LLLovely

I am close to completing my MSN in midwifery and am looking for practice tests. I have the candidate handbook and Kelsey's Midwifery newest edition, but am unsure of what other practice resources are truly useful. My school does not provide prep materials. Since I learn best by answering practice questions more than any other form of review, I want a resource with as many questions as possible.

I don't know your life circumstances, but there are options to get where you are going without incurring more debt. While I think the PHN certificate is great, I think many certificates are not valuable if they aren't required and tied to a specialty that only hired those with certificates. I don't know enough about PHN to know of the certificate does that. However, it certainly makes you more competitive for graduate school. You could do some travel nursing and pay off debt and save up for grad school, or you could work at a university medical center where employees get free tuition. There are probably schools with great grant programs and other options for free schooling. I was in the military for 20 years and know many who joined to get their schooling free or paid off after the fact. However, the military is not for everyone, grants are not guaranteed. Graduate assistantships are another way. Those students generally get tuition free and a stipend, plus better parking. Of course, not everyone lives near a university medical center or a good grad school with widely available grants, so then you have to decide if you are willing and able to move. There are a lot of moving parts and it can be an enormous burden. I moved half way across the country to go to a grad school that works for me. I'd start with finding a nurse who does what you want to do. Whatever nurse role is embedded in the foster system, find one and shadow them. Find out what the options are for doing what they do, what the pay and hours are like, what job satisfaction is like, etc. Maybe work is the way you want to be involved in the foster system and maybe it isn't. I know many people who became foster parents, and they felt that was one of their callings in life, but it wasn't career-related for any of them. Remember, there are *** in every crowd. Sometimes one bad apple spoils the bunch. It's okay to move on if your floor or the facility is a crap environment. If you are miserable, move on. Good luck in contemplating changes.

You are definitely being too hard on yourself. I get wanting to leave the ED if people were jerks to you, and I'm not suggesting you should have stayed and subjected yourself to such treatment. At the same time, if the ED is your dream, don't be put off by a week of not catching on. A week is no time at all. With experience under your belt, you could easily go to the ED again later and be successful. Also, don't let those ED turds intimidate you. They get scared and clueless too. You should see them (and the ICU nurses) get flushed and panicky when one of our OB or postpartum preeclampsia patients end up there. The fear is palpable, also funny and delicious! ?

I've never heard of them until just now. I think they would not have been useful for me. The dilation boards are useful because you can actually put your fingers inside the holes and compare to how the cervix felt. For me, this is better than a chart or beads, which are essentially like a ruler. It just doesn't feel the same. The basic boards are usually floating around hospitals because they are supplied by companies that make OB related products. For example, the ones we have at my current facility were made by a company that makes fetal fibronectin tests. Belly beads might be useful, but I hate having extra stuff hanging from my badge. I do have a belly balls teaching tool. When I first started nursing, we had a supply of them that we gave to all breastfeeding mothers. I kept one and found that most hospitals do not supply these as an educational tool for parents, so I use my own. You can make a kit of your own easily by printing off a PDF from online and buying your own shooter marble, ping pong ball, and plastic Easter egg, then putting it all inside of a ziploc to use to teach parents. Sometimes, the midwives where I've worked have brought in a bag of shooter marbles to give one to new breastfeeding families, so that they can keep touching it to remind themselves that baby's tummy is small. Those are inexpensive and could be great as I find that families learn better when they can touch and keep things. Just my two cents.

I am in an MSN program for midwifery and will be taking advanced pharmacology this Spring. We will be lumped in with physical therapists and all other MSN and BSN to DNP tracks for this class. Pharm is challenging for me, so I asked a friend who is a pharmacologist what he recommends to help me internalize a ton of material in a short time. He recommended Sketchy Pharm. He said a lot of medical students use it and the residents where I work confirmed this and said it is good. On their website, they have different focuses: medical, MCAT, PA, pharmacy, and nursing. However, the nursing focus is for undergrads who will be taking the NCLEX. So, has anyone used Sketchy Pharm for their pharm class or boards? If so, which focus did you do? I feel like PA might work, but have no idea how their school or licensing exams actually work. I think medical is probably overkill and nursing is definitely not going to work for advanced pharm. I like the idea of the way they teach the concepts. Hopefully somebody here has personal experience with this tool and can offer some insight. TIA!

