mombabyrn

Thanks for the reply. If you don't mind answering, what is it that makes you wish you had done the RN-MSN? I'd like to learn from those who have walked this path before. BTW I believe we are in the same state- IL. I think I remember reading a post from you before saying you were around Peoria. Does anyone else have any comments? I do have a good idea of what I'd like to do. But with the way the MSNs seem to delineate careers now, I want to make sure I don't severely limit myself. One of the fantastic things about nursing is that there are so many options and paths to take. I'm still a long way off from retirement (if that is even possible anymore) and who knows what the future may hold.

Ghetto????? If you think that of the community colleges, then don't bother working in Chicago as a nurse. Whatever makes you think the colleges are ghetto is probably also present in every hospital in the city. I have worked with many nurses who were grads of CCCs, and they all had good foundations. Improving your outlook may help you get into a "better" school. Next time think before you hit that 'submit' button.

Hello! Does anyone have any insight as to whether there is any benefit over first obtaining a BSN and then an MSN, or going into program where they are rolled into one? I am taking prereq's now for an RN-BSN program, but my goal is definitely an MSN. I'm getting a little overwhelmed by the different programs, and I am wondering since it truly is an MSN I am after, if I should head directly into a program that does both a BSN and an MSN. Finances are an issue, but like anything I'm sure that will all work out. Here's my other question: When I got my RN via an associate program 11 years ago, there was only one MSN. Now it seems to be much different and the degrees seem much more specific. I want to delve into this more, in regards to what degree suits me best. I have been in obstetrics my entire nursing career, and I want to stay there. I don't want be a midwife; I don't want 24 hour accountability. I don't think I want to go into management either. I do love precepting and teaching. I am thinking maybe being a staff educator or maybe even teaching in a nursing program. A CNS is also on the table for me. But I don't want to limit myself, and I'm afraid an MSN with a focus on education would do that. How do you decide which do? I want to be sure to make the right decision on this! Any thoughts or comments are appreciated!

The childbirth educator has a unique and, in ways, powerful role to the patient. This is where all of these things previously mentioned, in regards to elective pcs versus the expectant management of labor, can be addressed. You can even address the "ambushing" of pts by their doctors, if it is done carefully and tactfully. What I used to do is try to make my pts feel very empowered, and very in charge of their bodies. I would explain that NOTHING can be done to them without their consent, that if they are so much as touched without their consent it is assualt, etc. I would not say "Now we all know here that Dr So&so is notorious for doing unnecessary sections, so watch out!" I would not address individual physicians preferences or routines, although I did strongly encourage the pt to talk with her doctor individually. I felt I did it tactfully and legally. I did not commit slander (although I also, like some of you, felt like doing so). Now, the separate issue of having the pt admitted, in labor (or not), and the doc is pushing for a section. Well, that is tricky in regards to action at the bedside right at that moment. You certainly can't throw yourself over her so the doc can't section her. And you can't sit there telling her how she doesn't need a section and her doc is a nut. You can certainly address her questions and concerns, absolutely. But do it in a way that you are stating facts, not your opinion. No "I don't think you need a section because ABC." But more "There are risks and benefits to each..." and go into understandable detail. What WILL make a difference is if the unit, as a whole, addresses the issue. If this doc does this routinely, you aren't the only one getting these pts and you aren't likely to be the only one with an issue with it. The unit as a whole, addressing the concern together, is much more likely to make a difference than one nurse going to address the unit manager. If you don't feel the manager will consider the issue, then write a letter as a whole unit, arm the letter with FACTS (research, stats, etc), send it to the manager, the director, and up to the CMO and the CEO if needed. But make yourselves heard! The hospital (and the whole health care system) would collapse without nurses. We have much more power than we give ourselves credit for. Personally, the doc at our hospital whom we had the same problem (among other problems), this is what we did. We addressed the issue as a unit. We made it clear that pt care was being compromised. We armed our pts with knowledge (not opinion). Not long after the elective pcs stopped. And eventually he was no longer delivering there. You can make a difference, if you don't stop at the first brick wall you encounter! Keep trying!

Well I will say I was a bit disappointed in the Adv EFM course, now that it is over. I thought it would have been more in depth than it was. Lisa's approach is different than her predecesor, Michelle Murray, whom I loved, so maybe I am biased. She does know her stuff for sure. I was just hoping for more in the course. More pathophys, deeper eval of strips, etc. The second day of the course she definitely put on her law hat, and the course took on an entirely different feel. I asked her if she felt the advanced class was a good way to prep for the exam, and she said she thought it was, along with reviewing AWHONNs publishings on EFM, since a good bulk of the test is based on their EFM book. So that's what I'll do, and I think I'll be fine. Thanks for the replies!

"FHR tracing eval must include a baseline rate, baseline variability, presence (or absence) of accelerations, periodic or episodic decelerations, and changes or trends over time" This is straight out of Miller's Advanced Fetal Monitoring course. So it sounds like there may be a bit of confusion about what to chart as periodic or episodic, but you are supposed to be noting this in regards to decels. Now exactly when and where you are supposed to chart these things seems (to me) to be up to the individual institutions. Assessment does not absolutely mean documentation every single time. Review the NICHD definitions. Personally I think it makes it so much easier now that we are all supposed to be speaking the same language and viewing the strip in the same manner now.

