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melmarie23 MSN, RN

L&D/Maternity nursing

Content by melmarie23

  1. melmarie23

    How does your unit train Level II Nursery Nurses?

    We have a SCN/Level II with the same population as yours and I got 4 months of orientation (at two,12h shifts/week as I am PT). I'm also to always be scheduled with a mentor immediately available, meaning a light floor assignment that can easily be passed to another RN, for another 6 months (at the very least--more if needed). I am halfway through the latter. They always put me in the SCN, except for my call shifts (I get labor then). We are a LDRP unit with the SCN, of which about a third of us are trained to the nursery.
  2. melmarie23

    One quarter of our census are withdrawal kids

    We've also have had a huge influx over the past couple months as well. It is indeed tiring...and it's even harder watching them going home to who only knows what.
  3. melmarie23

    Bedadine for vaginal birth

    We don't use a prep either. We just wipe away stool as needed.
  4. melmarie23

    Sterile water injections - back labor

    As for "selling it," show them the evidence. It's a low cost procedure and doesn't really require any specialized skill set to do. It doesn't interfere with monitoring mom or fetus. My advice is to try and get but in from a physician or two, as well as your unit leadership, and go from there.
  5. melmarie23

    Sterile water injections - back labor

    We still do this on my unit. It's part of our standing orders for labor. It's not often we do do it...but we can and do. It hurts the patient like no other and it's why we have two RNs to do it so that it's as quick as can be. But it usually works and gives them some relief for a good while after.
  6. melmarie23

    C/s incision dressing removal

    We have orders to remove post op day 1.
  7. melmarie23

    Need to pick up your brains LD nurses!

    LNA/CNA. Usually after a couple nursing courses under your belt and you can get certified.
  8. melmarie23

    Banker to nurse - Would you make the switch

    I am PT and work two, 12hr shifts a week. Most L&D/mom-baby jobs in my area are 12hr shifts. I work on a LDRP unit that also has a SCN (Level II nursery) that I am cross trained to as well. I was hired onto my unit as a relatively new RN. I too was a career changer. I don't ever regret changing careers to nursing!
  9. melmarie23

    Circ boards

    We swaddle the arms. They're not strapped down...only the legs are.
  10. melmarie23

    Is it hard ?...

    I was hired as a PRN on my current unit. I had no experience in the speciality (OB). Had 6 months orientation, 3 to mom-baby, and 3 to labor, as we are a LDRP unit. Then I filled holes as a PRN. Eventually I got a part time position. So it is possible.
  11. melmarie23

    Are there NPs who work as RNs in Massachusetts or NH

    Chincka, one is an acute care NP working in Worcester (worked in an outpatient surgical center prior to this) and the other works per diem as hospitalist covering the med/surge units and then in the ED Full time at another hospital (sometimes rotates to their urgent care center). All make well over 6 figures starting (in Lawrence MA and Manchester NH). So I guess it depends on the speciality and setting you get into.
  12. melmarie23

    Are there NPs who work as RNs in Massachusetts or NH

    So in short, if you are close to finishing your program...then keep going! I don't think you'll regret it.
  13. melmarie23

    Are there NPs who work as RNs in Massachusetts or NH

    I am not sure where you are looking for employment, but I have many NP friends in both states (I am in NH) and they all make significantly more in that role than when they were bedside RNs. All work in the hospital or urgent care setting.
  14. melmarie23

    What would you have done? Episiotomy

    I am happy that someone finally decided to represent her! It's taken over a year and a half, even despite the video evidence which clearly shows her not consenting to the procedure. Most lawyers refused to take he case because nothing was "wrong" with her or the baby. There are so many things wrong with this that I don't even know where to begin...
  15. melmarie23

    Vital signs on labor checks

    Q4 if stable, not ruptured and GBS-. If GBS positive and/or SROM'd/AROM'd then a temp q2 in addition.
  16. melmarie23

