obrn23

I'm in L&D and I felt that way for the first two years. There is so much that can go wrong, and so many things that didn't go wrong on my internship. I felt like I was being pushed out of the nest WAY too early. The bright spots will come. You will recognize something that someone else didn't. You will know for certain that you need to call your doc, and do it without hesitation. You will make a difference somehow, and you will know it. You will have those moments where you totally want to high five yourself. You will find your footing, and you will see you retained a lot more than you ever thought you did. Develop very specific routines to eliminate errors. With IV meds, I always hang them, scan them, start them, then chart them. If it's scanned, I know I hung it. If it's charted, I know I started it. Print out a policy or Lippincott procedure per shift and try to learn it. Preferably one that is relevant to your day. We have a policy that states that after a particular med is given, a temp needs to be taken one hour afterward. I was never taught that in my internship, but I'm responsible for knowing that. I actually keep a binder of these at home to reference. Nerdy, I know. Look back at the nurse's charting prior to your shift. "Steal" their wording on things that you love. Learn from their mistakes too. Assume the worst, and prepare for it. Whenever I have a red headed patient, I assume they are going to hemorrhage. I keep a copy of my standing orders on my clip board. Print out my policy. I make sure the pp hemorrhage cart is where it is supposed to be. I set aside blood tubing and NS. I keep Cytotec in my pocket. Prepare what you will say to your doc. Practicing "mock scenarios" in your head will make you feel a lot more prepared when they do happen. You will feel more in the moment, have a specific list, and you will be able to delegate better to those who come to assist you. Carry a pocket sized notebook and write your important numbers on it for the shift. Your doc, anesthesia, code team, pharmacy, etc. Then, no matter where you are, or if the call light isn't working, you can call for backup.. Even if it is with your cell phone. In my notebook, I also keep charting examples, specific lab values for pregnancy induced hypertension so I can remember what I'm looking for.. How to set up an OR, what to remember to do before discharge, things to include in report, codes to doors. Eventually, you stop looking at your cheat sheets, and you realize you really know these things! :) You can't know everything about everything right now, but you can make an effort to learn something every shift!

HCA may owe you back pay for lunches that you worked. According to the Fair Labor Standards Act, during an unpaid meal period: Nurses must report off and completely relinquish care. Nurses should not be expected to chart any changes in condition, fetal heart tones, vital signs, etc that occurred during their break. Nurses should not be expected to answer calls or pages during their break. Nurses should not monitor any phone line, even if no calls come in. Nurses should not be expected to monitor their patients from TVs or computers placed in the break rooms. If the hospital's size or staffing is such that a nurse cannot take his/her break legally, that nurse must be compensated for that time since he/she is unable to completely and safely relinquish care. The existence of a no lunch” exception book has not proven to be a viable defense in past cases. Hospitals often discourage writing in no lunch, and make it difficult and intimidating by mandating it be approved by a supervisor. Often times, nurses would rather remain silent, than push for their earned wage. Another issue addressed by the FLSA is that of combining smaller breaks. Many third shift nursing home employees prefer to take three ten-minute breaks instead of their 30-minute unpaid meal break. Is it okay for them to substitute the (smaller) breaks for their meal break? No, the employee must be compensated for the smaller breaks.” How much money do they owe me? The amount of back pay in this case would likely be double the amount of the wage you are owed if the hospital's violation is considered willful under the law. This could mean you are entitled to pay for every single lunch break you have worked x2 during your employment, possibly more if you worked any overtime shifts. For a full time nurse making $30/hr, the amount of back pay you are owed could be over $14,000, much higher if differential/overtime/call back shifts were worked. This does not take into account additional damages that are often awarded in these cases. Any employee who has worked for HCA for any period of time over the past three years is eligible to sign up for this collective action. If you know anyone who may have been affected, please pass this information along. To learn more about how to claim your due wages please contact Jack Siegel. email- [email protected] telephone- 512.585.3663 **HCA has stated that they have strict zero tolerance anti-retaliation policies in place. Your job and/or future references are protected under the law.

