APL&D

An update: So I spoke to the staff who took care of the patient after me. They kept stopping and starting the Pit on her because she kept having recurrent lates. Finally it was decided that the Pit would be stopped for two hours and restarted at the lowest rate. It took her forever, but the pt delivered lady partslly. However, her placenta looked like crap and the cord was very skinny. I really think that the baby would have crashed if we kept going up on Pit. I am so happy that the outcome was great and the pt got to have a lady partsl delivery. Thanks for all your input.

Thanks so much. To clarify, I think min. variability was just due to sleep cycle. Def. agree with you on limited EFM for low-risk patients.

So, just started working with a new doc who is really aggressive with his Pit. I had a patient the other day: prime, post-dates induction. Had a round of cervidil and was started on Pit when I got her. The Pit was at 8, she was 3-4 cm, 50%, high. Contraction pattern inadequate. She would couple or triple, and then her uterus would do nothing for 7-8 minutes. Baby looked good. She did not have any pain meds. Then variability was minimal. I thought baby was sleeping. But then after her coupling or tripling contractions she would have a late decel. I turned her to side and gave her a bolus of fluid. I did not want to shut the Pit off just yet. Well, then she had 3 or 4 late decels. I talked to the doc about stopping the Pit, but he said to just up the Pit to get her in a regular contraction pattern. He saw her lates, but was not concerned about them, because they occurred after coupling and tripling. Not sure what happened with the patient, because I went home. I can't wait to ask the nurse who took over for me. But what are your thoughts about increasing Pit in this situation? I understand the doc wanted her to deliver faster and she would not dilate with that contraction pattern, but clearly the baby was not tolerating Pit at that contraction pattern. Would the baby tolerate it when she was contracting every 2 to 3 minutes? And why is it that we are taught one thing, and the docs tell us something else? Where do they get their reasoning? I can't justify increasing Pit in a situation like that in my documentation. Please, help.

Some hospitals offer a nurse-extern program for student nurses before their last year of nursing school. I did that myself. For twelve weeks in the summer you shadow a nurse in the specialty of your choice. It was a full-time summer job, and we got paid. That was a great experience. It gave you an idea if you really wanted to do that kind of nursing, you got your foot in the door, got familiar with staff and management. A lot of people got hired to the same units after they graduated. I would definitely check that out. Good luck.

I am sure there are still backwards hospitals out there in the country, but I think it is going towards having an in-house OB 24/7. I used to work in a small community hospital a couple of years ago, and last year they started requiring an OB present in-house 24/7. Not only do they have to be present, but they had to see all triage patients within 1 hour of arrival to the hospital. I think it is a law in some states and a standard of care. Sorry you feel so discouraged. Next time you interview for a job, make sure to ask questions like these. Good luck.

I also changed from tele to L&D! I love it! It is very different. You will find it challenging in the beginning. I would suggest to start reading about pregnancy, labor and delivery, etc. I would approach the manager, as dianah suggested, and ask her if you can come in and shadow an experienced RN through the process of childbirth for a couple of shifts. We had RNs coming from other units who were interested in transferring to just watch various types of deliveries. I would also join AWHONN and take NRP and EFM course, if you can afford it. Good lick.

The advice I give everyone that is considering becoming a nurse is to go to an RN program, preferably to a 4-year college, where you can graduate with a BSN. Looking back, I wish I had done that. I am actually kicking myself for not having done that. So if you have money and a 4-year college nearby, go for it. You will have a better opportunity for hire with Bachelors. Good luck.

I have to agree with the other posts. It takes time. There is no quick and easy way around it. Just have to work and wait. If your co-workers have faith and confidence in you, you should have faith as well. I am sure if you were doing poorly, they would have let you or your manager know. After all, they have to work with you. This time next year you will be feeling much better.

JustBreathe, congrats on your new job. You are going to love it! I just wanted to tell you that a lot of places use report sheets/cardex that have all the important info a nurse should know. And it is a nurse's responsibility at the change of every shift to update it and pass it along in the report. I am not sure, but I think a lot of the hospitals do it, because it is recommended by JHACO. One of those safety steps that you take to improve patient care and outcomes. I would wait and see if your place use those. And if not, you can ask your co-workers. A lot of the nurses create their own. I am sorry I do not have one to share with you.

Start applying to various positions that are out there. I was a cardiac nurse as well first, but I switched to maternal child health. I think you have a lot of valuable experience under your belt. Give yourself some credit! While you are applying, you can join AWHONN and take NRP and EFM courses, if you have money. I hope it works out for you. I had to wait a while until I got accepted. The more flexible you are, the better chances you have. If you are able to relocate, that is a great plus as well.

