beachyfe

I got my first L&D job as a new grad! I was blessed to know someone who recommended me to the manager since I had worked at a different hospital during nursing school as an OB scrub tech. Have been in OB for 23 years now (have done everything but NICU) and love it as much as when I started.

I've loved all my nursing jobs except for the last one. It was at a hospice agency and was truly a miserable job. I worked 8:30-5 M-F, then was on call every night and weekend, had to go out to do admissions or dealth visits at any time of day or night immediately when I was called. I was told that I was expected to put my job first in my life - that all hospice nurses do that. And, to make it even worse, I was on salary!! I worked weekends and holidays without any additional pay or comp time. I nearly quit before finding a new job because the job consummed my life. Luckily I have another job now. That time was so stressful because I literally never got to see family or friends for weeks at a time. Sure took the joy out of the profession!

I work at a hospital that has in-house anesthesia, but one night we couldn't find him when we needed to do a stat section. We paged, called, went to call room, etc. but no luck. Doc had to start using a local and it was terrifying for everyone. The patient was screaming and we had to hold her down. Finally the CRNA arrived and quickly put her to sleep. I hope I never have to see that again.

I worked with a male L&D nurse who was a traveler. He stayed on our unit for 6 months and was a fabulous nurse. The patients loved him. He taught me alot and was really fun to work with. Haven't seen any others since, though.

I totally agree. Each place has it's benefits and risks. Every case is different and should be evaluated for where is the safest place to deliver. Some midwives (lay or CNM) are better than others. I had 3 fantastic home births with lay midwives and 1 horrible hospital birth with a doctor, but also worked 16 yrs in L&D with CMN's and docs. I've seen alot, and the qualifications of the attendant makes a huge difference.

That's my experience too. If a mom has an epidural for a long time, then repeated straight caths can introduce as much or more infection than just one insertion of a Foley.

I thought the OB Inpatient certification exam was harder than the boards! I did very well and passed, but I had worked for 3 yrs in L&D in a high risk unit and still found it to be tough. I suggest waiting until you have worked in L&D for awhile - book/class knowledge isn't nearly as helpful as hands-on experience, IMHO.

I hated using Cytotec. It usually caused ctx to be too strong and, unlike Pit, you couldn't decrease it. I found it to be very unpredictable - worked fine for some, but slammed others. Plus, it's so hard to insert. It always wanted to stick to the glove and not stay where I was placing it.

I saw it twice in 16 years of doing L&D. Very scary.

Would you hiring managers consider the "terminated" situation different if you saw that the applicant had worked several jobs since their termination? Personally, I would think that if other employers hired the applicant since the termination and everything went well, then the termination was probably not justifiable. What do you guys think?

I've been where you are (many years ago) and reacted the same way. Be very careful - you may end up making enemies who will come back to haunt you down the road. Never burn your bridges; nursing can be very political and it's best to stay out of it. I know you meant well in taking your concerns to the boss, but obviously she's doesn't agree and she holds the power. I would suggest you let it drop and lay low showing her that you are an excellent nurse by just focusing on your patients. Let her take the consequences for her decisions. And above all, do not gossip or get involved with others who are gossiping. Always remember this saying: "Be careful who's toes you step on today; they may be attached to the foot that kicks you in the rear tomorrow."

i did 2 months of training and it took between 1-2 yrs before i really felt like an "expert" at the job. it was a big learning curve because this is all about business and insurance. a totally different ballgame from nursing. but i learned it and also got my certification in case management (ccm) last year. i've learned a whole new field and widened my opportunities. good luck - hope you like it.

The RN's always drew cord blood where I worked.

As a mother, I had both home and hospital births. I also worked for many years with a home birth service. As a nurse, I worked in an L&D where we had every type of birth - from "home-like" to very high risk. I supported whatever the mother wanted as long as it was within the bounds of safety. We had many lay midwives act as support persons when they brought in a mom who planned a home birth but something was going wrong and eventually doulas became popular and we had many of them too. This is the ideal, but was not what usually happened when doulas came to our unit. Some were focused on just supporting the mom, but many seemed to want to "pick on" everything the nurse was doing. They acted very aggressive and pushy, trying to prove that they knew more than the doctors and nurses about what was best in the situation. The moms seemed sort of intimidated by them and didn't say much. That was sad. If something happened where we felt unreassured that mom or baby were OK, the doulas usually questioned our judgement and argued about everything. This made it so hard to explain the situation to the parents and help keep them calm. I am very supportive of natural birthing, but the real purpose of childbirth is to end up with a healthy mom and baby - the "experience" is not the most important thing. So, if interventions are needed, there usually isn't time to have a long drawn out discussion but we tried to explain things clearly in layman's language in the time frame we had. I just found that the doulas were defensive and argumentative about 80% of the time. One of our local hospitals had such a bad experience with doulas that they banned them! Parents can still have support persons, but told ahead of time that they can't have a hired doula. I sure wish the doulas I worked with had done this homework and realized that we're all a team trying to help these parents have a healthy, happy baby. But most seemed like they arrived "ready for battle." It was like they saw this as a Doctor/Nurse vs. Patient/Doula fight. What they didn't realize is that we wanted that mom to have as wonderful a birth experience as possible. We were there to help keep she and baby safe. But everyone also has to realize that doctors and nurses have licenses and are mandated to practice according to the policies and procedures of the hospital. If a patient doesn't want to abide by that, then they should deliver somewhere else. But please, doulas, just support the mother and help her cope with labor without being adversarial. We all have the same goal - a safe delivery.

