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BellsRNBSN has 2 years experience and specializes in LDRP.

BellsRNBSN's Latest Activity

  1. BellsRNBSN

    Housing Stipend vs. Company Housing

    I am currently in talks with a travel nurse agency and am hoping to start my first travel assignment in late May/early June. My recruiter keeps pushing the housing stipend over taking the company housing. The company housing appeals to me because I won't have to worry about rent and major utilities, as well as renting/buying/lugging around all of my furniture and housewares. I understand that with the housing stipend, I would be taking home almost twice as much money, but the added pay seems like less than what I would be spending on rent and utilities, especially for the area I am looking to work in. My recruiter says most travel nurses take the housing stipend. I want a one bedroom place and no roommates, as I would be working night shift and sleeping odd hours. Can any experienced travel nurses give me some insight on this? Is my recruiter pushing the housing stipend because they save money this way, or is that really the better option to choose?
  2. BellsRNBSN

    Magnesium for Neuroprotection

    So, recently I cared for a patient just over 31 weeks gestation with a hx of PTL admitted for PPROM. She was given our standard PPROM antibiotic protocol, steroids for baby's lungs, and magnesium sulfate for 24 hours for neuroprotection for the baby. I cared for her when she started going into labor, just a day or two after her initial magnesium infusion had been completed. Once her cervix started dilating and she was indeed in active labor, the OB ordered magnesium to be started again. I'm a little confused as to why we had to Mag this patient more than once. While some nurses on my unit confirmed that this was standard protocol, others were just as surprised as I was. What is the magnesium policy on your units? If you have a patient in early enough preterm labor, do you mag her during labor (strictly for neuroprotection for baby, when hypertension is NOT an issue), regardless of whether she has already completed a previous magnesium infusion?
  3. I've always wanted to try travel nursing, and now that I'm approaching two years of experience in my field, I'm thinking of applying to some travel agencies. It looks like most agencies require at least two letters of recommendation from direct supervisors. I worry about being able to get these letters because only one or two of my co-workers know that I'm thinking of leaving the hospital I currently work at. I was even told right after getting my current job that the director and managers were worried I would leave soon after my training to work elsewhere. Gossip is a problem on our unit, and I would hate to tell my supervisors that I'm trying to get another job so I can get a letter of rec from them and then possibly end up not getting the job, or deciding to stay, and having to work alongside people who know that I tried to leave. Has anyone else dealt with a similar situation? Any advice?
  4. BellsRNBSN

    Who out there is doing standardized pitocin orders?

    With our standard order set, there is a checklist that must be completed before the pitocin can be started (MD order in; gestation of at least 39 weeks, or documented reason for induction/augmentation if not; OB with surgical privileges on campus; the last 30 minutes of FHR monitoring must show moderate variability or at least one acceleration, no more than one late decel, no more than two variable decels that dip below 60 bpm from the baseline for 60 seconds or longer, no more than 5 contractions in a 10 minute period for two consecutive 10 minute periods, no more than one contraction lasting longer than 120 seconds in 30 minute period). If that checklist is met, the pitocin may be started at 1-2 and increased by 1-2 every 30 minutes, as long as the FHR requirements I mentioned above are met. The max pitocin dose we may go to is 20, but we can surpass 20 with an MD order.
  5. BellsRNBSN

