RNinLDRP620

LOL had to laugh over the "colossal turd" comment! We have Vocera, and I agree it does not work well when you really need it too. Mostly in emergencies. How convenient, huh?

NCMcman, You are right that you have to be vigilant. We all need to be careful when we are handling sharps and yes, you are right about some nurses becoming a little complacent. However, like many have already stated on this thread, nursing is FULL of exposure risks. I myself have not been stuck with a needle. I have, however, been splashed with urine from a tricky clamp on a foley bag and had my cheek/hair/clothing/legs drenched with blood/amniotic fluid during an "explosive" delivery. Neither were my fault, just unlucky. Its disgusting, and it happens. I once worked with an aide who was trying to clean out a bedpan with the little sprayer on the back of the toilet and sprayed herself with diarrhea residue. Thank God she was wearing a plastic isolation gown! She was not rushing, she just held the pan a little to close and the sprayer sent some "stuff" flying. She was totally disgusted. I hate to say it, but you will be exposed to disgusting things in most nursing jobs, especially if you work in a hospital. You will "heavier" patients who are immobile and incontinent. They will soak the entire bed in diarrhea. You will get old men who spill their urinals in the bed...and the floor. Your shoes will feel sticky and you will cringe imagining what you are walking in. You will see family members who ignore the "see nurse" sign and go into a c-diff room with no gown or gloves, and know darn well they touched the patient and everything in the room, and come out trying to touch everything in the hall. And they will be mad when you tell them they need to thoroughly was their hands before coming out of the room. My point is hospitals are gross, you are exposed to things all of the time and that is part of nursing. Also, you may be vigilant about need safety, but be aware that your co workers may not always be. A lot of accidents can happen in emergencies, particularly ones that end up being "organized chaos". I had a near miss needle stick injury when my coworker rushed her patient to our OR for an emergency D&C. I went to change the bed for her and almost stuck myself on an 18G starter IV she accidentally left in the bed. I don't believe for a minute that she was throwing needles around complacently, it just happens. Her patient was hemorrhaging, and she was moving quickly. And you may find yourself one day as the nurse in her situation starting an emergency IV and then jumping to the next task at hand and forgetting you sat your starter needle to the side. It is good to be vigilant, but know that emergencies are high stress and accidents can happen. I have been in OR and seen surgeons incorrectly hand back loaded needle holders to the scrub. Some doctors don't believe in cleaning up after themselves at all and they will leave you exposed needles to clean up for them. The good news is most IV starters now are fancy and have plastic sheaths that cover the needle once you are done. Most needles have safety you can utilize with one click and IV systems are now needless. Even drug companies are getting better about this, medications like Lovenox and Arixtra come in syringes that, if used correctly, are close to impossible to stick yourself with. The job in and of itself is risky. I personally feel safer starting IVs on a patient than being in a "droplet" or "airborne" isolation room! Don't get me started on that or I will scare you right away from nursing! lol. Sorry, I wrote a book!

Of course scrub techs are important, but not all facilities use them. Mine for instance does not. We are all RNs with just a few aides who are not involved in deliveries at all, whether they are certified or not. We as the RN scrub all of the cases. So RNs can certainly scrub and do it very well, it is not a job reserved only for techs.

Betadine on 4x4s and sterile water. There is always the risk for impaired skin integrity through tearing/episiotomy so maybe they use it to wash off as much bacteria as they can and decrease infection risk? That is my guess. We use chlorhexadine scrub for people with betadine allergies

Hmm...I agree that seems odd. I am all for detailed charting. Does everyone at your new facility chart this way or just a few people are this brief? I write the exact same note as you do, something along the lines of "SVD of live female/male infant, bulb suction to mouth and nose on perineum, dried and stimulated with towel on abdomen. Alert, quick pinkening, spontaneous lusty cry (if applicable), moving all extremities strongly and equally, FHR 150s (or whatever number i get as soon as I check) with regular rhythm. To radiant warmer for assessment." Our newborn admission form has separate areas from the small narrative box to chart medications, apgars and a thorough assessment. All of the placenta charting is done on mom's labor and delivery form. We also chart mom's BP right after baby is delivered and then again a couple minutes after the placenta delivers.

the tea time thing is an excellent idea for pp moms!

OH, we decrease the pump at the discretion of a physician at the bedside if pt is too numb to push and shut the pump off. That is it.