    Curious about formula marketing practices in your hospital

    We're a BFHI facility, no no formula goodie bags/swag here.
  17. melmarie23

    Neonatal assessment team

    We are a LDRP and special care nursery (level II) unit. Most RNs are labor & mom-baby trained. All NRP certified and can serve as second RN at deliveries. About a 3rd of the nurses are "core" and are also cross trained to the SCN, like myself (just coming off orientation). Any deliveries where there is fetal distress/crappy strips, mec, shoulders, vacs and urgent/stat cesareans we are to attend. Our Pedi hospitalists attended those deliveries as well. Provided all is well with baby, the nursery nurse leaves and the labor nurse recovers mom and attends baby. After the first hour, usually the charge RN, or a RN with a mom-baby assignment will relieve that labor nurse so she can get caught up in charting. Our recoveries/turnovers usually take about 2 hours (more or less) before that couplet goes into a mom-baby assignment. If a slow shift then the 2nd RN will usually stay after delivery and help with the recovery...and usually is responsible for "doing baby up" (measurements, meds, bath etc).
  18. melmarie23

    Urgent Csection

    As the circulator you did your job in pointing out an incorrect count and calling for an X-ray to ensure no instruments were left in the patient. Do not let anyone make you feel inadequate for doing your job correctly. As far as it being hectic prepping the patient for an urgent c/s, where was your charge? Ours is usually in there. As is a nursery RN/someone responsible for baby when it comes out. They could easily grab the heart tones and strap mom to table etc while you are doing your counts with the scrub tech.
  19. melmarie23

    L&d/nicu departments common?

    My hospital has LDRP and our SCN (level II NICU) all on the same unit. I currently do LDRP but am starting training to the SCN as well. About half our nurses do both.
  20. melmarie23

    nicuguy is now LDRP&NICUguy

    Awesome! Congrats!!
  21. melmarie23

    happy to join you all! I just got my unofficial job offer

    Almost all my classmates got a job right away after graduation/passing the boards. So in my experience, it didn't hinder my cohort at all. And I'd say about a third of my class are now APRNs (went on to get that). I've never had anyone really question or negatively speak to me of how I got into nursing. OB was hard for me to get into at first but that's specific to this particular speciality in general. Once I had bedside experience I was interviewed and hired into OB. I do LDRP now and when I go back in 3 weeks (am on maternity leave with my 3rd kiddo) I will be trained to our SCN/Level II nursery.
  22. I had posted about two weeks ago about how I had landed an interview for a per diem LDRP RN position. That interview was last week, and this Monday they had me come in for a job shadow. I received an email this afternoon from HR saying that they'd be calling next week to discuss a job offer after they come back from the long holiday weekend! And that they were writing because they didn't want to keep me waiting! I am over the moon excited! I am still a relatively new RN...and I've been working my way toward L&D/Mom baby since my last year of school. Now it all has finally paid off! WHOO HOO!
  23. melmarie23

    unit "culture"

    I work on an 18 bed LDRP unit. We average 1200 births a year. We have 3 OB practices, one with one midwife. There are also 2 family practices that deliver with us, one of whom teaches and has residents. Its not very often that we break down our beds for deliveries. I do it more often for tricky repairs than for actual deliveries. We lower the foot of the bed if needed, but usually we just raise the bed to the high the provider needs and/or the provider is gowned and is sitting on the end edge for delivery. Delayed cord clamping is routinely done by some providers, and for others is done on request of the parents. If baby is stable, they go right to mom's chest for skin to skin for the first hour (we're a BFHI facility). We even do skin to skin in the OR for scheduled and non-emergent cesarean sections. I like the variety that being a LDRP unit provides me. I can go between labor and postpartum/mom baby at will (we pick our own assignments provided acuity allows for it). Its nice to be able to labor and deliver a mom and then to take them post partum the next night. What do I dislike? The no pacifier aspect of BFHI. I understand the rationale behind it, but when you are on nights and trying to deal with those 2nd night babes who just wont settle and mom (and support partner) are just plain EXHAUSTED, THAT is when I wish I could just give them a bink. It is a personal belief of mine that nipple confusion is not that much of an issue that BFHI makes it out to be. Oh and I wish we had more midwives. And that we did water births.
  24. melmarie23

    My patient dropped her baby!

    this exactly. Its what the vast majority of cesarean patients on my unit receive. Its rare that we have a mom on a PCA.
  25. melmarie23

    Postpartum couplet care

    my unit follows AWHONN staffing guidelines. We average 3 mom/baby couplets, and never have more than 4.
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