ShannonSRN

I went to an OB ICU conference in Scottsdale, AZ and there was a presentation by Karrie Francois, MD on PPH. She stated that up to 80U can be administered PP even if PPH is not an issue. On PP C/S pt's in our facility may get up to 40units just in the amount of time it takes to close after the cord is cut. Then we give at least another 20 in PACU. I do have a few questions: 1) After the intial 80units post-op, do they get additional Pitocin? 2) Do your sections get Duramorph in their spinals for post op pain control? That would take care of the "Ouch" issue...a thought 3) Did you ask the MD his rationale behind the dosage ordered? 4) Did you administer it as ordered without question? If so, why? We do not have an MD who utilizes Pit the way this MD does, but they all have their quirks! I am really interested to know what his rationale is...I am doing a PPH project right now... Shannon

I am trying to see if I can set up a Inpatient OB review course for the nurses in our community. Has anyone else ever done this? If so...what education company did you use? There are 4 hospitals total in our county, so I know I could get the attendance necessary... Anyone have ideas or info?

What pregnancy is this for her?

If you ever unsure, have another RN check behind you. NEVER be ashamed or upset if you were wrong! I have had other nurses check behind me, a cervix can be paper thin and 1 cm and feel complete. Any nurse who tells you that you don't know what you're doing should be ashamed of herself, you are always going to be in a learning curve regardless how long you've been a OB nurse. The minute you feel you know everything, you should quit...

I had posted a thread in May of 2007 (I posted the thread at the bottom). I quit working at the facility over a year ago, and just about quit nursing all together. I went to work at the "Competitor" hospital after about 2 months of being unsure what to do, and started doing GYN/Oncology. The director of the unit believed in me even when I didn't believe in myself. She encouraged me to join her unit and I really enjoyed it, and even got promoted to Clinical Charge nurse after only a month. Well, about a month ago she approached me about an opening in L&D as a staff nurse (she is also the director of L&D). She knew that L&D was my love, and felt I would be the perfect addition, and encouraged me to interview with the manager. After a lot of thought, I decided to interview and got the position. I start on September 3rd. I am scared to death of it being like the unit I left, however I know deep down that it is a better unit. The doctors are great, anesthesia is always in house, and the nurses are a great team. The do many more deliveries than my old unit, about 250 a month (my old unit we were lucky if we did 60). I have never taken care of 2 women in labor at the same time. I could rarely even get a doctor to show for a delivery...How do you all do it? Does anyone have any advice? Thanks, Shannon "I have been working in a small facility for about a year. We do do about 65-80 deliveries a month. Problem is our doc's are no shows for about 20% of our deliveries...we have had 12 RN deliveries in the last 8 weeks. We have a midwife and 4 docs who deliver with us. When we call them re: pt status, give report of pt arrival, etc. the doc's who tell us that she will get there "after she takes a shower, and gets her kids to school" (the pt was crowning), our midwife on many occasions, states "I don't want to get out of bed" takes her time on calling the covering docs for pt's in need of section (2 abruptions in 2 weeks). Our last abruption was a 31 weeker with heart tones in the 60's x 70 min before we sectioned her. Waiting on docs! We have had several incidents like these. Our new manager is trying to implement change with the MD's, but not making any advances. Then we have nurse situations where we are cross trained to mother baby, but have nurses who refuse to work L&D, but we have to depend on them in emergency situations. (We have 2 L&D nurses scheduled everyday, with a backup nurse either on call or in M/B, but our backup has no idea how to function with us) so we end up "in a barrel with our feet in the air" with no one to call or back us up. I hate to give up on the unit, but I do not want to be responsible for a bad outcome, I don't think I could live with myself if I knew I could be a cause for a parents heartbreak due to circumstances that WERE in another person's (Doc's) control. I was wondering if anyone had any ideas or suggestions? What would you do?? Am I imagining the danger, or is this happening everywhere? I know doc's don't like to come in at night. I have worked in busier units and have never seen doc's like these. Please help!"

Thanks a lot for your encouraging words!! I am terrified, but ecstatic at the same time! I won't go into it with rose-colored glasses as I did before, however, I will go into it with an understanding of what it is SUPPOSED to be...I learned a lot of what NOT to do at the other hospital! I will miss the nurses I work with now, but I feel like I am doing them a disservice by staying. My heart belongs to L&D, and I am too new to be teaching others how to be exemplary nurses.

