at your cervix

Have you found any studies that support higher bilirubin levels? I did a project on delayed cord clamping and I was unable to find any studies that supported the idea that delayed cord clamping leads to higher bilirubin levels. I found many, many studies that supported the benefits and most of the those studies included checking bilirubin levels-all studies found that bilirubin levels were similar in delayed cord clamping and immediate cord clamping. Based on my research I believe the higher idea of higher bilirubin is a myth.

It is difficult for new grads to get positions in these areas, just as it is usually difficult for new grads to get positions in the ER or the ICU. My suggestion would be to "do your time" so to speak in a med-surg unit-you may hate it but your experience will be invaluable-you will make a better LD/NICU nurse if you have that experience. Hang in there and don't give up. In the mean time, while you are working in another area, introduce yourself to the department manager for the unit you want to work in-tell them of your desire to work in their department and ask them what they look for in a candidate for a postion. That way, when a position opens up, they will already have you in mind.

I have started putting all babes skin to skin with mom and I've even convinced almost all of the docs that I work with to let the cord stop pulsating before clamping. I take the bag and mask to the mom's bed and hook it up, I've even given PPV on the mom's abdomen with the cord still attached. I have read lots of studies about the benefits of skin to skin and delayed cord clamping and I must say-my experience has supported it, babe's temps are rarely under 98.0, they breastfeed better and we give far fewer IV's to babes just to give a fluid bolus. Most mom's also love it-now of course I do have the occasional mom that is "grossed out" by having the babe touch her before being wrapped up, and I will honor her requests. Just wondering if any one else would like to share their success stories.

Sometimes you need to take conrol of your own experience. Don't take it the wrong way but, you should NOT have been doing the baby bands, if you are orienting to L&D you need to find every experience that you can-filling out baby bands is not a learning opportunity. As a preceptor, I find it exhausting when I am constantly having to tell my orientee to redirect their attention to the learning opportunity going on at that time. If you seek the learning experiences and actively seek out new procedures, new things you haven't seen, etc you will do great but there are times when the preceptor will not direct you to what you could learn from.

I must say I don't agree with you at all and I worry that you have some issues with wanting to be in total control. I once read a comment from a patient that I will never forget and I have thought of it often to guide my practice, the patient wrote "I felt like the staff treated me as if my baby was a gift from the hospital to me and not my baby." The birth experience is the woman's experience, not the nursing staff's. Most people have very strict birth plans because they feel they have to in order to have the experience they desire. I have found that when patients have requests that I find unreasonable, such as NO monitoring, if I explain the reason behind monitoring with them, and recognize their reason for the request, they become very reasonable. I will explain that monitoring does not necessarily mean being on the monitors continuously but that we can do intermittent monitoring or auscultation (both approved methods per AWHONN) unless there becomes a reason that we may be concerned for the baby's well-being. I have NEVER had a patient refuse after I talk to them about it. A birth plan indicates to me that the woman and her partner have considered how they want their experience to go and have done some reasearch there are some nurses that feel threatened by that. We often forget that birth is a natural process and not a medical intervention, women need us to help them through the process, not save them from it.

Last May, I signed up for the New York City Marathon. I was so excited for it and I KNEW everyday that I HAD to run my mileage for the day or I wouldn't be ready for the marathon and I really didn't want to go all that way to DNF! Since a friend and I planned a week long vacation in NYC along with running the marathon I HAD to do it, just HAD to and I became addicted to running. So my advice is to set a very big goal for yourself (with a very big reward), then break it down into smaller goal and eventually you will get there.

I run. I love it! Some days I'll take off from my house and run around the farm fields near where I live, other days I'll drive somewhere new to run. Some days I'll load up the iPod with upbeat music, some days I'll just run with my own thoughts. Many of my best ideas have come to me during a run. Whenever I have a complex problem to deal with, I head out on a long run and frequently have the problem solved by the time I get back. I even trained for-and ran a marathon next year, I don't have as much free time this year so I'm only training for a half.

I've done the South Beach Diet a few times in the past and I've always lost 10 lbs in the first two weeks. It has always worked well for me to get a jumpstart on weight loss. I have tried to restart it a few times in the past couple of months and this time, everytime I try it I feel terrible by the second day. I will eat some fruit or drink some chocolate milk and I'm a new woman within a few minutes. Anyone else experienced this and how did you get past it??