OzMW~ Of course it is ethical to support a woman who faces a cs. I don't believe that was pirap's question. The question was specifically regarding when pts ask how their doctor compares with other doctors at that institution. I taught for many years. And I also dealt with physicians who advocated elective pcs. It raised a lot of hairs at my hospital as well. As the childbirth educator, it is your duty to give your pts the best and most up to date information that is available. Of course this also mean YOU must be up to date. It is your duty to make them feel as prepared as possible for their birth. The childbirth educator's job is to be informative, understandable to the lay person, supportive, and make sure when the mom leaves her class, she is as ready as she can be for her birth. It is not her job to play one physician against another. It is not her job to give her own personal feelings about a particular doctor. If there is an issue with a particular physician, there are certainly places to take those concerns. That is why the chain of command or chain of communication (or whatever you institution has named it) exists. The place to vent about your feelings about a physician's practices is NOT in front of the patient. THAT is unethical. If you want to make a difference for that physician's patients, then follow the appropriate routes to do that. It is certainly our job to be our patients' advocate. It is also our job to know the appropriate and best way to do that. I suggest you ask your manager what she/he thinks the appropriate action is if you feel your patient is being "ambushed" into a cs.

Has anyone ever taken this exam after going to the Advanced Fetal Monitoring Course given by PEC? I know they offer it in conjunction with their EFM review course, but I am wondering if the advanced course is a good review for the exam. TIA!

This is the NIH position statement on cesarean delivery on maternal request: http://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf

I don't think it is ethical for you to answer a question by a patient that is essentially a comparison of competing physicians. You hope patients do these things on their own, and long before they are near term. Citing the hospital's CS rate is appropriate. Citing nat'l rates as well. But as far as infering that their physician is going to push them into an "unnecessary section", you are walking a dangerous line there. It's sounds like you already know this and you are being careful not to cross the line. I had a bunch of stuff for the class I taught, but it's been a few years and I'm sure it's outdated. OB is ever-changing, and it seems the swing lately, and unfortunately, is that primary electives are becoming more popluar. I think there is a lot of talk in the media and hollywood, and I think this is (unfortunately) affecting deliveries. Be a patient advocate- explain the benefits and risks of lady partsl and cesarean deliveries. Put the information out there. But after that, it's up to the woman, and the doc she has chosen to see for care. I think eventually the pendulum will come back to center; it usually does.

First off I'd like to say 90 views and no replies, guys??!! Congrats on landing in L&D, secondly. It takes at least one full year to feel comfortable in L&D. There is tons to learn! It can be a very stressful place. And even when you have done it for 20 years you are still learning because there will always be something new in the field. Also, the minute you think you know everything, you become dangerous. No one knows it all, to have that mindset puts you and your patients at risk. That being said, one week to learn to circulate is a short time. So to not feel completely comfortable is understandable, for sure. Depending on your set ups, they can be pretty straightforward or a plethora of instruments, most of which you are going to use and to look at them initially and try to memorize them all can seem overwhelming. Are you learning to scrub, too? I think learning to circulate and scrub in one week is not really possible. Plus I would hardly think you are spending your entire shift in sections, right? So it's not like you had 36 or 40 hours straight of surgery. It is your preceptor's job to train you appropriately so that when she signs off on you, that you know what you are doing. If she is taking it seriously (sounds like she is) and she feels you aren't ready to be on your own yet, then she is obligated to say you need more time. Not everyone is ready in 12 weeks. I think it's a bit crazy to think you should feel ok in L&D after such a short orientation. And a week to learn to circulate with no OR experience... I think that's pushing it, too. Don't be hard on yourself. It's much more important that you be competent than you be a fast learner! Good luck!

traumaRUs~ I know the hospital you worked at, it is the tertiary for most hosptials around here, including the one at which I interviewed. I did see a listing for new grad positions with a start pay around there. I just figured, like everywhere else, your pay goes up as your experience grows! nicumom75~ No, it's a small hospital. I'm not sure how many beds the entire hospital has, but the OB unit only had 14 beds I think, or maybe 10. I'm sure that makes a difference in pay, but like I said, this difference seems very drastic and far less than competitive. Thanks, everyone, for the replies!

Well the offer I have is less than that, us3Rbent! With no benefits to boot! The research I did puts this offer way below the average for the area, especially for someone in a specialty with a good deal of experience. I just wanted to hear first hand from someone. Thank you!

Thanks, everyone! I actually did make some calls (all day!) yesterday to see if anyone was willing. CEG I even called UIC, I am waiting for Cheryl to call me back on that. I'm waiting for a lot of calls today. But I did find a few places that say they will offer to non-employees, just waiting to see if anyone has space. Thanks again!

Hello~ I am in Illnois, north central about 2 hrs from Chicago. I am trying to find an NRP class offered to non-employees. I am having a very hard time! I checked the NRP/AAP site, and there is only one place listed, 3.5 hrs away from me in Iowa. I have checked Chicago hospital websites, and I am only finding classes listed for employees or classes given infrequently (sometimes only once a year). Does anyone have any tips on finding a place that will give the class for a non-employee? I need the whole class, my cert lapsed when I was on pregnancy bedrest (go figure). Thanks!