MichelleB34

When my kids were younger I used to calculate the amount of motrin, tylenol, etc. they should get according to their weight. I never went by what the bottle said.

Where I work we went to mom/baby care about a year ago. Prior to that they did have a postpartum nurse, L&D nurse and nursery nurse. Usually the postpartum nurse would round with the aid. The nurse would do her assessment while the aid would get the vitals. The nurse and aid would work together to get water, change the bed, get patients OOB, etc. Then medicate patients as necessary. Then start your charting. Do routine meds. Make sure labs are on the chart. Relay necessary information to the doctor and/or midwife. Note orders. Prepare the discharge papers and coordinate the discharge with the nursery nurse. Make sure first time moms have their teaching tools and have watched the teaching videos. Of course your routine may vary depending on patient needs but this is a basic summary of a typical day.

Thanks for the information. I was not aware of this particular issue. We give stadol most of the time. Any risks associated with giving stadol beyond the normal assessments when giving IV meds?

It is normal to feel uncomfortable when you first graduate. I always tell my orientees it takes at least 6-12 months to feel a certain level of comfort in your new role. Don't be too hard on yourself. Is there another nurse you work with that can mentor or precept you? How are your midwifes to work with? Our midwifes are wonderful to work with. They are always willing to teach and answer questions. Most if not all of our midwifes have worked as nurses before. Also two of our doctors have a computerized charting system that is used for every office visit. When a patient is close to delivery the ACOG is sent to our unit. There is a lot of information about the patients in the ACOG. I have learned a lot about routine prenatal care by reading the ACOG's. The most common meds our patients take are prenatal vitamins and iron. I hope this helps.

I work on maternity so obstetrical emergencies, gestational diabetes, and GBS are some of the topics that peak my interest and are pertinent to my practice. But if you wanted to do something different maybe you could do something on infertility. There are so many new treatments out there. If you know couples or could find couples who have gone through fertility treatment you could really bring the emotional aspect of wanting a child into your report. Having real life stories would make an otherwise dry topic interesting provided they are willing to share their experience. Have you started your clinical yet? Maybe you could get suggestions from the nurses if you are comfortable asking them.

Curious Jomo Nurse your age is 94? Was that a typo?

I'm curious, those of you who mentioned you have 4 beds to a room? Where do you live? Our hospital has only semiprivate and private inpatient rooms. Our old ER trauma/cardiac room had 2 stretchers on each side of the room (total of 4). Our ER now has all private rooms. The PACU is the only place that holds more than 2 patients with curtains in between stretchers.

I did med-surg for 11 1/2 years along with some pediatrics because it was on our unit. I wouldn't say I was burned out but maybe frustrated. Nurses are always being urged to limit their overtime. Towards the end of the last year I worked med-surg I remember commenting about how much harder this job has become since I first became a nurse. I wasn't sure I was going to be able to do the same job for the rest of my career. God has led me in new direction. One year ago I switched to maternity. The overtime issue is still there because I'm in the same hospital but I love my new job (most days). I feel like I have found my niche in L&D. The funny thing is I didn't think I could make the change because the thought of working in L&D made me too nervous. I have to say though that having experience has been helpful in making the transition. There is still stress at times and it is a different kind of busy but most of the time my stress level is significantly decreased compared to my last job. I know changing jobs is not the answer to everything but it may give some of you a fresh perspective.

When I have had similar orders I will sometimes use the shift flush(es) during my med pass. When you are giving metamucil you can easily give 200cc of water or more so there is your first flush. Also I wouldn't mix the metamucil until right before you give it. The longer it sits there the thicker it will get. I also mix warm water in with the crushed pills to help dissolve them.

Set up PM, not sure what you mean. I don't know if it will help but remember that all your new coworkers were new at one time. We all have to start somewhere. Just take it one day at a time. Good luck.

I think it is within the nurses role to answer questions from the patient and or family honestly and within the scope of our practice. But of course the decision to place the patient on comfort care has to be made by the physician after discussion with patient and/or family in regards to the patient's wishes. Once the decision is made to place the patient on comfort care the nurse is often taking care of the family as well as the patient. ie answering questions, assuring them their loved one will be kept comfortable, providing emotional support, etc.

