stustressed

Hi everyone, I was just wondering how you all handle fetal heart tones being down for a long period of time when it turns into a crash c/s. I know we all do the same things (position change, IV bolus, pit off, SVE-possible FSE, 02, turb, etc) BUT what I am wondering is do you all have a protocol, a plan or smooth way of transitioning from the labor room to the OR ? *My concern is it seems as if there are "too many cooks in the kitchen." Someone usually calls the house doc and the charge (usually) comes to the room and someone "calls it" (to head to the OR if tones have been down too long) Someone also calls anesthesia,private OB, peds, nicu and the scrub tech to come to the OR. BUT Too many nurses run to the bedside to try and help, it always seems like a mess. Too many voices, too many hands in the way trying to adjust monitors and honestly I think that it is too scary for the family. I know our first priority is to get to the OR quickly for the baby but Im looking for a way to keep it calm and quick without it being so crazy. The other L&D unit I worked in was smaller and it seemed like it was a better transition with less people there. Does anybody have a formula/plan where certian nurses have certian roles? Any thoughts would be appreciated. Thx

I have worked in two different OB units. In one unit we had a manequin that simulated a dystocia and we were all required (even physicians) to attend the drill. The other hospital we (2-3 RNs at a time) went into a room with an educator and "walked" through what a dystocia would look like, what we would do etc. We also filled out quizzes at both facilities. In one of the hospitals we had a dystocia time sheet printed and taped to the inside of the closet so someone could be the timekeeper and keep track of what happened when for charting purposes. It also was helpful b/c they would call out to the RN (s) and the doc..30 sec, 1 min, etc. Time always seems longer when it is a stressful situation.

So I am a new nurse.. just took and passed my boards and I got hired in Labor and Delivery. I wanted to know if anyone has any advice to avoid pit falls or common mistakes. Im nervous and need some advice Hi, I have been in L&D 3 years. I went straight into it from graduation. The tips and advice I can give is pretty basic but.... NEVER be afraid to ask questions. You are dealing with 2 lives. NEVER think you know it all, you don't. There is always something new to learn and someone that has been through it. Be confident in the skills you feel good about, refine the ones you don't. Not all deliveries are storybook and perfect..some are difficult, sad, stressful. L&D is not just holding babies, it can be exhausting (like all nursing) but it is worth it. Use the physicians...seek their expertise and ask questions to them too. Try to understand the physiology behind your fetal heart monitor strip and what is happening to the baby, not just "what to do when this or that happens" You will make some kind of a mistake (or two), accept it, learn from it and move on. Congrats and Good Luck!

a few for me.. 1. a pregnant pt with epilepsy (non compliant with her meds and little prenatal care) seizing over and over..called the rapid response team and it took over 2 hours to get her stable enough for transfer. 2. Called the OB to come for delivery, It was her first baby and typically Id have enough time but urge to push was so strong, the mom couldn't control it, I called the house MD for back up but he didnt make it...i delivered the baby on my own. Scary but everyone was ok,the FOB even asked if I could get a raise- LOL 3. The mom of a patient getting ready to deliver was not adhering to our visiting policy and got so mad at me she came at me from across the room, got in my face, screamed profanities and threatened me (i was also pregnant at the time) As she was being escorted out by security, she continued to threaten me and our charge nurse. She ended up having to be escourted off of the property by the local police. 4. Seeing/hearing a FOB find out his full term baby passed away, A chilling noise, i will never forget.

Temper-MENTAL readheads posts sound like exactly how we practice in our unit. We do intrauterine resustative measures (o2 on, position change, fluid bolus, pit off) boom, boom, boom just like that. The pit is the last intervention of the 4. Of course we also perform a SVE, maybe a scalp lead and terb if needed. As stated in a previous post, the oxytocin receptors can get oversaturated=PP hemorrhage. Also, if IUPC wasn't picking up, did you palpate the abdomen? It is so hard not to always watch the monitors but rely on your basic skills. Also another really important thing that was previoiusly stated...were there accels? good varibililty? (I know that difficult to assess when you are trying to intervene to keep that babe healthy) BUT it is good to learn to try and assess that too. Everyday is a learning opportunity! Im sure you are doing great.