If I find that the clinical I receive from the facility doesn't meet criteria for the guidelines we use (Milliman and Interqual), then I first call the facility CM back and ask if they have anymore clinical or anything more pertinent that I can use to qualify the stay/visits. If they aren't able to give me something that will meet criteria, then I send the case on to the medical director. He does read over the clinical and the case notes and makes his decision according to the guidelines. If you aren't happy with the decision, you can appeal.

i don't think this is necessarily true. i had no experience in cm, dm, or um when i answered an ad for a case manager. i did have 16 yrs of clinical nursing experience, but nothing in insurance or business. i was trained on-site for 6 wks, then began working at home. i've done cm, dm, and um from home for 5 yrs now and last year got my ccm certification. so, there are some companies that are willing to train "newbies." i would suggest using a cover letter, though, no matter what type of job you apply for. this is expected of a professional. even if you apply online, there is usually a way to upload a resume and cover letter. i do not include references on my resume, but write "references upon request." on an online application, though, i do list my references if they ask. best luck finding the position you want.

In the many years that I worked in L&D, we had only one travel nurse and it was a male. At first the staff was a bit surprised, as no one had ever heard of a male L&D nurse. But he turned out to be a wonderful nurse and taught me a "trick" to help during pushing that I used for years. The patients loved him and no one ever refused to have him be their nurse. The docs liked him too. He stayed for 6 months and then moved on. I teach OB nursing in L&D and have had quite a few patients who refused to have a male nursing student during their labors and delivery. But I always think it's ironic, though, that most of them have male doctors and don't refuse male med students or residents.

yeh, that's one of the hardest things to learn to do as an l&d nurse - be sure the doc doesn't arrive too early or too late. sure would be nice if they gave us a crystal ball during orientation! i eventually learned to sense when it was the "right" time to get the doc in. i always asked them how much notice they would need and how long would it take to arrive. at least they knew i was trying to help them. they are not trained or educated in conducting the labor - they depend on you to do that. frankly, i liked it that way. i also have experience in both homebirths and hospital births, so i am comfortable supporting the patient with whatever type of birth she wants within the bounds of safety. while we did the majority of births in stirrups (mainly 'cuz most moms had epidurals), i had many moms who just pulled their legs back. a few docs would arrive for delivery and request the stirrups be put up, but at least the mom knew it was the doc asking and not me requiring them. i did whatever the patient or doc wanted. some docs would let us keep the bed together and they would just sit on the side. yeh, it's a rather silly tradition. we always kidded with the mom that her baby was getting the "baptism by betadine." i think it's outdated, but some docs would sit there and not touch the mom until you got that betadine applied. oh well. most of our docs would delay cord clamping if the parents asked, but not if they didn't. nearly all of them waited patiently for the placenta to be delivered spontaneously, though. i did see some nasty consequences for the ones who liked to "tug" on the cord - like the time the cord popped off before the placenta had detached!! i think that was a resident. that was pretty routine in my hospital. we gave one bag of pit wide open after delivery.

First, you don't have rounds in L&D like on med/surg floors. One doctor from each practice will usually stop by the hospital each day to see postpartum and antepartum patients and will stop by L&D if any patients from their practice are there. But mostly you just get doctors coming in for deliveries when you call them to come. They will write orders if they're on the unit, but the vast majority of orders are given to you over the phone. I agree with Tinkerbell - day shift will provide you with more opportunities to have labor inductions, C/S's, BPS's, etc. Night shift staffing is lower, so you don't have as much help available for problems/emergencies. Night shift usually has more spontaneous births (as opposed to inductions on day shift), so an inexperienced nurse can get overwhelmed more easily. I started on nights, but it was truly a "trial-by-fire" way to begin (and I was a new grad!). It all worked out though - I did it for 16 yrs; 9 on nights and 7 on days.

I look very professional and have 2 certifications in my area. I've applied for 11 hospital clinical positions in my field (with over 20 yrs experience) and have had just 3 interviews and no job offers. I finally took the only position I've been offered because I desperately need a job, but it's in a completely different type of nursing than I've ever done (and not sure if I'll like) and it's with a private company. But a job's a job when you're going to be unemployed in 4 weeks! Maybe there isn't the same type of age/experience discrimination in travel nursing because I would assume that the agency is paying any beginning traveler the same, no matter their years of experience. But a fulltime hospital nurse is getting paid based on years of experience, so a nurse with 2 yrs experience can likely do the job as well as one with 20 yrs and will get paid alot less! The hospital is thinking about their "bottom line."

That wouldn't be hard to do - I used FM's for 16 years and still do EFM CEU's to keep up my Inpatient OB certification. In my area, most hospitals are now requiring EFM certification be done soon after being hired in L&D.

I agree! When I got my last job, all the interviews were done by phone. It certainly cuts out discrimination based on gray hair, body size, ugly face, frumpy clothes, etc. You get hired based on your credentials, knowledge, experience, and ability to communicate well. I sure wish all nursing interviews would be done by phone - I might have already gotten a job by now if they were.

I have a BSN and teach nursing clinicals. I'm just called the "Nursing Instructor." What else would you need to be called?

The hospital where I worked got computerized charting over 15 years ago and I used it for about 10 years. Not much has changed in L&D since I left, so I don't think it would be too hard to get back in. I may get a contingent job to "freshen up" and then maybe I'll have a better shot at traveling.

Try insurance or managed care companies instead of hospitals. I got a job as a CM without experience. They are usually looking for nurses who have significant clinical experience and they train you as a CM. Most will require you get the CCM certification within a couple years, though.