CA CoCoRN

Truer words have never, ever been spoken.

We have hospital supplied scrubs. Only the RNs wear a certain color. Ancillary and technical staff wear two other colors. No one, not even student nurses can wear the color the L&D nurses wear. I've had to reasonably "jump" on a housekeeper or two for wearing our color. The reason? We all used to wear the same color on the unit. We had an incident when a father-to-be notified a "nurse" that something was wrong with a patient. He had actually notified ancillary staff who didn't/couldn't find the nurse and didn't notify another nurse. Father delivered his own baby....and the sequalae with his outrage (baby was thankfully fine)....mandated a solution to the problem. Solution?? Differentiated scrub colors. The scrubs are hospital/agency laundered, except for those nurses who are irritated by that process. They they wash their own. Our unit has special stripes on our badges for the L&D, PP, WBN.

I don't know where you're working, the number of deliveries per month/annum, average age of the nurses, your previous experience....nothing about you. But I will tell you this: LISTEN and SHUT UP. Ask questions to clarify, write key points down...but don't worry about what you did elsewhere, heard, someone said, etc. At least not until you have a good grip on the new stuff you're learning. I'm a preceptor....and I'm going into another round of precepting. I call my preceptees "Birdies". One day they will be off flying on their own. However, for now...I'm the "provider" and I am providing them with knowledge of how it should be done universally, and if applicable, as pertains to our particular unit's protocols. In the beginning stages...especially when they're brand spanking new to L&D, I don't want their minds polluted with what "so and so" said/did/heard/useta/coulda/woulda/shoulda, etc. . It may seem harsh...but it works. Then the preceptee begins to understand what they really didn't know...and the magnitude of what they're learning. My one Birdie who didn't listen to me recently had an "event". My other Birdies are flying just fine.:wink2:

As has been said before, we only use LVNs as our scrub techs. We don't use them on the floor in any capacity (in Labor and Delivery) except to fill in as OB tech, etc. On postpartum, I believe they still use them.

Why would you have a baby when you are planning to enter a rigorous program?? Do the baby or school, separately. I was in the program as a single-mother: it was tough!!! I've been out of the program for a while now, but when I attended, classes were M-Th 5-9 p.m., depending on the courses in which you were enrolled. Clinicals were every other Saturday AND Sunday, from 6:30 a.m. - 5:30 p.m.

Right. This year, working a four day work week for most of the year, I broke the 6 figure mark. HOWEVER, in California, with housing prices the way they are, and my need for quality childcare, I haven't cleared enough to buy a house. At least a house that's not an hour or more drive from where I work and currently live.

Hmmmm...well it depends. Unlike Smiling's facility, we actually DO pay specialty pay once you have completed the "residency"/training in L&D and taken an AWHONN test. Then, after so many years in L&D and obtaining one of several competencies, and an RN-C, you could move up to a Specialty II RN in L&D. I'm working on that in the coming year. It'll mean a SIGNIFICANT (~$4/hr) bump in my wage. I'll really like that!!!! Your "regular" wage depends on your number of years as an RN. However, due to our union restrictions, you can only be hired on at/up to a certain rate.

I politely defer that conversation by saying that I prefer to keep my religious belief and affiliations private, out of the work setting. Funny thing though: I work in a Catholic hospital. Every morning at 8 am there is a daily prayer. We are all expected to stop and "pay our morning devotion" no matter what our belief. I think it is only respectful...but it doesn't mean I share in the same belief. If the person persists, then I firmly insist that I understand that their religion is important and I will respect it, I will not discuss my beliefs. Or a cop out is to say I'm Jewish if they see my "mother-designed" Star at my neck. That doesn't explain my religion, but it keeps 'em quiet.

I guess the jist of this thread was to identify facility induced use of scripts. A couple of years ago, my facility tried to implement scripting, also with the use of the phrase, "Is there anything else I can do for you?" It didn't go well. However, I will say that SOME folks around there NEED scripting to encourage the return of common courtesy. It's safe to say that many people on phone service, reception, etc, do NOT know phone and greeting etiquette. It gets my goat. I should be a consultant for customer service...I'd be going through firing folk left and right.:chuckle

I don't call it a script...but I do have a schpiel which I tailor to the pt as applicable. I even translate it into Spanish when necessary. I find that I don't say the same thing the same way all the time...but I hit the same points. I don't like to say the same thing the same way because it seems to become devoid of emotion and "connection" with the pt. So my schpiel changes as my pt's do...some points I may hit earlier in the conversation....but I make all the points and answer all the questions.

