cabbage patch rn

Those of you who have already become certified, what educational materials did you find essential? There are so many resources out there and it is very confusing. I am interested in a self paced study, not seminar based learning. Any feedback is greatly appreciated.

I recently had a similar opportunity. Let me tell you about my experience. I was working a prn job at my local hospital, very happy for the most part except the pay was less than desirable and the hours were a bit undependable at times. I found out that a "sister" hospital was paying $6 more an hour and had an open full-time day shift position with full benefits in my specialty. My role would be expanded, and since I love to learn new things and tend to get bored when I get "comfortable" I thought I had nothing to lose. So I transferred. The money was great and I enjoyed that part no doubt. However, the drive was about an hour one way so that money was eat up in gas for the most part. The new job ended up being a nightmare for me. I could tell within the first week that I had made a terrible mistake. You know how you embark on something new and think "What have I gotten myself into?" Well it was like that but 10 times worse. The staff was cold, distant, and for the most part essentially not helpful at all. Now there were a couple of nurses that were really nice and did what they could, but the attitude was really different. The doctors were very difficult to work with, very hard to please, and I quickly found myself in an impossible situation. I kept telling myself that it would get better, once I was oriented to my new position and everyone warmed up to me. I stayed for a few months but things only got worse. I won't go into every detail of this, but wanted to say that sometimes things look better from a distance than they really are. If you are happy in a job, then really think about it twice before leaving. In my case, the money was the biggest factor in my leaving. I ended up learning that money is not everything. I'd rather take a cut in pay and be happy. So I ended up transferring back to my home facility and I've never been happier or more appreciative of a job! Turns out, we're getting raises next month too. This is only my experience, and doesn't mean that you will have a bad one if you decide to transfer, but really weigh your options before you jump. Usually these places are desperate to hire for a reason.

Thank you both for responding. I was beginning to think it was just me, since I have social anxiety...especially with new people and situations. Minou, your tips give me somthing to think about. I appreciate having your perspective. Nesher, thank you for reminding me that my patients and their families will appreciate me when no one else will, and they are my first priority. The other stuff will hopefully fall into place in time. I guess I just haven't been in this situation in awhile and had forgotten how it can be.

I have recently changed jobs. The OB job I was working was very demanding physically, but aside from the low pay, the BON violations, and the fact that I could barely walk out to my car at the end of my shift, I liked it. I liked all of the people that I worked with and was very respected by my co-workers and the docs. So I am offered this new position making much, much more money, the unit is so nice and more technologically advanced and for the most part, it will be an easier job once I learn their way of doing things. What is it about starting a new job? I feel so out of place there. I don't remember feeling that way at the old place, ever. When I walked into report the first couple of days it was as if I didn't even exist. No one looked up, spoke, nothing. I thought that was strange. Some of the nurses (not all of them) still won't even acknowledge me. I asked about one of them and the girl that I was orienting with said it took a long time to "get to know her" I just find tactics like this rude. Is it just me? Maybe I'm too friendly but I couldn't ever be rude to someone like that. I don't want to come across like I know everything to these people and I don't want to appear like I don't know L&D either. But I'm feeling sort of green these days, their way is an entirely new way of doing things. I have a lot to learn before I can work independently there without asking 100 questions. I'm not a young chick, I have many years of experience as a nurse but I want this to be my final nursing job and want to start things out right. I guess my question is, how do I get what I need during my orientation so that I don't offend someone or come accross too over-confident? Also, one of the nurses told me that one of the OB docs had trust issues with new nurses and that it would take him at least a year before he would trust me enough to even talk to me about one of my patients. I really want to work at this place. Any advice from those of you on the other side of this?

Same thing happened here with my last 2 children. So I don't have any real good advice but wanted to let you know you're not alone. Breast babies just prefer their mommy and breast milk over a bottle and formula. That has been the general concensus with my breastfeeding friends as well. I was fortunate enough to stay home with them at the time and nursed until I absolutely could not do it anymore. I weaned cold turkey with ds#2 at age 11 months and dd at age 16 months. I honestly don't think that your baby will dehydrate while you're at work though, and you would be amazed at the things they will do for other people when you're out of sight. Good Luck!

