enfermeraSG

Welcome to OB, glad you are enjoying it. My advice is to be plenty patient with yourself. OB is a steep learning curve and it will be a couple of years (at least, and that's if you're in a busy place) before you feel somewhat comfy. Also, ask lots of questions, go home and learn what you can, know your basic OB meds and emergencies. Always ask for input when unsure about anything from fhr tracing to SVE. You won't ever look as dumb asking than you will if you didn't and missed something crucial. Good luck! SG

Personallly, I agree that high-risk should be on continuous monitoring - however AWHONN does give guidelines for high-risk intermittent monitoring in the event a pt wants it. (Of course a situation like pitocin usage requires cont. monitoring per my hospital policy). Many factors involved which is one reason this is such a litigious area of nursing. Thanks for all the feedback everyone! SG

Hi all, I have searched the AWHONN site and their wonderful book but cannot find the answer to this specific question. Regarding intermittent monitoring, it is clear how often FHR needs to be auscultated in each stage of labor depending on low vs. high risk. However, it is unclear how long you should auscultate each time. Some providers argue that you need only listen before, during and up to 1min following 1 contraction. Others say you need to listen up to 20 mins - like and NST each interval. anyone?

Wow! Thanks for all of the wonderful tips! I am going to take a PALS, ENPC, and TNCC course by the end of the year. I don't have a date yet but expect to transfer this fall. The orientation in our ER is 12 wks with precepting and classroom time. This ER is not a designated trauma ER, so I'd imagine that 12 wks is pretty good. I think the biggest challenge will be all the med info I need to absorb, and the wide range of illness, injury and age/ranges. We have lots (at least one per shift) of emergencies on my L&D unit because we are the designated high-risk OB and extremely busy, but that's so different because the focus is narrow compared to the ER. Can't wait though! SG

Hi all! I am planning on transferring to the ER this fall, and at that time will have just over a year experience in L&D. I work on a high-risk, high-volume unit and started there as a new grad (worked there as a tech for 9yrs prior). ER is what I really want to do. I am planning on taking an ACLS and PALS courses this summer. What else can anyone suggest to help me ease into this new territory? I am used to working under stress and thinking fast on my feet as we have many life-threatening emergencies in OB, and of course our turnover can be quick oftentimes also. Are there any books or courses, med knowledge, etc, that anyone would recommend to get me ahead of the game? Thanks in advance! SG

We have approximately 5-6,000 births per year, and are currently in the process of getting everyone cert'd in ACLS. (See my post regarding "OB ACLS" has anyone heard of this?) Anyway, I think it is a good idea. We are a 500+ bed urban hospital with 15 birthing rooms and 3 OR's. Our Mom/Baby unit has 25 beds. SG

Hi all, Our dept has finally decided to require all L&D nurses to be cert in ACLS. We slid by without it before because we have an anesthesiologist and CRNA exclusively available to us 24/7. Anyway, they are requiring we take a mini class called "OB-ACLS". This is not the regular ACLS, and would not count as such. Some of us decided that we may as well take the real ACLS in the event that we wanted to go anywhere else, but our dept said we would still need to take this OB ACLS as well. Has anyone else ever heard of this, and if so - how is it different than regular ACLS? SG

Hola! Always I must pop in on this popular topic and offer my little words of caution. Be careful using online translation because they can be quite inaccurate, even babelfish. Many, many things and phrases do not translate directly and the computer does not know the context in which you are speaking. For example, the phrase "have a good time!" will translate incorrectly and literally. There is actually an all-inclusive word in Spanish that means "to have a good time". Not that you would need to say that in the hospital, but you get the point. : > I do applaud anyone who is willing to go that extra mile to provide better care by attempting to communicate in another language. That is very commendable. I would imagine the pts appreciate your efforts greatly. SG

I have to agree with a previous poster (Crocuta, I think) do not use programs, plain ol' online translation sites, dictionaries, or microsoft word, etc to translate. The majority of the time the translation comes out completely wrong, mostly do to the fact that the computer does not know what context you are speaking in. Also, many, many things do not directly translate word for word. As others have mentioned there are companies that will do this for you. We have a large enough SSO population that we have all of our forms in both languages. I translated some consents and other forms before for an anesthesia group, and I know there was some legal implications involved, don't quite remember how we worked that out. SG

If you look at the top of the OB/GYN forum this subject is a "sticky", the websites are great! Don't feel too much pressure to be able to read strips like a pro, it is a long learning process and can be tricky. I wouldn't feel like you need to "get it" as a student when it takes the floor nurses awhile to get it when we are new! Get a handle on the basics of it, make a cheatsheet if it helps. SG

Same here, no Mag on AP or PP. We also do all the above, except that BP is q 15 just like for epidurals, and DTR's, lung sounds, recording vitals, and I/O's q hour. Everything double checked with another RN when beginning the bolus too. SG

Wow, nurse's aides trained to scrub c-sections. Well, a previous poster mentioned that this is no big deal as a C-section is "not hard", at this I had to post-up. You are correct, a textbook, every goes smooth section is not hard. Unfortunately for us and the pts they do not always go well. I had a previous instructor (I was a cert. scrub in my other life!) tell us that you could train a monkey to pass instruments, but to have the theory behind what you are doing and why, how to anticipate and handle a bad situation where someone could potentially die - takes a decent amount of training. I would not want to be on that table with someone who had a few weeks of nurse aide training along with some on-the-job scrub training, if something went wrong in my surgery. There is so much more to it than passing an instrument and not touching what is not blue! I mean really, who couldn't do that? I also can't believe that JCAHO is alright with this considering they make us pull our employees files to prove that they are not only school trained scrubs, but also certified. I wonder why some L&D units consistently lower their standards compared to what is acceptable in the main OR? Surgery is surgery. SG

I have never heard of a unit claiming to have "different" O.R. standards than AORN calls for. I mean, it is an OR and the goal is to protect the pt from infection, injury, etc. We are expected to follow AORN guidelines on our L&D unit just like the main OR, and JCAHO expects us to as well. I would think that if your facility can produce something in writing where the AORN says your type of unit is the exception to certain rules, that's the only time I would feel comfortable. In regards to the family member being present, they do put on paper gowns, booties, mask, etc to protect the environment. That is not the same as compromising the sterile field by leaving a set open for 24hrs draped. Good luck! SG

Thanks for all the info! Also, I appreciate Mitchsmom typing all of that for us. I agree with another poster, 1:2 on pit is quite a challenge - mostly because of the charting, but bouncing from room to room to bump that pit up every 15 mins and then keeping up with the charting (especially if a strip is not the best). Whew, that's some work. Sounds like there are much worse environments to work in however. SG

I must learn to navigate that website better! I couldn't figure out where to find that info. Anyway, I'll just ask you instead....is being on pitocin for induction/augmentation bump a pt into high risk? I would love to know where to look for these guidelines and others on that website if you could give me some hints! Thanks, SG