I suppose it's accurate to say that I do NOT understand your argument. Any educational system is built on proving what you know...leading to grades in courses thusly to degrees granted. That's what matriculation is. That holds true not only is this country, but worldwide. Proving what you know, in order to do it, is a result of industrialism. That's how any PROFESSIONAL field should be. You SHOULD have to prove what you know, whether you are a Computer Programmer obtaining certification in Microsoft, C++, SQL, etc or an RN or other nurse or healthcare practitioner. Just because I know an awful lot about Word, Excel, that I learned on my own...does NOT mean that I should be granted a certification in Computer Software Proficiency. I should be made to PROVE it to a set standard. That's the point of licensure: you have proven via a standardized (non subjective method) that you have the minimal proficiency to function in whatever role. It should be no other way...otherwise you degrade the definition of profession. It's unfortunate that some may not have the funds to go to school. However, if one's will is strong enough, you will get to whereever you want to go. I paid "through the nose" to go to a prestigious, reputable institution because I wanted it THAT BAD. Anything you want is worth sacrificing for, right? Right. Excuses should be thrown out at some point...if it's what one really wants.

RNs are covered and no further cert is required.

RNs WILL NOT be required to obtain this certificate as we are LICENSED by the State and that covers us for venipuncture. It's included in our LICENSURE and included in the Practice Act. (Now if your license is not active, of course you can't do it). LVNs who are not IV therapy certified will probably need to obtain this cert or the IV therapy cert. Info on CA Phlebotomy Certification Reason for the New Regs For those phlebotomists who have on the job training, we can also sign off as proof of their experience.

*edited for content*I work in L&D as well, and as a courtesy to the pt, I also draw my labs off the IV stick. I figure, since I'm putting such a large bore catheter in them, I might as well pre-empt any other discomfort they'd feel with further sticks. We have dedicated techs on our unit who draw our labs...but they know to leave the tubes and let me draw my pts.

As an RN or LVN, you CAN NOT take on a position as MA or phlebotomist. Once you are a licensed or Registered Nurse, you will always be expected to function in that role if you are working in a patient care arena. Therefore, if something with a patient was awry, you couldn't say "well, I'm just the MA" because you're NOT that, and you'd be responsible in a greater fashion. If you wanted a second job, you could always take on Registry/Agency work using your specified licensure. However, if you are looking for extra income without using your license, it would be best to look OUTSIDE of healthcare.

No, I do not think you, as an LVN/LPN, are blind nor stupid. I say what I say as a result of speaking to a couple (read 2) LVNs who became RNs, and what they had to tell me about the CHANGE in their THINKING and FUNCTIONING in their new role. Though both of them worked in my specialty, they didn't function in the role of RN and thus were a bit shocked as to what we do...that they didn't see from the outside looking in. I do take those role requirements for granted as I've never been anything but an RN, so speaking to them opened my eyes and made me see the other side. The side that you are speaking from right now. If you choose to go on to RN, you may or may not see what they saw. Good on you whether you do or not. As for "holding you back" as an LPN: no one is doing that. If you are unhappy and feel slighted, change the law, or go back to school. RN is as it is, "above" the LVN...same as NP is "above" the RN. I could get mad because I hold the same license that an NP has to have, but I'm not given that recognition automatically. But, alas, that would be silly since that role REQUIRES MORE EDUCATION. Simple and plain. To get that recognition, I've got to go back to school. Let's not get into the "you could do what I do with just a little more training". That "little more training" is the educational path that leads to being an RN. Therefore the point is moot.

"RNitis"? Mmmm, okay. I was not making an argument as to invaluability at all, or functioning of roles. I will say this: if you choose to do what you do, do you to the BEST of your ability. DO NOT, however, belittle the "greater" education that I've obtained and in turn, I WILL NOT downplay your abilities.

You grieve with the pt in a composed manner. It's a hard thing to lose or be a part of the situation when a baby is lost. Most IUFD situations I've cared for, I've shed tears with the parents. It allows me to "share" their pain...the same as I "share" their joy when a live baby is born. Honestly, it does hurt my heart to know that their dreams for their little baby has been lost and, though other children may be had, cannot be replaced. I've cared for moms with pre-viable losses and moms with full term demises: it still hurts. While you shouldn't break down bawling with the pt, empathy with tears is a human expression. I've had back to back IUFD pts before, and I've had to let my charge/supervisor know that I needed a break. The hardest one I ever had was a pt who was coming in for a repeat cesarean, scheduled. When we put her on the monitor, baby was "gone". Surgery revealed a triple tight nuchal cord accidental asphyxiation. Nothing that could have been done. She'd just been checked in the office the day before. The baby came out perfect: he looked as if he were asleep. I can still see that baby in my minds eye.

