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beepers40

beepers40

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  1. beepers40

    But I have little kids!

    I just want to put in an opinion that part of the resentment around holiday scheduling comes from abusive work policies. When I started working as a nurse two years ago, I thought I understood what working on weekends and holidays would entail. I have three kids and a hubby with a very demanding job. I talked to my manager and the charge nurse about what might happen if I needed to trade for the occasional shift, as things do come up more often when you are juggling scheduling needs for five people vs just one or two. All assured me that trading was no problem, it was easy to get the time off when you needed it, etc. It was one of the reasons why I accepted the position there, as opposed to the other places I was considering. It didn't occur to me, of course, to ask if this were the case with the noc shift, too. Also, it wasn't until after I was hired that I was told about "policies" that weren't necessarily in the union contract, they were just unit policies. Such as, not only do you have to work every other weekend (Fri night and Sat night), you also have to work every other Sunday night too. So you never get a true weekend off, since you're always working either Sat. night or Sunday night every week. Well guess what. In two years I worked nine out of ten holidays the first year, and eight out of ten the second. I had New Years Day off on the first year, and New Years Day and MLK day the second. I also worked all ten of the nights after (I worked noc shift) so that meant that I worked both Christmas Eve beginning at eleven pm and Christmas Day at eleven. And though I didn't have to go to work on New Year's Eve, I did have to go in at eleven on New Year's day, since that was not a holiday. The union contract dictated that Christmas Day and New Years Day were signed up for on the basis of seniority. I would not have been able to spend Christmas with my children for the rest of the years they lived at home under this policy, as in two years the hospital hired only one new staffer who was a transfer from another unit, so I remained at the bottom of the seniority ladder. We used travellers to fill in the holes. Thanksgiving was not included so again it was seniority for requests for vacation time/time off. There went Thanksgiving for the rest of my kids' growing up years too. (My kids are school age, not small). Memorial Day, Fourth of July, Labor Day, etc. etc. Also worked both Halloweens (not a holiday, but when you have kids...) I don't think I'm entitled to special treatment because I have kids. I don't think ANYONE should be expected to work EVERY holiday just because "you knew you would have to work holidays when you took this on." There are some very abusive work enviroments out there. My husband finally told me I had to pick between my job and him. I quit and took a per diem position. I'm working Thanksgiving Day this year, taking the rest of the holiday weekend off, and taking the entire Christmas vacation off. No regrets. I'm lucky I'm able to do this. My poor co-workers at my old hospital will continue to have to work insane holiday schedules because they continue to be short staffed because of crazy policies like this.
  2. beepers40

    Cytotec for PPH

    We, too, use 1000 mc cytotec PR for PPH. First line is pit, second line is usually methergine for vag births, but if it's a section we often go to cytotec, either in the OR (climbing under a drape to place it--oooh, fun!) or in the PACU. And yes, it usually works really well, without the diarrhea or elevated BPs.
  3. beepers40

    staffing

    We are a tertiary care center and do sometimes end up with three patients each, but only if they are stable and not doing much, i.e. cervidil or low-dose pit, or early labor where pt has UCs but not feeling them, or stable antepartums. Once pt. gets active or unstable we give up the other patient(s). Usually. Once or twice a year I end up with an antepartum who is sleeping through the night on continuous monitoring (e.g. preterm labor, no UCs tonight) and my other patient is suddenly complete and delivers--then I keep both patients but usually there is someone to lend a hand here and there when I need it. I guess what I am trying to say is, three patients on the rare occasion when there is no other choice is one thing; three patients on a daily basis is something else altogether.
  4. beepers40

    A career as a RN....later as a MD? (need advice)

    David, Look into Masters' Entry programs for people with bachelors' degrees but no nursing experience. You earn an Masters' degree while you're going to nursing school. UCSF has a great one, and if you're down in SoCal several of the universities there have similar programs. These programs are typically about three years in length; the first year to year and a half is spent on the clinical nursing courses that qualify you to sit for the NCLEX and get your RN. Once you have your RN you can work part-time if you need to. The second two years are ususally a masters' speciality course to prepare you for advanced practice nursing, either as a Clinical Nurse Specialist or as a Nurse Practitioner. Working as an NP can give you greater insight into whether the whole MD route is one you want to continue on or whether the NP role is the right one for you. Check UCLA, USC, Long Beach State, and some of the San Diego schools for this option. Most of these programs have some basic science requirements that are the same as for entry into any nursing program in the state (because they are required for licensure): Anatomy, Physiology, Microbiology, etc. You can usually take these inexpensively at a local community college if you need them. Good luck to you. N.B. these programs are generally academically rigorous and fast-paced, with very competitive admissions.
  5. beepers40

    East Bay SF Area help!

