amber1142

My initial response to SBE was a simple disagreement. Go back and read it. (Edit: In fact, read my first two posts in response to her. I was not rude in any way. She thought I was accusing other people of being not being morally defensible. She was the one who became defensive and accused ME of being rude.) She took it further because she didn't like my response. We are allowed to disagree with her, aren't we? (though when we do that we're accuse of being "rude" and "inexperienced" and told how "we'll see what it's really like" That sure sounds like being patronizing to me) Apparently when you're a moderator you're allowed to lecture and accuse people of "tilting at windmills" any time you want. The original question was about tips on charting, which a few people gave. OF COURSE one has to check professional standards and institutional policies. What kind of dummy wouldn't know that? I suppose some people think they need to point out the obvious because they think it makes them look really smart. BTW, she couldn't resist a private message to me telling me to stop addressing her. She obviously can't stand dissent of any kind. I've been on email lists and discussion boards for many years, and I know how they work. I understand that boards have "favorites" who are allowed to get away with **** with impunity. I have no interest in listening to lectures and walking on eggshells when I disagree with someone.

How about if I agree to work on my style if you agree to work on yours. I'll stop being "rude" if you stop being patronizing; I'll stop tilting at windmills if you stop lecturing.

My post was the equivalent of asking for tips on starting IVs, and you answered with the equivalent of a lecture on infection control. I am aware of legal issues; I was asking for charting tips. This is pompous. I'm sorry, but people who believe differently than you do should not be dismissed simply because they are inexperienced. I happen to be 40 years old and on my third career. Different ways of thinking of litigation and risk isn't a matter of experience (ask any midwife). No, you don't. Some people are comfortable playing games like writing "decel occuring late in time" rather than "late decel" while cranking up the pit on a vbac patient. I'll save my fear and concern for where I think it matters.

I don't assume a "lack of morality" on anyone's part, but I refuse to live in fear (and it's not because I'm new; it's because it's what I believe). (Ever wonder why the csection rate in this country is 25%? why people think hospitals are safe? why EFM is used routinely when there is absolutely no evidence that it affects outcomes? What if people took a stand? What if people said, "I will not be a part of this?). Feel free to practice nursing any way you want; I will not be afraid and I will not contribute to the culture of fear and litigation that led away from evidence-based practice in the first place.

Believe it or not, I know this. You may not remember what it's like to be starting out, but when people are learning how to chart they start with small steps. As far as "legally defensible", I like my idea better. I practice morally defensible nursing; I provide good care, and I will document the care that I give. I am not afraid.

Ok, thanks. I wish there was some practical way of practicing on myself. I'm going to run out of patient (not inpatient) volunteers.

I was told *not* to advance the needle at all, rather push the hub and advance the catheter into the vein because that way you won't re-puncture the vein. (Eeek, so many different ways to do it wrong! :rotfl: )

I have four kids, and sometimes I think about having another. I'm appalled by the number of friends (people who would not be impacted in any way) who say, "No, don't; you shouldn't have any more." I can't figure out where they're coming from. What difference could it possibly make to them?

ok, i've been practicing. I've managed to get the needle into the vein a few times (progress!). Once the needle is in, how hard or easy should it be to advance the hub and thread the catheter in? It seemed like it didn't want to go in. Should it be very smooth and easy if it's in the right place?, or will it always take a little bit of pushing and manipulating to get it in?

I dream about checking the fetal heart rate strip! (OMG, it's been 15 minutes!)

I posted a question a while ago asking for documentation tips for new OB nurses. I've learned a few things that I thought I'd pass on: When someone comes in for triage (we serve as ER for all pregnant women), on the nursing note I usually say something like: "Pt reports contractions started at 8 pm; occurring q 15 minutes. Pt reports no fluid leak or blood per lady parts or odor. Pt reports positive fetal movement. " If the patient's BP is up I will write something like: "Patient denies headache, RUQ pain, and blurry vision. Urine dip reveals ________." When a patient is leaving I have been taught to write: "Patient is discharged to home. Patient verbalizes understanding of discharge instructions; written instructions given." I think these things are so automatic for experienced nurses that they don't even thing about them, but learning which phrases to use in our documentation is very useful for us newbies.

I'm having real trouble with blood draws and IV starts. The patients aren't generally very gracious about being used as pin cushions, and I can't say I blame them, though it makes it harder when they say things like, "You don't know what you're doing". (Actually it does annoy me; *everyone* was new at IV starts at some point; how do they think people learn?) Anyway, I'm very frustrated because I can't seem to do it.

Hell, I gave birth at a birth center, and I wore my own damn panties! :rotfl:

I think most schools offering nurse midwife programs require experience in L&D, though I'm not sure that they require it as an R.N. or if experience as a doula might count. A few phone calls to CNM programs would clear up that question. As an aside, most direct entry midwives do not suddenly one day decide to deliver babies. They apprentice themselves to a master midwife and assist at hundreds of births, gaining their experience that way.

Do you see a gynecologist regularly? You should go yearly and ask for reassurance at that time. That said, women have a lot of glands in the vulva; sometimes it looks like goosebumps. Inoffensive, non-odorous discharge is normal at different times of the month. When you're ovulating it might be very thick and clear and stretchy; at other times it might be thicker and pasty. See your doctor if it smells really bad or if it is itchy or if it burns when you pee.