indigo

It just takes a second to aspirate and why not be safe?

Our policy is to back off on the pitocin if more than five UCs in ten minutes. We rarely use IUPCs, but I wish we did more often sometimes to get a more accurate picture of what's going on. indigo

I had a pt recently, 19 years old, difficult social situation, in labor, pit aug, but just couldn't progress. I felt at the time that it was fear holding her back, but now I'm thinking it was disgust and being grossed out also. I spent a lot of time working with her, getting her to describe her fears, talking to her about her emotional state, reassurance about the birthing process, etc. I endured her screams, "I don't care about this f-ing baby, just get it out of me!" After birth, when we went to put the little guy on her tummy, she pushed it away. It was difficult, I was pretty disgusted with her inside myself, but never let it show. She was verbally abusive even after the birth. People say, Oh, it's so wonderful to work in labor and delivery. Not always!

I so appreciate the tips on vag exams. I usually work with CNMs who are in house and do all the vag exams, plus we are so small we don't birth that many babies (150/yr). Occasionally I get to do a vag exam, and it is so stressful, but I'm grateful for the chance. I just want and need more experience, so periodically I consider going to work out of town in a bigger hospital to get better at this. indigo

I am also thinking of going PRN. I don't need the health insurance, get that thru my husband. I am a staff nurse working nights in labor and delivery/med-surg at a very small community hospital. We are usually fairly desperate for nurses, esp. labor and delivery/OB nurses. We ALWAYS have a job opening on nights for OB. I see PRN nurses coming and going at will, getting scheduled full-time plus sometimes. It would increase my salary at least $10 an hour. Because we are so small and always needing RNs, it's hard to get time off, especially in the summer. Just thought I'd add a few more thoughts into the mix. On the downside, I have my children to support (my husband doesn't support us, we just share bills and he gives me health insurance) and I do like the security. But it's hard when I see others making so much more money and having so much more freedom. I am also stuck on nights for the foreseeable future and PRN may give me more day shifts. indigo

It makes sense to do a head-to-toe always so you have your baseline. Make that your practice. The only way to know a fundus is firm is to palpate it, otherwise I guess you're just hoping it's firm. Even if it is firm, assess the amount and character of the lochia. Be sure your pt doesn't have a full bladder first!

To circ or not to circ? I am an OB nurse who assists with circs and it is SO totally barbaric-seeming. The babies scream and cry and they come out with a swollen, bloody member. For what. I am also the mother of three uncircumcised sons and none of them have ever had a problem. I am so glad I didn't have them cut on when they were so brand new to the world. I feel so glad when new parents don't want to circ. It's about 50/50 where I work.

Thank you for pursuing this and for your bravery and for being the ultimate patient advocate and woman's advocate. Please stop that monster.

During circumcision, you are number one the patient's advocate. The poor little guy has no choice but to submit to this barbaric mutilation. Get an order for EMLA cream and get it on a good hour before the doctor arrives. Try to comfort the patient as best you can while it is being done, let him suck your gloved finger, wrap him and hold him close when it is finally all over with. It is my wish that no one would EVER do this to their newborn son. Be sure to provide the family with information from the American Academy of Pediatrics before they sign the consent.

Yes, I did pass the NCLEX on the first try without taking a review course, but I did study, study, study with my Saunders review book. It is not an easy test, but if you put in some good time studying and arrive on test day confident, rested and well-fed, you should pass with no problem. Best of luck -- you'll feel so happy when you pass!

I am a new RN and have been through only one code. Even though our patient died, it was amazing to watch everyone jump into action. For the first half of the code, I was more or less a gopher, then I became recorder. It was then that I really could hone in on what was happening. I felt useful and less stressed than I had earlier. I had never seen someone die before, so it was a sentinel event. I am going to take ACLS. I know I can handle whatever is thrown at me....that helps.

Our hospital has a total no smoking anywhere on campus rule. It was instituted a few years ago. No one pays any attention to it. Patients drag themselves out and smoke right at the ER entrance. As a new RN, I refuse to take patients out to smoke. I respect patients' right to smoke, but I do not want to be an active participant and we have a strict no smoking policy in place. Most of the CNAs, however, don't seem to have a problem wheeling people out to smoke. Our hospital is short an acute care manager, so there is basically no one even paying attention to this. Now there's a new "smoke shack" being built. Right next to the NO SMOKING ANYWHERE ON CAMPUS sign. Obviously it's a difficult issue, but personally, I will not take my patients out and I explain this nicely to them and they understand. I offer to get an order for a nicotine patch. As nurses, we are responsible for promoting health and helping a sick person out to smoke is not promoting anything but illness and misery.

I am a brand new RN and I have a nose piercing. I think it is attractive and I don't see how it would offend anyone. As far as I know, our hospital doesn't have rules against it. My nursing program did (I had to use a plastic plug that made it look like a blackhead!@?!?!), but as far as I know, when I go to orientation on Monday I will have it on and don't intend to take it out. I have given presentations at the RN staff meeting, and I wore it at graduation and no one complained. It's really no big deal. I have a tattoo on my forearm that means loving-kindness, and when someone asks me what it means and I tell them, they always give me a warm, loving response. I'm a 49-year-old lady, a breast cancer survivor (just finished chemo/rads in January) and mother of three, as well as a new nurse. Can't see how I would freak anyone out!