    What area of nursing are you interested in?
  6. beepers40

    Northern Calif Roll Call

    I live in the East Bay and work L&D. Nice to have a local forum.
  7. beepers40

    Would I be considered a "difficult patient?"

    "Do I have any formal education as a health care professional? I've been waiting for this question. I do not believe a woman needs formal education as a health care professional to make informed decisions about her health. I think it is imperative that all women become more actively involved in their health care. This question was asked of someone in the homebirth community....sorry I can't remember the name. She had written a book one birth and was asked what credentials she had that would qualify her to make the statements she did about birth. Her reply: "I can read." I, too, can read. I hope you will not discount the wishes of your patients simply because they do not have the schooling you do. " I would like to share my experience around this issue. I have three children; all were complicated pregnancies, with a c-section for the first birth and two VBACs to follow. With each birth, and a demise at 20 weeks in between the last two, I learned a little more about how things worked, with regards to both my own body and the general hospital environment. I read every pregnancy book I could get my hands on, talked to lots of folks, and was generally well-informed about my choices and comfortable with my decisions. I got so interested in pregnancy and labor in general that I decided to become a doula and help other women with high-risk pregnancies enjoy the kind of labor support that is often only offered to low-risk women. I entered training and was given a reading list with 10 or 15 books of required reading. I attended births as a volunteer at the local public hospital, often working with immigrant women who spoke no English and to whom our hospital system was terrifying. I loved my work and felt necessary and helpful, and felt even more well informed, well educated about how to help laboring women, and dedicated to my field. But I wanted to do more...and one day while driving home from a birth it hit me that what I really wanted to do was become a midwife. I talked to the midwives at the hospital where I volunteered about whether the licensed midwife or CNM route would be preferable; what decided me was the midwife who said, "I want to work with women of color, and most women of color deliver in a hospital, so that's why the CNM route was right for me." That winter I enrolled in a local community college to start taking prereqs for nursing school. Four and a half years later I graduated with a BSN, knowing that, just as what I had learned as a patient was a teeny fraction of what I learned as a doula, so what I learned as a doula was a teeny fraction of what I had learned in nursing school. Then I started my job as an L&D nurse and learned...that I knew nothing. That I could read every book and write every paper and ace every test, and spout every theory and statistic in the universe, and still it wouldn't matter, because there was no way to gain knowledge except through experience. My hands had to learn to palpate contraction strength, and feel for veins, and recognize the onset of chorio long before a temp started spiking. My eyes had to recognize the difference between strip patterns that looked okay and ones that heralded trouble down the pike aways, to see the difference between bleeding that was normal and bleeding that was not. My ears had to hear the change in heart tones that signaled I better get that patient back to the OR NOW, and to recognize when my Mag patient's SOB was due to incipient pulmonary edema and when it was her underlying asthma kicking up. And still, today, I am learning every moment. Every patient teaches me something new. My job is to prevent problems from happening, to prevent small problems from becoming big problems, and to provide care and comfort during those rare times when catastrophe is truly unpreventable. It is a hard, hard job, far harder than I ever imagined in all my days as a patient, as a doula, and as a student. I am a mother and a nurse. Being a good mother is incredibly difficult. Being a good nurse is harder still. I greatly respect every patient who takes the time to know her body, her own wishes, and what will make her feel safe enough to labor under my care. I respect the doulas who take the time to comfort and care for these women after undergoing rigorous and well-informed training themselves. I only wish these women would more often respect my experience as much as I respect theirs.
  8. beepers40

    Becoming a Labor and delivery nurse

    One thing I wanted to add here is the importance of getting assigned to an L&D unit for your senior preceptorship. The three of us in my class (class of 2001) who did our senior preceptorships in L&D all ended up with job offers from our respective hospitals--in my hospital's case it was the first time anyone could remember the hospital offering L&D training positions to new grads, and they hired seven of us, along with five experienced nurses, for the training program that began the September after we graduated. Incidentally, all the new grads stuck it out and made it through the program, but we lost three of the five experienced nurses along the way. Most of us are still there two years later.
  9. beepers40

    Would I be considered a "difficult patient?"

    This is a very interesting thread. I concur with the posters who think that it's not what you say, it's how you say it that earns you the label of "difficult". Difficult patients are not about this or that particular intervention, they are about control issues. I find that the most difficult patients come from two extremes of the spectrum: 1) the ones who have absolutely no idea what is happening in labor and just want what they want--i.e. the baby out, now--and don't want to do the work to make the birth happen, and 2) those who want to control all aspects of the birth and feel terrified when they find themselves having to trust someone without being able to call six references and look up nine articles on the internet first. What makes these patients "difficult" is usually that they don't understand how quickly decisions and actions must sometime happen. In the half hour that it might take to convince a mom that putting her back on the monitor is a necessary thing, the baby could become severely compromised. Those of us who do this day in and day out all have stories of babies who go from looking great to bradycardic in an instant, and that's when those 4 minute 'splash and slash' crashes save lives. Those are the kind of risks that are always in the back of the L&D nurse's head when she is working with patients who are declining certain preventative interventions. The L&D nurse has seen many bad babies, and the patient often hasn't seen any. I actually think that for patients who truly intend to refuse interventions, the most responsible thing for them to do is birth at home, because then they really are accepting the full responsibility as well as earning the priveleges of their choices. I wish home birth were more widely accepted because I do believe it is a legitimate choice that needs to be available to all women, so that when they come to the hospital to birth it is because they want to, not because they have to.
  10. beepers40

