jennobrn01

It depends on what type of unit you are hired to. On my unit we are all cross-trained to do all aspects: antepartum, L&D, postpartum, nursery. Of course there are some nurses who have definite strengths in one area, and other nurses who lament that they get "stuck" often in one area. A new grad orientation is 18 weeks (I think) and includes all areas. I have a friend who was hired out of nursing school onto an antepartum unit with the goal of getting into L&D. She soon saw that her chances were slim, and transfered to Peds...which she now loves. When it comes your time to decide where to work....do your research and keep your eyes wide open as you visit the units.

I agree...don't spend the $$$ if you don't have to. In nursing school I was all about the Littman's. In the real world of nursing.... our unit is stocked with non-Littman steth's, and they work just fine. :)

"I got to watch the whole thing in the reflection on an overhead lamp.....to see one's own csection, well is a trip. I am glad I could." OT: That is so funny... I did the same thing....though I didn't notice the reflection until the MD and first assist. started closing. They were like two old ladies at a quilting talking about suture material and techinique. What an odd experience to watch without feeling.

I try hard to find some way to compliment the way they care for their baby (if delivered). This means a lot to new moms, especially if you are specific. If undelivered and I sense the baby is coming into a good/secure family unit I say that to the mom. "This baby is lucky to be born to you...I can tell you are really going to enjoy her." something like that Oh and as mentioned above...allowing the pt. and family to see if you are emotionally moved never hurts. :wink2:

I have only been in OB for four years and have seen a pt. 5 or 6 days post partum seize. She was feeling "bad", came to the ED, and while being registered seized right in the waiting area. Adequately treating pt.'s with PIH according to standard is not "over doing" it. Jenn

I am 95% sure the recommended ratio is 1:4. Yeah I have been in situations where it was 1:6 and even 1:8 :uhoh21:

Ahh so refreshing! Thanks for sharing! I especially liked the fact that she realized that the nurse is her advocate...even if it means standing up to her family. Wish more would realize that...

wow judy ann, i'd love to sit down with you and hear all your tales. :-)

Post partum our guidelines are as mentioned by mugwump. Though, I am in that room every hour. Just anal...

I agree that legal issues have curtailed the hand's on experience ob pt.'s need and deserve. Consider looking into a birthing center, or a hospital that advertises themselves as low-intervention.

I completely agree with this! :-) I went to OB right out of nursing school in 2001. We have a small unit, and our new grads do a certain amount of time in the post partum/gyn area before doing L&D. This area also receives non-infected med-surg pt.'s when we are slow. This does give the new grad good organizational skills while still being in an OB environment. My belief is that they are easier to train when they are fresh. The med-surg nurses that have come to our unit just don't quite "have it". We do have a couple nurses that did ICU before L&D, and they are very good. I love ob nursing! For me that is nursing.

Talk to a superior quickly! Document what she has said and done and have specific dates. Tell your nurse manager what your pt's have said. Just please talk to someone. I had bad experiences my first year out, and my career suffered because I did not speak up.

Wow, awesome job! I was so proud of you as I read your post. Be proud of yourself!

Technically, we are supposed to say to pt.'s that we do not permit VBAC's. This is so the ob docs can draw up an policy on the issue. Nevertheless, VBAC's are still done by one practice. Yes, we have a huge disclaimer form that the pt. must initial each statement and sign. The ob doc and anesthesia must be present throughout the duration. IMO, the real reason why there is a push to ban VBAC's in our hospital is because of the inconvienence it brings to the OB doc to have to stay with the laboring mom. I hope and plan to VBAC with this preg. Many of the nurses on our unit are fighting hard to allow women that right.

We work 12 hour shifts. Full time works three 12's a week. Part time two 12's a week. And we have per diem, and casual nurses filling out the holes. We are a small unit... 6 LDRP's and 6 PP's/GYN rooms. The charge nurse of each shift makes out the assignment. 1 nurse in L&D, 1 nurse in float (receiving infants, and general catch all), 1 nurse in Mom/Baby, and 1 nurse in PP/GYN. 4 day shifts a week there is a triage nurse, and 5 days a week a resource tech. There is also a unit secretary on days too. I work nights and am used to working without those extra frills. :) We have great team work, so these assignments are flexible, and we all really help each other out. We try not to ever sit down unless we all can sit down. On days the triage nurse will decide with the MD/CNM if pt requires admission. She (if not swamped) will often to the admission paperwork. If not the L&D nurse does this and the IV/teaching/orientation to unit. Our ratio is 2 laboring pt's to one RN. If one RN is full, then the mom/baby or float nurse will take laboring pt.'s. It really does flow usually seamlessly...it's great to have RN's that are crosstrained. Night shifts are a little different. The L&D nurse usually triages. But, we often take turns during the shift. Discharge paperwork/pics etc. are done by the Mom/Baby, Float, PP/GYN nurse. Does all that make somewhat sense? Since we are all cross trained; we know what it's like to have a hellish day in any of the assignments. So, when a co-worker is having one of those days...we pitch right in. Unless of course we are all having a nightmare day then we slog through together. :) I hope that helps you.

This is an issue where it is soo nice to have a very specific policy. You can always fall back on, "Our policy states...". In my opinon, this is where "baby story" type shows have done a disservice to the L&D profession, and the laboring mom. So many family/friends want to "get in on the action" just so they can say they were there. These people loose sight of their role to the laboring woman. Rarely, do I see support people actually be "supportive". More often than not they sit and stare, then go off and brag to their friends. So, a policy is nice. We hand out little badges that say "Support". I try to also talk up the role of the support person so they realize that they are there to assist the laboring mom.

Good luck to you. Its always good to try something first and like it..then jump in and then hate it later.

good tips given already! mild fundal pressure can help going over to the left or right...sometimes it is displaced a little practice, practice. go in confident there's nothing like finding that hard to reach cervix...like that satisfying "pop" when you start an iv. :)

Sarah B., That would be ideal. But during the middle of the night we are afraid of what our docs repsonse would be to this method. I am helping in bench-marking, so I am not sure if risk management has been involved yet. This venture is only a few days old. Thanks much for your responses. Jenn

Thanks for your help, and the link. I would like to hear from more of you on this one though! :) This is an issue we are working through now in our facility. Our new nurse manager would like to discontinue telephone triage, while the ob's would like to continue it with better documentation. Any other opinions/experience?

We are working on a telephone triage policy on our unit. RN's have done telephone triage in the past, and we are now working on documentation of our t.t. Some questions: Do RN's on your unit do telephone triage? If so, what is the mode/method of documentation? We are looking at using algorhythm's. Do you use this method, and what are your opinions about it? Any other views/opinions/research about RN's doing telephone triage is welcome! Thanks much! Jenn

Thanks for your replies. I'll have something to take back to the couple of nurses on our unit that just don't quite want to see it go. :)

Working in OB, I see it all. Some of the best stories stem from body ornamentation. Tattoo's and piercings are as creative as their owners. The time had come for one of my pt.'s to have a vag. exam. After first talking through the procedure with her; I pulled back the covers. As the patient spread her legs, the little rodent footprints tatooed on both inner thighs...leading up to her perineum...were unavoidable. The patient willing said with a grin on her face..."Yup, that's my rat trap!"

We have 6 LDRP's and 6 post partum/gyn rooms. All of our staff is cross trained. So whether the pt. stays in an LDRP, or is transfered to a PP room...the RN there is equiped to care for her with a Mag drip.

We do LDRP team nursing. Our floor has awesome team-work! That fact is always noted by all the SN's we get. It is less stressful, more fulfilling, and I think it just makes you feel better about your job all the way around.