LaborLovinRN

Good luck, I hope you hear soon from Frontier!! I am in Class 112 - CNEP student - and just returned home from Frontier Bound. I have to say it was a great experience and I'm very excited to part of such a wonderful community :)

I came across a very interesting article in the current issue of Nursing for Women's Health. The article featured The University of Utah Hospital and a new way to assess pain - developed specifically in relationship to laboring women. They have developed a "Coping with Labor Algorithm" We all know that JCHAO mandates an adequate pain assessment, but how many of your patients look at you like you are crazy when they are in pain and trying to deal with UC's and you want them to rate their pain on a scale of 0-10? This new method really makes sense and the article states it is JCHAO compliant as well. It involves asking the question "how are you coping with your labor?" and looking at physical and emotional ques as well. This seems a much more effective method than charting pain 10/10 on a primip that is still smiling and giggling! (you all know exactly what I mean!) Have any of you heard of this, or better yet, use it in practice? I think it is a great idea and have emailed the University of Utah Hospital to get more specific information on implementing a trial on my unit using the algorithm. Curious to hear your thoughts! :typing

On our unit there is definately a difference between a Tech and an extern. Our techs function as techs, and the externs are assigned to an RN who they work with the entire shift. Right now I have an extern on a regular basis - 2 days a week, and this is her second semester with me. She plans to work L&D when she graduates next year, and has also been a labor doula for years. Now that I have had her for a while, I allow her to do as much as possible within her scope. With permission of the pt I allow her to do all she can, and then I check behind/with her. I tease her and tell her that I will be her assistant! It is a great experience if you can find an RN who will take you under wing as an extern. I was fortuante enough to find a willing soul to do that for me, and now I am passing my good fortune on by teaching someone else! PS...try talking to the supervisor of the unit and ask if you can follow an RN instead of functioning as a tech. Good Luck!

Where I work, the L&D is a "closed unit", meaning no RN floats in or out. It is a matter of training - a med/sug nurse can't just pop in and deliver a baby or circulate and recover a c/s, and I can't just drop in to do a complex wound debridement and dressing change on the surgical floor (it's been way to long! LOL) It's not feasible in my opinion. As far as cross-contamination, I have never heard of or seen this? I'm not sure why that would be an issue if proper/routine universal precautions are taken? Patients deserve to be taken care of by nurses who are qualified to deliver specialized care, if an RN is adequately equipped to work more than one specialty area, I guess it would be okay.

The pt being able to VBAC will depend on facility policy as well as the MD. The hospital policy on VBAC's is usually dictated by the insurance carrier. For our facility, in order for a physician to authorize a VBAC, that MD or the covering MD must be in house while the pt is laboring in case of uterine rupture. (We have 24/7 anesthesia, so that isn't an issue for us) For our Kaiser docs that isn't a problem, they are 24/7, but for the community docs, they aren't going to remain in house, so they don't offer the VBAC option to their pt's. The Kaiser docs will VBAC as long as the pt has not had more than 2 c/s, and as long as the previous c/s was more than 24 months ago. That is just what we do in our little corner of the world!

If you want to work L&D, I think you have made a great first step in taking the initiative to apply for this position. I'm sure it must be similiar to what our unit calls "OB Tech". Before I was an RN, I worked as a Tech, and it enabled my to learn the dept from the ground up. It helped me to understand every aspect of how my dept functioned, as well as learn what the docs expected before I was under the pressure of being a new RN. I know each facility is different, here is some of what our OB Tech's job duties include; Pick up pt's from the ER, hook them up to EFM, get their initial VS, run the UA, and a basic triage of why they are there. Make delivery tables, stock rooms, run to pharmacy and lab as needed, help assist in deliveries - hold legs, record del time and infant stats, etc. And one of the most important responsibilities is to function as the scrub in L&D OR. Our tech's get a lot of training and orientation! They are such an important part of my team, great techs make the dept run much more efficiently. It's a great way to find out if L&D is really where you want to be! Good Luck!

Congrats to both of you who passed, this is definately something to be proud of! WOO HOO!! I took the exam Sept 24th, and will not have my results until the end of October I think the exam was the most challenging I have ever taken, even harder than the NCLEX! Anyway..I'm still holding my breath to see if I passed...UGH!! I too had the Pitocin question, and you are both correct, the answer is 6. And, on the paper exam, that was an answer choice. Congrats again

This is always such an interesting subject to read about when discussed by other nurses. There are always people who will quote statistics about the fact that things "rarely" happen, or that certain emergencies are "unlikely" to occur. However, the fact remains that emergencies DO HAPPEN, and in OB...they happen quickly! I see (with my own eyes) emergencies every single day I work on the L&D unit. On 3 occasions in the last 4 years I have had women come in that have tried to deliver at home, and finally present after a prolonged labor/pushing, only to find that there baby is dead. Is that a large percentage, no, but is it worth the risk, in my opinion, no. Just my .

