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?

I’m sorry, that was a typo! Elective IOL allowed at 40 weeks, and cervical ripening allowed at 39w1day (not 38!). To be honest, we only have a cervical ripening probably once or twice every few months. It is not common.

Absolutely no regrets! I always knew L&D was my goal, but I thought PP was where I wanted to start out. Ended up with L&D right out of school, not gonna lie I was a little intimidated at first! But I’m so glad I landed where I did, and love that I’m not PP (although I do get to float there every now and then which makes for a nice change of pace). To be fair, had I landed in PP first I believe I’d have been perfectly happy with that as well but still have the goals of L&D. But since I have been able to do both, PP is far too boring for me most shifts and I’m thankful it’s not my everyday. I cannot imagine doing any other type of nursing though! I’m not interested at all. If it isn’t mamas and babies, no thank you!

My brain sheet likely wouldn’t work for you as it is specific to what I need to chart each shift per policy. On one sheet of paper I have 4 brains (will last me two shifts). So basically 1 pt per quarter sheet. I have a checklist of things I need to chart such as nursing handoff, allergies, fall risk, suicide screening, 2 assessments, etc. then on the other side of my quarter sheet I have spots for VS, pit, position where I just write my next due time (depending on pt, I may do VS q4hr or more often, so I just write my next due time). Then in the bottom of the quarter sheet I have a box where I write random notes. For instance, I’d i talk to a doc and need to chart a notification I’ll write “notify <time>” and then erase or cross off when I chart it. After my mom delivers I write down my fundal check times and check off as I go. If she’s on abx for GBS, I write that and the due times in my box. Took me 3 months off orientation to figure out what I wanted in my brain. I’d suggest you figure your own out as it will be easier to customize to your needs. And to add on what the other poster said, I do a lot of strip charting because it keeps my times for me. So I can go back on the strip and see when the provider was with us, when I started O2 or a fluid bonus etc.

I would look up your policy again if I were you...we have a similar policy but it explicitly states WITH CONSENT.

My facility allows elective IOL at 40wk only. At 38wk1day they are allowed to try a cervical ripening. Basically they are admitted as an observation pt, they get PO cytotec (up to 2 doses) but if no significant cervical change (must meet th BISHOP requirement) they are DC’d home.

I have a Littman (I forget which series) but it has both Mom and infant on it, I just turn it and flip to the large or small size depending on if I’m listening to Mom or baby.

I started applying the month I was set to graduate, but several hospitals in the valley require a RN license number for the application to go through. Banner being the exception I believe. But even then, I believe it's rare for Banner (or anyone) to offer a job prior to passing NCLEX. But no, it never hurts to try!

Ours is very similar to this. Our NICU RN's are typically assigned to be the baby nurse, but L&D nurses can if needed for staffing. So baby nurse is responsible for apgars, resuscitation if needed, breastfeeding assistance, vitals for the first 2 hours (or til transferred to PP), assessment, orders, footprints and measurements. If we are super busy with deliveries, sometimes they need to catch and release so the labor nurse takes over for the couplet as a whole if possible or someone else does baby vitals if couplet care isn't appropriate staffing wise at that time (issues with the Mom that the L&D Nurse needs to handle). Our baby nurses typically don't do anything with the delivery at all, only baby stuff. If there's a Mom emergency, other L&D nurses come to help and baby nurse keeps baby. C-sections they are responsible for the same things, except they typically get all the measurements and footprint stuff done in the OR versus having to wait for that stuff after a vagincal delivery.

Hi, I'm a new grad in L&D (8 months in) so here's some tips from my perspective: For SVE's...crawling the fingers helps, if it's very posterior you can have them pull their legs back (pushing position) to bring it forward. Tips like fist in the back or bedpan have never worked well for me. I typically try to sweep my fingers in a circular motion til I feel something I can "hook" and then I can either put my second finger right there or have to sweep it along the edge til I feel the other side (when they are 7-9cm). And I've found it's easier for me to find the cervix if I sit on the edge of the bed vs stand over them. It's also helpful to take a deep breath and relax if you are not finding the cervix right away, and ask the pt to do the same! It's so uncomfortable but is easier when they relax their muscles and breathe. And don't be afraid to ask someone to check after you if you're unsure! I'm flat out with the patient and say things like "I just cannot find your cervix, sometimes I can't reach far enough back so I'm going to have xyz come check" or "I am going to have xyz check you because I don't think I feel any cervix, I just want to be sure before we start any pushing". Because sometimes the way baby's head is squished makes me think hmm, is that a lip of cervix? So I grab an experienced nurse I can trust to tell me one way or the other. For calling the dr, this is something that takes practice! But you can tell when they are moving the baby and when their pushes are just not effective yet. Typically once I can tell baby is moving, I take my fingers out for the 3rd push of the contraction to see what is happening without my help. If I can see about 1/2" of head and the Labia are bulging, I call for the dr. Obviously, I call sooner if it's a natural pt because they can't just let a contraction or two go by before the dr comes into the room. Typically it's a couple more pushes when the dr gets there before I call for nursery (they catch our babies) but sometimes I call at the same time as the dr, just depends on how well the momma is pushing! It will come with practice. I'm still trying to perfect my timing with it all and not second guess myself! I haven't been totally off base yet but I still don't 100% trust myself I guess. I always call the dr before nursery, or them both at the same time. Never nursery before dr. I'm saying that because you ask about calling the charge nurse, we don't do that for ours so I'm wondering if your charge is your baby catcher and you're asking who we call first...of course, all this assumes the dr is in house. If that's not the case, I'd call before doing any practice pushing at all just to communicate a timeline.

As a new grad with limited experience I think the following would be helpful in addition to the ones already listed: drills for placing blood orders (in the few I've been involved in it has always required multiple nurses to get the orders in correctly, even those with years of experience needed help!) NRP situations (both at delivery and delayed) maternal codes