AmberL&D/RN

I have worked in numerous facilities and have found that it is up to the anesthesiologist. I have worked at one hospital that the anesthesiologists would refue to put it in unless ALL family members stepped outside. They wanted minimal distractions. Monitors had to be turned completely down and tv or radio OFF. On occasion if the FOB refused toleave some would let them stand off to the side but be behind the nurse so as not to see or interfere withthe procedure. I found that if I informed the family well enough in advance that when he got there they would be expected to leave the room it went over better. I would say something to the effect of it being a good time to make phone calls, get coffee, snack whatever. Most of the time it ws no problem, but we woud never let it escalate. The nurse was the one responsible for clearing the room but if I had a Dad that was adamently refusing to leave I would let the doc handle it, since the dad wasn't bothering me! 9 times out of 10 the anesthesiologist would never say anything to the FOB, but I heard about it later from the doc. But whatever, just let it roll. My job is to keep family happy, and patient safe.

LD_RN_OH... That was a typo between "IV" and "catheter", shouldn't have been a coma. I meant IV catheter. Thanks for the feedback, I thought maybe I was just being sensitive and feeling defensive. I have spoken with some of the other nurses on nights and they have a dislike for the way she is about the inductions but no one will say anything. I will probably just keep my mouth shut but continue to practice within my scope of responsibility

Just want to throw an incident out there to get some feedback on whether or not I am over reacting... This hospital I am working at staffs 1 L&D nurse, 1 nursery nurse and 1 PP nurse on nights. Days has 3 L&D nurses and the rest of the staff the same. They have one dayshift nurse that comes in at 0530, I thought to help get the inductions ready. Here is the situation... I had one patient all night, then at 0430 primip comes in huffing and a blowing, doing great! 0500 I am trying to get IV, table, ya know, all the goodies ready for her. The day shift nurse comes in at 0500, and two inductions start rolling in the door at 0530. Prior to them getting there I had pulled all the papers, prenatal, filled out as much as I could with the info on the prenatal, started the delivery papers, etc and put them all inside a chart (not in the brackets) I had also pulled all the things for each ones IV, catheter, fluid, etc and had the rooms set and ready. SSSOOOO>>> I am kinda busy with this one that walked in in labor and the day nurse is sitting right in the middle of the nurses station and says to me...you know...you should have had these IV's spiked and primed, Pit mixed and spiked and primed and everything hanging in the room so all I had to do was go in ans start the IV." Later I found out that she had said to the PP nurse that the admission papers should have been more completely filled out with all the papers in their respective dividers. When she made the comment to me I could feel my blood start to boil. All I could say to her was "I'll do what I can" I felt like the NERVE of her, here I am trying to get things ready for this delivery and she says something like that. I told her I didn't routinely mix up meds for a pt. that wasn't here yet and I walked off. She had also said to the PP nurse "I wonder what {the director} would think...two agency nurses here all night doing nothing" (the PP nurse is also agency) I had pretty much done all I felt I could do for these patients seeing that they weren't even here yet. She routinely gets a pat on the back for being so quick in getting the inductions started. Now I know how she does it. She has the other nurses so afraid of her rath that they fill out all the papers and I mean everything on the admission down to "lungs clear to auscultation bilatarelly"!!!! before the patient even arrives! I have a real problem with that. My dileema is now Do I confront her about it now that my blood is only simmering? Also, her comments have made me not want to do a gosh darn thing before the pt gets there. SO... do I continue and do the things that I can do or do I go above and beyond and do what SHE expects? I don't have a problem doing what I am able to do but if I have someone in labor they do take precedence over an elective induction. Part of me thinks ya know, I am not gonna do s%#t for her, then the other part says, you really need this contract don't blow it suck it up and do it PLEASE HELP

I am sorry about you r experience. When I had my son I pushed with for 3 hours being OP. He was definately not coming. After a manual rotation he was born 30 minutes later. In the process I broke my tailbone. (all without an epidural). I remember telling my nurse if the pain in my back would just ease up I would be OK. I too was told I wasn't pushing effectively. Since that is my only birth I couldn't tell you if it is more painful, I just know it hurt like hell. As for the nurse not allowing you to hold her hand, I don't know. Many times I have allowed a patient to hold my hand during a contraction only to find them with a death grip feeling like she was about to break all my fingers and not letting go. I have literally been brought to my knees by a patient squeezing so hard. Maybe she didn't want to expose herself to the possibility of that. I know I think twice before I give a patient my hand to squeeze. I encourage other forms of expression of pain. Squeezing doesn't make the pain of the contraction any better and IT HURTS whoever is one the other side of that squeeze. Hope this gives alittle insight into her unwillingness to let you squeeze her fingers. It probbly wasn't that she was trying to be unsupportive, she maybe just likes the use of her hands! LOL

When this doc got there he said he wasn't going to check her. He said if it wasn't breech he would just flip the baby over like it was. I was like "whatever makes you happy...crack is crack!" Well he did check her and I read in the progress notes later he documented butt was at +3!!! Even still... let her sit for almost 30 min with this anesthesia quack trying to put in a spinal. In to OR time...0109 cut time...0132!!! "BUTT"...whatcha gonna do?!?!?!