I'm a new RN and am looking to buy a PDA with pharmacy info. software. Any advice out there? indigo

Great suggestions and replies. I am graduating too in early May. My program did a couple of units on taking care of ourselves and dealing with stress, and yes, I passed the tests, but really, it is a personal responsibility and no one can teach you to make yourself your number one priority! But I'm still trying to learn that.........

Yes, the breast. My arm is fine. My breast surgeon (who lives 250 miles away) told me this does happen and that I should find someone who can do lymphatic massage, but alas, in my small town, there is no one. So I'm just limping by trying to do it myself and it's not really working......

I just finished breast cancer treatments three months ago -- lumpectomy, axillary dissection, chemotherapy, radiation. Now, suddenly (just as I am going crazy trying to finish nursing school and graduate in three weeks), I have developed lymphedema of the breast. Has anyone heard of this or dealt with this before? There is scant information available because it's not very common, but I've got it and it isn't fun. Any help would be appreciated.

I am just getting ready to graduate as a registered nurse. At times, I feel we students have been treated in a hellish, disrespectful manner by nurses and nursing assistants alike. We are doing our clinicals in a small hospital in a small town in a rural state. This hospital has never had student nurses before. We really had to carve our own inroads. It has been a learning experience for all of us, including the registered nurses who are now our preceptors. Now, finally, I feel like we students are getting the respect we deserve. But we had to go through a process of proving ourselves. I can't say it made things any easier, but that's how it all worked out. I will never forget how terrible and small I felt many times driving home from clinicals. Please let no one ever discourage you from pursuing a career as a nurse. Keep doing your very best. Student nurses need to be humble, but student nurses always deserve the utmost respect and support. All people do.

I am a nurse, but above that I am a woman. I couldn't stand the way one female character was repeatedly sexually harrassed by various men. A supervisor hits on her, a patient kisses her and one of her peers comes up behind her at her locker and puts his arms around her. All of these encounters were pushed on her and she became "angry" in each one, then, oh well, she went on to get assaulted again. How long are we women going to stand by and let this crap get into the mainstream media? The treatment of nurses was indeed offensive, the treatment of women was heinous. How do we reach the producer?

Thank you to everyone for your well wishes. Love to you all and I will write again.

I was recently diagnosed with infiltrating ductal carcinoma, with one cancerous lymph node. I have a stage II breast cancer. This summer I've had a lumpectomy, followed by a wider excision with sentinel node biopsy, and then an axillary dissection. I am looking at 4 months of chemo, followed by 6 weeks of radiation. I am working on an ADN stepping-stone type program, and I just graduated as an LPN and passed the NCLEX. Our RN year starts later this month. I live in a small town in Alaska and am doing a distance-type nursing program with a university in another state. It is a unique opportunity -- to become an RN here in my home town, without having to uproot my husband and three sons. I have been DEVASTATED that I would have to quit and give up my dream of becoming an RN, especially with only 9 1/2 months to go until graduation. (I am 48 years old and this is my first foray into higher education.) But I found out just yesterday that my program will accommodate me and let me do clinicals after my cancer treatments are over. I will still have to take two nursing theory classes on line during treatment. Why am I writing about this? Because I am so, so, so happy to be able to continue in my program. It gives me a powerful kind of energy to fight my cancer and get through my treatment. I just wanted to tell a lot of people that even though I have cancer, I am still fortunate enough to be studying nursing!!

I so understand and empathisize with your desire to have a professional life and be able to mother your child in the way that you want to. But I would not recommend nursing unless you really feel you have a calling for it. I am still a student, but I couldn't imagine making the sacrifices that nursing entails if I didn't strongly feel called to do it. For what other reasons are you interested in nursing besides having a schedule you want and a job whenever you need it? When I begin my nursing career I imagine I will have to take what I am offered in terms of a schedule. To make good money, I'll have to work a lot of hours. Even so, I feel grateful to be entering the profession and if that's what you decide to do, the best of luck to you!!

I'm an ADN-bound nurse just getting ready to start my final year of school. The whole concept of nursing diagnoses was completely new to me when I started. This system has been very useful to me as a student, and I believe that it will be also when I begin my career as a nurse. It gives me a framework to help me identify the needs of my patient; nursing diagnoses also define the concerns of a nurse. This system carves out our territory. Years from now when I am experienced I will probably never think about nursing diagnoses. But for the newer nurse, I think it's a great system. BTW, I think "constipation" is an important nursing diagnosis. There are also some very interesting nursing diagnoses, such as "energy field disturbance." This is laughable, but on another level it really isn't. If you think about your patient holistically, this diagnosis may have some validity. Don't get me wrong -- I HATE writing care plans and coming up with nursing diagnoses. But I do think this system serves a purpose.

This seems to be a subject that begs to be discussed.

Right on. For me, I think midwifery is for women and about women and it makes sense for women to attend to women birthing. But for others, it really doesn't matter and a male l/d nurse would be fine. Let the mother decide.