HCA may owe you back pay for lunches that you worked. According to the Fair Labor Standards Act, during an unpaid meal period: Nurses must report off and completely relinquish care. Nurses should not be expected to chart any changes in condition, fetal heart tones, vital signs, etc that occurred during their break. Nurses should not be expected to answer calls or pages during their break. Nurses should not monitor any phone line, even if no calls come in. Nurses should not be expected to monitor their patients from TVs or computers placed in the break rooms. If the hospital's size or staffing is such that a nurse cannot take his/her break legally, that nurse must be compensated for that time since he/she is unable to completely and safely relinquish care. The existence of a no lunch” exception book has not proven to be a viable defense in past cases. Hospitals often discourage writing in no lunch, and make it difficult and intimidating by mandating it be approved by a supervisor. Often times, nurses would rather remain silent, than push for their earned wage. Another issue addressed by the FLSA is that of combining smaller breaks. Many third shift nursing home employees prefer to take three ten-minute breaks instead of their 30-minute unpaid meal break. Is it okay for them to substitute the (smaller) breaks for their meal break? No, the employee must be compensated for the smaller breaks.” How much money do they owe me? The amount of back pay in this case would likely be double the amount of the wage you are owed if the hospital's violation is considered willful under the law. This could mean you are entitled to pay for every single lunch break you have worked x2 during your employment, possibly more if you worked any overtime shifts. For a full time nurse making $30/hr, the amount of back pay you are owed could be over $14,000, much higher if differential/overtime/call back shifts were worked. This does not take into account additional damages that are often awarded in these cases. Any employee who has worked for HCA for any period of time over the past three years is eligible to sign up for this collective action. If you know anyone who may have been affected, please pass this information along. To learn more about how to claim your due wages please contact Jack Siegel. email- [email protected] telephone- 512.585.3663 **HCA has stated that they have strict zero tolerance anti-retaliation policies in place. Your job and/or future references are protected under the law.

The hospital I interned at used Johnson's baby shampoo and warm tap water. The hospital I'm at now uses betadine and sterile water.

We are a non-union, fire at will state. Would OSHA get involved if they are following the CDC guidelines? Who would you contact at the NIH? I'm sorry I have so many questions. We are feeling some blow back from speaking out at the meeting. A few of the girls refused to sign the paper saying we received training and now they are talking about taking them off the schedule. I don't know if it was legitimate or if they are just trying to intimidate the rest of us to keep quiet. We are so understaffed at this point, it might be impossible, but who knows. They said the CDC gave us a designation, but I don't know what that means. We are a small community hospital, but we are one of the closest to the airport. We do not have a high level pregnancy team either. Most day shifts we work with a core staff of 4 plus a tech, including our charge nurse. The night shift girls have 3 I think.

We get paid the same across the board. We float to antepartum and to post-partum, but I would never feel comfortable floating to gyn or med-surg.

I don't blame you at all. I keep thinking about how hot those suits are. I would definitely be sweating. If you have sweat rolling into your eyes (because you're wearing cheap plastic glasses) in a room where you're forehead is exposed to droplets.. you're infected. I'll have to look into buying my own tonight.

No, I'm with you. We were angry. I can't understand why they won't put the zip up suits and hoods on our floor and let us use our nursing judgement. The compassion element in all of this is missing. It felt like a money issue. If I could swipe my badge and pay for it myself when I need it I would! The difference between this and Presbyterian Dallas, is that we know better now. We have time to prepare. And the hospital is knowingly choosing to fail us and the patient.

Elvish- Your hospital is providing hazmat suits for people answering yes to the screen without a confirmed ebola blood test? I think the way that they are handling it would have bumps in the road, but at least it would keep everyone safe and guarantee care for the patient. Would an L&D RN be attending delivery, or is the whole thing strictly handled by ICU?

