tablefor9

I'm the women & children's day shift charge RN. Either the director or I interview and chart review each proposed overflow pt before that pt is assigned a bed on our units. Dementia, psych issues, total cares, febrile illness, infections, wounds, N/V/D, and HX of MRSA, VRE, TB, or CDiff-ever- are automatic disqualifiers. And, you have to be female to ride the ride.

Lol! I thought the same thing. My oldest would say, "Mom, you really should not smoke crack"

1. Read the recommended books on the sticky at the bottom of this forum. 2. Join AWHONN. 3. Remember that although the peripartum period is not risk free, it is a state of health, not illness. Use your time wisely to encourage healthy behaviors, family bonding, and the mother's belief in her ability to parent. 4. Find a mentor. Don't believe all of what you hear about the nurses you'll be working with. Listen & look more than you speak and find the nurse you most want to emulate. There's a potential. 5. Keep a reference in your locker or bag and look up what you don't know.And a couple thoughts from the high risk OB side of my brain: 6. Never assume pph can't happen after 12 hours. Delivery doesn't cure pre-eclampsia. And if mama looks at you and says she's going to die, you better pay attention.

Shop around...and not for the transilluminator. Look at both sides,hands to ACs, just like you do for IVs. Try starting your blood draws an hour early, like right after 3am VS. For some LOP, very fragile veins, the tourniquet may be what the problem is...try without it. Put a warm compress on before you stick...about 10 min will do it.

Rare to get a call on my day off, and we are a closed unit (no one floats...in or out...of our unit). It's not that we have a ton of staff, either. It's that we all have a mandatory call shift once a pay period....which started (you guessed it) because people weren't coming in on their days off. I *always* have to work my 4th day for the unit to be covered so I just take the OT $ and run!

PCA Morphine/Dilaudid postop

Money go? At our facility, it's not a black hole in the CEO's office as much as it's an entitlement mentality and an abuse of the ER, EMS, and the healthcare system in general. Quote from this week: "I want x, y, and z...because it's free, well, at least I'm not paying for it"

Rare, especially in the South. That being said, the one I've worked with has been great, and the patients didn't have issues with him. Besides my life as a labor nurse, I'm also a grand multip. I wouldn't have cared who helped me during my labors or births. One thing to consider, though, for those that don't understand why a person who would have a male OBGYN but would prefer not to have a male L/D RN...your labor RN is much more present, active, and personal in your care. Your OB shows up maybe to break water and to catch. MUCH different, especially when you consider a labor without epidural...your labor nurse may spend 10 hours with you bare naked, holding monitors on, having hands all over your belly to palpate contractions, uterine tonus, perform leopold's, do vag exams, massage your back, apply counterpressure to your hips or low back...a good labor nurse really isn't what you call your hands off. Good luck to you, in whatever you do. T

I don't like the fire first and ask...well, don't ask, ever...mentality, either. And, I believe any nurse mgr worth their skin will take other action. However, many times, especially in situations like the one you describe, the root of the patient's anger is that they don't feel that they were listened to or treated with respect, and that does require some type of corrective action and staff intervention. I certainly know about labor, it's how I make my living. If I had a dollar for every time I've seen a pt angry because the shift before me sent them home, or the hospital across town sent them home, I'd take everyone on this thread out to dinner. I also know about crackpots. Literally and figuratively. I've had my share of "cocaine induction" patients, but I've also seen too many times when our cynicism has gotten the best of us, to the detriment of our patient relationships. The fact is, we can't afford to let that happen. Our patients have all kinds of unrealistic expectations, and we need to use every tool we have to build rapport and stop the problems before they start, especially in an era where our reimbursement is tied to our pt satisfaction.

As a nurse, you are the advocate for your patient. You are also expected to follow MD orders, when those orders are not harmful to your patient. That's basic. As an employee, you're expected to follow the protocols put in place by your employer, and submit to the authority listed as your supervisor, when doing so is not unethical, illegal, immoral, or harmful to yourself or your patients. Still pretty basic. Where it gets complex is deciding exactly how much you hate power struggles, because by your own account, this isn't an isolated incident. Seems to me you've got three choices: 1. RUN. Find another job, because this lady *using term loosely* isn't going to change and one of these days, you're going to be screwed, and maybe sued, for ignoring MD orders in favor of policy or reprimanded, and maybe replaced, for ignoring policy in favor of MD orders. This is a no win situation and leaving may be the only way you don't come out on the losing end all the way around. 2. FIGHT. Document issues with your clinical coordinator, then file a complaint, working your way steadily to the top. Everybody but God's got a boss, or at least an agency providing oversight and accountability. This isn't a comfortable choice, but it may help patients and other staff. Plus, it's satisfying to see a bully get what they've got coming to them. 3. WAIT and SEE. How's that working so far? This is okay in the short term, and perhaps somebody else is already working on OPTION 2. Since you are the only nurse, I kinda doubt it. Good luck to you! T

Our L&D will admit a patient that is OB-ICU to our L&D unit or one of our ICUs and work collaboratively with ICU staff to manage patient care. We also open our high-risk OB inservices to the ICU RNs. Perhaps you could work to develop a similar program at your facility...it's gone over well, here.

The only way I would recommend a new grad moving straight into specialty area, even L&D, is 1. the specialty is her/his passion and 2. the orientation will be extensive and supportive. While L&D is a law unto itself in many ways, after several years of precepting all kinds of people in the L&D, I'll say this: experienced ICU and post-surgical RNs have the easiest time making the transition. Why? They have solid assessment skills, they have a good grasp of basic nursing scope, skills, and time management, and they are comfortable in their own skin as a nurse (trust own abilities to prioritize, speak to physicians, initiate chain of command as needed, work collaboratively within the unit setting, and have the backbone to deal with ancillary departments that may or may not see the childbearing unit as a priority). Certainly, one can get every bit of this experience in the women's center, and many of the qualities I just listed may be ones you, as a more mature individual, already possess. If so, great! I'm precepting a 25yr old new grad right now that is going to be an amazing nurse, but she still allowed herself to be ejected from a patient's bedside by an US tech who didn't prefer to have an audience. She's had 12 weeks on mama-baby and gyn. She'll get 14 weeks in L&D, after which she will go to nights and be paired with a mentor with 20+ years of labor experience. She will complete AWHONN basic, NRP, PALS, and ACLS during her dayshift orientation. From an academic standpoint, I know it's plenty. Whether it'll be enough real-world experience, I guess we'll see.

Steak or grilled fish dinner, water mug with Women & Children's Logo, diaper bag, baby hat with quilt or blanket, blanket with baby footprints added at delivery, and still pass out the gift bags. For BF moms, we give packs with lansinoh, medela steam bags, ebm storage bags and bottles, nursing pads, and a book on breastfeeding written by our hospital's IBCLCs. Holiday babies receive additional holiday bibs, hats, blankets, and boy/girl gift.

At my current facility, RNs may insert FSEs once trained (AWHONN class) and signed off (3 successful observed insertions). IUPCs are CNM/MD only. Last Florida facility was RN FSE and IUPC, same requirements. Yearly AWHONN course/competency and skills checkoff are required for all family birth center RNs.

Since our average primigravid pt gets her (very dense) epidural about 10 hours prior to delivery, we place foleys. If we have a multip at 5-6, we proceed on a case by case basis.