Aristillus

This whole scene might have been avoided if you'd simply knocked on the door and asked if you could come in.

So you're thinking it might be a good idea to do "an annual delivery with a provider where the nurse actually catches the baby" and your Nurse Practice Act says that's acceptable so long as you don't "do the delivery when there really is a physician available." Hmmmm... No. Just no. You can do drills. You can practice a delivery with a mannequin, going over how to clear the airway, dry the baby, clamp and cut the cord, yada, yada. You definitely should know what to do in an emergency...a shoulder dystocia, a nuchal cord, a malpresentation, meconium, etc. Nurse deliveries are almost always uncomplicated and precipitous. Anyone can catch a baby under those circumstances. There is absolutely no need or reason to set yourself up for all the legal ramifications of doing a delivery when there really is a physician available!

Ah the innocence of a nursing student. Bless your heart. Once you have cared for enough overdosed young people, with a tearful parent standing by saying "He was such a great kid, a good student, I never suspected anything like this," you will understand the pain behind the dark humor which gets many of us through our shift.

Exactly! Florence Nightingale has been dead for a very long time. Hospitals in 2017 are corporations, not charity operations. As my favorite old Ann Landers quote says: "If you don't want to be a doormat, don't lie down in front of the door!"

Not so long ago a nurse on my unit was fired for doing exactly this, stealing (IV fluids and drugs) hospital property in order to feel well enough to work. You were doing neither yourself, the physician or your patients a favor by doing patient care with a saline-lock in your arm! I understand the difficulty of staffing a unit with a call out. I also understand that sick time can be abused. There are better ways to deal with this issue. An on-call list is one of them. Requiring a physician's note is another. Allowing a limited number of call outs per rolling year with disciplinary action for excess is how my hospital handles it. Many hospitals require management to pitch in when there's an emergency. I suppose in an "employed at will" state a nurse could be fired for any reason or no reason at all and I understand that in a small town finding other employment isn't so easy. But my gosh, you and your co-workers need to band together and stand up to this! It just makes my blood boil that a) hospitals take advantage of nurses and b) that nurses are so timid. Can you imagine any group of physicians who would allow themselves to be subjected to such a rule? Remember this: They can't fire ALL of you.

Ohboy, can I ever speak to this! After a long career as a bedside nurse, I retired a couple months ago. Two weeks into my retirement I suffered a serious injury requiring surgery and hospitalization. Unfortunately I also experienced a serious lack of compassion from many of the nurses who cared for me. They were competent, they were respectful, they answered my call bell in a timely fashion and offered plenty of pain meds. They even mustered up a certain amount of sympathy for my predicament but I wouldn't call saying "I'm sorry for what happened to you, sweetie" compassion. They reminded me of a young nurse I worked with, to whom I described my toileting routine for patients on flat bedrest...explaining that I placed a bedpan on a fresh chux under a bedpan and then used the chux to clean their bottom. This nurse haughtily declared, "Well I'm not going to wipe anyone's butt for them!" I've always known being hospitalized puts a patient in a vulnerable position but had never experienced just how vulnerable it feels until my accident. May I just say that a little kindness and empathy, a touch, an anticipation of a need without having the patient ask for every little thing...can make an unbelievable difference. If being kind and showing your humanity is going to lead you to a burnout, maybe you're in the wrong profession.

I think we're all a degree of terrified in the beginning. It's the ones who aren't, the ones who are fully confident that they know everything and are ready to save the world who are dangerous. Fools go in where angels fear to tread, right? Embrace your terror. It will keep you safe. In your first job you will have a preceptor to guide you. You won't be thrown to the wolves with nowhere to turn for help. It will be OK! And those staff nurses who make you feel stupid? Remember they are probably busy, and stressed and their priority has to be their patients, not you. Don't take it personally. You will gain confidence as you gain experience, when the things you have to think hard about now become second nature. School doesn't make you a nurse, school prepares you to become a nurse. Even after 40 years I have occasional moments of terror and learning is a lifelong process in healthcare. Yes you are normal and yes you'll be fine!

There are nursing jobs which are day shift only. Outpatient surgery, dialysis, etc. I would suggest you look into that. But if you want a job on a unit which has rotating shifts and ask for exclusive days, you might be perceived as not a team player. In my unit, permanent day shift assignment is based on seniority. In other hospitals where I've worked, there's no such thing as permanent day shift and everyone had to either rotate or work nights. So before you make such a request, I would suggest you do a little investigating and find out how this is handled at the place where you want to apply for a job. As a new nurse you really don't have a strong hand experience wise and to then make what might be considered an unreasonable request could well be a deal breaker.

