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.

Do you have policies/procedures on your unit which would answer your question (and which would ensure that all of the nurses are doing things the same way?) We have a little split port extension which comes off the IV hub so we don't have to start two IVs if we're running mag, pit and LR. (It gets a little more complicated if we're also running insulin and AZT- in that case we do start two IVs).

This is not new information (I say that not to criticize you for posting it- I'm really glad you did). I'm really astonished that people don't know this. Our RESIDENTS don't know this.

It can be difficult to adopt a very young child or baby in this country, and that's what most people seem to want. Plus, there is a trend towards open adoptions here which doesn't appeal to a lot of people. Many people don't like to process of having to "sell yourself" to a birth mother. There is also a chance that the birth mother could change her mind. There are also the residual effects of black social workers' group's discouragement of the adoption of black children by white families. I did read somewhere though that one of our larger exports is of black children to Canada for adoption. Anyway, those are some of my reasons. (My husband and I adopted our youngest child from China.)

I understand; I feel that way too. There are many circumstances of abortion, the one in this article included, that just disgust me. But practically speaking, either women have a choice or they don't. I know this is what frustrates many Americans in the middle (neither absolutely completely anti-abortion or unquestioiningly prochoice).

I didn't mean to hijack adpiRN's post, and I wonder if this got buried. Anyway, I'd really like some feedback if anyone has any to give. Thanks :-) Where I work, residents generally don't want a patient with ROM to get up and walk, use the bathroom, etc. Sometimes if we push, they'll say, "Oh, well, ok since the head is applied." Some of the midwives are more lenient ("She walked in her ruptured."). Many of the nurses will not let a woman who comes into triage c/o ROM get up again once she is in the bed and ROM is confirmed. "Help me wheel her to her room." Anyway, I'm not sure what is reasonable or not. What is the policy where you work? If there is no policy, what do your providers say? What do you do in your own practice? *** Second question, I've never personally dealt with a prolapsed cord. Obviously, if the patient is *in labor* and you see decels, you have to get your hand in there and keep the babies head up. But it has happened on our antepartum unit that a PPROMer who is not in labor will prolapse a cord. (the nurse notices during assessment or the patient feels something). One of our OBs was scolding the nurse for putting her hand in the patient to raise the head and said that since the patient wasn't in labor, there was nothing pressing on the cord. She also said something about if the fetal heart beat goes chugging along without any decels, there is no need to put your hand in. (I don't believe in this case that the patient was on a monitor- should the nurse have gone to get one to assess the FHR?) So, what would you have done? Assess the heart rate first? Put your hand in? Just call the physicians and prep for a c/s without putting your hand in?

For those who have changed from "lukewarm pro-choicers" to "staunch pro-lifers", how would you craft a law to make some abortions ok and some not which would account for the myriad circumstances of each woman?

What "choice" looks like. I don't have to like it. But it's hers to make.

I don't know of any protocols or legal requirements. But I would think you'd want pitocin (can be given IM) and O2 masks for mother and baby. Is your staff NRP certified? Otherwise, I would think your main job is to keep mom and baby warm and call 911.

I have two questions on related issues: Where I work, residents generally don't want a patient with ROM to get up and walk, use the bathroom, etc. Sometimes if we push, they'll say, "Oh, well, ok since the head is applied." Some of the midwives are more lenient ("She walked in her ruptured."). Many of the nurses will not let a woman who comes into triage c/o ROM get up again once she is in the bed and ROM is confirmed. "Help me wheel her to her room." Anyway, I'm not sure what is reasonable or not. What is the policy where you work? If there is no policy, what do your providers say? What do you do in your own practice? *** Second question, I've never personally dealt with a prolapsed cord. Obviously, if the patient is *in labor* and you see decels, you have to get your hand in there and keep the babies head up. But it has happened on our antepartum unit that a PPROMer who is not in labor will prolapse a cord. (the nurse notices during assessment or the patient feels something). One of our OBs was scolding the nurse for putting her hand in the patient to raise the head and said that since the patient wasn't in labor, there was nothing pressing on the cord. She also said something about if the fetal heart beat goes chugging along without any decels, there is no need to put your hand in. (I don't believe in this case that the patient was on a monitor- should the nurse have gone to get one to assess the FHR?) So, what would you have done? Assess the heart rate first? Put your hand in? Just call the physicians and prep for a c/s without putting your hand in?

What I don't understand is that a term baby moving around does NOT feel like gas. You can SEE them. I'm skeptical of most claims of "I didn't know" but I suppose it does happen on rare occasions that a woman truly doesn't know.