I'm presently leaving a job having had similar problems. I work 12 hour shifts and feel lucky to get a 20 minute lunch break in that 12 hour period. I managed to put up with it for awhile, and I put up with it because like you, I loved my job and assumed that it was like that everywhere. Well I was wrong. I have found a new place that is adequately staffed and we get to take our breaks, including 30 mintues for lunch. Amazing isn't it?

First of all, nursing school is nothing like what it will be like in the real world of nursing. You will have to practice for a few years in order to find out if it is for you or not. When I was in school, the first clinical I decided that nursing wasn't for me. I hated it and thought I had made the biggest mistake of my life. But I decided to stick it out because I didn't want to quit, lame I know. The first few years after graduation I can't really say that I enjoyed it either. But, after becoming a seasoned nurse and finding my niche in OB, I can honestly now say that I LOVE what I do. It will take some time before you know for sure.

Usually, I get too hot to wear a tee under my scrub top. I haven't had the problem with my v-neck gaping open, maybe it's the way certain tops are made?

Living in a rural area, I have driven an hour to work before. It is do-able, but it is very tiring, especially if you work nights and have to drive home after a long horrid shift...it's hard to stay awake to drive. For me it got very old after awhile.

It usually IS a staffing issue, if there is no one to replace you, then you cannot take a break. And in most hospitals, getting administration to erect a closed cupboard for food/drinks is not reality. I agree that we shouldn't have to eat or drink at the desk, but what other choice do most of us have? 12 1/2 hours is a long time to be deprived of food and drink. For the life of me I just cannot understand how it is a infection control issue when I wash my hands after patient care and then go to the desk and drink my covered drink while charting. Maybe I'm just dumb.

The frequent practice of inductions is one of my greatest frustrations. I guess it wouldn't be quite so bad if they would actually wait until mom is actually due, but we have many, many inductions at 37-39 weeks. It's exhausting. And at least 50% end up being failed inductions as you would expect. Our doctors usually end up letting mom rest overnight and then re-pit the next day and of course those moms end up being sections on that 2nd day. What a bunch of stress and crap to put an unborn baby through because you are selfish and can't wait 2 more weeks when the baby is actually ready to be born. I don't understand why doctors can't grow balls and tell their patients "no" when they come into the office asking to be induced early. A little education would go a long way, but this takes time and they aren't willing to spend the extra time with their patients to explain why uterine receptors aren't as sensitive to pitocin at 37 weeks. And we as nurses can talk until we are blue in the face but the patients aren't going to listen to us. In the past, I've tried to educate these women, telling them that if they wait a couple of weeks, the success rate will be much higher, heaven forbid they go into labor on their own. Of course, 5 minutes after talking with them, they opt for the c-section that the doctor is offering as being the "only way" to get the baby out. :angryfire

What kills me is that the majority of women do not want all of these people around during their labor/delivery. The family members are usually just overbearing and pushy and insist on being in there. Usually they are just being nice, trying not to hurt certain family members' feelings. Our policy states that only 2 people can be in the room at one time, but it allows people to switch off which is really annoying with our security door system, which the nurses answer because we do not have a unit secretary. It takes too much of our nursing time to answer the door ten thousand times a day to let people in and out. During delivery, we also allow only 2 people but if the doctor "okays" it they can have a 3rd person which really gets cramped. (By the way, why are doctors allowed to change hospital policy?) Our labor rooms are so extremely small, not at all like the new birthing rooms that most hospital rooms have these days. You would think they'd get the picture when I'm forever saying "excuse me, I need to get to...." It blows my mind that people just stand there with that deer in the headlights look while I'm trying my best to serve my patient, at the same time trying to avoid them as an obstacle. I know it's an exciting time for patients and family, but why would you want to interfere with a patient's care or even subject them to harm in an emergency situation? Anything can and sometimes will go wrong during a delivery and when the room is crowded with unecessary persons there is no room to carry out your work when time is of the essence. *sigh* Sorry to rant, but this is my greatest pet peave.

We had the same rule where I used to work. What I don't get is the JCAHO rule is "no eating or drinking in patient care areas" so how is the desk a patient care area? You don't acutally take care of your patients at the desk do you? My present employer says it's fine to have a drink at the desk as long as it is covered with a lid, and we are JCAHO accredited. Busylynn, your manager sounds like a real sweetheart. I wonder if she throws the doctors' coffee/drinks in the trash as well? Would be interested in your answer.

