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I am a mom, wife, friend, nurse, student

acuteobrn's Latest Activity

  1. acuteobrn

    Evidence Based Practice

    Gwenith, Thanks for the referral! I checked out the site, doesn't have anything on what we are currently working on but the models are a good reference. I went to a conference last week, and it has shown that Euro/Australian medicine is WAY ahead of us on this one. Thanks again Acute
  2. acuteobrn

    Evidence Based Practice

    Ok, so I have been away from the forums, for quite along time, but I need some input. I am part of the hospital's EBP program and we are starting one for labor and delivery, my specialty. Now up till now, there is very little EBP used in L&D units as far as I can see. Especially at mine. We are trying to streamline out practice and have set standards, so that we can avoid having to use the chain of command on some of our older OBs. Are any of you currently using this type of pactice at your facility? I am specifically working on PPH and would love any input. My eyes are going cross with the amount of research out there and would like to know what other hospitals are doing, if anything. LIke I said, this is brand new to us, and is in it's embroynic stage at our facility. Any help, input is welcome. Thanks! BTW, I didn't realize how much I missed reading the forums! Acute
  3. acuteobrn

    Toradol for PTL?

    very interesting use of Torodol. I would be interested to know which conference you went to and their references.
  4. acuteobrn

    new med order

    I work at an institution where this is a standard option for 2nd trimester IUFD inductions. It works very well as another poster mentioned above, the POC and placenta were delivered sometime during the second bag. This is a viable option for those w/o CI. We tend to run standard AMOL on s/p c/s patients, dependant on their incision type and dating. I realise that when this is not your standard of practice it can be intimidating to use, however, if you were to research this, you will find that this is actually a safe alternative to several days worth of prosteglandins and eventual pitocins, which has a higher rate of retained placenta and hemorrhage. The key is the rest period between bags and that there is no viable fetus to be conserned about FHR with. Just remember to watch for water tox and use a toco & strict I&Os. These patients tend to do very well.
  5. acuteobrn


    Hi all, I am walking in unfamiliar territory, and starting an EBP program at our hospital, specifically for the Labor and Delivery unit. Now, we do occasionally visit you folks, but recently have been managing some very sick patients in our unit. My question to you is: How is your hospital/facility handling monitoring of hemodynamics post hemorrhage. Labs included. Do you have an Evidence Based Practice program in place and use algorhytms? What are your current standards. I am thinking of specifically post partum hemorrhage. And realise that you deal with other types of large volume hemorrhage on your units, granted the physiological state is a bit different. Any references to articles related to this subject would bewelcome. Thanks AcuteOBRN
  6. acuteobrn

    Rush University Medical Center

    I think that I saw the same rates and that was for a resourse program if I am not mistaken. Good luck w/ all of that I worked in Rush's perinatal system for over a year now and wouldn't mind working at Rush, I like the intensity but perfer not to be crosstrained. Guess I am old fashioned in that I like L/D and just L/D nights on MBU or in the nursery is not my cup of tea. I have learned from experience that suburban hospitals/ dependant on which system you work for, is actually higher paying. I have worked a few in the burbs and one (got offers from 3) in the city and generally I am making about 8 percent more in the burbs. I still work registry out in the city. Not bad rates either. Either way good luck to you and congrats on your new career. BTW if that was Rush's regular rates, I don't think they would even need to post any position because those are VERY high. $21 is not that bad, actually average for new grad pay. I started at $20.50 straight pay.
  7. acuteobrn

    What's your craziest delivery story?

    Another one comes to mind as for babies just flying on out. Had another multip, was 7cm, wanted to go on her side, BOW intact/bulging, so ok no prob, doc was in the lounge. About 2 min later she says she feels pressure so I go to check her, she isn't even all the way on her back and I see the membranes bulging through, I called out to the tech to call the ob in and give me a hand, so next uc comes and this girl must have had poly cuz, I go back and her bag explodes and shoots fluid across the room and the head is on its way out well I just barely caught that kid, It was quite slippery and was shot into my awaiting hands. beautiful baby, crying and all was good, brought to the warmer and did very well. I on the other hand was soo soaked that I needed to take a quick shower, It was in my hair, down my shirt my underware was soaked, thank god no mec! Well the doc comes in and was in a really good mood, didn't mind that he missed, goes to put on his gloves and by this time the pt was up in stirrups out comes flying the placenta, not just coming out like litterally 5 feet from the bed the thing landed by the doc's feet with a ploop. All he could do was laugh and say that he missed that too. Family and everyone was laughing. Same thing w/ the same doc happened a week later, this time a primip who was 5 cm and still laughing. Next thing I know, I was talking to the doc by the door w/ my back to her and she says " um I think the baby's comming" I literally turn around to see the baby fly out and land at the foot of the bed. I felt horrible. Pt was ok, but was like does that always happen, um no not usually w/ first time moms w/ no sign. pain. :imbar
  8. acuteobrn

    What's your craziest delivery story?