I'm from Columbus, but haven't lived here since I graduated from high school. My background is mostly maternal-child health and I'm considering going back to working on the floor. Currently, I work in a private OB office and at OSU doing biometric screenings. The private practice pays poorly and OSU keeps cutting my hours, and I really need the money. I'm considering applying to both RMH and OSU. I'd love to hear your experiences of L&D in one or both of those hospitals. My points of consideration are as follows. Pay Environment or practice, treatment of patients, and management Autonomy vs. lots of residents Call requirements for part-time/PRN Type of providers: OB, FP, CNM Float requirements Time to wait to work on days Thanks for any input you may have!

Generally, an employee is held liable for the highest licensure that they have regardless of what position they are working. For example, some registered nurses take positions that are coded for LPNs or even CNAs because that is all that is available at a given time or all that fits with their child care options. However, being licensed as an RN means that if you do something wrong that an RN should have known how to do, you can be disciplined as an RN. However, facilities may still restrict your scope to the position you are working in and may report you to the state licensing board for violating hospital policy, or discipline you internally. If you were my employee, I would likely not discipline you unless hospital policy required it. However, I think it is essential that you clarify with your manager what you are allowed to do and provide your manager and HR a copy of your nursing license if you haven’t already. Remember, once is a mistake. Twice is neglect.

I’m sorry this has happened to anyone. Did you know that even physicians are treated poorly in maternal child settings when they are women who say they feel something is wrong? Stuff happens. However, we aren’t really talking about either of those things. Your anecdotal experience does not negate the fact that this happens at an alarmingly higher rate to blacks (not POC in general) and an even higher rate to black women. I’m not saying you shouldn’t be pissed about what happened to you, but your experience doesn’t speak to the bigger picture here.

You are assuming that she is saying that all of the prejudice exists in the hospital. Statistically, black women ARE treated differently with regard to pain especially in both hospitals and medical office settings. That is not to say that every single nurse and doctor is a prejudiced. Again, implicit bias does exist and many don’t realize when that is happening, but that is not all that is happening In addition to implicit and outright bias, there is also systemic racism, everyday interactions with those who have implicit biases, microaggressions that happen over and over even by friends and family of black women who are not POC and don’t necessarily realize they are doing and saying things that are offensive. Ultimately, most studies show that it is the cumulation of racism that black women face that causes poor outcomes. Imagine living in a society where you are just EXHAUSTED by the continuous onslaught of oppression, bias, judgement, disproportionately higher incarceration and murder rate of people who look like you, and then add sexism on top of it. There are long term health effects from that sort of stress, and yes it is a direct result of racism. Whether you are interested in voting for Warren or not, this is an opportunity to sit with this uncomfortable truth and do some introspection about how you and your colleagues can do better. We can all do better. Also, while Warren is not my first choice for President, I give her big kudos for bringing the health outcomes of black women to the national stage. It would not occur to most other politicians to give a second look to poor maternal morbidity and mortality at all (and it is piss poor in this country given how much we collectively spend on it), let alone the even poorer outcomes of black women and to even begin to speculate why it is happening, and that includes other politicians who are women. Very few politicians in the history of this country would bring such an issue to light knowing that they are implicating themselves as partially responsible. This is a bold and brave move on her part and it may even bring about funding, research, and change that will benefit black women. I thinking sitting for a moment with the question of why so many nurses seem automatically offended at this is important as well. This wasn’t a flip comment about playing cards on shift. This was a call to action to make things better. Why wouldn’t we want that?

