MomBabyUnitRN

^^^^This

I absolutely don't think it's wrong to tell them you can't take patients. How would a med/surg nurse like to come up to L/D and take a patient? I used to float to med/surg all the time early in my nursing career from a PP/L/D floor. I worked med/surg for years and was comfortable there. Just because we've all gone to nursing school, those in administration believe we can be floated around and take patients wherever we are. Not true; the old days of med/surg are no longer. It became more specialized and when I'd float there, I was finding I was more of a hindrance than a help. So I'd go and basically work as an aide or a tech. I'd refuse to go unless going as a tech. I can take people to the bathroom, do VS, bathe and bring them dinner -- I can even help out in a code... but managing art lines is a different matter altogether. Yes, our med/surg floor took care of art lines. Give me a good old laboring mom... I'm comfortable there.

It can be hard to forgive yourself when a med error is made. I still remember my first med error; gladly, it has faded over the decades. I had floated to another floor which was common back then. It was a written order, but at our small hospital, we had no pharmacy at night, yet, they were supposed to fill the patient med drawer with the appropriate meds. When I went to give it (it was a cardiac med) it wasn't there. So I called our house supervisor who had to go to the pharmacy, unlock it and get me one and bring it to me. My fault was not checking what she brought me, but I assumed that it was the correct med. I took my patient in the meds and all was well... the next day, the pharmacy caught my error as she has signed out the wrong med to give me. My supervisor called to tell me I'd given a beta blocker instead of an ace inhibitor or vice-versa -- I don't recall. But I do recall the conversation. She's still a friend to this day and I'm grateful she used it as a teaching moment instead of a blaming and shaming moment. No harm came to the patient, but I learned my lesson that giving medications are to be checked, and double checked and using those 5 rights, I would have caught it myself. I didn't have the right med. Stupid mistake and I was totally in the wrong. Kinda like drawing up a medication and expecting another nurse to use it. (Yes, I've seen nurses do that) I'm no longer doing bedside nursing, but teaching now. I wish we were all perfect. We're not. No one is. Forgive yourself. You're going to go on to be a great nurse and help many people and save lives. Best of all, forgive yourself.

Where I work, it's $800 per credit. My CNA class is a 4 credit class; so it's $3200 per semester. Some semesters are module classes meaning they may be only 8 weeks long or it could be a traditional 12 week semester. The clinical instructor gets 1 or maybe 2 credits of that which is $800-$1600. (If there is a T.A., that's 0.5 credits s/he earns.) The CNA instructor gets the other 2-3 credits. I also offer non-credit CNA classes. Those are paid hourly at $25 for the CNA instructor (Which has to be an RN) and $20 for the clinical instructor (which is usually an LPN). If an RN does clinicals, it's $25 an hour. As a CNA Coordinator, I have to teach one 12 week credit class a semester. I get zero credit money; just my usual salary. If I teach another credit class, I do get that adjunct wage of 2 credits. The other 2 credits are split up between the two clinical instructors.

What do you mean they oversold it?

I've been teaching high school CNA classes for about a year and a half. I love those kids! They are so much fun. These are 4 credit classes that they take through our professional-technical education program. Most of them are wanting to on to earn their RN and having a CNA is often a prerequisite. I also teach college non credit CNA classes and both classes are taught basically the same, except I have more projects for my high school classes. They are now also required to join HOSA in our state. I was just promoted full time to CNA director (my bosses job) as she went to the PN program. I won't get to teach the high schoolers anymore, and I'm sad over that. But on to newer responsibilities. :) Good luck to you in your role! You'll have a great time!

Hi fellow nurses... I'm in this class right now, and I can feel your pain so acutely. Is that Era III? Anyway... Just know that you're not alone in your painful feelings of reading and trying to understand this. :)

Oh my gosh... sorry, I just seen this! I have 46cu's left to get my MSN. I believe you have to 150cu's to get your MSN. My first term went very well. Booted up some classes from my next term to finish this one. I LOVE WGU!!

I go to WGU and have never had a course mentor that doesn't have a Ph.D. My student mentor has an MSN however. I know that there are course mentors that have MSN's, but they're generally not teaching or lecturing there. At least, this has been my experience since I've attended. I LOVE WGU. It's been a very positive experience.

I am starting the first of July. I have two friends who have gone there. One completed her MSN and now teaches (at home) for WGU and one completed her BSN and works for public health. She is pregnant and will continue her education for her MSN at WGU when the baby is born. Their enthusiasm has encouraged me to go back! Right now, I am an ADN and teach CNA classes, but would like to do home teaching plus gaining more knowledge is always a plus, right?! :)

It's been a long time since I worked in a SNF, but it was against policy to get residents up before day shift. We didn't mind getting them dressed if they were already up, but to physically get them up and get them dressed was considered assault (I think) by the admin. because it was against their will. Breakfast was usually at 8 or so. Day shift got there at 6. Restorative aides got there at 5 to start the few baths that they could do. We pretty much had a skeleton crew at night anyway. At the very least, we'd have 6 or 7 dressed because they were already awake and wanted up.

