azzurra29

Hi there, I'm seriously considering PH nursing and I had a question for those of you already in it. If and when you check on antepartum patients do you usually see them in their homes or in clinics? If you see them in their homes do you use one of those listening devices to check the fetal HR or is there something like portable EFM monitoring that's done (I'm totally guessing on that)? What do those types of visits entail? I'm just curious about all that. Antepartum stuff would be new to me and I was hoping you might be able to share your experiences. THanks.

Hi there, Thank goodness for these specialty forums. I've had almost 3 weeks of orientation for a postpartum floor I am working on. Granted, I've learned a lot but since I'm a new grad I'm still learning how to deal with the fusion of obstetric and pediatric physiology and nursing care given. While I've been digging into my OB/PEDS textbook a lot lately, I still don't feel up to par with things. Part of me thinks that the rest will come with time and experiece but I need to be prepared for anything. SO, what would you say are the most important things to look out for in newborn care i n a nutshell? (if possible) To me, I'd say the basics are s/sx of infection, dehydration/feeding/hypgoglycemia, hyperbilirubinemia and of course the ABC's. Would you say that's about right? Oh and safety of course. I must ask however, what to look out for with newborn dehydration? Lethargy, poor tone, dry mucous membranes, elevated temp? anything else? I'm so scared that I must miss one of those signs because from what I've been learning, the important thing is measuring fluid status with the baby's output. So all the wet diapers etc. But I guess some babies will not be gettig enough despite meeting the minimum number of wet diapers? This part gets me confused. If you wouldn't mind sharing some helpful tips and expertise about this I'd so greatly appreciate it. Many thanks from a desperate new grad

I can't remember if I said thank you already but all the spanish phrases thrown in by everyone have been very helpful. Muchas gracias!

Wow, I really appreciate all the helpful posts (including the humorous ones). Thanks everyone. I've got my work cut out for me .

Hi there, Any PP nurses who know medical spanish or who are spanish-speaking, would you be able to help me out here? Or direct me to somewhere on the web... Just started out in a PP unit and I'd like to be able to get some better Spanish skills on board. Thanks. For example, how would you say (in simple yet understandable terms) things like: -are you breastfeeding or formula feeding? -have you breastfed the baby recently (within the last two hours)? -any dirty diapers? stool or urine? -anything else you might want to throw in -have you urinated? Have you had a bowel movement? -please call me when you want to go to the BR so I can assist you. -I'm going to palpate your uterus. -I'm massaging your uterus. -have you had more bleeding? -what is your pain scale 1-10 with 10 being the worst pain? Just wanted some input. Thanks so much!

Thanks shortstuff. The descriptions really helped me to visualize things a bit more. Question: when you say the pt trickled blood for awhile, what exactly do you mean? That is, what exactly are you seeing when you examine the pt? This is one thing I haven't really understood. Another question: I read somewhere that pushing too hard on the uterus can cause uterine rupture... is that true..? or what exactly do you mean when you say you pushed hard? Thanks.

I have to say I very much concur with this. Had I known how difficult the real world of nursing is I know I might have rethought my choice for this career. I'm totally a new grad as well and dealing with one of the most difficult things I've had to do in my entire life; it's almost unbelievable to me and I have never cried this much before. In fact, I get so much anxiety on my off days that sometimes I wonder if I should just quit already. Yet, that in itself is a hard decision. I just wish I could fast forward to the 6 month/1 year mark and know that I will be more comfortable and solid. I can totally relate to the trials of being a new grad. I'm glad we can share them here.

Wow, thank you both for the helpful information/answers. Actually, I know from theory that PP hemorrhage can be insidious but I wanted to hear from more seasoned nurses. Wow, I'm still processing all that--especially what this means for new nurses on the unit. The good thing is that the experienced ones can certainly help them out to spot things. Thanks.