I agree that DNP is not necessarily worth more money, but that part of it doesn't add much time. I am interested in the DNP because eventually it will be the standard, and because I would like the option to be able to teach without having to go through any more schooling later. I think if I am going to get an MSN that the DNP is within easy grasp, so I might as well finish it in one fell swoop. Thanks for your thoughts!

I previously lived in Colorado Springs and applied for and was offered several different positions when I retired from the military myself. All of them had astonishingly low pay rates. I ended up applying to jobs in the Denver area and got offered one position. The pay rate was significantly better than anything I was offered in Colorado Springs, so I commuted for a time. Ultimately, I moved to Denver and took a different job, which was how I realized that my first job in Denver actually payed really crappy wages as well. Live and learn. But that meant too that wages in Colorado Springs were even worse than I thought they had been. If there is a different explanation other than retirees, I'm not aware of it. If you have seen some of the Army towns in the lower 48, you'd realize what a dream location Colorado Springs is. It has beautiful mountains, fresh air, 300 days a year of sunshine, tons of trails, lots of dog friendly places, and more. Most military towns are known by the fact that they are the armpit of whatever state they happen to be in, so towns like Colorado Springs, Honolulu, and Tacoma, WA are jam packed with retirees because they are decent places to live that also happen to have access to military facilities such as health care and shopping. You can't swing a cat without hitting a retiree, but contrary to popular belief, most people don't live solely off of their retirement checks. The retirement checks aren't big enough for most to do that, but they do make a difference in what sort of wage you are able to accept and still make ends meet. So, while I don't do economic assessments and can't speak to other market factors with any authority, I would say that the basis for this assumption is valid, though I can't say what else might be at play. Thank you for bringing up the autonomy piece! Pay is an important factor, but I know I would prefer the ability to have more autonomy in the long term.

I've just been accepted to a DNP-FNP program. At the same time, my husband has two job offers pending, one in Tampa, FL and one in Colorado Springs, CO. I am a bit hesitant about moving to Colorado Springs. We previously lived there and I found that RN pay was dismally low due to the number of military retirees in the area who were willing to accept low pay because they already were getting retirement pay. I'm not sure if the same is true of NP pay. I recognize that job trends go up and down, but I would appreciate any insight into one area vs. the other. I don't want my husband to take a job, then find out after graduation that I'm screwed trying to find a job with a decent paycheck that makes it worth it to have a DNP. I'm also interested in personal perspectives regarding hiring for first jobs in those areas. Again, trends are cyclical, but also tend to vary by region. I wonder if it is easy to get a job right out of school or especially difficult. Thanks for your thoughts!

If one is already good at vocabulary and writing, and one needs some brushing up, but was always very good at math, what is the shortest amount of time one could student and expect a decent score? I realize that sounds shitty, but I realized that the school I'm applying to has clinical requirements that I may not be able to meet. Now I am beginning to apply to some alternate schools, at least one of which requires the GRE and has a deadline that is approaching very quickly. Does anyone have great resources that really helped you study? Anything I shouldn't bother with because it is just mediocre or the material can be sourced elsewhere in a better format? I'm open to all tricks and tips, but I really need to be able to take the GRE within four weeks to meet the application deadline.

It can be so hard to tell from a visit/interview. I would ask about staffing ratios, like whether they follow AWHONN standards. I would ask how often they have requirements outside of your shifts like meetings, classes, online work, annual trainings, on call, etc. I would ask how shifts and on call are scheduled like first come, first serve, by seniority, on a rotating basis. I would ask about their relationship with the postpartum/Mom-Baby floor. I would ask about their relationships with physicians/practices, whether they teach there, whether they have Family Practice docs delivering, whether there is a midwife practice. If they teach there, I would ask how that modifies the RN role. I'd ask what the acuity is and if they have a lot of antepartum patients (not my scene at all). As an example, I work at a place now that I really love, but they do a lot of teaching, so I mostly do not check patient's cervixes. I have to ask before I make any moves. It took me a while to get used to that as before I worked where I am now, I had worked at places with little to no teaching going on and I was very independent, physicians primarily just showed up to catch. Overall, I have found that I can make just about any L&D job work except LDRP (hated it with a white hot passion), a hospital with no midwives, or a manager who doesn't support the nurses well. When you see people there, see if they look happy or if they look like they have been dragged a few miles by a horse. Look to see how clean the place is and whether stuff is just shoved in any available corner. All of that may not matter to you, but sometimes I think it is a very good indicator of the overall quality of a facility and what sort of support you can expect from upper management.