    Dealing with Overbearing Visitors

    I'm coming up on one year in LDRP now (so, still a new grad) and an issue that I still haven't found a very effective way to deal with is having patients who have overbearing visitors. To give a few examples: - I was recovering a mom from a C/S whose sister (an LVN in an unrelated field at a different facility) put O2 on my patient while I had my back turned even though my patient's O2 sats were fine (not to mention the obvious fact that this non-employee sister performed a medical intervention on my patient, totally unacceptable) and then proceeded to cuss at my patient's newborn in a sing-song voice, despite my patient's repeated requests for her to stop. Yet my patient still wanted her sister in the room with her. (This was during my training however, and I now do not allow anyone besides the father to accompany mom and baby in C/S recoveries, but my problem was knowing how to deal with this sister.) - FOBs laying a major guilt trip on my patients for wanting/getting an epidural - Mothers of my patients ordering my patients around, speaking in condescending tones, and making them feel bad about the way they are trying to tend to/breastfeed/change their babies - I even once had a FOB step in my way and try to stop me from repositioning and giving O2 to my patient in labor whose baby was having a big decel, despite having explained to both of them what was happening and the rationale for my interventions. I worry about overstepping boundaries in doing something about these family members who mistreat my patients, and I know that some of the reasoning behind these behaviors is cultural. I realize that this will become easier as my confidence increases, but do any of you have tips on how to deal with family members/visitors like this?
  6. BellsRNBSN

    Epidural + Hypoglycemia

    Thank you for your responses! If I have a situation like this in the future, I will try IV dextrose first. And ideally, I would love for my laboring patients to eat and drink anything they want, but as a hospital employee, I have agreed to follow hospital policy, which includes certain diet restrictions for moms in labor (especially when my moms have epidurals!).
  7. BellsRNBSN

    Epidural + Hypoglycemia

    What is your hospital's policy/what do you do when you have a diabetic mom with an epidural who has low blood sugar? Do you push dextrose? Do you disregard the ice chip diet and give juice? The other week I had a gestational diabetic mother in transition with blood sugars in the 60s and experiencing some dizziness. She hadn't eaten solid foods since the night before and I knew she was going to need energy for pushing. The OB was okay with me giving her cranberry juice, which the mom later threw up (lesson learned!), although it did raise her blood sugar to a more acceptable level. My charge nurse recommended that I push dextrose or hang D5LR (I think?) in the future. I'm not sure if my hospital has a specific policy for this, I am still researching. Just wanted your input!
  8. To all of you moms (and dads too!): If you had a wonderful, positive birth experience, what was it that your labor nurse did/contributed that made your experience so great? And on the opposite end, if you had a negative birth experience, what was it that your labor nurse did or didn't do that left a bad taste in your mouth? Just trying to better my practice and give my patients the best labor experience possible
  9. What Ashley said. Most hospitals probably add their own touch to things as well. In our care packages at the hospital I work at, we include a locket in the bereavement package that splits in two - a small one for baby and a larger one for one of the parents. We let the parents take home any blankets, clothing, or hats, that they used to clothe or wrap their baby in. We also offer to take photos of the baby and parents for them, if they so desire. Some parents don't want the photos right away, and will call the hospital several months later asking if they can still have them, and we are happy to oblige. We offer consults with the Chaplain and with Social Services. Not just any OB nurse on our unit is assigned to a miscarriage or fetal demise - only nurses that have experience in dealing with such tragedies and feel that they can handle the emotional load. We also try to keep these patients in rooms that are closer to our Antepartum unit, where they will be less likely to hear the crying babies of other patients. Needless to say, this is a very sad, emotionally draining time, and I'm sure every OB unit across the nation does their best to remain extremely sensitive to the situation and give the family as much time to grieve and as many resources as is necessary.
  10. BellsRNBSN

    maternity- helpful hints/advice to students

    Yes, OB is very different from med/surg. Obviously, each nursing student's clinical rotation experience differs, depending on the student, the clinical instructor, the clinical site, the nurses on the unit, the patients, etc. etc. In my personal OB clinical experience as a nursing student, we were fairly limited in what we were allowed to do. I passed meds maybe a handful of times (mostly IV antibiotics in labor and PO pain meds in postpartum). I observed vaginal and C/S deliveries and epidural placements. I bathed a newborn. I inserted a couple foley catheters and started an IV. I did a few assessments on moms and babies, although they were not full assessments, and were a bit limited. I was one of the few in my clinical group who was allowed to check a laboring patient's cervix. Expect to spend a lot of time observing (and staying out of the way). Also expect the possibility of patients turning down having student nurses participate in their care (this tends to happen a lot with the male nursing students). In labor I often had a lot of downtime, waiting for the moms to progress. You'll get some exposure to the OR and Recovery (comparable to PACU) with C/S's. Some parents are very wary of nursing students doing ANYTHING with their newborns or getting anywhere near mom's fundus. Other parents are amazing and will take pleasure in including you in this most intimate of family experiences. Even if OB doesn't interest you, take advantage of the opportunities you will likely have to brush up on your nursing skills such as starting IVs, inserting foley catheters, and hanging IV meds. Remember, your clinical experience is what YOU make it! Good luck!
  11. BellsRNBSN