Oh my gosh! That was so morbid. I'm going to die at 79 of a heart attack. Very interesting, thanks for sharing the link.

Thanks for your suggestions. After reading, I'm thinking that now I need to figure out how to deal with my manager. She is VERY aware of this problem but her unique way of handling things is to turn a blind eye and avoiding any chance at confronting this nurse about her behavior. She keeps saying things like "I need to talk to her about..." but she never does. Very passive-aggressive if you ask me. The thing I wanted to avoid was being mean to this woman. I have noticed that most of the RN's have a very short fuse when it comes to this nurse, but I guess I'm going to have to take a tougher approach myself. For instance, when she comes up and asks if she can go out and smoke, after like the 5th time in 2 hours, most will tell her "no" not until she completes a certain task. One of the RN's will tell her to start cleaning when she finds her sitting idle. I just don't have the time or patience to babysit and wish that management would do their job. Plus, I can hear her whining right now when I tell her that I'm no longer going to allow her to leave the floor 15 times a day. She will think I'm kidding, seriously. Ugghh! I guess I need to know how to switch gears with her?? Since the nice approach is not working, how do I let her know that I mean business? I don't want her to think that I am the nurse that she can get away with anything, like not doing her job. I don't want to overstep...how do you go about setting limits with a person like this? "No you can't leave AGAIN because when you're outside, you leave us shorthanded, not to mention we don't get ANY breaks? I feel like you take advantage of us by taking breaks too frequently." Do you say "Please be careful with your tone while speaking to the patients?" Or "Clean up your area before going home and don't leave a mess for night shift." Am I on the right track or does this sound *****y? Any other suggestions would be great because I've never had to handle a person like this.

I love ER and have also watched from the beginning. This particular episode annoyed me for some reason. I think it was because they were treating the diagnosis and not the patient.

We have a co-worker who is driving us (entire staff) nuts. She is extemely lazy, manipulative, and just plain annoying. It would take me all day to address every problem concerning this nurse, so I'll just try to hit the high spots. First of all, she goes out of her way to get out of work. She goes out to smoke at least 15-20 times in a 12 hour shift, and that's being conservative. She'll ask me all the time "You don't have a problem with me going out to smoke do you?" The thing is, I don't have a problem with her actually going out to smoke, but I don't get a break other than 20 minutes, maybe, for lunch. When she is gone, she usually stays gone for at least 10 minutes, and usually we end up needing her for something, ie, phone, lights, etc. It causes us to have to pick up a lot of slack when she is out. And the next thing is, if she did her job, maybe 3 breaks per shift would be in order. But she does not do her job. She constantly needs to be reminded to do simple things. The other day I had to remind her to discharge a patient that was waiting on HER so that she could go home. She had been waiting over an hour while this nurse was piddling around, not to mention she took 2 smoke breaks within the hour. We get very, very busy because we are so short staffed. I try to delegate very easy tasks to her when I am swamped and have no choice. I asked her to go and put a binder on a patient the other day and she had the nerve to tell me that the patient wanted me to do it. She had not even been in the room so I knew she was lying. One of our nurses was sick the other day and called to find out what the next day was going to be like since she was scheduled to work. When she found out it was going to be busy, she said she would just come on in. The "problem" nurse was talking to her on the phone and kept telling her that she needed to stay at home, and she assured her that she would work for her if needed. As soon as she hung the phone up, she told me that she was not working the next day, she would not be at home if the phone rang. :angryfire This made me irrate and I said "Why did you tell her that you would work then?" This woman is rude to the patients and to the patient's visitors. Her teenage kids call the unit constantly and it is very distracting to have to take time out from what we're doing and go and find her to take a nonsense phone call. They also visit her on the unit at least 1-2 times in a 12 hour shift. So the other day, our phone starts ringing constantly as it always does (we don't have a unit secretary.) She makes the statement "We're going to have to tell these people we can't have all of these phone calls, we're busy." I responded to her that I wouldn't be telling anyone anything of the sort. It is not my business how many phone calls my patients receive. Later that same day, her kids start calling non-stop over ridiculous issues that we have to hear every last detail about, and of course, takes her away from the work at hand. There have been numerous complaints about how rough she is with the babies. And just a few weeks ago, a patient complained that this nurse told her she would probably be too tired to care for her infant in the nursery that night, being that she was a day shift nurse and she was working nights that night because we were short staffed. Her main job is the nursery while she is there, and ALL of the on-coming nurses dread following her because the nursery is ALWAYS left in disarray after she has worked. She leaves things undone for the next shift to do (hearing screens, baths, PKU's) because she is "so busy" although none of us can figure out exactly what it is she does. The other day, I caught her sleeping while the rest of us were running our asses off. She told me that one of the other RN's would be making her work if she were there. This comment was a wake up call to me. I realized that I had been allowing her to take advantage of me, and had fallen prey to her manipulative ways. For the past few months, I have felt sorry for this woman, because she is so hated by the rest of the staff. I have tried my best to be kind to her because I am one of those people that looks out for the underdog. I have heard all of the talk from other nurses about how this nurse operates, but chose to form my own opinion. Well, it seems that she has taken advantage of my kindness, and I have seen her deviant behavior firsthand on more than one occasion. I don't want to put up with this crap anymore, and would love some tips at handling this person. I'm afraid I'm not a very aggressive, nor assertive person when it comes to something like this. But I'm tired. My co-workers are tired as well. I don't understand why our manager puts up with her. She too voices her disgust with this nurse and often schedules her days opposite of her so that she doesn't have to deal with it. Any pointers with this type of personality would be greatly appreciated.