I think you will be fine if you pass the second time and have a good GPA overall. I do also think it is worth discussing with your instructor. Let them know that you really want to be a nurse and do well in this class and ask what you can do to improve your skills.

That makes perfect sense. I misunderstood initially and thought you meant going to part-time with school. Good luck this spring! I'd love to hear how it goes for you.

I would keep trying. I am an L&D nurse and just took a full time school nurse consultant job in August. I needed to have more time with my kids. I am pushing close to 50, but didn't start having kids until later than most, so mine are still in middle school and high school. I love the hours and it is still new to me, so there is a lot to learn. Diabetes, OMG! Despite wanting to have nicer hours, I couldn't let go of my inpatient job. I still work there PRN, typically three shifts per month and have the option to pick up more hours during the summer if I want. Three shifts in a row was starting to take a toll on me, but if you split up shifts so that you limit yourself to two days in a row, I think you'd be fine. If you want to do this, start with a smaller hospital in the summer and see how it goes. Is it possible to go to part time or float with your school nurse job? That would allow you to shift back and forth as you like or need to. Do keep in mind that starting on L&D, you will be a night shifter. That is the hardest thing these days for me and I used to be a real night owl. Keep trying if you are really interested and good luck!

This is what I have experienced, or this with minor variations, at most of the places I have worked. However, right now I work at a large teaching hospital and we do things a bit differently. Each day a mom-baby nurse is assigned to be the "baby nurse," however that nurse does not enter the room until an hour after delivery. When delivery is imminent, we call our charge nurse who acts as backup in the delivery. She will typically dry the baby, complete and apply ID bands to the family, put a hat on the baby, and hang pit. If need be, she will draw cord blood or package up a placenta to send to the lab. She also may fetch things like methergine or hemabate as needed. If there are known risk factors, we call the peds team to come down for delivery. If baby is good when they arrive, they often just leave baby on the chest. If baby needs a check, they do it at the warmer as quickly as possible and leave or take baby to the NICU if needed. Once the immediate stuff is over, the L&D nurse is responsible for the baby, but no documentation is required, no VS. We make sure baby's breathing is good by observing the couplet, ensure there is no central cyanosis, assist with initial breastfeeding, ward off pushy family members who want to hold the baby during that first hour, etc. Only if baby appears to be decompensating or in distress do we do anything other than protect mom and baby. If we get an unexpected problem at delivery, the charge nurse and L&D nurse do the initial resuscitation, just some stimulation and suction on mom's abdomen, or whatever is needed and call the peds team if a full resuscitation is started. At the one hour mark, the baby nurse comes in to do VS, measurements, eyes and thighs, head to toe assessment, suck reflex/latch assessment, and call to peds resident for newborn exam. They also take the tube of cord blood collected by the delivery provider and send to lab if needed. (The L&D nurse is responsible for ensuring that gases and placenta get sent as quickly after delivery as possible if they need to be sent.) The baby nurse also starts preparing the family for discharge by documenting information on who their pediatrician will be, whether they have a car seat and transportation, whether they plan to circumcise, whether they need any assistance at home, and so on. I have to be honest that this process made me nervous initially because I was accustomed to getting VS immediately and q15min for the first hour, then q30min, and so on, but it works really well. It ensures that mom and baby get as much bonding and breastfeeding time as possible in that first hour. Everything else can wait. Plus, it avoids a stranger coming into the room immediately after delivery. Our moms, with very few exceptions, have already met providers, students, attending, and charge nurse before delivery, so all the faces are familiar. By the time the baby nurse arrives, they are cleaned up, sitting up, covered, etc.

