Hushi05

I am job hunting and was asked to provide references from previous employers. My current (soon to be former) supervisor tells me that HR rules say that she cannot provide a reference for me because of "liability issues". All she can do is confirm employment. I have never heard of such a thing. How do you get a new job if your previous supervisor (for 7 years) is not allowered to provide a reference? I was a little paranoid that my supervisor just didn't want to give me a reference, but she swore up and down that that wasn't the case and that HR has a policy (which I haven't seen yet). Has anyone else heard of such a policy? I'm rather upset- how can I hope to get a new job if no one will say that I'm a good and reliable nurse?

I know this is an old thread, but I had to chime in. I have worked weekend option in L&D at a hospital for the past 6.5 years. I'll tell you, answering phones and doing paperwork and occasional vital signs sounds heavenly to me. I guess you could say I am BURNT OUT!

You didn't provide much information about your unit, how busy it is, etc., but it sounds like the unit's management has failed you. Six months is a good long orientation, but no matter how long an orientation is, if it doesn't prepare you to practice independently, it's no good. Did you get feedback from your preceptor when you came off orientation? Doctors shouldn't be the ones telling you whether or not you are prepared; nurses teach their own. From what I've read and talked about with others, most L&D nurses need a full year before they begin to feel comfortable and another year before they feel really competent. It's a very steep learning curve. It takes a while (much longer than six months) to know your role in an emergency. You shouldn't be too hard on yourself about that. How supportive are your fellow nurses? On my unit, a nurse should be able to function on her own during labors and in the OR, but once off orientation, the new nurse almost always has backup. Functioning alone is an expectation but not an ideal way to work. I don't know what you should do, though I do think you should always ask for back-up help (and offer it to others). You need to decide whether you have a unit culture that is supportive of asking for help and back-up or not. If not, you might consider finding a new job. I see no benefit to moving to med-surg; L&D is a specialty- you need further specialty training. Good luck to you.

We use ibuprofen 800 mg for lady partsl postpartums and add Percocet if there are lacerations. For lady partsls we also use Epifoam and Tucks (witch hazel) pads. Post c/s we use Percocet after the morphine PCA is turned off or after the Duramorph wears off. Sometimes we add Toradol if the PCA or Duramorph isn't enough. Occasionally our anesthesiologist prescribes clonidine 0.1 mg sublingual and/or rectal Tylenol as an adjunct after c/s.

I can't think of a reason to ask a woman that question other than as part of gathering a social history.

Mag sulfate in postpartum preeclamptics is for seizure prophylaxis. It is a *mild* vasodilator which accounts for the slight lowering of BP and perhaps mild increase in urine output, but the real reason for the diuresis is that the preeclampsia (a vasospastic condition) is resolving. Mag sulfate is not given to *cure* preeclampsia. It is "working" if the patient does not have a seizure. Monitoring urine output is a way to determine if the preeclampsia is resolving and also to keep an eye on a patient who could become mag toxic if she is not excreting it through her kidneys.

I have never heard of such a thing. Wow, talk about "old school"!

Both the bottles and the IV saline bags say "preservative free". Both solutions are labelled "sterile" but of course neither would remain sterile once opened. I think the issue is more than that of concerns about sterility because the saline from the bottle of infusion saline could be kept sterile. The particulates answer makes sense to me.

I want to know because I'm a curious person. I saw the bottle the other day and saw it said, "Not for injection" and I'm not one to take things at face value. I want to know why!

I couldn't find an answer to this anywhere. Why is the saline for irrigation that comes from a bottle not suitable for injection? As far as I can tell, it is chemically the same an an IV bag of normal saline. Does anyone know the answer?

I agree with ktliz. There isn't much need to be exact with cervical checks. All you really need to know is closed/long/high, change from last exam, and crowning.

To be an L&D nurse you have to be willing to have patients who are "unstable", i.e., patients whose conditions are rapidly changing. Some nurses prefer a shift where you can kind of predict what will happen, plan your day, care for the same patient for 12 hours etc. It sounds like, coming from PACU, you are already used to rapidly changing patients and environments. I guess I'd say that strengths required are flexibility and a certain tolerance for adrenaline rushes.

We don't get a lot of private patients who can afford doulas but our unit is pretty accepting. Many of the L&D nurses where I work are former doulas and aspiring midwives. The doulas I have worked with have been pretty low key and unobtrusive, there to comfort the mother. I was working with one laboring patient and her doula. I suggested that the patient get OOB and I showed her how to rock her hips and hum. The doula was surprised and said so. I guess many doulas think L&D nurses are the enemy.

Does anyone know if there is much demand for Women's Health NPs? I'm an L&D nurse, and I do not want to be a midwife, but I would like to provide prenatal care as well as well-woman care in an office setting. I don't personally know any WHNPs, and I'm wondering if the demand is regional or if the role is more frequently filled by Adult NPs or Family NPs or even CNMs. Does anyone have any insight? Thanks!

That is so exciting! I'm thinking of moving "off the floor" at some point. I'm thinking women's and children's case management. Remember, you can always go back to OB if you don't like what you're doing.