cubbynurse

Where I work, if the parents have consented for a circ the baby will be circ'd before discharge. The RN assigned to that mother/baby couplet is responsible for setting up the circ room, applying the emla cream or drawing up the lidocaine, and setting up the baby for the circ. She is also responsible for bringing the baby up for the circ and doing the checks after. I think its something you'd have to ask about in interviews.

I passed boards June 23rd and started work on a High Risk OB floor July 28th. I had a good relaxing time off to review (yep, I took my books to the beach!) and I'm really enjoying work. I have 7 more weeks of orientation but my preceptor has really pushed me hard and I'm feeling pretty confident...and hoping that come mid-October when I am actually taking patient's on my own I am still this confident!

I am a new OB nurse (High Risk Antepartum/Postpartum) and I am about to start week 5 of 12 of orientation. I recently cared for a patient with preeclampsia who had been treated with magnesium. She is a healthcare professional but not in the OB field. She was questioning why she was not being given a diuretic to treat her BLE edema. I know that diuretics are ineffective antepartum and have not seen them prescribed postpartum. I explained that they were not commonly prescribed and that her body would naturally diurese but I felt bad that I could not give her an explanation that satisfied her. My preceptor told me (not the pt) a diuretic would most likely not be prescribed unless the pt developed other complications, such as pulmonary edema. Does anyone have a suggestion of how I could have approached this? I do not want to insult a pt's intelligence but I also do not want to overstep my boundaries in giving an explanation.... Any thoughts would be much appreciated, especially as I am sure I will be in this situation again at some point!

I am having two issues currently during orientation and I don't know how to go about either of them. Issue #1: I'm not sure if my preceptor is always following proper procedure. Sometimes my preceptor will do something that she has recently told me I can not do (i.e. excessive verbal orders, putting in orders, such as for a diet, without ever talking to a doctor, taking orders from a med student when the resident is in the middle of surgery). This always confuses me completely because she will have just recently told me I specifically cannot do this thing. I'll ask her for an explanation but I don't really get one. My mom (who is not a nurse) said it sounds as if my preceptor is not supposed to be doing these things and that is why she can't give me a good explanation. I'm concerned that I'm learning incorrect shortcuts and I thought that part of orientation was to learn proper procedures for that hospital and unit...and I don't feel like that is happening. I don't want to get anyone in trouble here but I also don't want to learn the wrong thing, make a mistake, or cause harm to a patient. Does anyone have any suggestions of what I could do here? Issue #2: I cannot delegate. I know this has been brought up a lot....but my situation is a little bit unique. While in school I was a nursing assistant on the same floor where I am now a nurse. I loved the unit and despite my concerns about this transition, I wanted to stay with this same patient population. While I was a student many of the other NAs would complain to each other and me that the nurses were "lazy" and that was why they were making the NAs do their work. I would never complain like this and tried to point out that we were all busy and all trying to take care of the patients. The only time delegation bugged me was when I actually would overhear a certain nurse refusing to do something a patient requested, like take out her garbage, because "that's not my job, I'll send in the NA" (technically not my job either, but if a patient asks me and I can physically/legally do it I'm not going to refuse to do something!). Even in school I did not have a full concept of how much charting I would have with a full load of patients. I was very nervous to delegate but my preceptor encouraged me to practice doing so, so that when I was too busy to do all the RN and NA work I would feel comfortable delegating as appropriate. I am polite when I ask (and having been an NA on that floor I know very well what can be delegated to an NA) and always say to please let me know if it cannot be done. Last night I asked an NA to check a blood glucose on a patient. She said okay and when I went to check it had never been done. I asked her what the result was (thinking maybe she just hadn't charted it) and she said she hadn't done it. I asked her to please let me know, next time, if she is unable to get it done so that I can go and do it. She just looked at me and walked away. I did the chemstick myself, which wasn't a huge deal as I am fully capable of doing it but I felt like my attempt at delegation was completely ignored. I don't know how to word my delegation any better....and I am scared that I am going to be labeled as a "lazy nurse" if I continue to delegate but I also know that if I do not ever delegate I will be swamped. Any thoughts?