The first bunch of cervical checks I did were not cervical checks. They were me with my fingers in a lady parts, afraid to go in further, and feeling nothing of clinical relevance. Finally, an experienced nurse told me to slide along the bottom of the lady parts (posterior if the patient is supine) and go in really far, then start "looking" with my fingers. The cervix is often much further back than you might imagine. Walking is for when you are already far enough in, but the cervix is too posterior to reach without a little help. Walking won't help if you aren't in the right vicinity. In early labor, I always have the mother put her fists under the small of her back and use light fundal pressure. Once I figured out what I was doing, it was a breeze after that. In five years of L&D, there is only one cervix that I absolutely could not reach for assessment after figuring out what I was doing. I have short fingers, so I simply couldn't reach. That patient was a prime at 37.1. Even though I couldn't feel her cervix, the clinical picture told me that her cervix was very posterior because she was just not in labor. I told the physician this and he said we needed to know for sure, so I asked him to check her. It was a painful 10 minute process, after which he declared her very posterior and closed. Practice on a cervical measurement board to get the hang of those middle of the road measurements, 5-8cm or so. You will get it with experience, same with knowing when to call the doc and peds team. Even the best of us get surprised once in a while though.

What was the deciding factor in going to part-time next year? I have a family and pets and all of that, so my plate is always full. I prefer full though. When I have too much time on my hands, I tend to get bored and just ignore everything. I need tight deadlines and to juggle stuff to be at my best.

Apparently, the comment I replied to was deleted or somehow got lost when the thread was moved. I'm unable to delete my comment and I didn't want people to wonder who in the world I was talking to.

So, you are going to school in a traditional brick and mortar program where you attend classes on campus?

I am in the process of applying to an FNP program. I work full-time as a school nurse, a job where I get to make my own schedule. I choose when I am at a school and when I am at my office, and occasionally, I work at home. I also have a PRN job at a hospital, working 3 shifts per month inpatient so that I can pick up hours during the summer when I am not doing my school nurse job. The program to which I am applying is primarily online, though there are 3-4 day intensives at the beginning of each semester, and it is primarily full-time, though they do allow part-time attendance. Because it is a DNP program, it is nearly three years (8 continuous semesters), so part-time would probably be closer to four years. I came to nursing later in life and four years is a huge chunk of time. However, my family needs me to work full-time. Who has experience with a full-time FNP program? Is working full-time during the program feasible assuming that I could schedule clinical around work once clinical hours begin in the second year of the program? Or am I just being ridiculous? To be clear, this is not an online program from a school that does competency based, fit in all the credits you can each semester style of learning. This program is at a large reputable university that has begun expanding into online programs to keep up with the times. It is fully accredited, both the university itself and the nursing department, so this is not a "gimme" sort of degree. I appreciate all perspectives. Thank you!

In my experience, it really depends upon the hospital's model of care. I have seen LPNs who take care of infants immediately upon delivery, even assigning APGARs. I have seen L&D RNs taking turns "catching" other nurses' babies for them and caring for them while the mom is recovering. I have seen post-partum nurses assigned to L&D to do transition care of infants. I have seen L&D nurses take care of their own babies until the couplet is ready to move. In most every case, this initial care is passed on to a post-partum nurse within a couple of hours, or the primary LDRP nurse once the mother is recovered. But as others have mentioned, parents should and do care for the infant's basic needs, and call for assistance when they need it. Unless the baby is in a higher level of care, the nurse should always encourage the parents to do the infant care as part of their discharge education.

I think if it is something you feel strongly about, you should take the L&D job. However, I can also tell you that after doing L&D for a year, I was moved to working Med-Surg. I was none too pleased, but I learned a lot of things that I feel were very helpful when I returned to L&D later. Sometimes you get very complex patients on L&D and it's very helpful if drips and lines don't scare you and if you are familiar with some of the things that routinely put someone in the hospital. Any acute care experience can be useful to you.