HI there, I'm sorta new to OB nursing but I've been reading up again in my school textbook. I'd just like to ask all of you whe practice in this clinical setting about PP hemorrhage during the hospital stay (I guess that's considered EARLY pp hemorrahage then right?). I know it probably depends on what's happening like if it's internal bleeding or some hematoma formation versus bleeding out into peripads and saturating those. Is it more often than not, PP hemorrhage can be caught earlier on (VS, peripads, mental status?) or is it a mixed bag of possibilities? Does it become easier to pick up on PP hemorrhage with more exposure and time? What have your experiences been like/any tips/recommendations/suggestions? I have to ask because I'm a new grad, still very green and just thinking about PP hemorrhage sends shivers down my spine :uhoh21: (I know I'm not the only one). I may be working in a PP unit and I know that this is the reality so I'm trying to come to terms with that. It's super scary to me and I know patients everywhere in the hospital bleed BUT for some reason this really bothers me. Hmm, maybe I shouldn't be in that unit? I don't know. Thanks for any comments/feedback. I'm really grateful that these forums exist.

SmilingBluEyes--thanks for telling it like it is although it makes me more frightened now since I'm a new grad possibly entering a PP floor. Our nurse recruiter suggested this for me since I couldn't handle the stepdown floor of our large teaching hospital. I hope I can manage.

Thanks for the comment, Mirasol. What you said makes sense and yes, I'll have to investigate further the issue of expressing clots.

Hi there, I wish I could say I retained more from my OB classes/rotation in nursing school (just a year ago) but I'm a bit rusty. I might be getting a PP job soon so I've been trying to polish up some of my theory. I was rereading my OB textbook and reviewing fundal palpation and massage. I need some help understanding something here. If the fundus is boggy, they say to gently but firmly massage the fundus in a circular motion. They also say that a boggy fundus may be r/t accumulated clots which should be expressed. I was then reading that one isn't suppose to express clots until the uterus is firmly contracted. wait, what? You're supposed to help the uterus firm up but how is going to if you can't express them? I am SO CONFUSED. I am either totally reading this wrongly or the book is not articulating itself well. Oh, and another thing: I was reading that you aren't to "push" on an uncontracted uterus--aren't you somewhat "pushing" on the uterus anyway when you are palpating it and then massaging it or does this mean like blatant pushing? And if yes, is it pushing/pressing down on the fundus down towards the direction of the lady parts? I don't remember ever learning about this in nursing school. Anyhow, Can I kindly ask for some helpful comments here? I'd really really appreciate it. I've been making a concerted effort to really try to understand these things but the above just throws me off. THanks so much.

Thank you for the great explanation. What kind of nursing does one have to do to get into such a position? Do they require other types of experience as well?

Hi there, I needed some help understanding what utilization review RNs actually do, what the job is like, what's it like on the pay scale continuum, etc. Thanks so much!

I really appreciate all the comments/advice so far. rose61, I think you described a lot of what I'm feeling so far. I am indeed frightened and I think my biggest fear is not catching something when a patient starts deteriorating on me, especially with unexpected bleeding. I get nightmares over such stuff and then I really wonder if I'm cut out to be a nurse at all. I mean, that's what health/illness is all about right? Facing all kinds of situations and seeing the good, bad and ugly. However, it never really hit me until I started working in the "real world" and I sometimes wonder how I could possibly not understand that before. I tend to be hard on myself but I don't see any other way when you're a new grad, inexperienced and when liability is greater these days. My, oh my. Maybe I'm dwelling too much on the negative but I guess I'm also being realistic. I just have to believe that with all my hard work and effort I will grow more confident and really be a great nurse.

Thanks for all the info KatRNBSN. dria: What is "PDN" and "HHC"?

Hi there, It seems to me that to get anywhere in nursing you have to pay your dues (obviously) and get some experience down. From what I understand that usually means some acute care experience to land a job in a clinic maybe a year later at the earliest. It probably varies from place to place, but do you know of people who got their BSN/RN and didn't go directly to a hospital to work and instead, went elsewhere and found employment? I guess I'm referring to non-clinical jobs. I'm curious as to how such is done if it is at all because I'm thinking that most jobs would want experience. I really don't think I'm an acute care nurse at heart and I'm really struggling with it but I know it's hard not to get elsewhere without experience unless I'm overlooking something. For all I know, I kind of want a job that isn't clinical but where I can still use my credentials. I know it's hard to get jobs without any solid clinical experience (and right now, working at a hospital is like pulling teeth for me but maybe that's just the way things go) Any thoughts/ideas/opinions? I guess I've been hit with a rude awakening and having second thoughts about my potential career but I'd like to think I can utilize what I've gotten so far in some decent capacity outside a clinical environment in some way. I hope, at least, but I don't know.