I felt pretty confident when I finished the exam and walked out.....it took me several tries to type my credit card number in correctly for my results 48 hours later though because my hands were shaking and I had barely slept. That confidence definitely waned over the 2 days following the test, but I had passed.

I would say that it would be critical to have another nurse show you (and possibly multiple times) how to properly check for clonus. I just started on a high risk antepartum/postpartum unit and many of our moms have PIH/Pre-X, so we check for it often. I keep asking for a demo of it because I have yet to have a positive clonus check and keep thinking I am not doing it right.

I definitely hear what you're saying....I'm terrified at the thought of delegating. I worked as a Nursing Assistant on the same unit where I am now a nurse. Unfortunately, some of the NA's consider some RN's "lazy" when they delegate. They see the RNs sitting there at the computer charting and think they aren't doing anything, therefore the RN is lazy. I had been through my nursing classes and understood the whole delegation thing so it only bugged me when the nurses were unwilling to help out because they felt a job was "beneath" them (aka I won't take out an overflowing garbage bag when I leave the room....instead I'll walk out, page the NA, and have her go empty it). Unfortunately, I am now scared that if I delegate I will be labeled as "lazy" too. My preceptor keeps encouraging me to delegate and says I need to learn this because as I take on more patients I will become more and more busy and be unable to do total care myself, despite the NA duties being second nature. I just don't have the courage to delegate yet to the same NAs that oriented me to the unit 14 months ago.

That'll be a great story for him to tell his baby when baby gets a bit older!

Can anyone tell me what is involved in becoming chemo certified? Thanks!

K new grad here so I've got a few questions :) I was recently informed that I will need to become chemo-certified for work so that I can give methotrexate for ectopic pregnancies and chemo to our pregnant patients with cancer. Has anyone ever been required to become chemo certified while working only on an OB floor? I guess I understand the reasoning but it still seems kind of strange and it makes me nervous because I feel like the chemo drugs are ones that we won't see very often but can still have some very major side effects. I just started on that floor as a nurse but while in school also worked there as a NA. I remember about a year ago or so we had this patient receiving methotrexate and was complaining about significant pain so bad that she needed dilaudid to relieve it. What about administering this drug would cause such significant physical pain? I was looking it up today and saw that its also used to treat some autoimmune diseases (I think) so that didn't make sense. I also remember another patient who had had several ectopic pregnancies...received methotrexate for the first two and then after that they removed the affected the fallopian tube. I was reading some info (I think on Medline) and it said that people taking methotrexate have a harder time getting pregnant. Is that why they would limit the doses? Or do you think that would only apply to people that take the drug on a regular basis? Does anyone know of a good drug reference sheet or place I can find info on methotrexate specifically for ectopic pregnancies? Everything I find seems to be just general information on the drug and not what I am looking for. Lastly, has anyone else given chemo to pregnant patients on their floor? I don't know how soon I'll be certified or if they'll even have me working with these patient in orientation (or if we'll even have one then), but if I had questions about this would I be better off asking them here or in the Oncology Forum? Thanks in advance for help on ANY of this!

Not a thought, but a question....what do you mean by "no cord"? Does the cord detach when the baby dies in utero? Sorry if this sounds stupid...

i just finished week 1 of my 12 week orientation. for the first 8 weeks i am 40 hours/week and then weeks 9-12 i drop down to 32 hours (what i got hired for)

i don't think it necessarily indicates a potential problem with the hospital....as an update, i was incorrect in calling it a signing bonus apparently. thats how it was described by the recruiter but the person who processes it in HR (who i was talking to for more info on it) stated that its actually more of a tuition forgiveness policy.

Look into it for your state...I was told that in IL there was no opportunity to work as a "nurse" until you had passed boards (new nurse practice act as of 1/1/08), so "graduate nurse" was not an option for me.

All I will say to that is that vents were not as scary as I expected....I did my role transition/final rotation of school in a NICU and was terrified to get a ventilated baby. I was absolutely positively shaking when I had to suction for the first time but learned there is always someone there with you when you are suctioning.