of nursing and paying my dues. "A truly good Med/Surg nurse is worth his or her weight in gold"...