    community vs teaching hospital

    Hi all, I just accepted a position with a teaching hospital run by a well-known university in my area. My current job is at a community hospital in a high-risk L&D unit where we do about 700 deliveries a month. My new boss at the university hospital says her nurses tend to do less independent management of patients than most of us who've worked at my current hospital are used to, and that that sometimes poses some problems--for example, we are used to doing SVEs, placing scalp leads, etc whereas at the university hospital the residents do these things since they need to learn them and so the university nurses are less skilled . I'm just wondering, for those who have worked in both kinds of environments, whether they found this to be a generally true state of affairs and what they did to keep up their competencies if so. I know nurses who have left and then come back because they feel like their skills were not being maintained at the other hospital. I really don't want this to happen to me, and I really want to stay with the university hospital for other reasons. Thanks!
  11. beepers40

    Fentanyl for Labor Pain?

    Fentanyl IVP is our first-line narcotic. Standard orders are 50-100mcg IVP Q1-2 hrs. No special O2 or other mommy VS monitoring, just FHR and toco. Works really well, wears off fast, babies do really well with it, too. Take effect immediately. Mommies don't usually like the dizzy feeling they get at first, but generally are quite happy with the relief they get. Our facility also uses fentanyl for epidurals. Rarely do we use nubain or stadol.
  12. beepers40

    How much do you make?

    1. RN 2: 18 months 3. L&D noc shift 4: $39.20 SF Bay Area
  13. beepers40

    Need help for clinical project!

    AWHONN, the Association of Women's Health, Obstetric, and Neonatal Nurses, is the standard-setting body in nursing for OB. Lots of info available. They have a website. Do a search on AWHONN, it will give you the link.
  14. "Shortage? What shortage? All the nurses I know are tall." --Alleged comment from our illustrious leader.
  15. beepers40

    How many ??????? on NCLEX now?

    I can see how someone could assume that the length of a test gives a more valid result, but in this case I don't believe it's true. This is a case where the computer is our friend. NCLEX questions are rigorously tested out before being used in the part of the exam that "counts" (although the tester never knows whether the question is a "real" or an "experiemental" question. The computer has an enormous database of questions to draw on, with a required minimum number in each of the clinical areas (med/surg, pediatrics, psych, maternal health, and so on) and areas of clinical skill: assessment, intervention, evaluation, etc. The questions each have an assigned degree of difficulty, and mastery at a certain level of difficulty is required in order to pass the NCLEX. The computer starts you out with an "easy" question; if you get that one right you get a harder one. If you get that one right you get a harder one still; if you miss it your question difficulty reverts back to the previous level of difficulty. The computer continues testing until the tester demonstrates a consistent level of mastery, and then moves on to another area for testing. This way, a candidate can quickly demonstrate mastery, by answering correctly the questions at the highest level of difficulty, without having to waste time answering a bunch of easy questions that most likely will be answered correctly. This method of testing is called Computer Adaptive Testing and is used for many standardized tests such as the GRE, as well as licensure exams. Does it work? Well, my experience was that out of my nursing school class, only three classmates didn't pass the NCLEX--and they were exactly the three who had no business possessing a license until they gained either more clinical expertise, more life knowlege, or more plain common sense. I would say the NCLEX computer test did a bang-up job. BTW I took my NCLEX at 8:30 am on Sept. 11 (Yes, that Sept. 11) and there was a power failure during the exam in which all the lights went out, the computers all shut down in the middle of the exam, and we had to stand outside on the sidewalk for half an hour while they figured out whether we were under attack, someone was a little trigger happy, or just what. I passed with 75 questions. Just a little pressure;)
  16. beepers40

    Should I shadow a Nurse? HELP!

    Shadowing a nurse is a great idea. Try and find someone in the specific area you're interested in (ER, long term care, mom and baby, etc.) since the work and the environment varies so much from place to place. Find out who the director of nursing education or the nurse recruiter is and ask to be set up. Don't be discouraged by folks who are happy to give you a list of all the reasons why you can't do it (except to consider that this is a representative response from a certain percentage of the nursing workforce--unfortunately there is a lot of negativism out there.) What with the nursing shortage and whatnot, recruiters and educators are not about to turn away an interested prospect. Don't be discouraged by naysayers.