suezan59

Had a new dad ask me if they had to wipe ALL of the poop off of the baby's bottom when they change the diaper - seriously made me doubtful about their personal hygiene!!

We started doing bedside report several months ago, but it usually ends up being more of a "meet-and-greet" than an actual report. Either there is a room full of visitors (and even if the patient says she's OK with you talking in front of them, I'm sure she doesn't really want you talking about her hemorrhoids, her psych history, her Valtrex prescription, or her baby's positive UDS in front of them!), or the patient is finally getting some sleep. We usually do the main report before we go in the room, and just do a quickie revamp of any major issues (as long as they're not potentially embarrassing to the patient in front of visitors) and what/when times of any medications. We ask the patient if there's anything she'd like to include, any questions, or anything she'd like the oncoming shift to know. That's not really the way bedside report was intended to be, but that seems to be what it has become for us. Some of the patients do comment that they like it - it makes them feel more involved in their care - but most don't seem to care one way or the other. I do like the introduction component of it - I feel like it smooths the transition between shifts better for the patient.

One of the more humorous birth plans I've seen had "code words" that all staff was supposed to use until after the mom delivered. There must have been close to 20 words that staff was forbidden to say around her, and of course, they were all words that you use routinely during a delivery. I honestly don't remember exactly what they were, but it was stuff like substituting "pressure" for "pain", "flowering" for "dilating", "relaxers" for "pain medication", "waves" for "contractions", etc... I remember the nurses were forbidden to use words like IV, monitor, needle, catheter, blood, basically anything that sounded remotely medical was taboo and had a substitute word for it. The most ridiculous one I've seen dictated that the patient required 7 orgasms during the 2nd stage of labor to help her relax, and that the labor nurse should assist her with achieving those. Uh, hello?? Call me crazy, but isn't that called sex?? For the record, the nurse that was taking care of her said that she told her she would NOT be helping her with that part of her birth plan, but that if her husband wanted to take care of that, she would give them some privacy.

I'm on the postpartum side so I don't know many of the individual reasons for some inductions, but I do know that there seem to be more when certain MDs are planning to go on vacation - a disproportionate amount of their 37/38 weekers will be sitting over on L&D at 1-2 cm dilation hooked up to pit a week before they are supposed to leave... Coincidence??? I had one postpartum mom who said that she had tripped up the stairs and "bumped" her belly (in addition to scraping her knee), so she came in to be checked just in case it hurt the baby. The baby was fine, but the doctor said that since she was already at the hospital and 37 weeks along, why don't they just go ahead and induce her??

We use Toradol for post-op C/S all the time; however, they max out at 4 doses because it's rough on the kidneys (or so I was told). The breast milk transfer issue is not taken into consideration because mom is just not making that much milk yet. Same with the Dilaudid and morphine PCAs we use all the time - OK for newborns who are just getting colostrum, but not if mom's milk is in.

Our hospital is currently in the process of going baby friendly (we have about 6 weeks before they close our newborn nursery) and most of the staff is pretty upset about it. Not that we aren't already supportive of breastfeeding and rooming-in, but we just feel like our concerns aren't being listened to (dropped, smothered babies; exhausted moms who desperately need a few hours of uninterrupted sleep; spitty, gaggy babies whose parents are too terrified to sleep, etc...). One thing that no one will address for us is why we have to get rid of the nursery - from what criteria we found online, you only have to "allow" moms to keep the baby in the room 24/7, not that you can't have a nursery! I think that what management really wants is for the nurses to do more "procedures" (hearing screens, blood work, weights) in the room, since those are the main reasons our babies go to the nursery, but too many of our nurses are "old school" and resistant to it (some even take the babies to the nursery just to get vitals!!). If we could get these nurses to do all of it in the room (and all the peds to see the babies in the room), we would have a higher percentage of "rooming-in" babies, be able to keep our nursery AND be "baby friendly" (and yes, several months ago they collected data on how many babies went to the nursery for ANY reason and the percentage was too high to get "baby friendly" status). I feel like all of us (and the new moms!!) are being "punished" because a handful of staff is resistant to change - it's like management is too afraid (or too lazy!) to hold these nurses accountable for adhering to new policies and they are taking the easy way out by just getting rid of the nursery and saying "there, problem solved, now they HAVE to do it". The most upsetting thing is that we seem to be making these changes just to get a certification - not because moms want it, not because the community wants it, not even to necessarily increase our rate of breastfeeding moms (which, being a night-shifter, I think this will hurt our rates. That exhausted mom who simply can't cope with her cluster-feeding baby's demands at 3 in the morning any more and asks for a bottle, I can usually persuade to forgo the bottle in favor an hour break from the baby - mom needs a break and some support, not a bottle! Now that option is being taken away). We're doing it because we have a new clinical director and his old hospital was baby friendly and he wants the certification here, too. Period. Did I mention that our first "change" was to put ALL babies to the breast immediately after birth? Not just skin-to-skin, but actually latched on - even with the moms who are bottle feeding and absolutely do NOT want to breastfeed. Oh, and this is without asking and getting mom's consent first...

We have facility scrubs that we have to wear. They are stamped with "Authorized OB Staff" and are part of our "security" system - we tell the moms that if someone comes to take the baby (to the nursery, for an MD visit, or whatever), they should be wearing those scrubs. If they aren't, they shouldn't give them the baby!

I have a pair of Crocs Bistro (no holes, non-skid sole) that I love - my feet never hurt in these and I've never slipped on a wet floor like I did with regular Crocs. The only drawbacks I've found are that the toes get scuffed and there's no way to buff them out, and my feet get sweaty in them (and I don't usually have sweaty feet!!) because of the lack of holes.

Our hospital types the cord blood on all babies, regardless of mom's blood type.

