bbnurse

We have both meditech and OBTV. HP has a cable developed for Columbia/HCA but it is not available for other places...THIS is info' from the IS person where I work. It is a LTP? I believe. It was said to be bi-directional. Iatrix also is working to devlop one. We don't document in OBTV since it doesn't export to meditech at this time. HP did tell us that meditech can co-reside on the OBTV screens but they didn't advise it. It also depends on which revision of OBTV you have. It's certainly an issue to transfer paper info into meditech. I actually like the latest upgrades of meditech. It allows more ease of movement in the nursing module. It is more windows' based. I do not like HP but am surrounded by it everywhere I look. YIKES!

Hey everyone!! Thanks for the insight and the answers. I wasn't sure how other places did their meds. I don't like other people mixing my meds either so I know it's the control thing. I understand that it isn't the same level of care if I don't mix it in a laminar hood: BUT I DON'T REALLY CARE.... I know what I'm mixing and how. I, too have seen pitocin look like water then have a massive decel and tetany. Odd thing, the human body! Thank you again for the input. I wonder where your pharmacy get the premixed bags of pitocin. Our pharmacist hasn't found a source. Do you know the IV solution vender? I'm surprised that you have 40 in 1000 for the mag. Our director is having major palpatations about 20 in 500. Thinks it will get away from us and have fatal results(as well it could, but geez, what's my job if not to watch out for that kind of error?). What do you use as the vendors?

We just started using Pyxis and a recent survey we were told that nurses in LD should not be mixing pitocin, nor mag. We should use standard premixed bags of these meds. What mixture of pitocin do you use? Is it standardized? What strength of Mag sulfate is used as bolus and then maintanence doses? Obviously, who mixes it in routine situations? What does your hospital consider "emergeny" criteria which allows the nurse to mix these? We're really trying to find a way to comply with the new pharmacy standards the rules folks are pushing. Thank you for any help you can provide.

I went directly into Maternal Child many years ago and have NEVER regretted it at all. I firmly believe that most OB nurses are "born"...that we know from the first that we love it and will always find a place to work that allows us that expression of love. Many others stumble into OB and find they have the capacity to do it well and love it too. I worked in long term care, did consultation work and have worked in small hospitals requiring me to float to med/surg and ICU. I could function in all areas within reason, but I always asked questions and never assumed that I knew M/S as well as those who work it constantly. All these other experiences taught me valuable lessons but I did learn the art of prioritization, assessments and caring in Maternal Child. I think you take what you learn in school, use the basic principles applied to wherever you are and LEARN from others. You can learn anything anywhere with the right attitude and approach. I have and will always accept applications from new graduates if I have that option. They are eager and generally know WHY they went into nursing--meaning they went into it to be an OB nurse. I encourage new grads to try applying. You never know what might be happening in the unit, making the director open to hiring a new graduate. It at least gives you the opportunity to make a positive impression about your love of OB and maybe keep you in her mind at another time. I'm surprised so few people have responded to your question. There are lots of OB nurses who absolutely love it and their regrets are few.

Our nursery has been routinely performing a blood glucose test upon admission and in 2 hours. The majority of peds and GPs agree that this will diagnose and prompt intervention for the asymptomatic infants and prevent brain damage by quick treatment. One physician insists that only LGA, SGA and infants of gestational diabetic mothers are to be tested. Our standards and orders suggest routine screening at birth and in two hours whether at risk or not as well as PRN. WHAT does everyone else do? Is there a national SOC ? Where would we find literature to support one or the other of these practices? We are all very stressed when we forget and test his babies. And we need some data to support or delete our current practice. It would obviously cost less to only test those at risk babies as listed. What do you think? Any help would be great!!!! Thanks

So WHAT did the Pain seminar suggest as the best analgesia meds for active labors??? We use Stadol and Phenergan combo and epidurals or intrathecals with fentanyl. Did you answer this thought or did I just flat miss it? Thanks.

Stable, to us, means not in active labor, in crisis for whatever the admission dx was or near term. May include controlled gestational diabetic, arrested preterm labor, pregnant with a medical or surgical problem or things of this nature. Unstable is active labor, bleeding, unconscious, seizing, etc.

use your AWHONN Guidelines for staffing to support the correct staffing ratio for acuity. Even if the state requires less, the national standard is what the lawyers will use. good luck

We had a policy in which physicians were to place it BUT we many times did it. Then, the committee decided, with legal counsel that the hospital should not have a policy for cytotec and took it away. Now, the understanding is that we DON'T HAVE a cyctotec protocol and the doc has to write his own orders for it. Some of the nurse insert it and others do not. I don't. At least they no longer insert it and send the patients home....That was lawsuit just waiting to happen. My feeling is that this is experimental and we have no policy....so it is their place to insert it. That is how I stand on cytotec.

For my observations, you may be missing a few points about the topic here. Let's suppose all the good, positive suggestions are in place. 1. pool is utilized, have "prn" staff too 2. good weekend diff is paid 3. OT is time&1/2 guaranteed 4. Bonus is also paid $200 5. Agencies are used, but hard to staff on a "late call" 6. NM helps when short 7. Retention bonus paid 8. Recruitment bonus available 9. Week end option available 10.Competitive pay 11. On call is used for "potential" short shifts 12. OT is voluntary 13. Occurances are given for absences and lateness. 14. poor behaviors are handled one to one Yet, there are call ins every week end. We pick up the slack but are getting tired of the others who seem to call in to extend their weekends, or the ones who call during football season only... Why not just "TRADE" with someone?? Or Request a PTO instead of the last minute calls? Or the ones who say in the morning, "I'm calling in tonight"....but wait until the agency couldn't possibly fill it and the pool is all assigned, to call in. Does she care?? Doesn't look like it to me. What if we like our NM and she does care for us? How can she change the climate of the dept or hospital if that isn't the problem anyway? How can KlareRN improve the climate, if the hospital is already working short? Who will be attracted to a place where there is a shortage that just gets worse daily? What happens to the patients?????Substandard care. Why? So I could use my sick time? I think not. Who takes care of them? Instead of calling this a "management" issue, I think it is more than placing blame. If all the good stuff IS in place, why do call ins happen that we all know are not legit? IS it OK to hurt the hospital (translated to mean "patients") so that I can use my benefits? When legit, yes. When bogus, NO! How can anyone, staff or management, produce a nurse and provide care to the patients when there isn't anyone? Tell, me where do we look for that nurse ? (taking into account, all the other good ideas you mention as do I, are in place) Where? Last I knew, there were no magic wanes issued anymore.

