babynurse357

I know mandatory overtime has been discussed numerous times. I've found plenty of cons about it but no benefits to it. I'm working on a project for my RN-BSN program regarding mandatory OT and I need to list both pros and cons. The only thing I can come up with is from a financial standpoint a facility probably saves more by paying OT than they would providing benefits for additional FTE's. Anybody have any other insight for me? Thanks!

Well as of right now we do staff 1:1 with our labor pts. It was just that somebody brought up staffing guidelines the other day and I'm a little concerned that when we do start having more babies he'll hold us to to 1:2 without central monitoring.

I agree with HeartsOpenWide. In early labor when they have pit already going and start coupling I turn it up as coupling is a dysfunctional pattern.

Approaching the board is out of the question because our OB/GYN is the head of the board. It's a new physician owned facility and he hates central monitoring. He wants the nurses at the bedside and says with central monitoring nurses spend too much time at the desk. It's expensive I know but cheaper than a lawsuit in my opinion.

I've looked on AWHONN's site and can't find any recommendation about staffing when you don't have central monitoring. I've been a labor nurse for 6 years and I've always worked in a facility with central monitoring and the place I am working at now doesn't have it. We deliver about 20 babies a month give or a take a few. A few labor nurses (myself included) are concerned about the safety of having 2 pts on continuous EFM without central monitoring. Most of our pts end up with pitocin during their labor either for induction or augmentation. Then there are a few nurses who think it's no big deal to have 2 inductions at the same time. I've done 2 labors at once but never without central monitoring. Can anyone shed some light on this? Is the AWHONN guideline the same regardless of whether or not central monitoring is available? Pitocin is a high risk drug and 2 inductions per nurse without central monitoring seems very unsafe. Thanks!

Yes the baby is in an open crib and she has the light practically resting on the top of the crib. I do think we have a meter just haven't ever messed with it because I've never needed to with these lights. What's the recommended reading with the bili-meter to be in the right range?

What is the distance the Olympic Bili-lite (the overhead light with like 6 or 8 bulbs) should be from a baby? We are having major disagreements about this at work and don't have the manual. The unit was a used one purchased from a small hospital that no longer does babies. I'm thinking it's like 18-20 inches and another nurse has the light like right on top of the crib which I think will burn the baby. Thanks!

Can somebody tell me the correct distance to have the Olympic Bili-lite (the old one on a blue stand with casters) should be from the baby? Our hospital just bought a used one without a manual and there is some major disagreements about the proper distance. I think it's like 18-20 inches but one of our "seasoned" nurses swears it's only like 20cm and has the light practically on top of the crib. I'm afraid she's going to burn the baby this way. Please help if anyone uses this type of light. Thanks!

Shoulder dystocia is my greatest fear because you never know when it will happen and how bad it will be. We had a t/f in with dystocia, the head was delivered and all attempts and maneuvers they tried to deliver the rest of the baby failed. They put her in an ambulance with the head left out. Needless to say the baby was already dead when they arrived. It's totally a personal choice and I respect that, just wouldn't be my preference.

I think I heard my best/dumbest one yet the other night. A laboring pt's sig other says "too bad you couldn't be like my aunt, she had my cousin an hour after she went into labor." No bid deal I thought until he added "but he came out really fast because he had a cleft palate, that helped" I had to pick my jaw up off the floor then turn around so I wouldn't laugh. Some people shouldn't be allowed to have kids lol.

Let me clarify myself. I was referring to hospital based birthing centers. If there even was one around where I live I'd consider one. Simply saying delivering at home wouldn't be my preference. Kudos to those that do, I've just seen too many deliveries that would have been really bad if they had happened at home.

I'm all for birthing centers that are more like home and use midwives. I'm totally not into delivering at home. Too many things can go wrong-not that they do very often, I just would rather not risk it. Many birth centers with MWs still do intermittent monitoring, etc. A "controlled" environment would be best for me but everyone is different.

That's just dumb that she's angry with you for having the pt push! She should be thankful that you tried the other interventions but had the common sense to know that this baby didn't like where it was at and need to come out. Good judgement call. Doc or no doc you had a healthy baby! Oh, and I definitely would NOT sign that paper. You'd be in big trouble if you had a bad outcome because you wouldn't let a pt push.

Points off for tone and breathing movement. He claims her strip was nonreactive but at 31 weeks looked fine to me. Intermittent minimal variability, but also average at times, 10 X 10 accels, no epidsodic decels even with occasional ctx. What more could you ask for at 31 weeks? She came for decreased fetal movement, also states she hadn't eaten anything but breakfast and it's now almost 8 pm. DUH-feed and hydrate her! I brought this to his attention but he didn't care. He already had his panties in a twist because I wouldn't start the pit. (and yes I was patting myself on the back when I heard she was sent home the next morning and everything was fine-she didn't need to be t/f'd in the first place!)

Definitely ok to cry, it shows that you care. I've had several demises and cried almost every time. A while back I had a mom come in to deliver her 1st baby-not a demise but her husband was in a very tragic (and very preventable) accident just 6 weeks prior. He was killed instantly. Her mom was with her and she had an 8x10 wedding picture in the window (they had just gotten married within the last year). I tried so hard at first not to cry because the pt had requested to her doc that nobody talk about it. After she started pushing I couldn't help it, she was crying and frustrated and sad and excited, as was her mom. How can you not be emotional too? These are the moments that pull at our heart strings and I think God makes our assignments those days. Like it or not, he picks the best nurse for that particular pt and whether you realize it or not at the time you will always have a special place in that family's heart for sharing that memory with them.

