OBERrural

I've been using it for 6 months. Before this I used QS and another program I can't remember from about 15 years ago. I feel like I have problems finding where to chart everything. I feel like half the time I'm searching where to chart what I need charted. I work in a VERY small hospital now (which is new for me) and we only have 1-10 deliveries a month so I don't get much practice with it. This is a big change from my 1-3 deliveries a shift where I worked before. Maybe if I used it more frequently, I'd feel better about it, but so far, it's not my favorite! I agree that they need people who actually use the charting to develop it. On a side note, I have been modifying things quite a bit to fit our needs. I'm in contact with Cerner almost every shift I work, trying to get things just how we want them.

We have it. It is called Fetalink and I'm not enjoying it.

You could take NRP and a basic fetal monitoring course. Most of the training is on the job, but this would let them know you are serious. Network, if you can. That always helps too.

I understand, when I worked in a big city hosptial, all of the departments kept to themselves too. I just started working rural this last year and it is a whole new world.

In North Dakota they do.

Depending on the size of your facility, could you volunteer to help in ER on their busy days? I work in a small, rural OB and when we don't have patients I ask to float to ER and have started to be oriented to ER. It's a good way to get your foot in the door and worth a try. Try talking to the ER manager. Good luck!

I've been a L&D nurse for 9 years. It took me about 4 weeks to even feel what I was supposed to be feeling and by the end of my 12 weeks, I was much more confident, but still had experienced nurses double check me for a long time.

One more thing, I would look into the legality of being on-call and not getting paid. I'm not sure that they can do that.

When I worked in a large hospital we took 10 call slots every 4 weeks. We always had two people on call per four hour block. Now I work in a rural hospital and we only have 1-10 deliveries a month (crazy, I know!). We do not take any call. They call all of our staff if we need help. If no one will come in, they divert our patients to another hospital. Not the best solution, but when you only staff one RN per shift and only have 4 full time nurses total for the unit, it's what we have to do.

Don't be scared! You can do it. You have an amazing amount of experience and a 2 year break won't hurt anything. I recently rentered nursing after a 7 year break. They were thrilled to get someone with 8 years of experience, even though I had not practiced in 7 years, and I was very grateful they gave me the chance. I think you will be just fine, especially if you'll be attending school during your break.

You can't control everyone else's behavior, but you can make suggestions and start getting things changed. Every place I've ever worked, we practice very independently as L&D nurses. The doctor is barely there until delivery. Most of the things you discussed, you should be able to do with your own patients. There is no rule that says you can't change the patient's position. Nobody is going to be the with you for pushing so just let her push the way nature tells her to. Pit the way you want to pit and when your patient gets to complete let her labor down. If other start seeing this, they may follow your lead. Remember, no patient is cut and dry. You have to adapt to your particular patient. Yesterday I couldn't get my patient to change positions during labor and that was fine with me. I'm a very laid back nurse and I think if the doctors see that in you, they will follow your lead! Good luck!

It sounds like you just need more practice. Your technique sounds good. I would say any chance you get, check a cervix, even if it is not your patient. Try to check a closed thick cervix, a swollen cervix, a cervix with scar tissue from a LEEP, etc. Practice, practice, practice...it will get easier. If you work in a small hospital, this will be a little harder, but eventually it will click. Don't feel bad, it takes everyone a while to catch on. I felt like I was never going to get it and then one day, it just clicked!

It's possible, but I personally would want experience in other areas first. I did one year of med-surg first and don't regret it one bit. You'll use the skills more than you think and your critical thinking skills will be much sharper.

I agree with everyone else. Usually you will only feel an internal and external os when the cervix is thicker. I'm not sure what your preceptor is talking about. In the beginning , just focus on finding the internal os. Don't worry about the external for now. That will come with experience!

I am also in the Midwest (iowa) and agree that new nurses start out at $21/hour. I have 8 years experience and don't make much more than that. Good luck!

Thanks everyone, I will let my manager know. I worked in large high risk hospitals for 8 years, but then took a 7 year break to stay home with the kids. Not using terbutaline is new to me. When I left we were still using terbutaline pumps. Our OB-GYN here still uses terb SQ occasionally, but now I know why the family practice only do one shot at a time instead of the old protocol of 3 q 20 minutes. It's nice to hear what other places are doing.

For some reason our hospital does not have a terbutaline protocol. I've been trying to research online, but all I come up with is the warning not to use it over 48-72 hours. So I'm curious, what is your hospitals's protocol?

We were told that it is part of "meaningful use" and must be done in order to get a grant they are applying for. We are a critical access hospital and get reimbursed differently than large hospitals, but I was wondering if this was something specific to our hospital or if it came with Obamacare. I'm not liking it at all!

I think you'll love. Go for it!

Our hospital just gave us a new rule that states we are no longer able to do ANYTHING with a patient until we speak to a doctor. We cannot put them on the monitor, check their cervix, or triage them at all. I find it a bit humiliating to call the doctor, tell them I have a rule out labor and then ask for orders. I'm used to being able to triage my patient before calling the physician. So, I'm wondering, is it like this everywhere now or just at our hospital?

Thank you. I will look into that for sure.

Associate degree, are you serious about nitrous? I've never heard of that and I've worked in big and small facilities.

Great advice. Thank you!

I recently started working in a rural critical access hospital. We currently have 1-8 deliveries a month; however, we would like to increase that rate. The problem we are facing is that our hospital currently has a bad reputation. The town next to us gets the majority of our deliveries. Currently we are trying to figure out what would bring people back to our town to deliver. Does anyone have any ideas on how we can get people to decide to deliver with us. Do you work in a rural L&D and if so, what makes your patients choose to come to your hospital. Our rooms our beautiful, we have all the modern monitoring with an OB on staff for c-section. We have perks like a stork meal after delivery and we give out lots of freebies after delivery. We have life flight here in town if there was an emergency situation. We have started working on small things like putting together a baby fair to bring the public in to see the unit. We are working on updating our website and hiring more doctors who deliver babies. I'd love to hear advice from others!

Thanks for the response. I forgot all about this post. Just an update, my husband is now out of the military. I had been out of nursing for 7 years. I took a refresher course, but decided to forego the clinical portion due to cost. I was able to find a job, no problem. I have been working for 3 months now and I'm amazed at how the skills were all still there. Once I was doing it all again, it was like riding a bike. Not much has changed. You still care for patients the same way. It is possible to go back and succeed. I hope this will help others not lose hope. Good luck! Wanted to add, I am writing under my new user is. I couldn't remember my old one...LOL!