I had a similiar situation when I first started in OB, and I got lots of advice on how to deal with "the nasty OB". Everything from ignoring him to telling him off. Well, here is how I handled the situation... One day right after a delivery he was being his normal grouch self and complaining about things (and I had done everything 100% correctly). He was sitting at the nurses station making his delivery notes, right as he finished, and I very calmly requested that he come back to the work room because I had something important to talk to him about. Of course he didn't say no because there were many people who witnessed me, very professionally, make the request. When we got back to the work room I said to him..."I wanted to speak to you away from the nurses station because I need to let you know that I do not appreciate the way you speak to me" The very first thing he said to me was, "I don't speak to you any differently than I do any other nurse." I then proceeded to tell him that I was only talking about the way he speaks to me as I can only speak for myself. I also let him know that "I consider myself to be an intelligent and hardworking person, and I'm giving 100% trying to be the best nurse possible and he was making it difficult by undermining my best efforts" Surprisingly he said "I don't mean to do that, and I didn't realize I was" He then proceeded to apologize (believe it or not). Literally, from that point on, things started to improve. It is almost four years later, and this physician and I have a great working relationship! It is really tough to make the first step in standing up for yourself, but in the end, it will earn you the respect you deserve!! Never EVER be afraid to stand up for yourself!! Noone should have to put up this kind of behavior in the workplace! Good luck!!

I work in a medium sized community hospital, we have about 275 deliveries a month. We can schedule up to 3 c/s per day (sometimes 4 if the docs push hard enough) 2-3 AM inductions, and 1-2 PM inductions per day. We also usually have between 8-10 NST's or other antepartum tests (amnio's, versions, rhogams, etc) per day. If we are busy, the inductions get postponed, which happens all the time! It is very rare that any C/S gets postponed, only if an urgent case bumps them. The docs have a fit if their sections don't go on time!

Fetal demises' never get any easier, you can never fully be emotionally prepared as every family and experience is different. I don't think there has ever been a demise that hasn't made me cry for one reason or another. Whether it is for a family who is devasted about the loss and doesn't want to let their baby go, or the crack addict mom who doesn't care/want to hold their child as his/her heart slowly stops beating, it always get to me. I have cried as I held someone's else's tiny angel (because they would not) who was not viable but still had a beating heart, not wanting that child to die being all alone. Every human deserves to feel valued and loved no matter how old they are. I have experienced that situation twice, and I never want to do it again. One other isolated situation that absolutely broke my heart was a full term demise, a beautiful baby girl. The parents were in total denial that their baby would not be born alive. After I delivered the baby and put her up on moms chest as she had asked, she tried to give her baby mouth-to-mouth breathing thinking she could bring her back to life. I cried and dreamed about that one for weeks after. I will never forget the anguish and pain I could feel from those parents, it wasn't like any other I have experienced. Okay...enough, sorry I started to ramble. I am just very passionate about taking care of my demise families because I have personally experienced several losses myself and can relate to what they are going through. A caring and compassionate nurse can make all the difference.

New grads in the Central California Valley start at about $38 hour. After 2 years experience $41+ per hour. At my hospital, the night differential is $6 hour more. We work 12 hour shifts, no weekend differential. I know that CA is one of the higher paying areas in the US. But...the cost of living is outrageous here too!

I don't know a single nurse on my unit who hasn't precip'd MANY babies. I have done three in the past month alone! We don't have residents, so if someone walks in the door delivering, the nurse is usually the only one there to catch! All of our community docs live within a couple minutes of the hosp, but as we all know, babies come when they want, no matter who is at the perineum! The only thing we can do is make the best honest effort we can to get the docs there in time. Usually the docs do not get anrgy with us over this issue, but occasionally to save face in front of a patient they may fuss at us. If there is a high risk patient, the doc will stay in the sleep room, but if there is nothing serious on the unit, they go home and wait for us to call. We have anesthesia 24 hours on the unit, but they wouldn't dare do a delivery! LOL :chuckle Bottom line....you can only do what you can do! As long as mom and baby are safe and healthy, all is well!! Good job!

I always ask my patients if they have any special requests (like does dad want to cut the cord, etc). The day before yesterday I had a patients husband say "we just don't want you to use your triceps". I looked at the patient and looked at her husband and said excuse me? I was clueless, so then he said "we have read a lot of bad things about triceps, you know those things the doctor uses to pull the baby out." Duh...he meant forceps!

We have to take a mandatory 24 hours (split up any way you like-or 2 12 hour days) a month of call on our L&D unit. Our system works fairly well. Every month the schedule goes up along with the call schedule. All the RN's in our dept are divided up into 3 groups by seniority. Group one with the highest seniority. The first 3 days after the call schedule goes up are designated - Day 1 group 1 signs up, Day 2 groups 1 & 2 can sign up, and Day 3 - groups 1, 2, 3 can sign up. After day 3 - it's free game. However, if a person out of group 1 forgets to sign up on day 1, then they have to take what is left on whatever day they sign up. The system actually works pretty well. When we are on call, we get paid a measley $7 hour for sitting at home waiting, but if we get called in, it's time and a half for the first 8 and double time for anything after. I would say we get called in 75% of the time or more, so we always have guaranteed overtime - like it or not!