Thanks for the input. The previous place where I worked for like 5 years did have 2 nurses present for delivery, so I'm aware of how things should be done (that's why I'm on this mission). What I think is the problem is that we only delivery about 400 babies per year and most of the nurses who work here have only ever worked here and maybe don't see how unsafe it is to only have 1 nurse in delivery. Also, our DON has no OB experience so she doesn't really get it either. Lucky for me I have a coworker who is also new here with previous experience elsewhere who is in my boat. Together hopefully we will overcome our issues. One nurse argued with me one day that we can't have 2 nurses in delivery at night because there are usually just 2 of us here and "these people pay $500 per day for the nursery, so if they want their babies in the nursery we have to keep them!" This is total BS in my opinion. The safety and wellbeing of a delivering mom and babe is WAY MORE IMPORTANT than a healthy baby in the nursery who could go out to mom's room for 1/2 hour or so... I'm just trying to get my ducks in a row before I bring anything up with the DON.

Does anybody have any good evidence based websites. There are several issues in the facility where I now work that need to be addressed. I'd like to have studies to back me up before I go to the DON requesting changes. A few of the issues are: 1.we check blood sugars on EVERY baby after delivery even if asymptomatic and not LGA/SGA/or infant of a diabetic mother,etc 2.if the sugar IS low we give empty calorie glucose water instead of formula 3.all bottle-fed babies get glucose water for the first feeding instead of formula, I have no idea why 4.there is most generally only 1 nurse and the doctor present for delivery-I think we always need a 2nd set of hands. What if mom AND baby crash? 5.we don't do couplet care, which is frustrating for pts at night to have a nursery nurse AND another nurse in and out of the room Any input on these issues would be appreciated. Thx!

We had a couple that delivered a few days ago; when the nurse put the hat on the dad immediately pulled it up so it wasn't covering baby's ears. She adjusted it again to cover the ears. He very innocently said "don't cover up his ears like that he can't breathe!" To think of this guy raising a baby..... In a different delivery I was in the pt wanted to see her progress pushing in the mirror. When I wheeled the mirror in she says "wow! that's an ugly crotch!" i laughed and said "they all are, that's why they're not in a place for everyone to see" Her family then started adding in...."could you imagine if it was like on the side of your face"....."or on your forearm" (as she extends her hand and says 'nice to meet you'..... We were laughing so hard I was crying as the baby is crowning. Times like this keep me going....

The other day we had a G5L4 (all delivered in the last 5 years) with decreased fetal movement. She was 31 weeks and some change. Her biophysical profile was 6/10 in the dr's office so he wanted to do a contraction stess test with oxytocin. We are only a level II facility AND this pt has a history (per pt's verbal report because no prenatal record was available) of multiple preterm deliveries between 30-35 weeks. We refused to start the pit due to her hx. Are CST's even very common anymore-especially preterm? I've been doing this for 5 years and have NEVER done one. (Pt ended up getting t/f'd to a level III hospital and was sent home the next day-they thought she was fine.) TIA

I agree with a previous poster. You need to check with your state BON and determine what is in your scope of practice. If you are practicing out of your scope and something bad happens, you will be held accountable not the anesthetist. At the first facility I worked at we didn't do anything but turn the pump off. No bag changes or d/c'ing catheters at all. Anesthesia did everything. I was suprised to learn that in my state RN's can change the bag and the rate with an order to do so.

I would definitely be searching for a hospital or birthing center that does fewer deliveries and allows for that nurse/pt bonding. I've been doing L&D for 5 years and having 3 deliveries every day would totally wear me out! As for coming off of orientation soon, you need to tell your supervisor that you aren't comfortable on your own yet and that isn't safe for your patients or your license. It's a big change going from being a doula and having one on one time with your patients to make their birth experience individualized and special to not having enough time to spend more than 5 minutes at a time in your pt's rooms. It is totally unrealistic for any director or manager to expect a new grad with no previous labor experience to be able to manage 3 laboring patients at once. I do believe that is even out of AWHONN's staffing guidelines. Hang in there and good luck. Any chance you could get in where you were working as a doula?

The old facility where i worked required a head to toe assessment & vitals initially when a c/s mom came out of PACU, then we did another set of vitals and another assessment every 15 minutes x2 every 30 x2 and 1 hour after that. The new place I am working only does 1 head to toe initially after PACU then follows vitals per protocol with only fundal and lochia checks. I think these pts are just as much a "surgical" pt as anyone else having surgery and deserve the same care. Many have questioned the way I do my post op checks wondering why I do it that way. How does everyone else do it? (I tried without success to find a policy covering post op assessments). They also chart the initial post-op c/s vitals/assessment on the same post-partum vag recovery form.

I've been working OB for 5 years and recently relocated. I'm still working OB and I have a question about "core staffing". The first hospital I worked at delivered on average 50-60 babies per month. We were told there that the standard of care by AWHONN is to always have 2 labor nurses at ALL times-even if the unit is closed. The new hospital I am at delivers about 30-40 babies/month. The DON says she can't staff on "what ifs" therefore there are some days that there is only 1 nurse on the whole unit. I mentioned this to another nurse who has never worked in another facility and she isn't at all bothered being alone. Isn't this falling BELOW the standard of care? I'm not sure I want to be associated with this kind of care!