We have OB TraceVU where I work. There are many good things about the system and the cons are mostly listed above. There are also several versions of this system. The first version had lots of false alarms and missed alarms plus the system was down frequently. They said if we upgraded to the next version, all these problems would go away. We did. They didn't. We have now planned to get Revision C. which they almost guarantee will solve the false alarms and missed alarms and shut downs. We'll see. We do like the ease of documentation that the system allows. Our hospital uses Meditech for all other areas and there is now a interface between OBVU and Meditech that allows BOTH to be on the desktop and for nursing to toggle between both. That will allow those PP and newborn assessments etc to be charted in computer at the bedside. If the Rev. C solves all the alarming problems, cutting the "down" time of the central system, we will be thrilled. It is a good system and there are less problems with it than with some of the others like Child Watch or is it Watched child?? Don't know at this time of day. The Marquette system is NOT without problems too. If you like the Phillips monitors, you will like the system. Hope your customer service folks are more prompt and attentive than ours is. We use paper strips too but do not print off things to the paper chart yet.

I recently had staffing issues about floating, use of the team leaders as staff and complaints about "fairness". I asked for 6 volunteers who were the most vocal about the issues to be part of the team to decide how to meet the patients' needs and still keep staff happy. The team decided how we would deal with time off, floating, who to call off first and all the little details for the entire unit. After each meeting, they would discuss the guidelines with the teams and come back with new questions as well as answers. Together we waded through the complexities of what everyone was willing to live with for the patients' safety. It got loud. It was stressful. It was also successful. It is after all, the staff who has the issues and the resolutions. By placing the only unbreakable rule first, we found solutions that we could all understand. That rule is "the patient comes first, the unit second and the nurse third". It works. We even posted the rules so it could not be said, "no one told me that"....

Well, I feel lucky after reading all these posts. Maybe it is just our nursing divisions' own actions, but we celebrate Nurses' Day separate from Hospital Week. HR has tried to combine the activities but have not won that battle. We have Nurse Excellence award every quarter and then have Nurse of the Year celebration on a day designated as Nurses' Day. The awards include a placque (sp?) with their name engraved, a beautiful crystal egg with engraving for the RN, LPN and Support personnel of the year, a check of $1000/each and a dozen roses. The gifts for staff are provided with money from Nursing Admin. and an equal amount from the Medical Staff. The hospital springs for a nice reception with cake and drinks on both days and nights. Nsg. Admin comes out to serve the night shifts and to deliver the gifts. The gifts vary in quality. The individual managers give small tokens of appreciation like a survival kit, chocolate( ALLWAYS needed and appreciated) other snacks or items. The charge nurses receive a special gift from Admin and their NM also give gifts or cards. The down side is the entire hospital comes to the celebration and nursing doesn't always get there. The Nsg. Adm. takes food and drinks to all the units in the hope that no one is missed. This year the entire hospital received a thank you bonus of 2% gross earnings of last year on our Nurses' Day. That was nice. I have seen Thank you notes provided to entire staff for doing the extra things for the patients and the hospital. I have given team members a thank you note. It helps to be noticed and appreciated in that manner. It certainly is your hospitals' choice as to when to celebrate Nursing. Our hospital week activities will include Cake, popcorn, ice cream, a luau, steak dinner and other gifts. We do feel (today) well appreciated. But treatment must include respect and loyalty and good will for the feeling to continue. And some folks never see the motive as good, no matter what the truth. I just try to do my best without assuming to know the motive. It is of no matter to me, what their motive is. What matters to me is my motive for providing my skills for my patients and coworkers. Have a great day.

Lots of hospitals are going to all non-latex gloves, especially in the nonclinical areas like the food handlers and housekeeping. Our nursing dept is going latex free sterile and nonsterile gloves for the most part. We are all hoping to see a decrease in the problems the insidious latex allergen causes. Hope it works. There are some really good (stretchy and conforms to hands better) gloves available. Costs are higher but the cost of nitrile or liners AND the human factors probably offsets the whole cost issue. We will be changed over by mid May. I can't wait!

We don't have guidelines nor criteria for albuterol tx. except for the nurse's own assessment of the child. If there are OTHER symptoms of respiratory distress then the child should have the treatment. We spent much of the past two winters arguing with RT about whether the child needed a treatment or not. Especially if the kid was satting somewhere close to 90 %. They would argue that if there was a good sat, then we were nuts to ask for the treatment. We were even told that the kids would be better off not to have the treatments so frequently---even with MAJOR symptoms of respiratory distress. We had two presentations about RSV this summer to" get us all on the same page" but the last kid we had with resp. distress, we still had an argument with the RT who said he didn't agree with the Dr. who presented the education supporting the entire assessment as the criteria to give the treatments. He bad-mouths the entire peds staff cause we call for treatments so often. Yet the kids are blue, retracting, wheezing and struggling so.... makes me angry at his arrogance. Well, HE hasn't had a kid code from lack of ability to breathe...JERK.