Hi Rhonda. I work in L/D part time. I remember when I first started working there, we'd use oranges (baby's head) to apply fetal scalp leads. That orange would be in a box of course. And it would be held there by the instructors hand. That was useful. We can guess hemorrhage(water and red jello) amts on blue pads. There are four different stations of hemorrhaged blue pads. Guess in mL's how much blood she's lost. We weigh pads if needed on our floor. Do a strip review of a a few different types of strips. Decels, variables, accels, ones of varioius variability and contractions. Does that help?

We follow AWHONN as well.

Just curious to know your Group B protocol. Ours keeps changing and it's driving us nurses crazy.

I am pro -whatever the mom wants. If she wants to go natural, go for it. If she wants an epidural, go for it. I worked with a mom who wrote out a beautiful birthplan the other night. When her midwife suggested she try a whiff of pitocin to get those contractions working for her, she agreed. She knew she had to be constantly monitored after that and she was OK with it. She did wonderful. I told her she could even get up and move around as we have a telemtry monitor that will follow her anywhere. Most mom's are OK with this knowing it's their baby and their uterus we're looking after. I'll do whatever the mom wants. It's her labor and it's her birth. I've had three kiddos naturally; because there was no anesthesia available. By the time I decided that I'd like something IV, it was always too late. I had all my kids in the back woods of Montana. If I had another, I'd definitely have an epidural.

I'm an oddball too, Elvish. We often do foley inductions and they work well. I personally hate Cytotec ripenings.

Not where I work, either. Thank goodness!

We go over all that information in discharge teaching. There is a PP discharge video that parents are required to watch before leaving that mentions it and we verbally mention and go over s/sx of PP depression before discharge.

Immediately after delivery, babies go directly to mom's chest. They are wiped off, and stimulated. They aren't taken away to a warmer for evaluation or assessment unless there is a respiratory issue. They are left to bond on mom's chest unless the mother requests differently, and surprisingly, many do at our hospital. We don't bathe until the infant has nursed as a rule of thumb. We have no formal policy on bathing babies. Dads are involved fully. Med can be given while in mom's arms. We see no reason to move them. Later, they're weighed, measured and a full assessment is done. In Summary: Babies are bathed about an hour and a half after delivery. I've only seen one mom who requested that the infant not be bathed and that was in the past month. Whatever. It was her choice. It was my choice to only handle that baby with gloves and a gown.

Our NRP is handled the same way. I paid for it out of pocket and they reimbursed me. They even paid me for the hours (Maximum of 2 hours) it took to take it at home.

I'm curious how your OB floor staffs for sick calls or when there just aren't enough nurses? Do they float from somewhere else? Do you have a resource pool? Do you have PRN staff you can call? Do you bring in travelers? Also, if you're called in extra, how is your pay adjusted? I'm just curious how your hospital does this. Ours in not a big hospital and it seems there are never enough OB nurses to go around and if someone calls in sick, we're just in hot water. I admit this weekend, I was selfish. I had no less than 10 calls for staffing this last weekend. I was a chicken and just didn't answer my phone. In fact, I turned my ringer off... I just didn't want to go in on my precious weekend off. There aren't enough trained OB nurses to float from PP or from NICU. We do have a resource pool that might contain about 3 nurses and if they say no, it's back to square one. Our PRN nurses are about the same as our resource pool. Most work elsewhere and may already be working elsewhere and can't come in. We don't use a staffing agency. if we're called in with less than 24 hour notice, we're paid 1.5 times our usual wage. We've tried to get our manager to hire more nurses for this type of situation, but she states she can't because administration won't authorize it. I don't know if this is true, but it seems she's constantly hiring and someone is always quitting. (College town and when the husbands finish school, they're outta there!)

We don't have anesthesia at our hospital 24/7 either, but their response time is amazing. They respond PDQ when we need them for emergent C/S's. I have to admit that most stay in house during their call time since we often call them anyway, but they're under no obligation to stay. On the rare occasion they do go home, they're there within 10 minutes when we need them. I have never cared if I had to wake one. That's what they're there for.

We have 9 LDR beds. 3 triage rooms, 2 OR suites. Staffing on nights is usually 3-4 nurses vs. 4 nurses on day shift. We are a 1:1 staffing and our charge nurse does all the triage and catching babies, plus putting out the other fires that may arise. It really works out well. We don't do our own surgeries.

Absolutely you should have two RNs on floor at all times. Minimum. We follow AWHONN guidelines to the letter.