woopcrane

What sort of supervisory position are you in? Document her disrespectiful behavior and take her aside. Let her know her behavior is disrespectful and you expect no further discussion about you to other staff or statements of hatred to other staff members or patients. You will expect professional behavior. Nurses are nortorious about being non-confrontational. This Will not work if you are a supervisor. Document the conversation. If you are in a position to give oral or written repramands - do it. Start with an oral - but document it in her folder. This behavior will only esculate. Obviously other staff members recognize it as unprofessional as they are telling you about it. If this is not your roll as a supervisor - who is her direct supervisor? - discuss it with her. Get collaborating documentation from your co-workers. She will either straighten up, or give you enough fodder for a formal action.

Care Giver Fatigue. New verbage for a sort of burn out... It's not that you don't care, it's just that no matter what you do, or how well you do it, you can't do it as well as you WANT because you STILL dont have the time - equipment - staff , or the charting is too burdensome, or the outcome wasn't optimal, you are continuously functioning in a crisis mode, and you are fighting the SAME fight AGAIN for patient safety, and it's true that things WON'T change until you have a SENTINEL event - and then all the stuff youve been fighting for and the changes you were screaming about are given to you on a platter - for about 3 months - then it goes back to same ol' same ol'. sigh I find Care Giver Fatigue really defines it well.

Myths and reality about breast feeding - How to get a kid to latch and the proper latch is always good. Obstretical emergencies - RN immediate actions and response for pp hemorrage (we had RNs who waited for the provider to get to the unit before doing basic interventions like - IV pitocin, GOOD fundal massage and clot expression, ETC) How to use a ballon uterine device for pp hemorrage (WHERE it is stored on the unit) What meds, equipment will the provider ask (scream) for when they get there.. Shoulder dystocia - importance of watching the delivery - (not the computer), marking when the VTX delivers so we can know how long from VTX to corpus, How to apply suprapubic pressure (which direction according to fetal position) epsioproc, what would be needed for repair.. Labor positioning to facilitate decent, utero-placental perfusion, uneven epidural, pushing positions, "cookie" position, changing positions Positions to facilitate tolerance of pain, pressure points to help relieve pain Epidural placement, possible emergencies during placement, mechanism of hypotension, drugs used for hypotension, The need to bolus prior to placement, How to check anesthesia levels, dangers signs of too high levels, RN actions that can mitigate all of the above... Proper use of vacuum (placement, vacuum levels) Name the instruments - Is this a piper or simpson? Alice clamp? What's a Metz? Care of the nursing breast - or the formula feeding breast. Proper support of the perineum during delivery. Tricks to active coaching of the epduralized 2nd stage Proper Magnesium assessment S/S hematoma (perineal) Caput vs hemorrage on the newborn Billi levels, how old vs how high, causes, thresholds for applications of bililights, Why does bili - light work? New born assessment Weight loss in the new born - normal, expected, abnormal intervention. enjoy

Hey, it's the hospital rules - and frankly, they do not want a possible vector working for them. They have the right to dictate under what conditions you are allowed to work in their facility. Look what happened last spring and summer with the flu and the amount of health care workers who got sick, then spread it to their co-workers before they were "sick enough" to take time off. Why haven't you gotten the flu-mist? It's not egg based. Every one in our hospital has been vaccinated one way or another.

We will occationally give mama a break, but not usually - we expect mom and family members to get to know the baby, get the Breast feeding down. We rarey have a new mom with out other family members. We do not staff a NSY. If we have to care for a baby, it eats one of the available staff, so we do it only for a few hours.

As the ave age of nurses is now late 40's we welcolme new young blood!!! Even when I was going through my bsn program,(80'S)the ave student age was late 20's which means, even then, nursing was not just for the very young. Good luck on your studies...I found the hardest courses were A&P and pharm. It's a hard job. You can't PAY us enough for what we do - we all survive though the secondary gains we receive...the satisfaction of (fill in the blank)! I hope you enjoy! -Pat BSN,MS, NCC, CNM, APN, OK, and a bunch of other initials.....(why is nursing initial happy?)

lady parts. She didnt realize what it ment...

I Start with the non-medicstions: - ICE packs, Peribottle baths and sitz baths, Closely followed by witchhazel, proctofom, followed by Motrin for the uterine cramping, Tylenolfor inflamation, and getting OUT OF BED!! For 3rd - 4th degree lac I may prescribe 1 percocet and colace. PC-NS-CNM

I helped a hospital change to couplet care -= Any sort of change, as you know will cause resistance/depression/etc studies show that for the first 6 months, your staff will not be happy campers as the bugs get worked out and the change is asimulated. Pitfalls to avoid when changing to couplet care- DO NOT create a "nite" or temp nsy where the nurses will watch the baby - this will VERY quickly become a permenent fixture, and destroy the couplet care idea. Charts should be kept with the patient - not at a central charting area, so the nurse never has to walk to the central desk - MDs can also go into the room to see the charts - they have to see the patient anyway if peds wants to see the baby, peds needs to go into the room - not have the baby brought to him/her - For C/S patients - arrange a family member to stay overnote to care for the baby - esp the father - makes for a great initiation into fatherhood. anyway - good luck and no, I can't spell

I'm sorry - the physician cannot prevent a patient from having whomever she wants to attend the delivery, with in the hospital visitation rules. She needs to quietly and calmly inform the physician that the doula will be there for labor support. (If you want to quote the evidence, labor support directly impacts on medication use and C/S rates - it's in the green journal - any OB doc is aware of this research) If the physician decides this is encroaching to far into his territory, go to either another Physician, or a Nurse Midwife... I perfer the CNM This is your friend's delivery Not the physician's

Unfortunately the COBRA law simply states if the women is having contractions.... It does not define active labor vs. latent labor vs. braxton hicks contractions. It simply states contractions as the defining condition. Hospitals interpret this in various ways. One interpreted it in its strictest manner, and would admit persons in early latent labor. Here is an example of a law with inadequate defining factors

WOW - just read this thread - brings up a lot of issues doesn't it? So here is my 2 cents As we are learning more about the second stage of labor, we have discovered that often there is a latent phase, usually soon after 10 cm when the body slows contractions and the women takes a rest. Many do not immediately even feel like pushing - epidural or not. This phase can last up to 30 min. Your nurses who suggest the squat position are right on target - it opens the pelvis and assists with decent. If the epidural is a "heavy" one, this is the time to slow it down so the woman can feel her contractions to coordinate the pushing, or GET into the squat. THIS IS NOT TO SAY LET IT COMPLETELY WEAR OFF!!! Women with epidurals need active coaching to coordinate their pushing efforts. I find it usually takes about 30 min or so to really get a woman into coordinated effective pushing. Hopefully the count down clock starts when the woman really starts to push effectively - not when she hits 10 CM. As for lying. As noted above, this is not professionally acceptable. Besides being dishonest about a patient's true condition, it is a return to the old subservient doctor nursey games. As a professional RN, you do not need to lie - tell it how it is, that the person is pushing well, the head is descending, and you anticipate a lady partsl delivery - Innercity Nurse Midwife with 14 years as a labor&delivery nurse