USC2001

I would reccommend getting experience before starting an MSN program. I just finished my FNP program (yesterday, actually, I graduated). When I started I had 2yrs experience in L&D. I then switched to Home Health for the past yr. Its not impossible by any means, but you could tell a difference between the RNs in the program with at least 2yrs and the ones who went straight out of school. I think they had a harder time grasping and remembering some things because they did not have the work experience to relate to. On another note I would highly reccomend Home Health to anyone considering FNP or Adult NP. I have learned so much and seen so much in my year in HH. It is also helpful to be on your own and teaches you independence. Good Luck!

I am also starting w/ Novapro in Jan 2007. My friend traveled with them and really enjoyed her experience. They have been very nice and accomodating for me.

Hey everyone, I need your help with a problem. I worked in L&D for 4.5 yrs and then have been doing Home Health for 8 months. I am going to go do some travel nursing and the majority of the positions are in L&D. The problem is I let my NRP expire (I know... I'm bad:sniff: ) and the travel company wants me to find somewhere to renew it. My old L&D won't let me take a class there since I am not an employee anymore. Any suggestions? (I am in South Carolina) Thanks!

I worked 36hrs a week (nights) for the first year. When I started my clinicals I dropped down to 32hrs, which just those 4 little hours made a big difference in my sanity. However now that I am in my last semester and am doing clinicals all the time I just do 24hr. I have pretty much worked every weekend for the last 2 1/2 yrs. That is how most people do it in my class is by working all weekends. Good Luck!

I had a pt last night, primip, 30yrs, 1/90%/-1 (hey at least she was thinned out :)) contracting every 10 mins, 41 wks (hey- how did that happen- I didn't know you could stay pregnant that long under an OB's care :chuckle ), who was dying from pain so the OB kept her with plans to possbily induce if she did not change on her own. Anyway, she has one of her 6/hr contractions when the Ob is in the room and looks directly at him and in all serious says "I didn't think this would hurt". He was kinda flabbergasted and said "you mean having a baby" and she said "yeah". I did my whole "that's why its called labor, its hard work speech" but she still expected a painless birth. Sometimes I wonder where this "pregnancy isn't uncomfortable/labor doesn't hurt" myth comes from. Even the stupid baby story which everyone seems to watch shows "some" pain. Anyway....

Could the "sample of the cervix" been a Fetal Fibronectin (FFN) maybe? That is something they would do if you were preterm, but I don't know about at 36 wks (that would be too late I would think). Sorry for your experience!

I work in L&D and we had one come in the other night via EMS with baby in arms! Swears she wasn't pregnant! She had delivered at work (CVS) in the bathroom. She said she just felt "woozy" all day and then felt contispated and went to the bathroom.... Well it wasn't a BM that came out! Luckily her co-workers called EMS (becuase they heard her screaming). She and baby did fine (baby actually looked overdue) ,but she just kept saying "I can't believe I had a baby!". I think some people live in major denial!

Alot of our docs are too exam-happy for my taste. I try to minimize my vag exams. We have some docs though that will check a pt literally 5 min after you so they can say "she's 7-8" when you said she was 7cm. Ok...and how does that change our paln of care? none. Sometimes there are pushy pts and families that want to know every 2 hrs what "she is", even after education on infection, etc. "when you gonna check her again? huh? huh?" I love when you have a primip pt with an epidural and they are so worried that the baby is going to fall out in the bed (which yeah has happened, but rare for me) and you explain to them about pressure, etc. Then when they are 10cm they are like "now I know what you were talking about!"

I agree with Deb (of course :)). Even with an epidural I have found that most pts can feel the pressure when the head moves down to a +2 station, even if they couldn't before. One of the great things about working nights is you can labor down a pt becuase the doc is usually asleep in his room and has no idea if she is complete!

I had a heavy-set pt one time that went to her doc for dizziness, nausea, heartburn, etc. Her BP was up and they perscribed a BP med without doing the pregancy test. Well a couple weeks later she goes to the ER (of the only hospital in town without an L&D unit) and her BP is through the roof and her platlets are way low. Well, someone does a test and an ultra sound and she is 35 weeks. She is sent to us and has an emergency section due to pre-eclampsia. Within I think 4 hrs she found out she was pregant and had a c-section and was holding the baby. She was happy, but a little shocked! I have also had the "I'm in labor" pts.... oh wait never mind you just escaped from the pysch floor. We had one lady come via EMS c/o SROM at "8 months" no prenatal care. She wouldn't let us put the EFM on for anything. We though it was an abuse situation with the FOB so we sent him out but she still wouldn't let us. Turns out she was wearing a fake belly and had been lying to the "FOB" to keep him and that night when he threatened to leave she said her water had broken and he had called EMS. We ordered her a pysch consult and SW visit but she slipped out before they came (we unfortunately have a back stair door that no-one can get it without a badge but they can get out) Craziness! :rotfl:

I wanted to be a CNM too when I graduated nursing school. Well, I have gotten 2 years experience in L&D and changed my mind. I really would rather teach and work L&D part-time. I have alot of respect for CNMs and alot of the time I feel like I could manage the pts labor better then the doc, however I have also realized how much liabilty there is. Also, I really enjoy my role as a nurse with the pt. so, I would recommend getting experience first. As far as how hard it is to return well..I am going back this fall for a Family NP degree. It is hard but for me it would have been harder to go straight out of nursing school. I would have burnt out so bad and probably failed out! :) Good Luck in whatever you decide to do. Oh- and your original question- all the CNMs I know had previous experience.