edited for spelling/grammar

I work in labor and delivery. Yesterday we were given the latest education on Ebola preparedness at our hospital. We have been designated as the receiving hospital for positive screens at a major international airport. If they are entering from an area affected by Ebola (Liberia, Sierra Leone, Guinea), and they have a fever of 100.4+ w/ other symptoms, they are coming to us. We currently have had 6 patients present to our ED this week to be ruled out for Ebola, so I believe this is a real threat to us. The CDC guidelines don't really transfer well to L&D and I feel like we are in imminent danger. We spoke with administration after our "training", and it went nowhere. They stood by the recommendations already in place. Here's what we are currently being told. Anyone who enters the hospital is asked screening questions. Have you been to Liberia, Sierra Leone, or Guinea? Do you have a fever? (this is self reported, not taken) If they say yes, they are put in an isolation room. (Of which we only have 1 in L&D) Then, we are to call the house supervisor, the administrator, and the CDC. We are to put on our PPE (tiny plastic shower cap that doesn't hold my hair, N95 mask, gown with cotton wrist elastic, 2 pair of gloves, boot covers, and plastic "safety" glasses.) We are to draw their blood for the Ebola test, but do not start an IV. We are not to provide any other care until the "team" gets there. If they say no to a fever, but yes to travel, and are found during assessment to have a fever, then we leave them where they are in a non-isolation room, as not to contaminate and have to incinerate supplies in 2 rooms. All visitors are self reporting temps, and there was back and forth on whether it was allowed to take their temperatures if they answered yes to travel. The issues we had and the answers we received: Q: Pregnant patients are likely to report to the hospital hemorrhaging, not with other Ebola symptoms. Will we be provided hazmat suits to care for a suspected Ebola patient (answered yes to the questions) who is delivering or hemorrhaging? A: No. Hazmat suits are only provided for confirmed Ebola patients. Q: How long does it take to get the Ebola test back? A: 12 hours Q: If they are positive for Ebola do we plan to transfer them out? A: That would be the plan, but there are no hospitals who are willing to accept the transfer of a pregnant Ebola patient, so we will likely keep them. Q: What are we supposed to do if the patient comes in, answers yes, and is bleeding severely or delivering and the CDC team hasn't arrived? A: This is backwoods nursing. We bring in limited equipment, because everything will have to be incinerated. You will give minimal care. You do not go into that room. If the baby delivers in the bed, so be it. Q: Will we have fetal monitors in there? A: Yes. Q: If the strip is bad, and we need to do a c-section, where do we go? A: We may do it at the bedside. We don't know. Q: A bedside c-section on a suspected Ebola patient? A: No, I don't know. No. Q: Will there be a policy in place to protect our license if we withhold care to this patient because the team isn't there, and there is a negative outcome, and she turns out NOT to have ebola? A: If you follow our policies you will be protected. There will not be a specific policy. Q: Will care be on a volunteer basis, or will it be mandatory? A: We will ask for volunteers, then it will be mandatory. If you refuse a patient, that would be patient abandonment, and would be dealt with on a case by case basis. Q: Say this patient has Ebola. Dialysis and intubation are considered high risk procedures requiring a respirator. Is lady partsl delivery or c-section considered a high risk procedure that produces aerosol? And if so, will we be provided a respirator? A: We will not be providing