Every room is full, you empty one room and two patients come in..you know the kind of day...then, a doc calls and tells you that he has a patient that's scheduled for a c-section in three days but she's in labor now...and here's where the real fun begins. This "laboring" patient (with contractions every 20 min and a thick, closed cervix) arrives with her entire extended family. I ask them to step out while I admit the patient and prepare her for her c-section. A few of them leave but then trickle back in within a few seconds. I ask the patient who her support person will be in the OR-since it's not obvious from the numerous people in the room. She begins naming off people and I stop her at five (she has eight people in the room and so far she's been pointing them out in a clockwise manner) and tell her that for safety and infection control reasons (if not pure lack of space) she can only take one person into the OR with her. She and the entire family now jumps all over me because "the doctor said we can take whoever we want in." I have to politely explain to them that the doctor does not have any say over visitors in the OR-it's a hosptial issue. The CRNA comes in and agrees to allow two people in. Now the entire family is fighting over who will be the second person (would have been easier to limit it to one.) Now, the mother comes out and informs me that she and the husband will be going in, but "we will need a nurse to film it because Aunt Betty was going to but now you won't let her in." I tell her that the nurses in the room have duties related to the surgery that they must fulfill and that they are welcome to take a video camera in but they will have to video tape it. She then says that there is no way they can film because they want to watch so we need an extra nurse to come in. I explain to her that we are very busy today and do not have an extra nurse to go in and again tell her that she is welcome to film it. OK so they finally go back and we have to virtually physically restrain the family members who continually attempt to "wander" into the OR and refuse to wait in the waiting room-they must be in the hall the entire time. This whole time I am also the charge nurse and have another labor patient. Every nurse on the floor has a huge patient load. We run around all day long. So, a half hour before the end of my shift I finally have time to sit down and chart and one of the babies will not stop crying and mom is trying to take a nap and refuses to have the (breastfeeding) baby returned to her room. I am able to soothe the baby a little by holding her. So, I am holding a baby and charting and a visitor walks by and says "what a great job you have, you just get to sit around and hold babies all day.":banghead: She is LUCKY I didn't rip her face off!!! OK, go ahead and vent here-we all need it now and then!

We had a patient last week call in to see if we had a bed open for her "inducement"

We are in the process of trying to develop some little "perks" for our patients. Some ideas have been a steak dinner for the new parents or a gift certificate for them to use at a resturant at a later date, sending home a "picnic" type meal for the whole family when they are discharged, etc.... What are some of the things that you are doing or even ideas that you have???

I'm sure we all have stories about patients requesting their "epidermal" and the likes of that, let's share some here. Now, while I never encourage laughing at or making fun of patients, this is a safe place among other nurses where we can find the comic value in some of these comments. I'll actually start us off by sharing a funny story about one of our OB doctors. I had a patient with intact membranes that was having some very deep variables, she came in and saw the strip and said "Let's go break her water so we can put in an IUPC and amnioinfuse." I think as soon as she said it she wanted to take it back because she realized how stupid it sounded but it sure gave us all a laugh for the day.

AWHONN has a positioning statement on the use of non-licensed personnel that is very good, it is the model that our hospital uses.

I agree with what everyone else is saying....if it's not harmful to the patient or the baby, no biggie. If it is harmful or potentially harmful, I have them sign an AMA form and document very extensively the teaching that I have done. For example, I had a patient once that came in and wanted to use the Bradley Method-fine, no problem there. She was however very unprepared, I think she just thought the Bradley Methond meant no medication. She literally screamed at the top of her lungs for eleven hours straight-she didn't even stop screaming between contractions!! We had to move patients to rooms in the med-surg department because they were complaining about her and they couldn't sleep. She refused an IV, she refused ANY monitoring, not even intermittent or fetoscope. At one point her husband asked me "is everything OK?" I had to give him the honest answer-"I am assuming so but since you won't let me do any monitoring, I can't be sure." He then actually said to me "well, I don't mean the baby, I don't care about the baby, I mean with my wife." I had this patient sign an AMA form and I documented that conversation as well! But I do have another question....is amniotomy standard procedure in your hospital????????

In our agency the RN takes the referrals whenever possible. In the situations where an RN is not available, the office staff will take basic info (patient's name, MD's name, hospital being dc'd from etc) and then they have a list of info to ask to be faxed to us-Face sheet with demographic info, orders, H&P, med list and discharge summary if available. The RN then reviews this info before going out to see the patient and will call for clarification if everything is not on the orders. There are alot of times that the facility will not even call us, they will just fax over a one page order with nothing but the patient's name and an order that simply says "home health" and then of course they act totally put out when you call to ask for info such as...oh, I don't know maybe the pt's diagnosis or, possibly their ADDRESS or PHONE NUMBER!