    Well, I have had more than my share of crazy deliveries. The inner city hospital where I work had several OBs that were pretty laid back about rushing in to deliver. So nurse deliveries were not that uncommon. Coupled w/ the fact that some of the ER staff was, lets say, alittle slow on the uptake. No offence to those who are ER nurses. But some just have a few screws loose. One that comes to mind is a few months ago, we had a call from ER a multip cam in and was "pretty uncomfortable" so they wheel her up after registering her, which usually takes at least 10 min. He comes in mom is half out of the wheel chair. ER nurse says "well she is having a hard time sitting, so she must be close" Well his hearing aid must have been on the blink, cuz I could hear a very definate muffled cry. Mom is spanish speaking and is going a mile a minute how the baby is here, ER nurse didn't get the whole pic. I help her to get up on the bed call for help and in one pull on her sweats, here comes baby...screamin up a storm. The ER nurse just looked like oh, well. Lucky all was well. I still can't get over that he didn't hear the crying baby or the huge moving baby in the pt's sweets. Found out from the patient that she was telling them down stairs that the head was coming out, and was delivering in the elevator.
  9. acuteobrn

    Anyone fax report?

    I think I know someone who works at your sister hospital on the floor and hates it. Main gripe is the fact that sometimes by the time that she actually gets to the fax the patient is already in their bed ready to be assessed. It has caused alot of tension between the floors and ER. I am sure that because it is new, and anything new takes time to get the kinks out and some getting used to, that some nurses are having a hard time dealing with it. Also some things (critical info) are getting missed and result in a phone call back the ED and phone tag inevitably ensues. She tells me it is more time consuming than the old fashioned phone call. I guess the plus side for ED is that they don't have to wait to speak w/ the nurse. Otherwise I don't really see the benefit in it. Gotta wonder about continuety of care?
  10. acuteobrn

    new nurse vent

    Sorry about your bad day, stick in there, organization and time management come from experience. Days like this are ones that will make you a stronger nurse if you don't let it overwhelm you. Did you care for your patients as best you can? If so then you done good. :)
  11. acuteobrn


    :rotfl: :rotfl: :rotfl: :rotfl: Trusn: You just saved me from the same nightmare!!!! :imbar Thanks for the good laugh!!!
  12. acuteobrn

    I Hate Pp!

    I'm with you. I too can't stand working postpartum. I like the teaching aspect and all, but would never want to do it even on a semi-consistant basis. I work nights and find it very boaring, to slow paced. I even get board w/ antepartum patients. Guess I need to be were the action is..deliveries, triage and OR.
  13. acuteobrn

    Choosing a specialty - website

    Interesting test. I work OB currently and that ranked #26 for me. Liked my Emergency med rotation and that ranked near last. My number one was Nuerosurgery followed by plastics. I always thought of myself as more of a truama/cardiothorasic type if I ever ventured into medicine. Wonder how they come to this conclusion. BTW I tested myself twice (used my other email address) same results both times!
  14. acuteobrn

    Tension in the workplace

    Thanks for the good ideas, I will start by speaking to the HR director when he comes back from vaction (every body seems to be on vacation except me;) ) You did hit that nail right on the head Kids-r-us, that is exactly what is going on from my perspective. Once the word "discrimination" entered the picture everyone got very stand-offish on vocalizing any thing or stopping any behavior. I have taken some steps like helping her to another empty room when she acts like this and bringing up the fact that this isn't professional behavior, ie risking patient complaint and a lost job. Told her to think of her kids when she is this upset, that they depend on her. Her reaction, very immature..."I don't give a damn what happens, that is what state aid is for, I will not put up with this....." You fill in the blank. The fact is they are not really discriminating against her, just they do not like the behavior as it causes alot of stress for us that have to put up w/ it. Anyhow I was talking to a friend of mine who says that there is a lawsuit in process for this exact thing from another former staff member who was of, get this, the same culture as this one we are dealing w/. And of course she knows about this and has brought this fact up. I don't know for sure, but it sounds like this is where it is going, gut instincts talking here. Who knows how far this will go. I just really don't want anyone to get hurt.
  15. acuteobrn