LovingNurse- I love your word decootify. That's great.

At our hospital we have preprinted PCA orders. The doctor picks which drug they want and fills in the doses and the hourly limit. I think the form has the concetration of the drug on it as well. When we program the PCA the first thing we put in is the concentration of the drug. eg Morphine comes 1mg per ml.

I work with PCA's often. I alway take the order in the room when I set up a PCA. Any medicated gtt has to be checked by a second nurse. But most of the time I am picking up a patient from PACU who already has the PCA going. In that case I also check the formula on the PCA against the order because when I take over care of the patient I am responsible for what is going into the patient. I think the nurses involved should receive a med error. This is definitely and opportunity for staff education. The nurses could be subject to disciplinary action for not following hospital policy if that's what management chooses to do. But I don't think this is grounds for firing the nurses involved. Provided these nurses don't have a pattern of making these kinds of mistakes.

You were certainly within your rights to feel out a report if that's what you felt was the right thing to do. At our facility our meds are profiled by the pharmacy. ie During pharmacy hours we can't take anything out of the pyxsis until pharmacy profiles the med (puts it into the computer). With the exception of a few select emergency drugs. We have computer generated MARS. When you come on to your shift you have to check your MAR against the kardex. If there is any difference or a new order is hand written you have to check the original order. Also at the end of our shift we have to run a report to check for any omissions. So technically the day nurse should also have an error for transcribing the order wrong. The evening nurse would have an error for omission and possibly for error in checking practice (at our facility) provided the order was transcribed correctly on the kardex. That being said I probably would have not made out an error report. It sounds like you work nights? If I had caught the missed dose early in the shift I might have chosen to give it. Otherwise I probably would have just fixed it and let the nurses know because it was only pepcid. But if it was an antibiotic or bp med that would be a different story.

At my hospital we only obtain a specific consent for the hepatitis B. I think the other meds are covered under the consent for admission to the hospital for medical treatment. But of course the parent could refuse the medications. I have only seen a few parents refuse the hepatitis B vaccine so far.

JCAHO just came through in December and this was not raised as an issue. We do keep the dermoplast and tucks in the bathroom and the lansinoh at the bedside. Perhaps you could get an order to leave the meds at the bedside. We have done this on medsurg for eye gtts, cough gtts, etc.

I work in New York state. I'm not sure if there is a law but this is what happens. An HIV test is done with the initial prenatal blood work. I have noticed that one of the doctors has the HIV test repeated later in the pregnancy but I don't believe the other group does. (I have been on vacation and haven't looked at a patient history in 2 weeks) If the mother refuses to have an HIV test during the pregnancy then the baby has to be tested. I know if an HIV test is drawn on the floor counseling is provided, usually by the infection control nurse. I can't remember how the counseling is done when the HIV test is ordered as part of the routine prenatal blood work. (It's been 4 1/2 years since I have had that prenatal blood work myself.)

I just became an OB nurse last summer. I had floated to OB from time to time and had thought about making a switch to OB. I also was crosstrained to pediatrics. I knew if I switched that I wanted to stay on days. It used to be that a day job on OB was hard to come by because OB nurses almost never leave so it seemed. Then one day while looking at the job board I noticed that someone I knew that was going to retire was retiring sooner than I thought. I had a lot of hesitation in switching because of L&D but I felt that God was leading me in a new direction. Now I don't mind L&D too much. I like having one labor patient to take care of (I work at a small community hospital). You can give all your attention to that one person. Gaining experience has helped me to have more of a comfort level in L&D. But by no means am I done learning. I think having the background I have has been helpful to me in making the transition to OB. One of our older obgyn doctors said to me early on that he thought it would be an advantage to me that I know how to take care of sick people. However I am not suggesting that you have to follow the same path that I did. I went to college right out of high school. I give a lot of credit to those that have to work and go to school at the same time. Good luck to you.