During school, we only had one day to observe in L&D - I was one of the lucky ones who got to watch a lady partsl AND a c-section birth. Our postpartum rotation was only a few days on the floor and I thought it was really boring (I'm a postpartum nurse now and I love it ). The previous advice to get a tech job or internship is great - the only way you're going to know if it's for you is to be immersed in it, and it's hard to get that in school. Please note that this is coming from a new grad, but I would recommend keeping in mind that a lot of OB/GYN nursing (at least the postpartum side of it) is patient teaching and monitoring. Most moms and babies are healthy and don't require any medical interventions beyond pain meds, and some nurses find this extremely boring (and from a student's point-of-view, it can be VERY boring). I spend a lot of time getting drink refills and snacks, and charting how many times the baby nursed, had a wet diaper, etc... Every once in a while something really exciting happens, but for the most part, it won't have the excitement that you'll get in other clinical experiences. It really seems to be one of those love-it or hate-it kind of fields. Most of the nurses I work with have been in it for years (more like decades!) and would retire before they would work anywhere else in the hospital.

Our hospital policy is to wear gloves when handling breast milk (because it's a bodily fluid), and changing diapers (also bodily fluids). When bottle feeding formula, gloves are not necessary, but if feeding pumped or donor breast milk, gloves are required. Gloves are also necessary if handling a baby who has not had its first bath yet and when assisting a mom to latch the baby on - she may have traces of milk on her skin, or if her nipples are cracked, the nurse could create an infection. I couldn't tell you if every nurse on the unit adheres to policy, though...

We test the baby's urine if the mom has a history of drug use, late prenatal care (none until after 5 months), or sporadic prenatal care (beware moms who have just moved from out of state and didn't get a new OB doc right away!!). If the baby meets certain size criteria (small for gestational age or head circumference under 25th percentile), we test meconium. We don't need mom's consent for the baby's tests - it's state-mandated. I'm sure that somewhere in their admission paperwork (that they don't read because they are in labor while they're signing it and being bombarded with paperwork in addition to trying to cope with contractions), there is some clause that gives us permission to do it.

I work on postpartum and we routinely get GYN post-ops - mainly because it's more convenient for the doctors to do rounds. We are also "associated" with (as in we have to share staffing, and are located next to) pediatrics, so it's not uncommon for some of the peds patients to be 60 year old hysterectomy patients! Also, they try to admit any pregnant patient to our L&D department - even if the reason she's there has nothing whatsoever to do with her pregnancy. They had the ER call with a patient presenting with SOB who was 24 weeks. The nurse who took the call asked if she was in labor? No. Cramping? No. Bleeding? No. Decreased fetal movement? No. The nurse politely suggested that they call respiratory therapy to treat her symptoms and call back if they needed to obtain fetal heart tones...

We use the HUGS system, too. I'm assuming that it's the same one the other posters mentioned - the baby's Hug tag is matched to the mom's Kisses tag. Our baby tag is only about the size of a quarter and a half inch thick. The edges are rounded, so it doesn't seem to rub the babies' ankles too badly. The band itself is what activates the tag, so they can't be taken off without triggering the alarm system. We don't get very many false alarms (usually just a "loose tag" message which doesn't cause a full lock-down, just flashing lights and an alert message) and an occasional mom-baby mismatch if a mom goes home and the nurse forgets to take the tags out of her pocket. There is a computer dedicated to the Hugs system that has a map of our department and shows where the tag that is triggering the alarm is located, too. It seems pretty secure. Our unit can only be accessed by the public by one elevator and the system will trigger a lock-down long before anyone could get near it with a baby. We also have a "welcome desk" at the elevator that is staffed 24/7. All visitors have to sign in and the tech that sits there has a walkie-talkie that is always connected to the security department. I haven't noticed any problems with the bands getting stinky - our babies only wear them for 4 days at the most, but I guess if they did get nasty, it would be easy to suspend the alarm and change the band.

I'm a new grad working on postpartum (still on orientation) and I surprised by the negative attitude towards birth plans. The nurses I work with automatically assume that the patient is going to be a PITA just because she has one! Most of the nurses I have precepted with don't even bother reading them, even though a lot of the time they cover postpartum issues as well as labor and delivery ones. They say that if the patient wants them to know, she will tell them (I believe that was the whole point of the birth plan, wasn't it??). Anyway, the thing that bothers me the most about their attitude is that the majority of the birth plans we see are pre-printed, multiple choice/fill-in-the-blank forms that the patients received when they attended our hospital's childbirth classes. So, WE are providing them with the birth plan, telling them to use it, and then holding it against them when they do!! These are very standardized birth plans and say right on them that we will try to accommodate the patient's wishes, but that the safety of mom and baby ALWAYS come first, so the staff may not adhere to the birth plan. The other day I pointed out to my preceptor that our patient's birth plan stated that they wanted the baby's hearing and newborn blood screens to be done in their room, not the nursery (this was the pre-printed hospital birth plan and we do have portable hearing screen machines for this purpose). She said "Oh. Well. I guess when we go to take the baby to the nursery, she'll stop us if she still wants to do that." I asked her if we should just offer to do it in the room (instead of trying to be sneaky or pretend like we didn't read the birth plan) and she responded with "When you're on your own you can do that if you want, but I never do." How is that advocating for the patient??? There was another patient who didn't want to be asked about pain medication repeatedly (it was in her birth plan and she was very frustrated that no one was honoring it) and made it known that under no circumstances was she to be asked if she wanted something for pain - she would let us know if she changed her mind. To get around the charting requirements, the nurse documented word-for-word what the patient said, and then did pain behavior cues, instead of the 0-10 scale, for her required pain checks after that. Legally, she managed to cover her butt, but still adhere to the patient's wishes.