MKPRN

I am a L&D nurse and have had STORK RN as my plates for a long time. No one has ever bothered me because of this. I am super proud of what I do. So I don't think there is anything wrong with it. And to tell you the truth I have got out of a few speeding tickets because the officer realized that I was a nurse.

My hospital has standardized Pit orders. We also have slow pit orders for cervical ripening. Pretty much the Pit is to turn in up 2mu q 30. If you aren't turning the pit up q 30 you need to document why. Turn the pit down 2mu once active labor is established. There are interventions that need to be done based on FHTs. Pit can not go above 20mu's without a doctors order and IUPC.

Oh and BTW, I just took a new job at another hospital in L&D and had to sign a contract that I would get my BSN within 5 years of hire. I don't want to start an argument here. I am just telling you what I am observing in the healthcare market that I live in. And yes, the name badges do say BSN on them.

What I meant was, that in specialized areas of the hospital such as OB, surgery, peds, ER, they are now expecting you to have a BSN. The Children's hospital in my area won't even give you an interview without a BSN. It is a fact that hospitals are going this route. I myself was a graduate of an ADN program. I have been a nurse for 15 years most of them working in L&D. I am currently working on my BSN because I am feeling the squeeze. And yes, I can run circles around a new BSN grad but hospitals don't care about that. They want that piece of paper. There is nothing wrong with being an ADN grad but be prepared that it may limit your job options.

I think the most important thing to do is to get your BSN done. All the hospitals in my area are all going to eventually require a BSN of all their nurses. I think they are saying by 2020. IMO, eventually ADN nurses will end up in more LPN type roles, like at SNF, offices, etc. As for your job, I know it is not what you want. I promise it is not forever. You are going to develop a lot of skills that just can't be taught in nursing school. I would go ahead and keep looking for something that might be a better fit for you but take advantage of the things you can learn from this job while you are there. Just think, after you get your BSN and are interviewing for jobs you are going to look like so much of a better candidate for hire with that experience under your belt. Remember this is only temporary. Hang in there. :)

I recently found out my unit is closing and I am now on the hunt for a new job. I have not been on a job interview in over 12 years. I am applying for hospital jobs. PreOp nurse, Mother-Baby floor position etc. It is now summer and beastly hot. Any ideas on what is appropriate? I don't have a lot of dress clothes. I was thinking black slacks with pumps. What type of top?

Yes, at a bigger hospital you can. A lot of nurses that do L&D start out on post partum.

Read the book and do the practice problems at the end of the chapters. If you can answer the chapter questions you will do fine on the test. Make sure you know the flow charts for rescesitation.

Here are a couple sites I used when studying for my C-EFM: Quillen College of Medicine, East Tennessee State University QCOM - Fetal Heart Monitoring - Home Page ACOG tutorial with test questions ACOG - Tutorial

I recently took the NCC EFM exam and passed. AWHONN Fetal Monitoring Principles and Practices was enough to help me understand what I needed.

This is an exact situation that isn't always about what you know but WHO you know. Definately talk to the managers! They are the ones that are going to scoot your application past HR. Also talk to the staff in those departments, make friends. When something comes open they will not only tell you but mention to their managers that they know someone who is interested. This is probably how the majority of the people in my department are hired. Another suggestion, take some OB continuing education courses so if you do get that interview you can show the manager that you do come to the table with some knowledge. Things that we are certified in at my hospital are ACLS, NRP and STABLE. They are also now requiring labor nurses to become certified in fetal monitoring. PESI.com and Proedcenter.com have great OB education courses but there are also others out there on the internet. AWHONN books are great reads too.

I work at a hospital exactly like the one you describe except no OB in house. I work nights and the only doctor in house is the one in the ER. However, when things are going down we don't call the ER MD. All of our OBs are 5-10 minutes from the hospital and I work with and amazing staff of nurses. I love where I work and have great nursing skills. I feel like I get to use my judgement and experience better here than I would at a big hospital. All the nurses in my department do l&d, postpartum and nursery. We all stabilize infants if they need a transfer to NICU. Many of my doctors have told us in an emergency they would rather have one of us as a nurse with them than at the big hospital nurses with a NICU because we have such versatile skills. Is it scary as hell? Sometimes. But I don't try to avoid the idea of something bad happening. I just try to make sure we are always prepared for worst case scenarios walking in the door. During down times I am checking and stocking rooms, making sure everything is ready to go. I can go through our infant crash cart in my sleep. I try to keep myself educated and up to date. I always end up doing quadruple if not more than my required CEUs. We also do lots of drills and scenarios. I firmly believe that God watches over us here at my little hospital. It seems like the worst always happens at shift change so there are extra hands on deck. We have delivered as early as a 29 weeker here. The down side is there are somethings I will never see (and hope never to see) here because those high risk patients are taken to the big city hospital. I have bagged lots of babies and had some pretty serious situations in l&d. In my 10 1/2 years here I still have never delivered a baby, lots of my coworkers have though. But if it happens I will be able to handle it because I am ready.

I typically VE my patients before and after epidural placement. I probably wouldn't check if my last exam was less than 1-2 hours prior. If my patient is hurting I want to know where they are and how fast they are moving. I check right after just to do a better exam and see if sitting up caused any change. I have had a primip go from 4-10 just while sitting up and getting an epidural.

Is the patient pushing at this point? That is what I am thinking but not a lot of info to go on. If she is pushing, first stop pushing, see how the kid recovers and notify the MD. If the MD was in the room and close to delivery would definately consider pushing every other contraction and give the kid a break. I have had strips that have looked like this during pushing right before delivery and they always belong to a kid with a tight nucal cord. It just depends on the big picture and the MD. If this was a patient who was laboring, I would reposition, ve, turn off pit, fluids, O2 all while someone is calling the MD.

After looking again, the 10:20 spot may technically be a variable by definition. The baseline looks to be 145 and at 10:20 the FHR drops to 125-130. I would not even treat this, it is a category 1 tracing, continue regular monitoring.

There are no variables in this strip. IMO there is not a greater than 15bpm decrease to classify this as a deceleration. NICHD defines a variable deceleration is as an apparent abrupt decrease in FHR below the baseline, with the time from the onset of the deceleration to the nadir of the deceleration as less than 30 seconds. The decrease is measured from the most recently determined portion of the baseline. Variable decelerations may or may not be associated with uterine contractions. The decrease from baseline is 15 beats per minute or higher and lasts less than 2 minutes from onset to return to baseline. When variable decelerations occur in conjunction with uterine contractions, their onset, depth, and duration may vary with each successive uterine contraction.

I have taken all the AWHONN fetal motoring courses. They were great. You can go to the AWHONN website and search for courses in your area. Having taken Intermediate and Advanced, I would highly recommend taking both. The book used for the course is a great book. I would definitely purchase your own if you plan to take the certification exam.

I have been an L&D nurse for 10 years now and still have times where I am questioning myself. When this happens I go to my coworkers. They can be a great wealth of knowledge and help to you. We have all be the new kid on the block before and know what it is like to be there. I feel that it is my responsibility to educate new nurses....especially when it comes to L&D. When I first started working OB I found myself always wanting to learn more. I attended educational classes as much as I could and would read anything I could get my hands on. If I didn't know something I would stop and grab a book and look it up. This is how we learn. Give yourself time, you are going to make mistakes but I promise you will learn from them.

The way I was taught effacement was to imagine 10 saltine crackers stacked on top of each other. Each saltine is 10%. So if your patient is 80% effaced the cervix would feel like the thickness of 2 saltines. Hope this helps!