Do you like OB nursing? Take everything else out of the equation... Do you love the deliveries, the emergent situations, the moms, the babys? If you do then maybe the OB unit at this hospital isn't the right fit. If you don't, then you might need to move on. What I heard in your post is disturbing...It seems as if you've lost confidence in yourself. Don't do that. Especially if you know you are a good nurse (and you've been told that numerous times). I see you can approach it a few ways. 1. If you truly feel that OB nursing is what you want to do then pick your chin up, have confidence in yourself and continue to hang in there in that unit. Maybe move to days if possible. 2. If you do love OB then try to get another L&D job at another hospital (although, it might be difficult with the pregnancy) 3. Shadow another aspect of nursing to see if you fit somewhere else. Peds, gerontology, hospice??? Don't give up on yourself. OB nursing is difficult and working with mostly women can be difficult and there can be a lot of backstabbing. That might not have been something you were as exposed to b/c you floated- now that you have a permanent unit, you might see it more often. Hang in there.

No, i actually have not. My original plan was to try and get a PRN position at the hospital (to see if i liked it and then apply once a full time position came open if I liked it) but they have a full time and part time position posted so I thought Id see if I could get the interview and go from there. I do have experience with the hospital (as a patient, family member-not an RN). There are 2 fairly large things that I don't like about the unit I am in. I LOVE the girls I work with but there are some things that I feel like compromise the safety of our patients. These things aren't changing...SO I like it but am bothered by some of the care we are providing. Thanks for your input..I will think it through.

Help, I graduated a year ago and have been working in L&D since graduation. I am wanting to apply for an L&D position at another hospital. Obviously, my graduate nurse resume needs to be updated. Does anyone have any good websites that have free downloadable templates or examples? I am totally overwhelmed when I google this! Also, should my references be from the current hospital where I am working? My other references when I applied for the job were from a nursing instructor and a friend that is a nurse. I don't want my charge or director to know yet. I am really only trying to make this switch due to more money at the new hospital and the hours I want. I do like the L&D unit I currently work in and should I not get the job or the interview, I don't want there to be any bad feelings...Help Thanks

WOW, i finished reading through this thread and it seems as if it is all just horrible work environments, horrible attitudes, gossip, etc in our workplaces..I am a new grad (starting my job June 2) and reading all of this makes me sick. I get that we need to vent to de-stress, vent to get advise but I really hope that I get to work with women who don't act like the ones talked about here. I know that I am a little green and new to this but I have worked as a tech. I had the opportunity to work on floors that were like the ones talked about here and I also worked on a floor where everyone helped each other out and there was a minimal amount of gossip. How in the world are we supposed to trust each other and "have each others backs" if all we do is destroy each others character and have a negative attitude about everyone ? I don't know if the girls on my floor are like this but no matter what I will give it a year, do my best and move on if I have to. Nursing has so many opportunities (don't have to work in a hospital..) I hope I don't end up so angry, untrusting and jaded. Please don't be offened..Im just a little suprised to hear how awful it can be.

women are such passionate,emotional creatures by nature and sometimes this translates into situations that are not healthy in the workplace. I believe that the best thing to do is to try and support each other and not participate in the nasty-ness. You can't control others behavior, only your own.

I heard (by a male manager on a med-surg floor) to have the woman cough while looking...he says that it WINKS at you everytime:eek:

Im just wondering (im almost a new grad so I don't know all of the in's and out's) If people hate precepting or aren't good at it etc then why do it ? It was my understanding that preceptors volunteer to do this job?

2btmanrn....AMEN to you..if I lived in chicago I'd be there on May 7. GoodOldNurse-thank you for your thoughts

WOW-THANK YOU...that is great info. I am so ready to give it my all but concerned about balancing the demands of being a new grad, studying for NCLEX and becoming a part of my family & friends lives again. I wil certainly take all of this into consideration THANKS

teensmom- Iam a new grad (in may) & just got an L&D position... I am nervous about facing things that you have explained but I KNOW that L&D is where I want to be and it sounds like you are trying to prioritize and hang in there. Just kill them with kindness, try to learn, hold your head high and have confidence in your abilities. I agree with the previous posts about questioning yelling preceptor about what would she do, etc. If you feel like you have exhausted all of your options through talking with your co-workers, management, etc then look for another L&D job..not every hospital is the right fit for everyone. Don't give up..you have gotten this far and you DO make a difference to the moms and babies!!