When I originally posted this question, I had a 18 y/o primip who had pushed for almost 3 hours. She also had a diagnosis of pre-eclampsia. This was not actually my patient, but I was helping out a co-worker because I had some time and our unit was particularly slow this day. She ended up going to section, but at the time I wondered if we had let her rest and labor down (in the earlier stages of pushing) maybe the outcome would have been a little different. I actually prefer this method as well, but I'm not about to tell a nurse with 13 years more of L&D experience than me how to run her delivery. So the next day I have this same patient post partum. When I go to check her lochia, my mouth falls open and I am panic stricken by what I see. I have never seen swelling to that degree before. Her poor perineum looked like one huge "blister". At first glance, it looked as if her bladder was protruding from her lady parts. I go and get the doctor since he was in-house for him to assess the patient. He said that since she had pre-eclampsia and pushed for so long, that the fluid was actually third spacing in her perineum. Has anyone ever seen this? If so, was there any specific treatment?

I have told my manager that I can not work more than 2 twelves per week just because of my poor feet. I would love to do more but it's not physically possible. I have really bad feet. If I work 3 twelves in a row, I can expect to spend that 4th day with horrible leg aches and cramps. Our shifts are actually 12.5 hours, with 30 minutes for lunch, which is a joke because we don't usually get even a 30 minute break. The entire time is spent standing, walking, and running. By the time my shift is over, I am barely able to hobble out to my car. Oh, and I work OB and the rest of the hospital thinks we have it easy. :rotfl:

I completely agree. How do you educate the "almighty" doctor though? Most take offense at the very suggestion of something. Their rationale is that you can convert from being GBS negative to positive during the last few weeks of pregnancy. "It's not an expense we are not going to pass along to our patients because the practice is completely inaccurate." I would like to see some literature on this but have not been able to find anything.

What about this...let's give everyone AMP prophylactically just in case "they might be" GBS pos??? You may think I'm kidding, but this is the way we really do it. I guess the bright side is that none of our babies get sick. :uhoh21:

Are you talking about a post partum/post gyn surgical floor? Or an actual unit that recovers these patients after delivery/surgery and then sends them to a floor? I think you would find it rewarding, especially if you like the teaching aspect of nursing. The pace is much slower than ICU I would imagine, but overall a much happier place to be. If you find yourself bored, ask to cross-train in L&D, study and become certified in a childbirth educator or lactation consultant certification course. There are so many things you can do to learn more about this area and become a more skillfull practioner. Good luck with whatever you do!

We monitor for 20 minutes prior to surgery.

Out of curiosity, wondering how long your docs/midwives allow your moms to push before they cut, bearing no complications, reassuring fetal heart tones? Ours will rarely allow our moms (first time) to push much longer than 2-3 hours. I wanted to see what everyone else does. :)

Umm, I was thinking the exact same thing. So much for that newborn smell huh?