Good afternoon all! I haven't posted here for about a year. I left L&D about a year ago after some disastrous events that occurred. Well, I have been working on a GYN/Oncology unit as a clinical charge nurse for a year, and although I do enjoy it, I MISS the moms and babies! I have only been a nurse for 2 years, and have become concerned that I am not continuing my education/experiences as a newer nurse. As a charge nurse I have the responsibilities of molding new nurses and encouraging older nurses to continue their education using the clinical ladder, etc. How do I do that when I am still new at this myself? I have been doing a good job, fulfilling all of the expectations of the job, but I miss being in the delivery room! So after A LOT of soul searching, I am going to go back! I have gotten over the horrendous events that caused me to leave in the first place. (I worked for a different hospital at the time.) The L&D unit at this hospital is amazing, with great management (both the GYN unit and L&D have the same Director). I sat down with the manager today and she is offering me a great opportunity. So, I am going to be an L&D nurse again! Has anyone else been placed in a management position they didn't feel ready for? Two years out of school seems too soon, especially when you are expected to help other nurses be the best that they can be.

O.k. this is a very interesting thread. I would like to make a small point... Medicare is no longer paying hospitals for "Never Events" (conditions acquired in the hospital) including: Skin breakdown, foley catheter related UTI's, surgical infections-mediastinitis, and wrong site surgeries. Medicare have also recognized other non-reimbursement eligible injuries that are going to be brought over a couple of years including: DVT's, etc. ALL of the commercial insurance companies are jumping on board!!!!! So not checking for skin conditions on 'walkie talkies' is absolutely going to cost all of us in the future. Actually performing a FULL head-to-toe each shift and charting your findings are going to CYA later. Eventually if documentation and assessments do not improve, we will find the changes reflected in our paychecks. Facilities will not be able to pay US if they are NOT getting paid. O.K. off my soap box....

I worked at Arnold and was there for the transition of Women and Baby services to Winnie. I was working there through nursing school in the NICU, and loved it. They opened Winnie Palmer on Mother's Day of 2006. It is all dedicated to Women and baby services, and Arnold Palmer is dedicated to Children's services (including a Pediatric Trauma Center). The NICU is enormous and is designed quite well. There RN training program and educator are phenomenal. I am an enormous supporter, and love to see all of the progress they have made. I can't wait to see what they do next! The administration is phenomenal, and believe in all they are doing. The pay I will say is not spectacular, but I think the benefits of working/learning there exceed all expectations! I would still work there if it weren't for the horrible gas prices, and the drive I had to make to get there. I really wish I could make the drive!!!! Sincerely, Shannon

I worked at a hospital in which there was a union here in Brevard County. Unfortunately, Florida is right to work state, so unions don't really do any good. When I started at the hospital the union approached us at orientation to "join" the union. We basically gave money to some unknown benefactor, and had 'representatives' that would bring nursing issues to the board of the hospital. They did do contracts for salaries, etc., but really it was all up to the board due to state laws. I really thought that the only benefit of the union was that our concerns were heard (not really ever paid much attention to however). I now work for a Magnet hospital in the same county. Magnet seems to work much better than any union. Nurses voices are heard, nurses hold high administrative positions, staffing and pay are always fair, recognition for career advancement, etc. Unions are basically useless in hospitals here in the great state of Florida.

I can't direct you to a website...I don't know of any, but I can give you a list of most common. You can go to central services in your facility and familiarize yourself with each. Usually the facility can open a pack for you to look at so you can see the instruments and get used to how the instruments are strung. Here's a common list: Hemostats (used for bleeders, blunt dissection) Kelley's Kocher's (used for faschia, and sometimes to clamp the umbilical cord) Long Kelley's (also used for umbilical cords) Allis Allis Adairs (some MD's use these to clamp uterine "bleeders") Babcocks (used for tubal ligations) Sponge sticks (also used on the uterus) Penningtons (uterus) Needle drivers Bandage scissors (to cut cord) Straight mayos (suture scissors) Curved Mayos (anatomy scissors) Metzenbaum scissors (used for the bladder flap and fine tissues) Pickups: Russians (uterus) Bonnies Adsons (skin) Smooth pick ups (bladder flap) Pick ups with teeth Retractors: Bladder blade Small and large richardson Gule (spelling?) extra: bulb syringe a couple of cord clamps cord blood tube needle counter towels rayotec and laps I think that is it.... Good luck, and get your manager to get you an open tray to familiarize yourself!

