L&Doldtimer

Been working nocs for almost 30yrs. now-less chiefs running around, after 9 or so usually less visitors, more independence. Best nurses work nocs! :) But gotta be able to sleep during the day-will NEVER work if ya can't. Positive attitude-sometimes at first it freaks ya out thinkin about bein' up all noc, but it really isn't that hard to adjust for most. Trouble is, it's really a "daytime" world for everyone else-once ya get them trained when and when not to call, etc. you can deal with it! Good luck to ya!

Do a rewrite on that paper stating what it REALLY says-"Dr. E doesn't give a _ _ _ _ about his pts or their babies, so if there are problems, remember-Dr. E's ego ALWAYS comes FIRST!

Never seen a cervix go from 5-6 back to 1.... Did you or the "seasoned RN" recheck the pt after the resident? I would trust a seasoned OB nurse before I would a resident! Don't know why it should make it any more difficult to deliver her lady partslly just becos she already had an epidural-just get her BOW ruptured, start the Pitocin and keep repositioning her, etc. (I take it she was being induced for a medical reason so sending her home was not an option?!)

Thanks...once had a doc tell me he almost always told his pts. they were farther along than they were the previous visit! Then they get to the hospital and we have to explain how one "goes backwards" in dilatation!!

Practice, practice, practice! And then you'll find a doctor's 4 is your 2!

I, too had a cerclage placed about the 15th wk of my pregnancy, but it was for cervical dilatation, not shortening. Does anyone else out there use the fetal fibronectin test for possible PTL threats? We have started using it-too early for me to evaluate... Connie

Shortened cervix as a diagnosis?? Are these pts. ones who previously had a preterm delivery? Noncompliant pts. that the docs want watched? I personally haven't heard that one yet, but it sounds a bit fishy to me...

Shannon, Sounds to me like you are in a much better situation at your present hospital-even sounds like if L&D didn't work out, you'd probably not have a problem going back to what yur presently doing (good NM support can make a WORLD of difference). I'd say give it another chance-I've been in the OB field for 29yrs and I wouldn't trade it for anything! It can be really rewarding, but it also takes time to get a "feel" for it (I'm talking about L&D here). Don't be so hard on yourself and ask lots of questions-get lots of experience-give it a couple of yrs. at least and then see if you don't feel different. L&D isn't something that's learned overnight and NOBODY is born with the knowledge! We all started out knowing almost nothing but textbook and we all know L&D is almost NEVER textbook! On a good unit, with supportive docs and a knowledgeable NM, you should do great! Good luck to you! Connie

Thanks for all the responses-wow, quite a diversity! Our hospital only does 50-70 dels. per month, so we are not staffed quite as well as most of you are-only have 21 nurses that work our unit, so 4 procedures before noon puts quite a strain on us. We all work all the areas, so L&D is not a separate entity, either (means that after 4:00pm the nurses are the ones answering all the call lights, the phones (our security system is set up to be answered by the phone also), etc. (no clerks or CNAs). Anyways, it was interesting hearing how other units work. Connie

Hello all-I would like to know what other L&D units out there do as far as the number of procedures (inductions and c/sections) they allow the docs to schedule per day... I have worked in one hospital where there was a schedule book that was kept and no more than 2 procedures were allowed to be scheduled per dayshift and two per nightshift-the docs would call from the office and the book was consulted as far as when and what and why. If we were busy, the inductions got postponed. The hospital I now work in, the docs schedule as many procedures as they want-never consulting the nurses as far as if the staffing is such that we can handle what they want to do. We had 2 c/sections, 1 version (that was pretty much guaranteed to be a section) and 1 induction scheduled the other day. Our usual staffing numbers can't handle that load and so they beg everyone to work extra, but I believe the situation is still unsafe for everyone. I think the procedures should be limited and we have discussed this at staff mtgs. and agreed that 2 per day should be our limit, but no one around there says "no" to any of the docs when it comes down to it. I think we should band together and not come in when they do things like that, but there are always those that come in anyway and so they get away with it. How do other units handle this problem? Any discussion on this issue? Connie

Elizabeth-Have you been to the forum at Delphi-"Traveling Nurses and Therapists"? It is all about traveling and most questions get answered by other travelers speaking from experience. Where are you working now? Where is it you wish to travel? They have great advice on the agencies, contracts, etc. on that forum. Connie

Hello-any nurses originally from Iowa who are now traveling? Would just like to chat about differences, etc. Want to travel but just can't seem to make the final committment. Labor and delivery is my specialty BTW. Connie

Wow! You measure their member? I can just see the arguments that would ensue at our hospital over that one! I think having them do the circs in the office would be great-that way the whole procedure, along with the tylenol we give before and 4 hrs after, wouldn't throw such a kink into the whole breast feeding process. Tough to get a baby awake sometimes afterward and if they were done later perhaps the breast feeding hurdle would be past. Connie

Crystal013, I agree with you for the most part, except for the epidural part-I take it you are not all for them...? Frankly, I think epidurals are comparable to sliced bread in OB. A comfortable, enjoyable birth experience-why not? What I DON'T agree with is, the patient getting her epidural and the nurse sitting at the central monitor, doing her charting or whatever else because now she isn't "bothered" by the patient anymore! I believe in actively turning your pt. every 20 minutes, side to side and letting her "labor down" so the pushing is not started too early resulting in loss of maternal push power at the end. I support whatever method my pt. wants to use for delivery, but I'm also the first to question their decision to rule out an epidural from the git go. I do get into conflicts with our docs over letting them labor down (I don't think they've even HEARD the words used before at our hospital) due to impatience and the belief that pushing has to start right away at 10 cms. If the woman is having a fast labor, that's one thing, but it tears at my heart to have my pt. progressing slowly when the pain is so great. Just MHO! Connie