We also do amnioinfusions quite often for variables and for thick mec.

I just left the hospital I was working for for this very same reason (among others) although I have 9 years of experience, the new nurses were getting a terrible orientation, much like the one you described, and we had a lot of new nurses and a lot just kind of falls through the cracks when you dont' have the same preceptor. Many of the experienced nurses tried to fix the situation by pointing out the problems, volunteering to precept the new nurses etc, but we got no where, we went to our manager, the DON and up to the CEO. We got no where and I finally made it known that I could not work in a facility where they would not listen to the concerns of the experienced nurses and put patients at risk and I left. The manager had less experience than most of the nurses on the unit and would do whatever she could to prove that she was the boss and no one was going to tell her what to do and it often compromised patient safety! I have been gone for six months and two weeks ago it was annouced that the former manager would be stepping down. This is a very good thing for this hospital!!

Two of my four! The first time I went into labor at work-had to call in the on call nurse to take my patients....and me!!! Second time I was on call and I was the patient that sent them over the edge to needing the call nurse (me) luckily, a friend had agreed to come in and take care of me so she just took my call for the night and got paid time and a half to care for me!!!!

I always feel a little uncomfortable! Just kidding!! Keep in mind that otherwise healthy babies have about 10 min of residual, therefore, a 2 min decel is most likely not going to cause permanent damage. However, the question becomes this....when you are two min into it, how much longer is it going to stay down? How quick could you have the pt back for a c/s if you had to??? I usually start inteventions (postion change, fluid bolus etc) at about 1 min, if no improvement after 1-2 more min, I call MD and continue with other interventions as needed. It never fails that as soon as the MD walks in the FHR comes right back up and he will probably make some comment about calling him when everything is OK. But, don't let that bother you. I always point out to the MD's that they are looking at the strip in hindsight, I was looking at in real time and it is a lot scarier that way!!!

I agree, just concentrate on doing the best you can in nursing school. I also went straight to L&D after graduation and also have been doing it for 9 years. I love it but if I could do it over again, I may do a year or so of Med/Surg nursing first. I have since worked part time on the side in some other settings and I am glad I did because it improved my L&D skills. Pregnant moms get sick and have surgery too so it makes you an even better nurse if you also know something about other areas of nursing. GOOD LUCK!!!!!!!

Not knowing anything about this situation but what you have just said, the one thing that you left out that I would wonder about is-what was mom's bp? It is very common to get a drop in BP right after the epidural and this can affect the FHR, usually if you get mom's bp up with fluid bolus and/or ephedrine, the FHR will come up too. I think you have listed most of the common interventions. Giving terbutaline can also help, even if the decel is not related to uterine hyperstim, but be careful cuz you don't want to give terb to a mom with a uterine ruputure or placental abruption.

We do a follow up call to our patients a few days after they deliver to see how they are doing and one of the questions is to ask if they have any comments about their stay. We noticed that one nurse in particular was named over and over and over. We started noticing that she was named on the calls that she made, she would only call the patients that she took care of (and made sure they realized that she had cared for them) and she would rephrase the question to say "Do you have any comments on your stay? Was there any one nurse that you particularly liked?" So naturally the patients would say something to the effect of "Oh, you were great". She still does it but everyone just laughs about it now!

This seems weird! When you mean deep variablity do you mean deep variables?

I have been an L&D nurse for 9 years now and yes I go into the room for every decel. Well, almost every decel, I don't worry about short V and W shaped variables but, is it really going to hurt anything to change mom's position? NO!! I don't freak the patients out with it though. I let my patients know right from the start that for a variety of reasons I will be frequently helping them to change position. Are you saying that you just watch decels and don't worry about them?????? I guess I just don't ever want to explain to anyone that I didn't respond to decels because I didn't want to worry the patient!

I think more important that what you say is how you say it. I am always completely honest with my patients, I remain very calm and say something to the effect of "It looks like the baby may not be getting quite as much oxygen as he/she needs right now so I am going to have you roll to your left/right side and put some oxygen on you and that should fix the problem." I will often then explain exactly why the position change, bolus or other interventions so that they will understand that it is important and not roll onto their back again as soon as you leave the room. If the interventions are not effective, I maintain the same calmness and continue to explain interventions to the mom. If interventions are not successful and FHR pattern is worsening, I will tell the patient, "if this doesn't work, we may need to do this....." Patients will usually remain calm as long as you do.