susancox

WOW! In what state is it legal to let a nursing assistant give any meds, let alone an injectable med!! Scary!! That has to be illegal. I live in upstate NY (Rochester) and the average for a new grad at the hospitals is $16-17/hr, however I am leaving in a week and a half to make $22/hr, perdiem at a LTC facility doing medical rehab nursing. I have my BSN (and a BS in Health Ed) and make no more money than if I had my ASN. However, long term I want to be an RN Life Case Manager /Rehab Case Manager, something along those lines and know I'll need the BSN then. The $16.50 I am making now working Labor and Delivery is not nearly enough for the responsibility I have and the work I do, not to mention the stress some days!! Any other medical rehab nurses out there?? I hope I am happy with the change I am making. Any input would be helpful. Thanks~

We use Nubain as well, 10-20mg q2hours, and yes q1hour does sound like a lot of drugs, talk about a gorked baby--yuck!! I worry with the doses we give and have my narcan ready, but with that much what does the strip look like?? I do see quite a few still go for the epidural even after nubain--it just doesn't cut it for them. We used to give Stadol before I was there I hear, but stopped because too many people were having bad reactions--psychotic type reactions. We do get the occasional "bradley" pt--any one else get these people?? ---and they go all natural--the tub, the ball, music, massage, dark room, etc. .....all in the "plan" of course. I'm okay with a birth plan as long as the couple isn't "married to it" and totally unflexible.

Yes all care for a healthy baby can be done at the bedside, however it was mentioned that the meds could wait. First off why wait too long as the L & D nurse can give them right threre in the room and also, you might want to check with the state laws. I live in NY state and it is NYS law (I believe becase of the reccommendations by the american academey of pediatrics--or waht ever it is called) that all babies get the Vit K and Erythromycin by one hour of age. We have had "Bradley" patients who are very particular in how the process "should" go. They want oral vit K and want to wait several hours. We don't have oral Vit K available and have to tell them state law tells us we have to give both by one hour of age. So you might want to check for the state you live in. The Vit K within minutes I find actually helps the baby cry more strongly which helps in clearing the lungs better, just my opinion. Not all babies need that extra stimulation to cry well, but some do and it makes a difference. Sounds mean but that strong cry at the start of life if good for their lungs. Good luck and I agree with all here in---STICKING WITH YOUR PLAN and letting them know ahead of time to allow for staffing adjustments is a good idea.

The L & D nurses get the Vik K and Erythromycin as a standard for every birth, to be given in the room after delivery, either by her or another L&D nurse, if we aren't real busy or another nurse has a not very active pt. The scale that sits in the hall is rolled to every single birth, except c/s's as there is one that stays in there. So bringing the scale in to weigh the baby in REALLY NOT a BIG DEAL. The other things to be done need nothing. Just because a baby is not quite term does not mean close observation by peds people is needed unless the baby is having problems (ie. tachypnic, tachycardic, flaring, febrile, etc.) The L& D nurse where I work does all the vitals, helps with breastfeeding and is in the room A LOT so the baby is pretty closly monitored. There is a lot to be done between the baby and the moms checks (q15 minute checks on mom x5--BP, uterus check, pain and bleeding to monitor.)We can get the couplet out to PP in about an hour and a half, maybe two hours- if we need to, or a little longer if it is quiet enough to do the bath there. So basically the L & D nurse has to be in your room a lot to care for you and so should be able to care for the baby as well. I suggest writing a birth plan ahead of time--there are web sites that will help you do that-- and bring it with you. Make sure the nurse reads it and if she says there are things that can't be done ask to talk to the charge nurse for any possible accomodations. Good luck and congrats in advance!!

The physical and first bath can be done in the room. We don't do any "test" feeding with our premies but do have them eat sooner and start a BG protocol for all SGA babies. How early will you be? We only deliver 34 weeks and beyond, they have to go to another hopsital if they are less than 34 weeks so what we do may be different than for a baby less than 34 weeks. ???????? As far as insisting...I would ask to talk to the Neonatologist for the unit. Find out what he feels are policies that can not be adjusted for safety reasons and what he can do about things that don't endanger the baby. A lot can be done in the room as long as the baby doesn't have any respiratory distress signs, or is in need of an IV. What is the medical reason for the induction? The answer to that may help to clarify.

1) The whole RT thing seems weird I guess because it's different, sorry. Without that person being a RN, can he/she do the ballard/dubowitz, meds (Vit K and Erythro.)? Because of the "assessments" is why we don't use any LPNs. How does that work with RTs? 2) Thanks for the dubowitz info. We must do an abreviated version or something. It looks at 1-the skin (peeling?, visible veins?Leather? Cracked?,etc.) 2-the nipple bud size, 3-the creases on the soles of the feet, 4-ears (well formed pinna, recoil, stiffness, etc.) 5-the genitals (boy-rugae deep?, pendulous? Testicles descened? etc. and Girl-proportions of labia majora vs. minora) it only takes a couple of minutes. What is on the Ballard? 3) I love the idea of the blanket warmers in the room!!! How cool!! 4) Yea, what is up with the picture of the floating babies???

I'm Curious....what's the rationale behind the "no Vit K before the bath"???? This is something new to me. What sort of time table then do you have to get the bath in and the Vit K in or do you have one???? Interesting how very different practice is everywhere. You'd think it would be more universal. ????????????????????????????

Ballard vs. Dubowitz???? Here in NY we use Dubowitz. Anyone out there know the defference? I hear a lot of people mention Ballard, does anyone else use Dubowitz? Here we do the Dubowitz on every baby term or not because dating by LMP is so not an exact science. As far as the warm blankets when baby goes to the mom's chest. Where I work most of the nurses ask the mom ahead of time if she wants to be skin to skin right after birth, as long as the baby is stable (crying, pink, etc.) and we put extra baby blankets or a large bath blanket/towel under the warmer. We turn it on at the same time we turn on oxygen, suction, and call for an extra L &D nurse, if one is available--at caput. That usually gives about 3-5 minutes for the blankets to get warm and then we put them over mom and baby. It works well. Cold blankets and the baby usually does get cold--the warm blankets and skin to skin help a lot.

Okay stupid question but what is an "RT"? Is that what some of you call your techs?

I read a reply talking about all the things done pp in the NBN and not in the L&D room. The post read that vit K and erythromycin were given in the NBN. Where I work it is protocol that they are both given in no more than one hour from birth. I only takes a couple of minutes to do both, so I don't see why it would be delayed. In the L & D room we do both plus a physical by both the baby or labor nurse (if we have a free second L & D nurse to help do the baby stuff we do get one in to help) and a resident, the dubowitz to date the baby foot prints and bands, vitals at 1/2 hour, 1 hour and 1 & 1/2 hour marks. after this they can be transfered to post partum. The bath only gets done if we have the time. Sometimes it is too busy and we need the room for another laboring pt. The baby has to have a temp of at LEAST 36.4 C AND have eaten (which I haven't seen mentioned) before the bath. The babies that need to be in the special care nursery don't get most of that in the room only because they are usually rushed off to the SCN after resp distress, a mag baby, etc. and c/section babies. Other than that we do that all. I have a question--do all of you L&D nurses have to have current NRP certification?