If I had to do it all over again, I would have picked a four-year college, where you can receive your Bachelor's degree (BSN). That way you will have better chances to land a job you want. A lot of the hospitals will give preference to BSN trained nurses, rather than ADN (2 year degree). It can be a little more money to go to a 4-year college, but I think it is worth it. I went for my ADN in a local community college, and it took me 3-3.5 years to finish it. Now I am older, and have kids, and have to work, so it is going to take me 4 years to finish my BSN online, plugging along, taking 1 class at a time. Oh, to be young again... I really suggest a 4-year nursing program. Good luck! I am glad to see young people like you make a commitment to nursing. That is awesome!

Congrats! This is great! I did med-surg for a while before transferring into NICU. It is a huge difference. You will need to do a lot of reading and studying. I thought it was like being in school again. But I believe that, if that is where your heart is, you will do wonderful. Just keep learning and researching! Good luck on your interview. So excited for you!

I am sorry about this. They always come up with stupid rules the nurses should follow so that the hospitals can get more money. How about asking doctors and nurses first. People making such rules apparently never did any bedside nursing. Similar things are happening in my hospital as the administration decided that we should become baby-friendly. It's all about money and status. Sick of it.

NAS - get familiar with the scoring, meds you are giving, your hospital policies on when to notify a provider. Feeders/grower - make sure they are gaining weight, maintaining temp, monitor for feeding intolerance, measure their abdominal girth, inspect their residuals and stool for any complications. Read up on nec. It is a freak tragic thing, but it happens. CPAP - learn the signs and symptoms of pneumothorax and know what to do, have a pneumo kit at bedside, monitor respiratory status. Hope this helps.

I don't know what your family situation is, but just try to sleep during the day, get dark curtains/blinds, loud fans for white noise, exercise, eat healthy foods that give you energy, and I do not mean coffee. And hopefully you'll be able to transfer to day shift in a few years. I do know from experience, though, that some people are just not cut out for night shift. Sorry!

SteveNNP, is there a research article on this? I would really like to show this to my manager and our docs, so we can get a policy done. Maybe, that baby was having low blood sugars, because we were infusing high concentration glucose in the UAC? Thanks so much for your reply.

When I graduated from nursing schools, almost 8 years ago, I decided to go work in med-surg to get basic nursing experience. And I did. I had an opportunity to work OB right out of nursing school, but did not take it. Then I had a really hard time getting into OB, because everyone around here wanted experience, and still do. I am desperately trying to get into L&D, and still have a hard time. If you have an opportunity and know you are going to love it, go for it. There are always going to be med-surg jobs, if you decide you made a mistake. It also depends on where you live, if you are willing to commute, relocate, all that stuff. I hope you will make the right choice for yourself. I know plenty of people who started in OB right away, and they are great nurses. Good luck to you.

Thanks! I did call the Pharmacist and asked him if it was OK to infuse D25 through UAC. His answer was, "I am not sure." I ended up talking to my clinical supervisor, who is not a NICU nurse, who called to ask our manager, who is not a NICU nurse, who said it was OK. I am definitely talking to her about setting policies in place. Meanwhile, I am looking for another job.

Do you have a policy for that or is it just something common knowledge?

Hello! I have a question for all you, NICU nurses. I am pretty new to this. I work in special care nursery. The other night I had a 38 week severe IUGR baby with blood sugars in the 30s-40s beyond 60 hours of life. When I got the patient, she had TPN with D20 running through her UAC and IL running through her periferal IV. UVC placement had been unsuccessful. The baby was also starting on po feeds with breastmilk/formula 15 cc q 3 hours. So, the sugars were still low, the doc decided to discontinue TPN and lipids, start infusing D25, and continuous NG feeds. The veteran nurse who had given me report mentioned that D20 was a max (?), and we should not be going any higher than that. Then the doc did a whole bunch of labs to check insulin, GH, thyroid panel, cortisole levels. Then she ordered hydrocotisone IV. Then she decided to transfer the patient to a higher level hospital with an endocrinologist. Sometimes I get a feeling that our doctors do not really know what they are doing. We have an educator who is not a NICU nurse. A lot of the policies in our institution are not in place. Nurses that work with me all have different opinions of what to do. I am so frustrated! I have read that nothing should be infused in UAC except for 1/2 NS with heparin and certain additives. I would like to know what other NICUs are doing and if there are any studies on the safety of high concentration dextrose infusion into UAC. Please, help!!!:***: