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.

SusyK-- Your story about the ER and the pt. who was 40% effaced got me laughing all over again about a patient we had recently. ER called to say EMS was bringing a "drop In"patient (without any physician) red lighting it with contractions q2". We started getting ready when they called back to tell us that EMS stated she was really active and would need to deliver in the ER so would we please bring a warmer. We grabbed the warmer and packs and shove that unwieldy thing as rapidly as possible to the ER. We set it up, turn it on and grab gloves when EMS calls again to tell us the baby is coming and they are 5 " out... There are now 3 ER docs, 2 OB nurses, 4 ER nurses/staff all lined up outside the doors, in gloves awaiting the arrival of this pt and possibly her newborn of uncertain gestational age. ER staff is all discussing what to do and who would do what. We are pacing, sterile little hands up in the air everywhere in the driveway when the ambulance roars in, doors pop open and there is screaming and panicked looking EMS jumping out. It all goes in slow motion now as they all hover over her and run to the ER area where the warmer is set up. One ER doctor tries to check the screaming woman and says he feels no cervix. The OB doc walks in now, assesses the situation---mind you, people are milling around and talking and EMS is shouting report and are sooooo relieved that she held that baby in til they are through with the transport. He checks her and the ER doctor is telling him we have this and that all ready. He looks at us and winks when he says, Well, I think we have time to go on to OB for this. ER starts her IV and we push that warmer back to OB and EMS brings the patient to us. When we get her, not only was she not ruptured, she was not dilated at all. She was drug seeking, tired of being pregnant and had voided all over herself. ER called to see about the pt. that they were so wired for and were so shocked that we sent her home 2 hours later, undelivered. EMS has yet to live that down. We just giggle when we get those panic calls now and ER has trouble getting us to take them seriously when they call to ask for our help. :OH WELL!!! Get some experience in OB and maybe that will help you find that cervix. I know this is off the topic, but couldn't resist the story. Have a great day. I smile with anticipation.

First let me say, I am NOT an information specialist...only a nurse. Our hospital has been developing the Nursing module of Meditech. My unit was the pilot unit for the VS and I&O. We love it. We have written the Intervention dictionaries for Peds and Nursery and developed Admission assessments, reassessments, etc. That will not be going live house wide for some reason unknown to me. In the interim, our OBVU system has been upgraded and we have potential to do Labor charting in it. The issues are how are you doing computerized charting in L&D if you have this ability? Do you do only LD on the OBVU system? Can you safely place Meditech on the OBVU desktop and toggle between systems? Where do you chart admissions and reassessments? What do you do about PP and Nursery if you chart L&D all in OBVU? Do you know of an interface? What about the Forms package on OBVU? Is anyone using it? Does it work as fast as meditech? If you can answer these questions based on your experience, it would be a great help to me. I have to make a logical proposal and I am not certain how to best accomplish a simple, non-duplicity charting system in the computer, based on these 2 systems. HELP!! Thank you if you can help.

As a manager, I feel the same panic and dispair when nurses talk of the sign on bonuses or the new gizmo another place has or when they resign. One thing which helps to get past the fear that we can't manage without them, is knowing that it isn't personal, it's one professional person taking care of herself. I tell them, I understand. If you don't take care of yourself, no one will. I have listened to the frustrations and needs voiced by the staff who are my hands and eyes. I can not do both their jobs and mine every day. So I depend on their expertise to tell me the issues with the care I ask of them. I truly believe no one goes to work every day to do a bad job or to make my day awful. I can help them and in return they help me. One success to make us the "favorite unit" was setting up some committees or groups to work on HOT topics. We avoided the use of empowerment or self governance since the CNO is not able to let that go. Groups set up our Closed Unit Staffing, Pt. education, QI, Improving "report", rearranging supplies and par levels, re-writing performance checklists, set a unit vision, and are currently working on our computerized charting development. No one leader has all the answers to all the issues in the unit. The one who does the job, knows the solution. When education was cut (again) the staffs' idea was to have each person chose a topic they could teach or demonstrate. We have had some GREAT posters and education which is effective. Each person is responsible to provide the education to every person on the unit in 4 weeks timeframe. Works great. Cheap. Present plans in the unit include making the "party" usually given with the departure of a nurse, a "WELCOME" party when new nurses arrive. We are planning a "Tea Party" for each of the rotations of the newest students to recruit for next year. We ask for people who wish to work with the students to arrange to work consistently on "student" days. Everyone is expected to recruit the students by their example and friendliness. We will eat cookies but Never our Young. I need to learn to follow my gut during interviews more. My hiring people who just don't interview well should stop. They rarely work out and leave quickly OR I have a poor performer that is dead wood for much too long. I think we need to not accept a warm body in desperate times, but look for good fits and abilities. Staff tell me, they would rather work short or do OT than to have someone who performs poorly or who hates their job. I have rambled way too much. My synopsis is this: Listen to staff. Give them feedback. Over communicate. The person at the bedside knows the best way to do the job and if I provide their needs, IT WILL BE DONE. And---I just like and respect them. I expect them to do well and they usually do. If they don't, it's probably the system that failed them. Correct it. If they still perform poorly, another story. For what it's worth, I love to manage but mostly I set the vision, provide the tools and then just get out of the way.

Yeah, it is a JCAHO requirement. Yeah, we use the pain faces scale and record pain by the numbers on the graphic. We have education sheets and we have a plan of care for pain control goals that we have to get signed by the patient. We do all the things you have posted here. I just wonder how you really apply the "Pain Standard" to labor and delivery situations. Labor, is inherently painful to a large population. Setting an acceptable level of pain control at 4 or 5, knowing that as the labor progresses, the perception of pain usually also increases, as well as knowing that most of our pain control interventions will not meet the unrealistic goal, is really not appropriate. It is nearly deceptive. It just doesn't make sense to me. How are most of you applying the requirements and the solutions that the hospitals' pain teams have invented? In looking at the pain standards, it seems to me that it was intended to address CHRONIC pain and/or cancer pain rather than the acute pain of childbirth. It even could address post op pain of cesarean sections or postpartum pain. It applies to post op GYN's. When you go to the pain sites, the pain assessments, goal setting, interventions and documentations with VS, seem to apply to chronic or cancer pain. So correct me here. How do you really meet this standard? What are you doing to make this apply to OB pts. in labor? And how do you use it with children? or newborns? This is driving me nuts. HELP!! How do you meet the standards really??? Thank you for clarifying this for me. Policy and procedure would be helpful too......

OK. I apologize that you thought I meant it is the mothers' fault. I am in the midst of a suit where the "damage" was compounded by her lack of action. And in some cases, it is the response to the initial injury that is compounded--although that was not intended to mean all blame goes to the mother, even in this suit I am involved in... So forgive the miscommunication and realize that we all have life experiences that color our responses to situations or comments. Frustration with non compliance can make the comments sound harsh or defensive. Each case is different because all birth situations are different in so many ways. I am so sorry you have this injury and the pain and suffering it causes both your child and his parents. For what it is worth, I understand the pain and the anger. I'm sorry I offended you and that you felt I was blaming the mother instead of the physician. That was not my intent, just my most recent experience. Best wishesnull

We call laboring down--when you just allow the position and the contractions to move the infant down in the pelvis. Letting nature take its' course and letting force of gravity work, so to speak. Is that what YOU others mean????

Well, things are clear now why the question. I agree that poor practice of medicine has to be addressed when we know it is occuring. I find it awful that "these things just happen", too. But the truth is, they sometimes do. Many red flags are there and we have the obligation to read them and report them. ANY injury is too much. There is some complicity by the mother too and some accountability. We, far too often, have mothers in this situation who deliberately CHOSE not to seek prenatal care. She has added to the uncertainty of a healthy outcome. I do NOT fault the physician who has to wade through a case like that without previous history, testing or supervision of care if the mother did not seek care. OR the mother who has had a Fx clavicle and is told to follow up and to keep the arm supported and who fails to do so. AND then has the audacity to sue when the arm is not "moving very much". It became a brachial plexus injury which was compounded by her ignorance, cheapness or something...and of course, someone must pay. I understand the frustration you must feel that the injury might have been prevented. No matter what else, if we know the manuevers and the way to get the baby out and we are ready to do so, we have some peace of mind if things go wrong, but we also agonize over the loss or failure. We are after all, humans with regrets built in.

OBs are bound by some ACOG standards and the Bloodbank criteria to transfuse at 7 IF symptomatic. If not dizzy or hypotensive, Fe is prescribed. Theory is that most pregnant people are young, healthy and if not feeling symptomatic, can recover on their own.

We instituted a policy a few years ago and the instances in which we may apply SE are Membranes ruptured Non-reassuring FHT pattern Absence of Previa (Ultrasound) Physician preference for notification prior to application or after was included in the policy. We also addressed the competency issue and the training issues. ie) year experience, Completion of FH Monitoring course (AWHONN) and 5 successful return demo's to TL or DR. We use it a lot at night and most don't want to be bothered for permission, just if it validates non-reassuring FHT patterns. We think it is a lifesaver.

Timonrn, You might want to get copies of the guidelines for staffing from AWHONN which were developed by the AAP and ACOG for the actual increased acuity and increasingly "sue happy" clientele of the pt. population you serve. Just a thought...