Minou

Unbelievable !. I work in a small Birthing Center that is actually in a separate building from the main hospital ( soon to be changed ). We are a closed unit so do not float ( that is nice !!!! ) The price of that is we take mandatory call twice a month for FT and once a month for PT. Personally I think floating should be illegal ...it is dangerous. Someone mentionned a rn is a rn is a rn.....that is the mentality indeed.....However, would anybody ever think of having heart surgery done by an orthopedic surgeon ? Every hospital unit has become so specialized with highly skilled RN's ( the professionals that we are ) that I dont understand how they can just throw a rn into a different environment and expect her/him to function normally. I'm glad I don't float but if I had to, I would expect to help out but not take a full load. This should never happen to anyone ! Minou:

I feel for you, indeed it is very difficult any time you have a demise, especially the full term babies that are/appear perfect. You probably never will forget your first demise, it is imprinted in your mind, but you put that in your bag of experience and you grow. Know that whatever you do for that family will be appreciated if it is sincere, so just be yourself when dealing with a demise ( you can't help feeling the way you do, and should honor those feelings ), Take heart, you are not alone Nancy B

What I found useful when I started was to read other nurses' charting to get ideas of what to write ( and sometimes what not to write ). Remember to be accurate, to the point and chronological . re-read your charting and if you're not sure, have somebody else read it and say if they have a clear picture of what you are saying. always remember that a big big reason to chart is for possible litigation in the future. eventually you will develop your own style and for the most part you will chart the same thing over and over again except for the abnormal stuff ( who has time to be creative with every pt, every day ? ) Good Luck, Minou

I do too....I guess ideally, this should be started before pregnancy but more realistically, in the doc's office...part of the initial prenatal care should be to educate the pt about the possible ways to do birthing...I guess if you're high risk at any point, well off you go to the hospital but other than that a midwife in a home or "alternative" environment would be great and certainly cheaper than the fast pace, production line of a hospital L&D I do believe we do too much intervening... low risk pts that want the natural way should probably not be in the hospital ( like a real birthing center close to a hospital, or home .with intermittent monitoring, heplock perhaps ) with midwives. Also it never fails to amaze me how some pts come in with high unrealistic expectations ( birth plan and ball ) yet haven't got a clue...Has anyone possibly mentionned that pain might be involved here ? Or they are adamant about breastfeeding yet have not read 2 lines on it, do not have a clue about what to do....it's kinda sad really So I guess it's education, education, education.

I agree....I totally respect pt's rights to go whichever route they choose...but they need to be educated and assume the responsibility of their choices...health care being what it is today, we don't ( pt and staff ) have the luxury of doing slow natural in a hospital, we need to find alternatives

I'm glad to see these responses...Here i am thinking i'm not a "supportive" l&d rn....well, the pt did'nt want to go home although we told her she wasn't in active labor and the doc didn't want to p.o. family. but yeah, I would've gladly given her a shot of demerol and off you go.... too painful to walk, to painful to go home... I work days so night shift ended up babysitting her and into the next day when she thought it wasn't fun anymore, she gave in, had pit with an epidural and delivered the next night... ouffffff !

Hi , I am curious about how other L&D nurses deal with an admitted primip, not ruptured , irregular uc's, not really progressing, but oh soooo in pain ( 1/th/high ), this being the reason for admit, and refusing pitocin ...and BTW, you only have 5 labor beds and are backed up with pts waiting for a bed. Now I am all for pt rights and stuff but....do you just babysit her or what ? too high for an "asrom" , of course, you could send her walking but she still officially has a bed....it can be very frustrating... And she has a right to decide how she wants to do it....do you give her a choice : you take the Pit or you hit the road ? well that would be rude, so how do you solve this ? Minou

Hi, I have to say that a c/section just because it's convenient is outrageous ( be it on the pt's part or...the doc's ...) But I do support c/s for valid reasons ... I have 2 c/section stories...that actually happened a day apart not too long ago.. ( I swear !!! ) First the happy story : I had a pt come in for a primary c/section...When getting report I was told that she had had a cerclage done ... G3P0 ...I go in to the room and think... Gee she looks familiar...look at her name and 'Bam', now I know...she was my pt 2 years previously when she miscarried for the 2nd time...I remember it vividly because it was one of those cases that stays with you for a long time, that makes you cry...miscarriages r/t incompetent cervix, hence the cerclage...which it was decided by pt/doc to not mess with in case she wanted another child later on ...off to elective c/s. It was truly an inspiring/rewarding case for me as I saw the whole family in tears...and such a wonderful family...Now that c/section made sense OK, for the icky story : This Doc has 2 pts in labor. Comes in to deliver the 1st, gets a little annoyed that the 2nd is only 3-4 cm because his office is far away and he will have to come back... Checks the pt and to everyone's disbelief ( as in...it ain't true ) he feels a pulsating cord...STAT C/S...Being the nsy rn that day I look up at the monitors and see only excellent EFM strips..." Hum...they must already be wheeling her in..." So off I go, get in the OR and there's nobody holding the head up ! ..." Hum...", " Shouldn't someone... "...."There's no time ", replies the Doc giving me a LOOK. So I shut up and do my thing. He doesn't wait for an assistant and makes the circulating rn scrub in. Now that is a violation of our unit policy unless it is a dire emergency, which he claimed, which it wasn't... I'm rather disgusted with this Doc ( he does crap all the time ). Anyone with suggestions? similar experiences ? If that pt gets wind of this, asks for a review, this Doc is toast, because the is no evidence to support his DX, but it's his word against ours !!!