    Not having answers to interview questions

    In cases such as this, I think the best strategy in answering these questions is just to be honest. If you never made a med error in nursing school, tell the interviewer this, and then tell him/her what you would have done if you HAD made an error (or what you will do in the future if you make an error). If you have never questioned your decision to become a nurse, then tell the interviewer that. Also, if a question catches you off guard, take a few seconds to think about it before you start answering - better to wait a few seconds and have a well thought out response than to hastily reply with something that you may regret or feel unsure about later. Rarely have I heard from my fellow new grads that they nailed the job interview(s) they had. It's a nervewracking time, and we are desperately seeking good jobs with a lot riding on getting hired. Some people are better at interviewing than others. Don't waste time ruminating over how poorly you think you might have done in an interview - it's over and done with and continuing to think about it will only add more stress to your life. Plus, you probably did better than you think you did. Keep in mind that with each interview, you will improve and learn how to answer questions better. Best of luck to you in your job hunt and on future interviews!
  12. BellsRNBSN

    After vaginal birth, recovery!

    Also, sometimes the fundus just happens to lie deeper in some women, or there is more fatty tissue in the woman's abdomen, over her uterus, making it harder for the nurse to palpate and massage the fundus. In this case, the nurse will have to push down harder on mom's tummy to find her fundus, which is often uncomfortable and even painful to mom. But like the PP said, this is all in the best interest of the mother to make sure that the fundus is firm and midline, so as to prevent possible serious consequences such as postpartum hemorrhage from progressing by detecting the s/sx early on.
  13. BellsRNBSN

    Why I LOVE night shift

    I'll be switching to nights in a month and have been pretty nervous about it - so thank you for this!!
  14. BellsRNBSN

    Did all you Nurses out there feel this way?

    Does it help you to know that you're not the only one with such thoughts? I am a new grad, about to start my first nursing job, and I have definitely had the thoughts that you described, and I KNOW they will be on my mind during my first few weeks out on the floor. I believe it is VERY normal to be a bit frightened about becoming a professional nurse when you're fresh out of nursing school. I have had MANY nurses tell me and have seen from many threads on AN that the *real* nursing training begins when you get your first job. In the meantime, congratulate yourself for getting this far in nursing school and remain focused on your studies. Take one day at a time and try not to worry excessively about what lies ahead. And you can use your fears to make you extra careful, humble, and willing to learn when you do get your first RN job. You're not alone! And it will get better! :hug:
  15. BellsRNBSN

    Dove Apparel Uniforms

    I would love to sell you my Dove apparel scrubs! I'm not sure if you would want the tops, considering I had to sew my university patch onto the sleeve of each top, but I have 2 white tops (1 unisex, 1 fitted female), 1 white lab coat, and 2 forest green bottoms. PM me if you're interested.
  16. BellsRNBSN

    Procrastination...why now???

    In my nursing school class, we had both the type A, constantly freaked out, anxiety-ridden students, as well as the laidback, "will study hard, but not getting an A won't be the end of the world" students. And as long as we all studied enough to learn and retain the information, BOTH groups got good grades and BOTH groups are now RNs. You just need to find which studying style works best for you. I honestly think that being able to stay calm and collected will serve you well in nursing. You will be able to handle a code or other emergency without freaking out, and the grief that is often given to RNs (by patients, patient family members/friends, other healthcare workers, etc.) will roll easily off your shoulders and not impede your work. You will also probably be more able and likely to not take work home with you, which is important! Every nurse has different strengths and weaknesses and just needs to find his or her niche.