Some people have it encapsulated, meaning made into PO pills that they take as a supplement. I personally have not sent a placenta home in a very long time, most people just let us dispose of it

Hi, I do agree that you do not need to make your birth plan "coworker friendly", however, I disagree with the above positing that it is the nurses job to talk you out of pain medications. There is a big difference between offering pain medications every hour and then giving them when the mother changes her mind and requests it. Assuming that all non-pharmaceutical methods have been tried and you are still rating your pain 10/10 and begging for meds it is not the nurse's place to say "I can't give you anything, you told me not to. I understand then you were completely comfortable when you told me not to but you made me promise to say no..." Don't you think that will just frustrate you and increase your anxiety? The decisions that you make for yourself are your responsibility. As you know, it is the nurse's job to make sure that you are making well informed, educated decisions but it is not her job to decide what kind of pain you can handle or not. When someone tells us they are in pain we are to take them seriously and not argue, and if they come to the conclusion of wanting pain medications then we are to safely implement that decision. Obviously as you progress through labor the pain and discomforts will change. A birth plan is just that...a plan. It is not set in stone, you can change anything about it you want at any time. A doula is a wonderful idea to help keep you on track with your plan. Just like you said in your OP, be flexible, things can change. Good luck, I'm sure you will do wonderful!!

Congratulations! OB is a great field, you will love it. For starters, I think it is great that you are studying. You certainly have a lot to learn! As an orient I would advise you to ask a lot of questions and do not feel embarrassed about it. If you do not know something please do not pretend to know - speak up. A good preceptor will welcome all of your questions and make you feel comfortable asking them. Observe a lot of different things, over and over again... there is so much to see. lady partsl deliveries, sections, epidurals, BPS, D&Cs, code pinks, blood patch procedures...if it is happening try to be the fly on the wall and watch it. If you and your preceptor have a pt who is early laboring but down the hall a different pt is delivering or going for a section then get in there and watch it! Set goals for yourself. Talk with your preceptor about what you are truly comfortable doing on your own and what you want to focus on week by week. For a new grad this will be a little more challenging because you are not only learning L&D but also how to be a nurse in general. Work on things like simple head to to assessments, prioritizing all of your "tasks" for the shift, time management, talking with doctors/taking orders your first week. Work on skills as much as you can. As an L&D nurse you will need to be proficient with IV starts, foleys and vag exams. Ask the other nurses on the unit if any of their pts need IVs or if you can practice a vag exam the next time one of their patient's need checked. Remember that what you learn is ultimately your responsibility so use your time wisely and soak up as much experience as you can. If you get to watch a section then practice scrubbing in with the scrub nurse, even if you are just gowned and watching. If you have any down time (haha) then look at a fetal monitoring book and ask "what if" questions. The more you learn the less anxiety you will have when you are on your own. I personally think the scariest new orients are the "know it all" types...the ones who want everyone to think they are as good as an experienced nurse right off the bat and just "wing it." Makes me cringe! Luckily I don't know too many of those! And don't get me wrong, of course it is good to be smart and know what is going on but attitude is everything. In short, when I have had an orient who really wanted to learn they did just fine!! Congrats again and welcome to being an OB nurse !

There are jobs out there. I would get the LPN and then bridge to ADN. I am sure that LPN wages are a step up from what you are making now if you are in a low paying dead-end job as you say. Doctors offices, nursing homes, home health facilities, SDS centers all use LPNs. If they will hire a medical assistant then they might hire an LPN. I also know LPNs who do still work in hospitals but they are hired in as "scrub techs." One you have the license apply to anything and everything you think that you could get hired for, someone will call eventually!

kirsnikity - when you say local are you injecting lidocaine or using a cream/gel? This is interesting, have you noticed a huge difference in survey scores?

I work in a 15 bed LDRP unit and we are pretty much an all RN unit. We have just a few nurse aides or "techs" and no LPNs. Our aides have minimal responsibilities, really they are only there for stocking, mommy vitals and babysitting babies at night. They do not even attend deliveries, lady partsl or section. In the OR the OB doc is the one with their hands in the body cavity pulling the baby out, and bay is handed right to an OB nurse. If a "tech" could scrub, their job would simply be to assist with instruments and possibly hold the bladder blade down/irrigate. Even if there was not an RNFA or second doc assisting then an OB nurse would scrub in to assist, not an aide. I cannot imagine a scenario where an aide/tech would be involved in actually delivering the baby