I'm a nurse. My daughter is an accountant. When my shift is over, I'm free as a bird. When my daughter leaves work, she brings paperwork home. When I have days off, I get to do what I please. When my daughter has a day off, many times she's far from home on a business trip. Now tell me again whose life is sacrificed?

Shift work definitely puts a damper on one's social life, married or not. There *are* 9-5 type nursing jobs but of course they seldom pay as well. I remember an old Ann Landers (advice columnist) comment: "You aren't going to meet the love of your life in between the TV and the refrigerator." So my advice is to get out and have fun when you are off. Hang out with your friends. Participate in activities you enjoy. If you happen to meet someone, you'll at least have that in common. Go to church if faith is a part of your life. Enroll in a fun class, take dancing lessons, a photography course, volunteer at a museum, a shelter, whatever...do things you like. Work on yourself and make yourself whole. No one wants a partner who needs someone else to complete him or her. Happiness, confidence and joy of life are attractive. Loneliness and being needy will drive anyone away. Let go of your princess bride fantasy and enjoy your finite youth. When you least expect it, it will happen. :)

I've been a L&D nurse probably longer than you've been born and the miracle of birth is still a thrill for me. If that is your dream, follow it! No, it isn't always as pretty as it looks on TV. But sometimes it is and those special births where everything goes right will be your reward for the darker days you'll surely have. I think the suggestion to take a doula class and participate in some births is a good one. You will see how much difference good support can make to a laboring mother. But bear in mind that this is only one part of being a L&D nurse. Your most important job will be making sure your patient has the best outcome possible, a healthy baby and healthy mother. Because without that, all the support in the world isn't going to make a whit of difference. I would encourage you not to go into L&D right out of school. A year of med/surg can give you the skills you'll need to feel comfortable with the inevitable sick patient. Hold tight to your dreams but keep your feet firmly planted on the ground and you will be fine.

For what it's worth, if I had to work med/surg I'd need to find another profession. You'd have to try it and see but I wouldn't let an unhappy experience on med/surg scare me away. Wishing you luck...

Ohboy! I've worked for all but a year of my 30+ years at urban teaching hospitals. The one year I worked at a small (~25 deliveries/month) non-teaching hospital was the most miserable experience of my life! My hat is off to the nurses who can do it but it's not for me. I pretty much managed the labor through phone calls with the doctor. Shame on me if I called them in too soon and double shame on me if they didn't make the delivery. Have an emergency? There might or might not be anesthesia in house. On one floor was L&D, nursery, postpartum and GYN. It was just overwhelming. I sure did learn a lot during that year and fortunately our patients were healthier than the population of an urban teaching hospital but I'll take my annoying residents, Level II NICU and in-house anesthesia ANY day. Your mileage, of course, may vary. My tip would be try a few share shifts before you make your decision.

I've been an L&D nurse for 30 years and don't know of any patient who has refused an epidural for religious reasons. I do seem to recall that they tried in California a few years back to demand a cash payment from uninsured patients for a "not medically necessary" epidural but it didn't go over real well. One ethical issue you might want to consider is patients who are pushed towards an epidural and yes, it does happen more often than you might guess. Caring for a patient who wants to "go natural" is much more time consuming for the medical staff and I see lots of cases where it's strongly encouraged when chances are with lots of coaching and encouragement the patient might succeed in her wish to have an unmedicated birth. Another ethical issue I've observed is the patient who is maybe 9cm and almost ready to deliver who begs for an epidural only to be told by anesthesia that it's "too late." It really isn't too late and so what if it is, really, at least the patient will know that they tried. Then there's the other side of the coin, a ruptured patient at 1 cm with a first baby screaming for an epidural only to be told it's too early. How early is too early? Not a lot of research on that one but most physicians have their own little policy, some of which depends upon how loudly the patient is screaming and whether or not she's a "private" patient. Just a few thoughts for ya...

So many variables in that, it's something only you can answer. Do you have the stamina, brains and $$$ to spend the next 11-12 years reaching your goal? Are you prepared to put much your life on hold that long to devote yourself to your goal? As for nurse midwifery, well, IMHO that's kind of the worst of both worlds. You're not going to make a whole lot more money than you would make doing L&D nursing but you'll be in school a lot longer, have a lot more responsibility on your shoulders, and still not have the autonomy of a physician. Just me but I wouldn't consider it.