babyktchr

It is one thing to live in a pyxis, they do have expirations listed on the bag. Once spiked, the bag is only good for 24 hours. Every bag of medication has an expiration date listed on it.

Tachysystole is correct terminology that has been approved to be used instead of hyperstimulation.

Have not kept up with national trends in this area, but I bet it is a HOT topic. I know my last units fall numbers were going up, and post vag delivery showers with and without epidurals were the cause. In my opinion, I think we get newly delivered moms out of bed way too soon, and leave them to their own devices probably too soon also. With bed crunches and short staffing, who couldn't see this coming, but patient safety is paramount. Our anesthesia group had specific orders that any patient with epidural could not get out of bed for 2, preferrably 3 hour after delivery. The also could not be left alone in the shower or if out of bed to bathroom x 6 hours post delivery. We even went so far as to making this a standard for any vag delivery. Extra teaching to patient and family to call nurse or CNA to get up to go to the bathroom, and bathroom door open for shower (at least the first time). Even on those crazy busy days, you have to make the time for this patient population. Even the strongest of women go down in that shower with that steam going and the hot water. Thanks for this post, got me thinking to do a bit of research.

The only thing I have to contribute here is that the OP does have a 90 day period in which the facility can choose not to keep her on, and most places now can do this without cause. As a manager, this is the only thing I can see that may hang her up. As a new grad, she will be in a 12 week or longer orientation, and may not get thru it because of her delivery, and would have to pick up her orientation, or lengthen it, because of maternity leave. Orientation if very expensive and they may not choose to extend, depending on the current climate in the facility or unit. Hopefully all will work itself out with a great outcome for everyone.

The new guidlelines are 56 pages long.

Although this could go a few different ways...I will jump in with this thought. If your facility touts "family centered care" or provides couplet care without nursery, it would be prudent that your customer/patient base KNOWS this, and can prepare accordingly. If they believe you have the capability, of course you will be dragging babies around in their bassinettes. It is a dissatisfyer initially, but if that is the model you are working with, then work with it. You cannot have patients believe you have a service you do not. Your managment is just wrong there. We went from having a nursery to mom/baby couple care and we did have a few bumps, but we rely heavily on the support person (hahahaha). There are times that we do end up with a baby or two at the desk, but for the most part we room in. Having a baby is hard work and so is taking care of them. How many times have you had a mom come in umpteen times for labor checks and demanding you get the baby out, and the moment it arrives into the world, they want it in the nursery???? Your management is going about this the wrong way, sorry.

Oh my gosh, honey.....you will get it in time. Its hard not knowing, but it all will make sense one day. Good luck to you.

The forhead, chin, tip of the nose reference is for contraction strength. Sounds to me like you need to sit down with your preceptor and have her really explain these terms to you. While seasoned OB nurses use these terms willy nilly, it is kind of unfair to unleash them on new people without explaining what that means. I suggest first that you take a deep breath and understand that you are not alone. When I first did a vaginal exam, I was like...ummmmmmmm, what was that? It will take many exams before you really "get" what you are feeling and probably months, if not a year, before you feel comfortable. I have been doing them for 16 years and I still get an exam that stumps me. Sometimes you have to dig around to find a cervix. My suggestion is always go into an exam thinking that you are going to find something and don't come out until you do (unless you are really hurting the patient). Think of the uterus being covered in a turtleneck sweater. The opening of the sweater is in the back of the uterus. As labor progresses, the opening (the neck of the sweater) is pulled forward, until it is in the opposite position in the front. So, in early stages, your exams will occur in the more posterior regions (and sometimes way behind there, and often times obliterated by a head) and other times it will be right there when you first go in. It will be different for every patient. The key is having patience. Sometimes you can feel the cervix but it is so far behind the uterus (the neck of the sweater is on the other side), that you really can't reach it totally. You can put your finger in the cervix and pull it towards you to bring it more anterior for you to examine. It does not always work, but it can be helpful when you are doing a very posterior exam. This is what your preceptor meant. A long cervix is actuallly referring to how much of your finger can go inside the cervix, the thickness. It is almost like sticking your finger in your mouth. Some cervix lengths go up to your first knuckle or even more depending on gestational age. Again, you will have to feel to get to know different effacements. If you put a piece of paper on the table and feel the difference between the table and the paper, that is 100%. My suggestion to you is examine as many people as you can. When I oriented, I examined everyone that came thru triage, even if I wasn't assigned there. The more you do it, the more familiar you will become. Remember, exams are very subjective. Your fingers may be a different size than someone else's, so your 3 may be someone else's 2 and so forth. It just takes practice and you have to give yourself that time. You do, however, need to ask your preceptor to teach you what she is talking about. She won't know you aren't getting it if you don't say anything. I wish you luck and I hope this helps you.

Honestly, it has been a while since I have had to look at resumes and such. No one leave my unit. Its hard when you don't have experience to try to catch a break. I was one of those people who did catch a break, and 15 years later I am running the unit. It is really a lot of right timing and how you present yourself. I see so many people who say OB is my life and then they get their chance and all of a sudden its...well maybe its not. I give more weight to new grads who have been externs on my unit. They have actually worked on the unit and know what the flow is, how the nurses work and how the unit runs for the most part. I would also look at what your previous work history was within your nursing career. Critical thinking skills are something I really, really look for in a new hire. Its difficult to get certifications and other training if you are not in the OB field. I don't know about anyone else's unit, but we do not offer NRP to anyone that doesn't actively work in OB, Peds, ED or Resp. One thing you can do is take the AWHONN online basic fetal monitoring course. It is very basic and will give you a nice foundation to fetal monitoring. That I would look at favorably. It is a tough arena to break into. It all comes down to being impressive and convincing your prospective employer that he/she should take a chance on you. Focus on what you can bring to the unit and really convince me why I should take the chance on you. Your passion will shine thru more than simply saying that I just want to be an OB nurse. I hear that too many times. Be unique, but be you. I don't know if this helps..but good luck to you.

Most specialty certifications require 2 years of experience.

I didn't think Dalmane was still around...holy cow. Ambien.

I go to conferences mostly to get my CEU's. This time around I may take the NCC tests to get them because I am way behind.

I agree. You say there are accels with minimal to moderate variability. That right there rules out metabolic acidemia..you have an oxygenated baby. Periods of minimal variability can have a differential of varying things, but I am wondering if this woman couldn't have benefitted from a liter or two of IV fluids. She is obviously dehydrated (mod ketones??) and isn't making the efforts to hydrate herself. That alone could be making her uterus angry and causing those ineffective contractions. It certainly couldn't hurt and would probably perk that baby right up. As someone else said, document your butt off (although you described a reactive strip). You didn't mention how many weeks this mom was? Term???

One of the things that is so hot right now in my facility is "duty to report". Do you have a corporate intergrity hotline that you can report things to for breeches and such? You can report this kind of "stuff" to them and the hospital is bound( forced) to investigate. I have run across this situation many many times, and I bring those cases to our OB/GYN meetings and lay it all out. I discuss the supposed diagnosis and then try my hardest to find evidence to support it and when I can't, I ask the doctor to help me understand. JCAHO is watching this stuff. It won't be immediate, but I forsee elective inductions becoming a hot, hot issue in the coming years. ACOG simply needs to stop putting out rules and not enforcing them....

I never did understand why clinical experience is included on a graduate application. When I do interviews with the grads, that is the only thing listed and it is umm...kinda required and it is supervised, so how can you list it as "experience"?. If I were looking at your resume, I would certainly appreciate your experience in the OB arena and look favorably on it. As a previous poster said, keep it short and sweet...you dont' want to look desperate. Good luck to you!!!!