AZBlueBell

Hang in there! The only people I know who had a job “locked down” prior to passing the NCLEX were ones working as CNAs/techs. After you have a license to put in the applications, you’re more likely to be looked at. Use any resources or connections you have til this point, but just keep applying.

Ok I’m going to be honest and prime my response with this: I read it all halfway through, and then skimmed. So take it as you will! I think based on what you said you miss from tele (apart from the “elderly” pt part!) that you may be a better fit for L&D. I say that as an L&D nurse who routinely gets floated to PP. I started in L&D so I have nothing else to compare to other than my floats to PP. But let me tell you, when I am floated to PP i am bored to death out of my mind 98% of the time. It is a very task-y type job, with the things you described (breastfeeding, the baby is “hiccuping” etc) seeming so dull and repetitive. As someone who doesn’t even do PP on a regular basis, I am consistently far ahead of my other PP coworkers in terms of charting and being on top of whatever needs to be done that shift. For example, I am starting my 2nd assessments when they are just sitting down to start their 1st. At first I thought maybe I was just doing it wrong? But after speaking to other L&D nurses (most of which started in PP), it just all comes down to time management. I find myself on PP pulling up the L&D fetal strips just to have something to do/look at while at the nurses station! In a way, I imagine those fetal strips would make you feel at home with your tele experience. We are constantly watching strips, even those that are not our own! Things can change in an instant in L&D. I have run to another nurses room when the baby is down to the 60s only to have the heart tones back up to normal by the time I open the door. And on the flip side, I have ran down that hallway to a baby in the 60s and had to help roll that pt back to the OR with baby tones not coming back up all and we are just praying for a decent outcome. I always thought I wanted to take the path of school> PP > L&D. And many people argue this is the best path to go! But my own experience is that of being so thankful that I went straight to L&D, where my heart is, and where I am constantly being challenged. Now, if you’ve made it through reading my whole response (and not skimming!) I’d say give it some time and then decide. Give at least 6 months before deciding anything major. Ask if you can shadow L&D. Ultimately, then you can figure out where you will be happiest!

Skin to skin in the OR is great! But it is, and should be, the responsibility of the baby nurse to oversee that skin to skin time. As circulator, we have enough we have to do and physically are unable to watch over the skin to skin time! Doesn’t matter how close to the end of surgery they are. I agree, that was an unsafe situation. If your unit is to continue the practice of skin to skin in the OR, I think better practices and expectations should be in place.

I check for all that if there is cause for it. If their BP is normal and no risk factors with their pregnancy, I don’t. I do check clonus with every pt/assessment. My preceptor did too and now it’s just habit for me. if the pt is on mag, they have more frequent assessments let our policy and I do check for everything including reflexes, clonus, Lung sounds, vision changes, RUQ pain etc. if I have to wake them to do so, I have to wake them. But it’s important. And typically, there’s something else I have to be in their room for and I can cluster my care to limit their wake ups .

I was not offered on the spot. I think they called me a few days later to offer me the position.

This is an issue at our work place too (ie dayshift feeling baths are dumped on them). However, our techs are pretty good about checking back with patients around 0600 if they had refused a middle of the night bath to get it done before shift change. Babies are taken from the room at some point during the night anyways for weight, so sometimes we can get the baths clustered into that time. But sometimes, the parents still just want it during the day when they are fully awake to witness the first bath. And if that’s the case, then we respect their wishes! And I think dayshift ultimately knows it isn’t dumped on them on purpose, but they still don’t like it.

Pretty much the same for our facility as well, except we do q30min vitals on baby. No specific timeline for baby staying skin to skin. We encourage at least until the first feed or first hour, but we’ve had moms that keep baby with them until the last possible second. “Hey, we need to transfer you to postpartum and need to get baby weights and measurements first”. Our facility sees a lot of natural mamas and so constant skin to skin is very common for us.

Same for us. OP, our hospital has no actual policy for it. Everything is left up to the provider. Protocol is that when pt is complete they are moved to the OR for pushing and delivery in case a cesarean is needed for twin B. Other than that, it’s pretty much the same as any other delivery except it’s in the OR and there are 2 babies (and more staff).

We do head to toe 2x per shift regardless. Our section mama’s also get a head to toe immediately in PACU along with frequent vitals until the 4 hour mark. Then it’s q4hr til they hit 24 hrs PP, then goes to Q6hr vitals which is also standard for our lady partsl deliveries. Once stable and outside of the necessary frequent vitals right after delivery, all our mamas are on q6hr VS and fundal checks.