    Tension in the workplace

    Hey, Sorry never did thank those that replied, so thank you! A month has gone by and not much has changed. I myself am frustrated. So are others. Our manager is back and fully aware of the situation, yet nothing has been done to my knowledge. So we just go on in this little vortex of ours. Call outs are now weekly, she seems not to have a baby sitter on a particular night and guess what calls in sick. This pay period so far has called out 3 times. I had to tell them I could work OT and ended up calling in because I am sick. They gave me a guilt trip (staffing is very tight). What can you do? I have documented some things and gave them to the NM. Just have to wait and see now. But again in the immortal words of Bartle and James,...Thanks for your support.
  16. acuteobrn

    Tension in the workplace

    Hey all, again asking for advice, but this time not for something that is specifically my prob. I have been working in a community hospital L/D for about 8 months now, love the job, and the co-workers are culturally diverse. Now one culture does override the other, but this is just how it is at this hospital, doesn't mean that they don't hire people from other cultures as I and another co-worker are both ouselves different, culutrally that is. Here's the thing my co-worker is hell bent on accusing our co-workers and now I find myself included in discrimination. She states that we pick on her, make her do more work than others and get the harder assignments. Well to be honest, she doesn't always get the harder assignments, I usually end up w/ them, which is ok as I prefere to be busy and we both just graduated last year, and you can only learn from doing in my opinion. She claims that she got shotty orientation, which she acutally had a little longer orientation than I did and overall wasn't too bad, frustrating at times, yes, and we used to talk about these frustrations, but that goes hand in hand w/ orientation I have now come to that realization. The thing is she is extreemly defensive, you try and help and either she gets offended or does nothing at all. She doesn't try and make it better by atleast appearing interested, she just gets defensive. This has been perpetuating more and more lately and it is becoming a big problem. Now she is accusing everyone of discrimination. Well, guess what, everyone is getting tired of it. She is always behind on charting, has found to be falsifying charting (ie BPs charted are not those off of the dynomap), doesn't act in a situation when it is necessary, doesn't chart meds, charting is usually incomplete and blatently becoming more and more dangerous. Now all my co-workers, those that are a different culture from myself as well, are becoming more and more upset by the situation. This culture is based on respect for your elders and for your fellow humans, and have NOT been picking on her specifically. They give her assignments so that she can learn and become more comfortable w/ these types of pts. She is now to the point of having tantrums, swearing, crying, lies, yelling at everyone, physicians included. She is becoming more and more unable to make a decision and blames everyone else when she ends up making the wrong decision. She outright accused us of being discrimanatory, states that "you are going to pay" for this, and I believe has become threatening. Sufficit to say no one wants to work w/ her, no one wants to be in charge of her and at the same time no one wants to fire her because, she is a single mom w/ three kids and our boss is on vacation (she was very aware of this and has been more than fair w/ her before she left.) This is of course causing BIG problems, physicians are asking for her not to take care of their pts, she is minipulative and just down right irritating. Two nurses are ready to quit. She calls out when she is pissed at us, causing staffing problems. She has involved the nursing supervisors and the nursing director as well. Nothing is outwardly being done. It is out of hand really. I have alot of empathy for her, as I know what it is like to be under alot of stress, and it does change your personality and behavior. But at the same time I DO NOT agree w/ what she is doing. I think she need help and even though this has been offered, she down right refuses it. Its sad really. No body wants to fire a single mom, but they are also afraid because of the discrimination accusation hanging over them. Some of them look to me becuase like here I am the only one of my culture/race on the unit & shift, as is she. I have no problems, and infact find everyone very caring and nurturing to me, as they were to her as well, until this started, now nobody knows what to do. And they talk about it to me because we went through orientation together and used to talk. But the more she became angry the more I stayed away and disassociated myself from her, kinda feel bad but I didn't know what to say or do. Not to mention it is not my place to be the one to make any decision or to be smooting things out, that should be left to the managers. Have any ideas or thoughts?