Standing up and SHOUTING!!! Stomping my FEET AND CLAPPING MY HANDS!!!! YES!!!! That's why I became an RN (and will go on to become an advanced practice RN). I don't want to be a doctor because I don't like where healthcare is going in that respect (and I don't like the hours I'd have to keep as an OB)...but I want my "independence". The way we function on the floor...esp. in higher acuity areas, we are the next best thing, the ONLY thing, until and if the physician gets here. Many LVNs don't get it because they don't see the functioning of the RN role in arenas like mine (L&D). LVN can't do what I do. Simple fact. State and "medical law" dictates that. Check your practice acts: RN is by far the most autonomous role, regardless of what YOUR individual facility may allow you to do. By the by: CA calls them LVNs too.

I've been watching the show since it came on TV, when Chicago Hope was up against it on Thursday nites @ 10. It was THE THING to watch at my house. My mom and I used to watch it together. She's an RN (FordGrad78), too. We used to giggle and pick the show apart in the early days because of the inaccuracies and mistakes that they'd make for dramatic license. I haven't watched the show, save for a few episodes here and there, in about two years. It has completely JUMPED THE SHARK. I can't take it anymore. Whenever there's a final ep, or when Carter leaves, I'll tune in again. I've thought about buying the DVDs....but I've watched the old eps so many times on TNT reruns that I probably know them all by heart.

Not to be snippy....but why become an R.N. if the info that you LEARNED to get into the role, you're "yawning" at. The whole reason behind the greater education (of becoming an RN) is that you learn WHY you are doing what you're doing, not just to DO. I don't think there's any yawning in that. *scratching head*

20 weeks or more goes to OB Triage. Doesn't matter what they are complaining about. If WE, not ER, rule them out from an OB standpoint, then they can be seen in ER or clinics, etc. Our OB building is separate from ER...so unless the pt's walk into the wrong building, even ambulance runs come to us first, we check 'em out...even if only by interview for dates, and if applicable, send them to ER.

TOL/VBACs are "allowed" but the issue is that all physicians are not willing to do them. We have a LARGE percentage of Hispanic pts who've had C/S in Mexico, with unknown uterine scars. The skin scars are vertical. We DO NOT VBAC these women. No way, no how. Those pts who've had sections with known medical and surgical histories and are pro VBAC sign a consent for TOL. All our pt's have IVs at least at TKO. No ripening agents: no Cervidil, Cytotec, PGE-2. Pitocin may be considered if amniotomy does not bring UCs on better. Pitocin, if used, is "low dose": no greater than 8 mu/min, usually...and they are bumped up very slowly. If ruptured, we (nurses) internalize them (use FSE and IUPC) They are on continuous fetal monitoring anyway, even if not SROM/AROM Our hospital always has 24 hour in house OB and 24 hour in house anesthesia.

Depending on how fast you gain weight period, and how hormonal shifts affect you, you could be showing. What you'd be "showing" though is rapid weight gain, extra fluid, etc. If you're only 5-6 weeks, your actually uterus is still probably not palpable (at least not very easily). You may have gained pounds and it's gone to your belly right away. After I've have my children, I've noticed that with hormone fluctuations, such as ovulation, etc, I tended to gain "water weight" and be very bloated. Many women go through the same thing. Otherwise, as the others have said, you're further along than you think, and you might want to start thinking about your last NORMAL period, and when it was. When women have breakthrough bleeding during a pregnancy, we usually (at least at first) ask about the last normal menstrual cycle. Then we use Ultrasound, etc to determine dates from there.

That bothers me. I was just shadowed by some nursing students, two of whom were men. My pet peeve is that anyone enter the room without permission. So I have my students of both genders wait until I ask. I don't think it matters whether they're male or female. We are to be PROFESSIONAL at all times. If the student can't be, then I'll have a problem with him/her...and that will be the end of that. Heck, medical students are not excluded because at some point they will specialize, so they need to see everything. The same for nursing students. The ONLY time I take into consideration whether the student (or other entering person) is male is when I know there is a RELIGIOUS or cultural bias/reason for the male to be excluded. E.g. I had a delivery with a middle eastern couple...and the RT needed to be there. He was male and the pt's husband "took offense". The RT needed to remain there, so we shielded the pt's perineum and went about our business. My students saw no less than three vag deliveries and quite a few sections. Our unit does have dressing rooms for males...well, actually, they use the men's physician locker room since we (the women) took over the "men's" locker room. We have lots of nurses...not enough lockers. And we have a couple of guys on the floor who work as techs. We had an LVN who would scrub, but he got his RN and went to Nursery.