Our c-section mama’s are the only ones who transfer to PP with a foley. Our lady partsl deliveries, if they have a foley in for delivery, will have it DC’d at some point in the 2 hour recovery before we take them to PP. some providers like the foley out for pushing, some don’t. If I have one already in place after a delivery, I take it out right before my last fundal check, so basically at the 2 hour mark just to keep the bladder out of the way for bleeding. If for some reason a mama needs her bladder emptied during recovery and cannot yet walk to pee, we straight cath them. as for the color, I have seen a range. Anywhere from clear, to yellow, to pink, to colored bright red (blood tinged bright red, not to be mistaken for just straight blood). I’ve been told by providers it’s sometimes due to trauma from pushing (thus some providers like it DCd when pushing). Kind of depends. If it is straight BLOOD and not just red tinged, this would indicate a complication to look at immediately.

1. We have a “transition Nurse” role assigned each shift. This is typically a NICU Nurse, but if NICU is full and they can’t spare a Nurse then an L&D Nurse can take this role as well. Typically it is one person assigned as this role each shift. 2. We aren’t required to stay in the room, at all times for those first two hours. We are in and out very frequently so they aren’t alone much but they have their call light when we aren’t in room. Typically our transition nurse cares for baby thefirst two hours and the L&D Nurse cares for Mom. Sometimes, if it’s very busy the transition Nurse will catch and release meaning they come for the delivery/apgars and then the L&D Nurse takes over care for both Mom and baby after that. 3. We sometimes do STS in the OR, depends on the situation. The transition Nurse stays with the baby for this. When you say you’re having trouble with staff wanting to keep the baby in the room, what does that mean? What do you do with baby at the moment, they are delivered and leave the room?!

What?! I have never even heard of this! More than 2 active labor patients?? I feel as though my facility is not as strict as others in terms of “high risk” being 1:1 but I have never had more than 2 labor patients at one time, ever.

Banner will, but usually you have to know the manager/director for the unit to get into one of those. PCH will hire new grads to NICU. I have heard Honorhealth absolutely will not hire this units without experience, and I’m unsure about abrazo or dignity. Good luck!

1. The first few days will be all corporate type stuff, policies and starting your online learning modules. There will be skills and sim days to teach you general skills and equipment (IV pumps, IV insertion etc). Add in any classes you may be required to take like bls/ACLS/ekg You will be required to attend monthly new grad forums where they cover a different topic each session (falls, sepsis, wounds...). If I remember correctly, you should start on the floor by the 2nd week with your preceptor. You’ll have a full 3 shifts, or possibly only do 1-2 with them depending on what other classes you have in that week. 2. The academy, although I can’t tell you anything about yours, is just a more specific way for you to gain knowledge about your service line. For instance, you will need to learn things a tele unit may not and vice versa. So it is kind of like a condensed lecture type thing. I found mine to be very helpful. 3. You’ll have to find your own routine. I’ve tried a couple different ways before settling into what I do now. At first, I was very nervous as I had also never done nights. So my schedule was this: night before: went to bed at normal time, set alarm to wake at midnight, stayed up til 6-7am, slept until 3-4pm and went to work. after night 1&2: came home, quick breakfast, slept until 3-4pm and went to work. After night 3: slept until 3, then tried to sleep like normal that night too. now my schedule is different because I felt like I wasted a lot of my free time being awake/asleep when no one else was and hated that. Night before: bedtime and sleep like normal until morning. Wake up like usual, run errands or laze around, eat an early lunch and nap 11:30-3ish then go to work. After night 1&2: still unchanged, eat breakfast and go to sleep after night 3: sleep til 1pm at the latest so I can get up and have the afternoon/evening and then actually be successful at “flipping” back to a normal schedule and sleeping that night (if I sleep longer than 1, I’m not tired that night and struggle to flip back which ruins my off days). My husband works days and I have kids so flipping back is a necessity for my family life. I know some people without kids sleep later than me, and wake up just before work and come In. I wake up early so I can not only shower and get ready but so I can have some time with my kids and we still eat dinner as a family before I go to work. I really dreaded working nights but I actually had no issues adjusting to them sleep wise, I just had to make it a priority. Fan for white noise, cold room and comfy blanket, eye mask and I’m good to go! You’ll find your groove. Good luck!

Sorry for the typo, we allow cervical ripening at 39w1d....is that considered against measures?