I appreciate all the input and comments. I still struggle with my choice for nursing but again, maybe I'm just letting my anxiety control me. Nevertheless, sometimes it's hard to know if your gut feelings are talking to you or circumstantial stress is talking to you. I guess each one of us has to decide and consider all these things to make the right decisions for each one of us.

Hi there, I'm a new grad, been orienting in a stepdown floor for about 3 months and realized that it just wasn't for me. I'm now trying to transfer to a less acute unit in my hospital but things are still in the air as there are no guarantees. Anyhow, I've been feeling a lot of anxiety (normal for new grads, I know) but the more I read about med errors or bad things happening like lawsuits 5 years down the road, the more I get to thinking which probably makes my anxiety worse. I mean, I always thought I wanted to be a nurse and I have been very cautious to practice safely but I guess it's a scary thought if something goes wrong and I guess my mind is just entertaining all those "What ifs?" which doesn't help me at all. I just feel like nursing is an incredible, amazing profession but there is a certain amount of risk involved and for some reason, it's really getting to me now. So much that I get antsy thinking about whether I can stick around even though I JUST graduated in december (worked really hard for my BSN), got my license in february and have been at a good teaching hospital orienting. Part of me feels like quitting but all my close friends and family tell me it's too early and I have to give myself and the profession a chance. A part of me really wishes I had chosen something less stressful like maybe OT or PT (I'm guessing they're not as stressful as nursing but I could be wrong) or something totally different. A part of me thinks I'm letting my anxiety (and stress) get the better of me because one can practice safely and do their very best but for some reason I just have all these second thoughts about taking care of people and their lives. It's all so scary to me and I feel silly because somehow it didn't really hit me before when I was in nursing school. Maybe this is normal, maybe I'm just stressed out or maybe I have to reconsider my choice for a career. Any of you have advice/comments you'd like to share? I'd greatly appreciate it. Thanks so much!

Thanks for the input KatRN, BSN. I plan to stick out my orientation which is about a week away from finishing up and that's with an extra week added on since the nurse educators felt I needed it. I told them I was "stressed" and they said it's normal but I think my stress has been excessive so that's why I was posting on this forum, trying to think things through. Looking back on nursing school, I did enjoy some of the clinicals but nothing major. In fact, I wonder if bedside nursing is really a good career choice for me as well. Actually I can see myself working more in the community in less acute settings although I don't know how easy that would be to get to that point. Anyhow, that is that. I appreciate all the responses so far here. THanks a lot.

THanks for all the replies from everyone. I'm getting to thinking a little more clearly about things although it's still hard to make decisions. Maybe quitting at 2 months is too early... thanks again.

Hi there, I already posted on this forum previously but I wanted to post again. Honestly, I've been reading a lot of posts here and very much relate to the experiences of new grad RNs. I've been orienting on my unit for about 2.5 months (didactic and unit time together) and I'm about 9 days away from finishing up. I've been training in critical care and felt I have learned A LOT however I get a lot of anxiety before, during and after work, and on my days off, just thinking about the unit and everything I've been doing. All the crazy thoughts/questions/ideas that fly through an anxious person's head has not been new to me. I know there is a huge learning curve for new nurses and people say this will pass with time however, I sometimes wonder if nursing just isn't for me. Or maybe it's the actual unit that isn't for me. However, with all the talk of liability and the stress of the units, my anxiety becomes even greater and I feel like I should just avoid it all by getting out. However, I have also worked extremely hard to obtain my BSN and RN license and quitting wouldn't be great at all. However, sometimes I just feel like my sanity and happiness is more important than all that and maybe I'd be better with a less stressful yet lower paying job elsewhere. I mean, I wonder if I could use my degree in a decent non-clinical job elsewhere. I've been thinking about taking anti-anxiety meds since it seemed to really surface during nursing school and now I feel it even more. I don't know, I just feel really divided and uncertain about what decision to make. Maybe some of you can offer some advice or pointers. THanksk so much.

