mitchsmom

I am wondering what most units are using for their orientation timeline? Also, do you set a goal for an actual number of checkoffs (certain minimum number of deliveries, baby catches, c/s, mag, etc.)? I am updating ours and so I'm just curious and looking for ideas. Our have 6 months and we have always done postpartum, L&D, then baby catching toward the end. Does anyone do L&D first? I know that postpartum is kind of an easier intro, but I'm wondering if maybe it would be better to start with L&D, when new grads are "fresh" and motivated, and wind things down with postpartum. (Don't know if we could even if I wanted to, because doing pp first also gives us staff to pull to PP during high census needs...but that would really be an advantage to the orientees because they always get ripped off by being pulled to pp when they are supposed to be in L&D training) Like I said, just looking for ideas and benchmarking what works for others. We are an LDRP unit with about 65 deliveries a month and we do it all: LDRP, OR circulating, OR catching, PACU, sick baby stabilization for transfer to NICU, lowish risk antepartum, etc.

This has been mostly answered, but every place is a little different. At my work: Patient Patient's support person OB First assist (RNFA or tech; we VERY rarely have a 2nd MD present) Scrub Tech Circulating Nurse (L&D nurse who is primary care nurse for patient) Baby Nurse (another L&D nurse who is available to "catch") Anesthesia (MD or CRNA) RT to assist Baby Nurse if needed (we only call Pediatrician to be present if unplanned/ anticipate complications/ certain risk factors) We are a community hospital and don't have a NICU, so we L&D nurses (& pedi/RT) would serve as "NICU" nurses to stabilize a sick baby for transport if needed (for instance if it's a preemie coming before mom could be transferred, or some other kind of sick baby (beyond TTN, abx for sepsis prophylaxis without symptoms, other mild issues). Like others said, we occasionally have students, etc.

Yes, it affects me because I'm too freaking tired to fool around after a 12! Otherwise, it is honestly a completely separate, & strictly clinical entity for me.

You said "They need an RN to staff a department even if it's closed." --> if you are working on staff, then I would think you should be getting paid at least your regular wage. Our on call (at home) pay is $2/hour and if called in, time+1/2. As far as I'm concerned, if I am ON THE UNIT, I am NOT on call, I'm AT WORK. KWIM? How can you label it "on call" if you're at work?? LOL ... yeah, something fishy...

Hmmm... I think our ped hospitalist is ordering it be done just if

I carry a lot of crap, YMMV: L pocket: some kind of breath freshener, chapstick, Evo smart phone (which of course is my phone, schedule/calendar, medical spanish app, translator, flashlight, internet, drug guide, do not forget list mp3 player, radio, calculator, camera, kindle, blah blah blah... can you tell I'm pretty attached? Some of us have even started to text the MD's on occasion. R pocket: --scissors, --alcohol pads, --pen (s) (I use a 4-way clicky pen with my name taped on it, because I different colors stand for different things on my "brain"/ pt cheatsheets, i.e. red= allergies, complications; blue=do not forget; etc. (I include highlighter if I'm working lactation, because I highlight red flags on each patients cheat sheet), --pt cheat sheet(s) --pyxis "receipts" (I only throw away after I've charted the med) --often an OB "wheel" although lately I just usually use one at nurses station, I need to procure a new small one :) Edit: nevermind... I just found "OB wheel" app for my phone... it seems pretty quick and I don' t have to use a magnifying glass to decipher what line the date is on Littman Classic II SE stethoscope (it's not a fancy cardiac one, but I also hate the lightweight cheapish ones) When I was new I made up a 3 ring binder where I put handy reference stuff inside of clear page protectors (policies, reminders, cheat sheets, all kinds of stuff I felt that I needed at first). I kept it somewhere close around the nurses station where I could refer to it. We still use several of the cheat sheets and stuff that I made up I also had a little general quick reference book but I didn't end up using it much. 5 years later, I actually still have a notebook where I keep stuff I want as reference, new policies, staff meeting stuff, articles, handouts, or whatever in my office :) Probably forgot something still, LOL!

Article regarding the release Guidelines can be purchased here, but as I said before I'll try to post sometime:

I didn't look through all the posts to see if someone wrote it already, but if not, be aware that the staffing guidelines were updated last year (2010) --> *to our advantage* --> for example, pitocin patients are now supposed to be 1:1. I will try to post the new guidelines when I can.

Wow... I didn't know rocephin was especially painful (I don't think I've ever given it)... my son got it in the ER about a year ago (with a couple of other shots) and didn't have any particular reaction or comment to it.

Currently in my area I think they are around $20k+

We are a closed unit, too. We only float within Women's and Children's- L&D floats to postpartum to task or take patients, postpartum can float to us to baby-catch if needed, but not to take patients (one way street), they try not to have us even task in peds because they are usually so contagious / "dirty" but we have on occasion (usually they would put a postpartum nurse on peds and then put us on postpartum to avoid it - then we can float back to L&D if needed). Totally agree w/ babyktchr... "Nursing administrations simply must get it into their heads that the "nurse is a nurse" mentality is just not applicable anymore" ... most of our staff are also career-long L&D people. I always liken it to MD's... would you go to an OB/GYN for heart surgery? I don't think so! ... you really don't want an L&D nurse for another specialty, either.

"I think the MB overflow is truly just for times when the normal MB unit is full. So its probably not very frequent that they get postpartum women/babes." There's one of your questions right there! We used to have an overflow area before our LDRP was split into separate L&D and Postpartum units... some probably would have said that "it's just when LDRP is full" - but in reality that was quite frequently (which is precisely why we split). I would ask how many MB overflows in a typical day/ week. Ask if you can shadow a nurse on the unit and see how things feel to you, and ask that nurse questions as they arise, too. This might seem funny but you may want to even ask if men are ever on the unit if that is something you'd like to know about... in our current overflow area, in the WOMEN'S & Children's unit... does sometimes have MEN. They try to keep it all women, clean sugical, etc. but sometimes there ends up being men, chest pain, occasionally "unclean"/contagious conditions... Those are some of the gripes that I see... Also I agree with nfahren05 in general.

Doesn't sound like a great idea for sure. Here's the CDC page on Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings. I don't know if it specifically addresses that, but it seems like common sense!! http://www.cdc.gov/h1n1flu/guidance/obstetric.htm They are constantly reviewing the situation and the recommendations can change at any time, so it is good to check now and then on the latest info.

I don't think Doula/CBE experience would be frowned upon at all, but I also don't think it would get you "in" like actually working on the unit in some capacity (OB tech, CNA, unit clerk, etc.). It can be an adjustment to go from a circle of peers who are educated, healthy, and on the same page as you are about birth- then hit a unit where the vast majority of the patients may be largely uneducated about pregnancy and birth. It can be dismaying. I pretty much knew it would be that way before I started - and you know what? You really can turn that dismay into an opportunity. It may sound cheesy, but you have so much more opportunity to teach and empower those patients who are not informed! You probably won't turn their entire world around in the time that you are with them, but at least you are not preaching to the choir - you have more chance to make a difference with these kinds of patients than with those who have already read the book & signed the birth plan to the last "T". They are usually very appreciative, too, that you have taken the time to explain things to them (like maybe no one has before!). It's all shades of grey out there... usually people are doing the best they can with what they know. You mentioned that you plan on doing a healthcare mission, if that will be in a different culture then you'll see even vaster differences in health beliefs... the L&D thing is just a milder version of the same thing, in your backyard. Does that make sense?

Wish they'd leave it alone, or at least wait until good & active in labor... but our MD's do it ASAP if they are around.