any respirators. Q: What do we do if we have someone who presents with a temp of 99.5 or 100, but they have been to Liberia? A: That does not meet the criteria per the CDC, so you will treat them as a normal patient. Q: Will we be taking care of any other patients? A: No, you will be 2:1. You will have a buddy who watches you don and doff PPE and watches you in the room to make sure you don't self contaminate. They will also be in PPE so they can help you in the room if necessary. Q: I've seen workers using decontamination chlorine bleach spray. Will we have that? A: No, but we have bleach wipes you will use to wipe your outside set of dirty gloves with. Q: I heard we have a patient who will deliver in 2 weeks who has a husband who is in Sierra Leon, but is coming back for delivery. Is he allowed to be in the room? A: Yes, he will be allowed in the room as long as he does not have a fever above 100.4. We were also told that we needed to stop watching tv, that we were hysterical, that this is just like AIDS, that they are exceeding CDC guidelines, that this is part of nursing, that we need to educate ourselves, that we needed to reevaluate if we really wanted to be in healthcare at this time.. What are your hospitals doing the same? What are they doing differently? I feel extremely under protected! My biggest fear is being in contact with the amount of blood and body fluids we have in a delivery in CDC recommended PPE. If the patient doesn't have a fever, but presents with severe bleeding, and has been to one of the 3 countries.. I feel like we should be in the zip up Tyvek suits with hoods. My concerns are falling flat though. From this study (which is really the only pregnancy ebola study I can find): http://jid.oxfordjournals.org/content/179/Supplement_1/S11.long "All women presented with severe bleeding." "They all presented with signs of hemorrhage, including severe genital bleeding (100%)" "Only 1 woman survived. She was 32 years old and had had a curettage because of an incomplete abortion after 8 months of amenorrhea. The patient survived despite hypovolemic shock caused by severe genital bleeding. One of the women was prematurely delivered of a stillbirth at 32 weeks. Four women died during the third trimester of their pregnancy. Only 1 woman delivered a full-term baby. The mother of this baby had developed fever 4 days before delivery. The delivery took place at the home of the mother, and the baby developed fever and died 3 days later. The mother died because of extremely severe genital bleeding." "A clinical diagnosis of hemorrhagic fever in a pregnant woman is complicated because pregnant women may bleed for other reasons, such as abortion unrelated to EHF or a placenta previa. During an EBO epidemic, every pregnant woman with genital bleeding should be considered as a suspected case of EHF." "Pregnant women with EHF may present with severe genital bleeding and may need a blood transfusion or curettage (or both). Therefore, health care workers caring for these women have a particularly high risk of acquiring EHF if they do not apply barrier nursing techniques. This includes wearing double gloves, a plastic or rubber apron over a long sleeve gown, a mask, and a full face protector (if available) or protective glasses for personal protection. Moreover, linens, instruments, bedding, and floors that have been soiled with blood or other body fluids should be disinfected with sodium hypochlorite. The application of universal precautions and barrier nursing techniques is not only of particular importance in maternity units in Africa to protect health care workers against EBO infection but also against other infections that are transmissible by blood, such as HIV and hepatitis." © 1999 by the Infectious Diseases Society of America (I know it's old, but it's all I can find!)