Jamonit, THanks for sharing. It's nice to hear from someone who has gone through similar experiences. I'm going to stick out my orientation and see how things go.

Hi there, I can TOTALLY relate to what you are saying. I'm a new grad BSN and I'm almost off orientation on my stepdown floor. My hospital is large, county-run, teaching facility and we see practically everything. So our floors are quite busy. My orientation has been quite overwhelming. I NEVER knew nursing could be THAT hard and maybe it's' because my unit is harder and more acute. Anyhow, I have never cried so much in my life than during orientation. I would often cry BEFORE work and even after because I was so stressed out. I've always been emotional but I never really started crying till the end of nursing school and now the real world of RN work. I suppose the stress has been too much for me lately and it's been hard not to break down at work even. Sometimes my anxiety would make me feel like I could vomit even (although I haven't thank God).. I quickly learned that I'm a bit of a perfectionist too and I get anxiety quite frequently. To me, I found that I either have to decrease my anxiety and take care of my health more or change my nursing unit to something less crazy. I have to stop beating myself up for thinking that it would look like a "weak" move or a "weak" response to stress. Each person is entirely unique and different and we have to do what's best for US. If we do that we can best serve and care for our patients. I've come to really learn this recently. A good cry is fine but I think if you feel like you are too overwhelmed then you should seriously consider your circumstances and what you need to do to stabilize yourself. Sometimes I have to just quickly walk into the bathroom or somewhere isolated at work to calm and recenter myself. Sometimes that helps. Other times I leave the unit entirely during my break and get some fresh air outside. All I know is that it's absolutely crucial to take care of yourself so you can be more stabile at work and in general. Gosh I so empathasize with you. I'm currently debating where I'm going with my nursing career. I JUST started so that makes it even more stressful. Anyhow, I will see how things go.... good luck and take care...

Hi there, I'm a new grad BSN and I've been orienting for almost 13 weeks now in a critical care program at my local county hospital. I've been working on a busy stepdown/tele floor and honestly the whole experience has been SUPEr challenging for me. I wanted to start out somewhere less acute like Med-Surg but there were no openings at the time. In any case, the floor I'm currently at has some great staff who are very supportive and the atmosphere is generally good because we're a teaching hospital. HOWEVER, even though I thought I wanted to work on this floor it's becoming very hard to handle and very overwhelming. I know I"m new and the learning curve is high for new grads but I feel like my anxiety is even greater than normal. For awhile I got really depressed thinking I couldn't do nursing AT ALL but then I realized I was mentally throwing the "baby out with the bath water". I then realized that maybe that floor is just too much for me and perhaps I should try to transfer somwhere else. I feel kind of bad that the hospital has used a lot of resources to train me but at the same time, I know that if if my health is really being affected by the unit then maybe I shouldn't be there. Maybe I was too idealistic as a new grad and CLEARLY naiive and inexperienced. However, I feel like maybe it's supposed to be this hard and i'm getting great experience and maybe I should just stick things out and it will be OK. I'm SO back and forth on this that I don't know. I just know that I have 3 more weeks of orientation and then I have to make a decision alongside the manager and nurse educators. It really stresses me out because some days I'm on the unit and I feel like I can handle things and then on other days I feel like there's no way. However, I realize that the main thing is patient safety and of course, my health and safety. If my response to the stress/anxiety clouds my ability to carry out good nursing that's a red flag and as uncomfortable as it is, I may just have to move on. I just needed to get that off my mind; I don't know what to do but I do have some idea of what MIGHT be best. Goodness, perhaps any of you have gone through this and can offer some insight and words of wisdom?