Here are a few of the web sites from my favorites. I hope this helps. Also on this web site under the specialty tab there is a section for obgyn nursing. I don't know if you would find any information there that would be helpful. Good luck. http://classes.kumc.edu/son/nurs420/unit11/FHT.htm http://www.obfocus.com/cme/fhr.htm http://www.fetalmonitorstrips.com/learn_more.html

I can relate to your dilemma. After 11 1/2 years of med-surg I switched to maternity in August of 2008. Several times in the first 2 to 3 months I was mandated to float to my old floor because I could take an assignment. The more time that passes the harder it is to go down and pick up a full assignment. I can do it but it's harder because I am out of the routine. I don't think a nurse is a nurse. I think when nurses are expected to take an assignment on another unit it should be in a related specialty and maybe the assignment should be a little easier because it's not your floor. I have not always felt this way but I think switching to a different area of nursing has given me a new perspective. As someone else suggested maybe you could work as helping hands when you float to that floor. I have done this the last couple of times I floated and it has made it easier. Good luck.

Our pharmacists mix the majority of our meds for us or the meds come in unit dose vials. The pharmacist also does the calculations for us. However I did have to learn how to do the calculations in school and I do still like to double check the calculations myself. I figure I am the last check before the patient gets the medication. If I have any questions at all that I can't look up I don't hesitate to call the pharmacist.

The hospital I work at has a LTC facility on one of the floors. To my knowledge they don't isolated for MRSA. However one has to remember that the nursing home is the residents' home. So the approach to their care is a little different than it is in the hospital. The hospital has changed the policy in regards to isolating MRSA patients in the acute care setting. If the patient tests positive for MRSA prior to hospitalization and the following routine is followed we don't have to isolate the patient. A patient has to use bactroban to the nares for 3 or 5 days (I can't remember the exact number) and has to shower with a specific medicated scrub for 2 days prior to hospitalization. Then they continue the bactroban to the nares for the first 2 days of hospitalization. We have had these patients a few times on OB for csections. I know I am getting a little bit off the original post but does anyone else have a similar policy?

I absolutely agree with the others on this thread that the nursing supervisor and charge nurse should have been involved. On the medsurg unit I worked on when you have a patient that is crashing or you have an impossibly busy assignment your coworkers help you. If everyone is truly busy our nurse manager would get approval from the supervisor to try and call a nurse or nurses in early. There have been a few occasions when the hospital was in a true crisis that a few nurses in administration have done patient care. On the maternity unit that I work we sometimes have to be on call for backup. It depends on the staffing for that day, the patient census, and the experience of the staff on (more so on the night shift because we have had a lot of new nurses and backup is not always readily available on nights). When you're on call it's usually only for four hours at a time, unless you want to do more. It's only once or twice every two weeks and sometimes noone has to be on call. We have a few perdiem nurses who often sign up for the on call. We get paid $3 per hour that we are on call. So that might be one option. We also have a rapid response team. If your patient is having any change in condition, minor or major, that you feels needs immediate attention and the doctor is not readily available you call the rapid response team. This is made up of the nursing supervisor and/or one or two ICU trained nurses, and a respiratory therapist. They have standing orders that they are allowed to carry out. ie ABGs, EKGs, labs, etc. They also carry a desiganated cell phone with them so they can call the doctor right from the room with the patient condition and what has been done and obtain further orders if needed. They will stay until the patient is stabilized or transferred if need be. One time that I called them was for a patient that had a lap chole the day before. The patient had a low bp and her O2 had to be increased to 4 liters. Her bp wasn't responding to the fluid bolus. I can't remember for sure but I don't think the doctor was calling me back in a timely fashion. The patient was alert and oriented and felt fine otherwise. The respiratory therapist and I felt something was going on with the patient so we called a rapid response. The patient ended up being transferred to the ICU and was on a medicated drip to maintain her bp. One of our nurses in the education department who is in charge of the team has said that we have prevented a number of codes by calling the team for changes in condition that need attention. Hope this helps. Keep us posted.

You won't know if you can do it unless you try. Since you would love to help care for others that might be the motivation you need to do some of the "messier" jobs. Helping somebody that can't help themselves brings great satisfaction. I worked as a CNA during college breaks and that experience was helpful to me in nursing school. It's a hard job but at least you would be making a difference. Good luck.