I see this is old, but maybe we can start it up again... I am originally from Fort Madison, now across the river from Burlington in Illinois (FINALLY the road is open both ways across the river-that flood was something I'll not soon forget). Work at GRMC in West Burlington now-thinkin' bout traveling-was looking at L&D position in Cedar Rapids at Mercy-shoulda gone for it.... Ah well.... Connie

Same here-except we are supposed to sing during the procedure! Geesh-think we've gone a bit overboard there, eh? heh heh

RNHeart, Sadly I would guestimate around 80% or the patients I encounter could care less what is happening to their bodies during the pregnancy, much less take the time to participate in any kind of classes to prepare them for delivery! So the sooner they are UNpregnant the better because they always "know so and so who had their baby early and did ok" and so they jump at the chance to be induced if that is what the doc suggests! I will never be able to understand their way of thinking-maybe becos it is not thinking at all! Connie

Hospital I worked in 9 yrs ago we were given the responsibility to do those procedures, now the docs in my present hospital barely want us doing vag exams... They tell us from their beds if the pt. needs pain med or not! It stinks coming from a l&d unit that made you feel you were competent and trusted and going to one where you are made to "check your brain at the door"! I am curious also-are there any other hospitals out there where the mentality still persists that the nurse is the doctor's handmaiden and the managements position maintains the "god-like" image of the docs-giving them whatever they want and no questions asked? connie

Not only do we use a consent but now we are doing the "time out" thing they do in surgery (to make sure they aren't working on the wrong arm or leg) also. Hmmm....let's see....why ARE we all gathered here in this labor pt's room and WHY DON'T YOU JUST PUT THE DANG THING IN??? We take the monitors off of our pts. and spot check if it takes longer than it should.

Frankly, I think the architecture is a bit messed up-something that size coming from an opening that size is a bit unnatural to me. Personally, I think epidurals are the best thing to happen to labor and delivery-as long as they aren't done way too early and done so they work well. I love it when mom is still comfortable enough to enjoy her delivery and the baby afterwards. Anything I can do to ease my pts pain, I am all for. I am NOT saying stick the epid in and then sit at the desk and wait-I am at my pt's bedside turning her and explaining what to expect with pushing and so on. At least we don't use IV alcohol for PTL anymore....:wink2:

Nora-I didn't mean to sound as if all the changes in OB have been for the better-we have come a long way in quite a few areas. I too remember the soap suds enemas and shave and strapping women down to the delivery table. I remember when we cleaned our own delivery rooms and had only one FHM on the unit (we are still using it, I believe!). I think with more women becoming obstetricians, the field has become more sympathetic toward our pts. It's mostly the paperwork and now it's the computer charting-don't get me wrong-I love the TraceVue program for labor, but I think Meditech sucks and that's what we use otherwise. And I am all for being my pt's advocate, but I have been called on the carpet for it a few times. There are a lot of other, what I feel are unnecessary procedures done to my pts that I would like to see them object to, but most of them do whatever the doc wants and don't blink an eye. We have one doc that routinely puts internals in each and every pt.-doesn't consider asking the pts permission or if I would like it done. Time for me to make a change I think. Connie

I am so glad to read where there are others of you out there considering traveling who sound like you're about my age, with the kids outta the house and yet aren't the most confident about the change either! I've been wanting to try this for a couple of yrs now but just can't seem to get up the nerve. I too registered on one of the sites and OMG! the number of phone calls was unreal! At least it made me feel wanted, heh heh. Congrats on what seems like you're dream job and location! Connie

I, too, wish I could retire-or at least do something else-archaeology in Egypt or something! This is one of the things that gets me also... Medicine has become so specialized, but now it seems, at least in the clinical setting, they are lumping us all together-answer stroke questions on my pts., geesh, what a bunch of busy work! Wonder what it is gonna be like in 10 yrs.? Joint commission, it seems to me, was out of rules that made sense yrs. ago and now the stuff they come up with is just insane! They want us to label the lidocaine cup on our delivery tables! It's the only dang medicine on the table and we are suppose to label it.....Well, I guess there is the pan of H2O, but come on! At our hospital if joint mandates it, then we do it twice what they recommend. If everyone else's normal is say 40, ours is 35. Drives me nuts, but then I guess I've been that way for yrs.!

I'm bthinkin 20 minutes is a long long time when you've got a prolapsed cord, unsuccessful vacuum attempt-just a FHR in the basement. Where I worked before the CRNAs were required to stay in-house if they had an epidural going-where I am now, they are out the door before the pt. is even comfortable sometimes! I would much prefer to have anesthesia at the ready. I've been in on 2 "local" c/sections and I don't think the local did the trick at all. It was a horrible experience both times but in both cases we had good outcomes. We were 7 minutes one time from finding a cord prolapsed until the baby was out-that's my idea of code red. Connie

I don't know where my brain went to...Sorry...I stand corrected and can't believe I said that!