What they meant by not delivering on nights was that they hydrate and sedate and keep that up (or try to) until AM. This doc even had me Terb a 36+weeker. And yes, THat is me, one in the same that worked the hellacious antepartum at a different hospital. I thought I WAS getting a vacation by getting out of that hospital. My friends at the hospital I trained at called me the s*it magnet. They even got me a keychain before I left that said "chaos, panic, disorder...my job here is done". I don't know whether or not they deliver breech lady partslly at this hospital. I doubt it since there isn't any type of NICU. Just one lone nursery nurse. AND... I definitely don't want to precip a breech!

I just statrted a new contract with a very small hospital. They have 2 OB docs and 30-40 deliveries a month. "they don't do deliveries at night" is what I was told by the other nurse working there with me on nights. Well, since I started there they have started delivering at night! LOL! Definitely had a pretty bad scare the other night (2nd night) g2p1 came in ruptured while getting out of wheelchair to bathroom, light mec. Anyway.. get her to bed start asessment, call report, doc says go ahead and check her. WELL... she is 6/100 and BREECH!!!! I call the doc back he says stat US, no problem, right? Wrong... Radiology has to be called out at night and it will take 45 minutes. Then paitent starts having "pushing pains" HOLY MOLY... she is complete and butt is at +1. Teach patient panting no pushing run and call the OB. He is ho-humming around (this particular doc doesn't like to come out at night and I found out he lives almost 1 hour away. I told him we hadn't had u/s yet but I knew what I was feeling. I told him that either way if he didn't beleive me about presentation he needed to come anyway because she was complete. I was thinking I don't have time to argue with you.just get you A#$ here! So I go back to room and she is REALLY panting. I pray like I have never prayed before for a patient. Get her in trendelenberg, I called to desk and asked the other nurse (nursery) to bring me terb. Well, troops started showing up for c/s ONE HOUR LATER!!!! Delivery time was 1 1/2hr from time of complete. The OB wanted anesthesia to sit her up for spinal. Not a one stick spinal of course, it took him 5 tries. Apgars...3/7/8. The whole time the c/s going the doc is griping about "having a day job too". I was in shock. He was giving me such a hard time about him having to come out in the middle of the night. See, two nights before this one of his patients precipted because he didn't make it(that was the first time I had met him). I told him "well I couldm't deliver thsi one for you" he kept on and on. Finally I said "well maybe you should have gone into dermatolgy" He didn't like that at all. Then later I found out he told the other OB doc he didn't like me. THE NERVE of this guy. He never once said thanks or even showed any type of appreciation. The family was very appreciative because they knew the seriousness of this. The family kept asking me..it is gonna be alright, right. I didn't know what to say. I DIDN'T truely know if it was gonna be OK. My mind was replaying over and over how to deliver a breech if necessary. But only seeing it done I was SCARED. Later I joked... I din't know who had passed more meconium...me or the baby!!! LOL

I have given Ativan to some pregnant patients I have taken care of. I don't remember what trimester, though. If she is concerned have her contact her OB/Gyn and see what he has to say. Good luck and I hope she starts feeling better soon.

Last night I had to stand my ground regarding staffing issues. I was on APU with an orientee, (no tech or secretary either). Got a call from triage wanting a bed for a g3p2 drop in (no doc or prenatal care). Thing was is she said it was her due date and had previous section x2. Came in for ctx, and ?srom, So they wanted to send her to antepartum to "R/O labor" I had 5 other patients (including 2 cervidil inductions, a prom at 29wks, a 33 wk PIH, and a 35 wk complete previa) So three of them were on Cont monitoring. I was like OH NO YOU DON'T... rule it out down there!! I am not gonna be 2 floors up from the OR with this patient! But I was just the "panicking antepartum nurse". This hospital has a different idea of what "stable" is than I do, because they say 1:6 with stable patients. Since my only help was an orientee she really didn't count on paper as being a licensed RN, so technically it was just me. They do staff with only 1 RN on the floor quite frequently which I totally disagree with. Especially with what they consider "stable" But...I am just doing my time now until my contract runs out...tick tick tick Amber

The other night the residents did a forcep delivery because "somebody" needed practice. YIIIIIIKES!!!

I have worked in both types of environments. In a teaching hospital I have found that you have to call the residents for EVERYTHING!! I prefer a non-teaching hospital over a teaching hospital for this reason. Maybe it is just the residents at this particular hospital but it is like you can't win. These residents believe they know everything about everything and if it is not in the books then it doesn't work or isnt the right thing to do. If you give a ivf bolus for a decel without an order then you were wrong and trying to induce pulmonary edema. If you don't you should have. They have to be backed up by the books for everything they do...For example measuring fundal height on a prom that started bleeding out. Stating that the "books say" that with an abruption the fundus will rise, despite that the blood is escaping, therefore, no rise in fundal height. They don't have the experience to fall back on that a certain intervention works so the only resources they have to fall back on is the books. We all know... L&D is not always black and white. In the time at this particular teaching hospital I do feel like some of my skills are going to the wayside. I am currently looking to get out of the teaching environment. But as I said before it may just be these particular residents, so if you really want this postion, give it a try and decide for yourself. If it is not for you, there are other jobs out there. You may actually like it better due to the fact that there is always a doc in house,. That in itself is always reassuring. Good luck in your ventures!

As a nurse that currently is working on an antepartum floor and in a BAD situation... I don't see any of the patients as "stable". They are all ticking time bombs if you ask me or they wouldn't be in the hospital. Any antepartum patient has the potential to turn "unstable" at any given moment. With 6 moms you have to take into consideration a minimum of 6 babies which totals 12 patients. Sorry this didn't really answer your question though. Amber