I work in labor and delivery. Yesterday we were given the latest education on Ebola preparedness at our hospital. We have been designated as the receiving hospital for positive screens at a major international airport. If they are entering from a affected by Ebola (Liberia, Sierra Leon, Guinea), and they have a fever of 100.4+ w/ other symptoms, they are coming to us. We currently have had 6 patients present to our ED this week to be ruled out for Ebola, so I believe this is a real threat to us. The CDC guidelines don't really transfer well to L&D and I feel like we are in imminent danger. We spoke with administration after our "training", and it went nowhere. They stood by the recommendations already in place. Here's what we are currently being told. Anyone who enters the hospital is asked screening questions. Have you been to Liberia, Sierra Leon, or Guinea? Do you have a fever? (this is self reported, not taken) If they say yes, they are put in an isolation room. (Of which we only have 1 in L&D) Then, we are to call the house supervisor, the administrator, and the CDC. We are to put on our PPE (tiny plastic shower cap that doesn't hold my hair, N95 mask, gown with cotton wrist elastic, 2 pair of gloves, boot covers, and plastic "safety" glasses.) We are to draw their blood for the Ebola test, but do not start an IV. We are not to provide any other care until the "team" gets there. If they say no to a fever, but yes to travel, and are found during assessment to have a fever, then we leave them where they are in a non-isolation room, as not to contaminate and have to incinerate supplies in 2 rooms. All visitors are self reporting temps, and there was back and forth on whether it was allowed to take their temperatures if they answered yes to travel. The issues we had and the answers we received: Q: Pregnant patients are likely to report to the hospital hemorrhaging, not with other Ebola symptoms. Will we be provided hazmat suits to care for a suspected Ebola patient (answered yes to the questions) who is delivering or hemorrhaging? A: No. Hazmat suits are only provided for confirmed Ebola patients. Q: How long does it take to get the Ebola test back? A: 12 hours Q: If they are positive for Ebola do we plan to transfer them out? A: That would be the plan, but there are no hospitals who are willing to accept the transfer of a pregnant Ebola patient, so we will likely keep them. Q: What are we supposed to do if the patient comes in, answers yes, and is bleeding severely or delivering and the CDC team hasn't arrived? A: This is backwoods nursing. We bring in limited equipment, because everything will have to be incinerated. You will give minimal care. You do not go into that room. If the baby delivers in the bed, so be it. Q: Will we have fetal monitors in there? A: Yes. Q: If the strip is bad, and we need to do a c-section, where do we go? A: We may do it at the bedside. We don't know. Q: A bedside c-section on a suspected Ebola patient? A: No, I don't know. No. Q: Will there be a policy in place to protect our license if we withhold care to this patient because the team isn't there, and there is a negative outcome, and she turns out NOT to have ebola? A: If you follow our policies you will be protected. There will not be a specific policy. Q: Will care be on a volunteer basis, or will it be mandatory? A: We will ask for volunteers, then it will be mandatory. If you refuse a patient, that would be patient abandonment, and would be dealt with on a case by case basis. Q: Say this patient has Ebola. Dialysis and intubation are considered high risk procedures requiring a respirator. Is lady partsl delivery or c-section considered a high risk procedure that produces aerosol? And if so, will we be provided a respirator? A: We will not be providing any respirators. Q: What do we do if we have someone who presents with a temp of 99.5 or 100, but they have been to Liberia? A: That does not meet the criteria per the CDC, so you will treat them as a normal patient. Q: Will we be taking care of any other patients? A: No, you will be 2:1. You will have a buddy who watches you don and doff PPE and watches you in the room to make sure you don't self contaminate. They will also be in PPE so they can help you in the room if necessary. Q: I've seen workers using decontamination chlorine bleach spray. Will we have that? A: No, but we have bleach wipes you will use to wipe your outside set of dirty gloves with. Q: I heard we have a patient who will deliver in 2 weeks who has a husband who is in Sierra Leon, but is coming back for delivery. Is he allowed to be in the room? A: Yes, he will be allowed in the room as long as he does not have a fever above 100.4. We were also told that we needed to stop watching tv, that we were hysterical, that this is just like AIDS, that they are exceeding CDC guidelines, that this is part of nursing, that we need to educate ourselves, that we needed to reevaluate if we really wanted to be in healthcare at this time.. What are your hospitals doing the same? What are they doing differently? I feel extremely under protected! My biggest fear is being in contact with the amount of blood and body fluids we have in a delivery in CDC recommended PPE. If the patient doesn't have a fever, but presents with severe bleeding, and has been to one of the 3 countries.. I feel like we should be in the zip up Tyvek suits with hoods. My concerns are falling flat though. From this study (which is really the only pregnancy ebola study I can find): http://jid.oxfordjournals.org/content/179/Supplement_1/S11.long "All women presented with severe bleeding." "They all presented with signs of hemorrhage, including severe genital bleeding (100%)" "Only 1 woman survived. She was 32 years old and had had a curettage because of an incomplete abortion after 8 months of amenorrhea. The patient survived despite hypovolemic shock caused by severe genital bleeding. One of the women was prematurely delivered of a stillbirth at 32 weeks. Four women died during the third trimester of their pregnancy. Only 1 woman delivered a full-term baby. The mother of this baby had developed fever 4 days before delivery. The delivery took place at the home of the mother, and the baby developed fever and died 3 days later. The mother died because of extremely severe genital bleeding." "A clinical diagnosis of hemorrhagic fever in a pregnant woman is complicated because pregnant women may bleed for other reasons, such as abortion unrelated to EHF or a placenta previa. During an EBO epidemic, every pregnant woman with genital bleeding should be considered as a suspected case of EHF." "Pregnant women with EHF may present with severe genital bleeding and may need a blood transfusion or curettage (or both). Therefore, health care workers caring for these women have a particularly high risk of acquiring EHF if they do not apply barrier nursing techniques. This includes wearing double gloves, a plastic or rubber apron over a long sleeve gown, a mask, and a full face protector (if available) or protective glasses for personal protection. Moreover, linens, instruments, bedding, and floors that have been soiled with blood or other body fluids should be disinfected with sodium hypochlorite. The application of universal precautions and barrier nursing techniques is not only of particular importance in maternity units in Africa to protect health care workers against EBO infection but also against other infections that are transmissible by blood, such as HIV and hepatitis." © 1999 by the Infectious Diseases Society of America (I know it's old, but it's all I can find!)