I have even done the hands and knees position with an epidural when mom was small and didn't have too strong of an epidural. I was so excited the first time I was able to get a baby to turn by pushing in this position! I was bragging to everybody! :)

Allergic to: ambien ativan loritab phenergan demerol morphine etc Nurse- "have you ever had any surgery or been hospitalized?" Pt- "no" Nurse-"Any medical problems?" Pt-"no" Ok... how the heck do you know you are allergic to all these wonderful drugs then? In L&D the other night. Pt comes by EMS becuase she has been "pouring blood for 3 days" (thats what was written on the triage sheet). Is she wearing a pad for this "massive amt" of blood?... no. Is there any blood on her perineum or anywhere?... no. When I check her cervix is there any blood on my glove?... no. When I ask where the heck all this blood is she finally says, after prodding, that it just happened twice in the past 3 days when she wiped.. Ummm guess she wanted to ride with EMS or something.

Congratulations!! Enjoy your new baby and try to get some rest! :rotfl:

We use Pitocin on VBACs but are just real cautious with it. Our normal protocol is to increase by 2mu q15min. On a VBAC the docs usually do 2mu q30-40 mins and put a cap on high you can go up. I still think though unless you have been sitting at the same dilitation for 4 hours, have high BPs or the baby is in distress you don't have to have a c-section. You already have had a VBAC so you have a "proven pelvis" so to speak.

Amen. Good advice!

Yeah it certainly does. I probably should have said that that was from the SC BON.

Here is what it says on the web site: Advisory Opinions Question 44 Question: Is it within the role and scope of practice for the registered nurse (RN) to insert prostaglandin analogs (e.g., misoprostol) into the lady parts for cervical ripening or induction of labor with a viable fetus? The Board of Nursing has determined that it is NOT within the role and scope of practice for the RN to administer prostaglandin analogs (e.g., misoprostol) lady partslly for cervical ripening or induction of labor with a viable fetus. The statement is an advisory opinion of the Board of Nursing as to what constitutes competent and safe nursing practice. http://www.llr.state.sc.us/POL/Nursing/index.asp?file=advisoryop44.htm

Huh? Thou Cytotec can be used to abort, we are talking about how in L&D we use it to induce a term pt into labor. Just like they use Pitocin, Prostaglandin gel, etc.

Huh? Thou Cytotec can be used to abort, we are talking about how in L&D we use it to induce a term pt into labor. Just like they use Pitocin, Prostaglandin gel, etc.

Oh yeah that has happened before. I had a pt who was G2P1 and had a normal length labor with her first baby. She came in and was 3cm,70%, -1, intact and contracting about every 5-7 min, but rated her pain at a 6 and wasn't even breathing with her ctxs. The dr said go ahead and admit her give her some Phenergan and nubain and I will be there in 2 hrs. I gave her the med (checked her before I gave it, still 3cm) and was in the room q15 mins to assess her. She was sleeping the whole time. About 1hr and 10 mins later she calls out and c/o's of pressure. She is still very calm. I look and the head is on the perineum! Well I got yelled at for not calling him when she was 6-7 cm. Umm.. I guess I should have kept my hand up there the whole time just in case. We also had a nicer dr who checked a G5P4 and she was complete, +2 and walked back out to the nurses station. Well, the nurse pulled back her legs and before she could even push once the head slid out. He ran back in but all he could do was deliver the placenta. He was like "oh... I guess I shouldn't have walked out". Yeah you think? Do you write incident reports on unattended deliveries? We have to and if the dr has had a lot recently they can get mad and blame you. They need to realize that if they are nice the nurses write the report nicer. "Pt had uncontrollable desire to push" vs. " MD called but did not attend delivery". Just shake it off and know that you did all you could, sometimes pts just deliver fast like some deliver slow.

We use Cytotec for ripening of the cervix the night before a Pitocin induction. The docs used to insert the first dose and then we would insert subsequent doses. However.... there was a big uproar in Novemeber or so becuase the SC state board of nursing issued an advisory opinion against nurses placing cytotec on a viable fetus. The docs freaked when we told them that we would not place it anymore. I had one get verbally abuse about us "d*mn nurses" not doing our job and we should do what they tell us to do. He got reported real fast. Anyway... we still place on fetal deaths and for PP bleeding. Now more of them use Cervidil so can they can place it at 6p and then go home.

What I don't understand is why did she go to three different hospitals for decreased fetal movement if she didn't want anything done about it? If you are going to refuse medical attention then don't go to the hospital!

We usually send people home that do not make a cervical change. HOWEVER, I would not have sent your friend home, nor would any of my charge nurses have let me. One of the reasons is it was her 4th child and that makes her have the potential for a fast labor. That combined with the fact that her ctxs were that close together would make me uncomfortable with sending her home. The very least that I would have done was have her walk to encourage dilitation or just watch her another hour or so to see if she dilates. I am sorry that happened and I think a letter is called for. Good luck in school!

I just had to add this story that I heard last night. One of the nurses at work that has been there for awhile said that we used to have a DR (who is retired now- thank goodness!) who would put Cytotec in his pts at the office so they would come in "in labor". The nurses would find the half dissolved tablet in the pt when they went to do a cervical check. Most of the time the pts didn't even know what he had done! I am so glad he was gone before I came. Can you believe that?