I sent this message to Suzanne, but maybe someone else has an idea as well. I need all the help I can get.... I am wondering if you could give me a bit of advice. I put the post "Dangerous Unit" and you responded...thank you! I am in a bit of a predicament at this fork in the road. With all of the difficulties of our unit at this point, with no end in sight...I am thinking of transferring to another department, probably at a different hospital. The L&D unit at this other hospital requires more experience...so therefore, I am considering just going to another department. Problem is I don't know where I would fit after being in L&D for such a long time. I was an L&D scrub tech for many years prior to graduating from nursing school last year. I went to a graduate nurse program at the hospital I now work at, but started in the ER...to try something different. But the ER was awful, mismanaged, outragious patient load, poor equipment, etc...so I transferred to L&D, as I knew it was what I enjoyed, and had the experience required. Well as you know from the previous post, this hospital is pretty much dangerous, no matter where I turn. So transferring within the organization is just not going to work. It seems to be an epidemic here. What would you do in my shoes? I do not enjoy med/surg...I truly enjoy critical care areas such as : ER, Critical Care, and OR (kind of seems obvious, as I did surgery for years, and still scrub on a regular basis). But I am starting out like a new grad, never been in one of these areas as an RN. What advise would you give? Thank you so much, Shannon

Thank you so much...to all of you. I have written incident reports in every situation. Charted my rear off. it basically boils down to a group of physicians who plain don't care, unfortunately. I spoke in length with my manager this morning after reading everyone's posts. (She has been here for all of 8 weeks) She is well aware of the problem, and we are working together now to fix it as best we can (or at least bring it to the attention of the hospital). I will be meeting with our President and Vice President of Nursing this week to go over all of my documentation as well as the incident reports re: RN deliveries, MD no shows, etc. As for the MD's, I honestly am not expecting a great deal of change unless we deal with those above them. It would be great if we could go to the Director of the OB Department, unfortunately it is one of the MD's in question. So we are working on a strategy on how to proceed, and go above them. I have requested a transfer to our sister hospital. I do not want to be responsible for a parents heartbreak...I absolutely refuse! I have a contract with this hospital for 1 more year, but I am not seeing this as a hurdle at this point. I believe they would let me walk out without question under the circumstances. To LINDARN, Thank you so much!! Getting the legal perspective of all this was a tremendous help. Fortunately I am very assertive, but the doctors do not respond, so legally, if it came down to deposition, I did what I had to do. In these cases, it boils down to negligence on their side. And now I know, after reading you post, that I will continue to be assertive. I just might have to be assertive elsewhere. Anyone know of a hospital in need of an L&D nurse

I have been working in a small facility for about a year. We do do about 65-80 deliveries a month. Problem is our doc's are no shows for about 20% of our deliveries...we have had 12 RN deliveries in the last 8 weeks. We have a midwife and 4 docs who deliver with us. When we call them re: pt status, give report of pt arrival, etc. the doc's who tell us that she will get there "after she takes a shower, and gets her kids to school" (the pt was crowning), our midwife on many occasions, states "I don't want to get out of bed" takes her time on calling the covering docs for pt's in need of section (2 abruptions in 2 weeks). Our last abruption was a 31 weeker with heart tones in the 60's x 70 min before we sectioned her. Waiting on docs! We have had several incidents like these. Our new manager is trying to implement change with the MD's, but not making any advances. Then we have nurse situations where we are cross trained to mother baby, but have nurses who refuse to work L&D, but we have to depend on them in emergency situations. (We have 2 L&D nurses scheduled everyday, with a backup nurse either on call or in M/B, but our backup has no idea how to function with us) so we end up "in a barrel with our feet in the air" with no one to call or back us up. I hate to give up on the unit, but I do not want to be responsible for a bad outcome, I don't think I could live with myself if I knew I could be a cause for a parents heartbreak due to circumstances that WERE in another person's (Doc's) control. I was wondering if anyone had any ideas or suggestions? What would you do?? Am I imagining the danger, or is this happening everywhere? I know doc's don't like to come in at night. I have worked in busier units and have never seen doc's like these. Please help!

Hmmmm, most do the opposite. I have several coworkers who went from OB to ER. I am currently a L&D nurse, but love ER as well. I actually finished posting on one of the new ER threads. I started out in the ER, but the ER I started in was a nightmare (low staff, unsafe pt loads, no preceptor, etc...) that I went back to L&D where I already had a niche (I was an OB scrub tech for years prior to nursing school). I absolutely love L&D, you probably will as well. ER RN's, in my opinion would make awesome OB nurses, due to the emergency situations that can arise on a regular basis. It is a bit different, we have pt with increased BP's but it is PIH, and is treated with different meds if the liver is involved, etc. OB is a great place to be, it is just a bit different. The doc's are different, you will bang your head against the wall a bit more. But it really is worth it. Good luck, Shannon