Hey, I thought I was the only one that used that Holiday Inn thing..." Are you the nurse " as you're getting ready for a sve....:-)

Wow, first of all congrats on the good nursing you provided this pt ( which I am sure she will never fully appreciate ), now, my pet peeve with these know-it-all people is that I don't understand why they don't just have their babies at home....Oh I know....they want someone to take responsability for them and they want to feel safe...BINGO...Well, let us do our darn job !!! They are also the first ones to sue if anything goes wrong....could we (staff/hospital ) not then countersuit for their obstructive behavior ?.... " Well, your honor they never told us my wife could die with a bp 27/12 !!!! " Do husbands/family go into an OR for other procedures and start telling the surgeon what they want and don't want ? Anyways, you did very well !

I just love this... a girl after my own heart...wow...I am going to cut/paste this somewhere, it is just too precious, Thank you for sharing, Minou

I know how you feel !!! my first job was like that ( not L&D, but med/surg ) and unfortunately lasted 7 months...I hated everything about that job ...lousy pay, lousy understaffing, lousy equipment, and the atmosphere, what a hellhole !!! A disgusting event made me clear out my locker...I thought nursing wasn't for me...then I found OB...The difference in your case is that there are many positives for you, including your years of experience ( so your confidence can't be shaken in a flash, I hope ), the physical unit. So, how are the staff among themselves ? Are they having fun ? Good rapport ? I mean if everybody is ****** among everybody, doesn't look too promising, but if it's just you and them ( and I'm sure there's nothing wrong with you ) then they will warm up. Just do your job and don't try to wedge yourself between your co-workers to fit in too fast...now that could be irritating ( we have such a person at my place ). Let them thaw out and THEY will start including YOU in their conversations/group. Unfortunately, human nature is quarky !! In my case, I'm very friendly, but there are times when I'm not up for meeting new people at 07:00, know what I mean ? I'm never nasty to anyone but I tend to ignore them a bit ( first day or so ). I guess it's shyness on my part...Maybe it's the same with your co-workers ? Hope you have a breakthrough soon, Minou

This is a difficult thing to settle... pt's right to have a record of the birth (makes sense ) vs staff's right to do their job unhindered and to not be on tape ( also makes sense ). Pt safety always, always comes first. we don't need people crowding the warmer ( oh, look at how blue he is, oh, hear that funny sound he makes ? Well we like all babies ( even boys ) to be PINK !!!While most families are genuinely only interested in the 'memories', and are completely cooperative and pleasant you sometimes have people/families who totally ignore you, treat you with disrespect ,like you're actually a nuisance ( never mind that we're helping their niece/nephew make a smooth transition to extrauterine life and therefore not have to be on the short bus when they start school )and who want to record everything to try to 'catch you' doing something wrong...like they don't trust you at all and it's their way of controlling you ( ...you better be on your best behavior !!!) It makes for an unpleasant situation...and most of the time, the pts themselves are sweethearts. If we've had a great rapport with a family, heck, we're the ones going :" Hey, where's your camera ", and give them suggestions of how to do pictures ( when everything is safe of course ). Example that comes to mind. About 2 years ago I had this Primip with her mom and sisters. Pt herself was adorable but her family totally ignored me. When she got to about 6cm, her family had her pushing. I would go to the room because I saw the pushing on monitor and would say : " I don't want you pushing right now for x, y and z ...as soon as I left the room they were at it again...I go back and before entering room I hear pt say : " but my nurse said..." the mom cuts her off and says :" listen to me, I'm your mom, that nurse knows nothing... (....SOMEBODY RESTRAIN ME !! ...) So I go back in and give her my spiel again....and the look on those women's faces ( except the pt )...like I was a bag of garbage. And honestly I usually have an excellent rapport with my pts...Of course video this and that, picture here and there...when baby came out, they're all over the place, we have to physically move them out of the way ( baby was on the floppy side ). We ask them to stop taping, they flat out refuse ( we have them sign an agreement beforehand to specific conditions ). Needless to say this was unpleasant...even the doc, who usually never interferes, got upset and threw them out.... I don't have an answer to this situation, but we need to come up with a safe and fair compromise that will satisfy family's need for great memories and staff's need to work safely and unhindered... P.S. Baby was fine but mom ended up back in O.R. when the bleeding wouldn't stop ... due to multiple cervical lacerations/tears ... Oh my ! what a surprise !!! Minou

we use mostly 18g, some rn's go for 20g when they have a hard stick but I tend to think if you can get a 20g in, you can get 18g in as well. 16 G, too big !! Minou

Well, since reading this thread a couple of days ago, I had a chance to mention Lotus Birth at work... not very popular....I get a lot of " WHAT ??? ", " Yuck " , " Are you serious ? " and " What for ? "...Whooey, I guess I can relax ...Lotus Birth ain't coming to my unit soon :-) Minou