obrn2

If my charge is hounding me to move a patient and she's stable, sometimes I move a patient when her epidural is wearing off and has not gotten PO meds. For the most part I try to give all my patients decent pain control, but sometimes unit needs dictate other things. If patients are sick, it puts this discussion on a whole different level…I was only referring to things that can mitigate tension during a normal and stable transfer of care. There's no easy comment re the other issues you mention at your hospital. Perhaps the high nurse turn over means there is something going on other than incompetent” nurses, but obviously I have no idea. The nice thing is with your background you are able to care well for mothers who do get sick PP and that is invaluable. Hopefully the other RNs you work with appreciate that, too.

Plan of Care :)

POC! In PP, there is a LOT to do so the plan is r/t teaching, vaccinations, breastfeeding, pain control, post-op care, baby weight gain/loss, screenings, etc. However, for L&D it's the immediate SAFETY of mom/baby and getting baby OUT - we couldn't care less at the time about Tdap or flu (I mean, we care...but talk to me about HIV, Blood borne disease, HSV, etc and THEN we're talking the same language)! Someone said cross-training makes it easier. Yes. I WANT to give a full report, but been consumed with POCs no longer relevant in the handover. The PP nurse may only be considering things needed from that moment on. As a previous Mother/Baby nurse I can say that my biggest pet peeve was floating L&D nurses blowing off the work I was doing. Oh, you think my entire shift revolves around water and colace?! That's insulting to anyone. Don't complain about a heelstick, then! Say a nice word, don't put down the postpartum unit and you will be in a good spot. When they get snippy about small details (I sometimes did) just say so sorry I was worried about the decels/contractions/pitocin/whatever and couldn't get to it. I swear, it wasn't something I understood until I cross-trained! If they brought it to my attention I realized it and backed off. The other thing I've noticed is RNs tend to have a Type A attitude, so each one thinks they're always right! LOL. We just do the best we can...

maybe a hemostat with her name engraved? always come in handy and get lost frequently.

I love GOOD doulas. The best doulas help with position changes, encouragement, getting my patients to the bathroom with the IV poles, feeding ice chips and MY FAVORITE, help with changing out dirty chux. OMG. That's the best. I can feel comfortable that my patient gets that "extra" bit of care...holding her hand during a tough contraction or counter pressure during back labor, that's what a good doula can provide. She can also calm an anxious partner and give guidance on what the partner can do to be part of the labor process. Those doulas are invaluable. A bad doula makes the entire experience awful for mother and staff. My worst experiences are when doulas speak for the patient. Hey, they can be an emotional and physical support all day long, but when they start refusing medical interventions they are NOT qualified to advise, you're going to get on my bad side. Speaking FOR the patient is not in the scope of practice and it's going to piss off the medical staff. And if on top of that, they sit on their ass not helping as I'm trying to get the patient to the bathroom or moving them in bed, then it's going to be a bad day for all. By the way, doulas DO have a scope of practice. Not all are certified, but should follow some basic "rules." Here is the scope from DONA International, one of the certifying organizations: DONA International – Standards of Practice for Birth Doulas and another from CAPPA Certified Labor Doula (CLD) - CAPPA Also, I'm not shy asking them if they're trained, with whom, how many birth's they've attended, etc. I do that to try and find some common ground so that the entire room begins to believe we're on the same team. Overall, I'm happy to work with them because I try to stay positive!

Ooooohhh, this totally resonates with me. I got it, too. Self-reflection is key and yes, tone does make a difference. As mentioned above, asking if they have time, would they mind doing this..., thank you, please, etc...It is understood it's their job, but no one likes to be talked down to. You might not think you need to change your behavior, but the reality is that you do if you want to be 'liked.' It is simply the POLITICS of the job and happens everywhere. Trust me, there are others out there just like you! My manager had a similar conversation with me when I was about two months into my new job. I was also told there was more than one complaint, and no, not one single person addressed it with me directly. It was just this vague "others." Part of me wanted to say screw 'em, but the reality is that the work atmosphere improved tremendously by making adjustments...also probably because I got used to the system and work, so my stress levels came down. Oh, I also started working out before work, which felt terrible at first, but then I wasn't so on edge during the shift!! I also look angry at the world when I'm stressed out and realize I probably looked right down furious! In fact, on busy days, I still do. My projection can be abrasive and curt, so when I catch myself, I will actually go out of my way to address it/apologize to the other person. It's not a perfect system, but my way to soften the impact and has helped to ease the tension when working. It may seem unnecessary to have taken these steps, but they have helped the social day-to-day environment. Stay strong, you will survive this!

It can be really trying to be a nurse caring for an OP baby. Go easy on yourself. You are not the make or break it person for the mom. We can feel that we are, but there are so many factors that go into this! My first thought is the mother has to be prepared to labor hard, even with an epidural, because that back pain can be tremendous. I've had the partners do lots of counter pressure during the contractions. Once you get the counter pressure going, the mom will basically demand it during the contraction. I also place them hands/knees, side lying with the opposite leg propped on the stirrup, etc. I wish we had a peanut ball at our facility! One of our nurses flips them completely on their stomach with lots of pillows to support their tummy and legs. A doula I've worked with made a comment that pregnant moms need to get off the couch. She said they cannot sit for hours every day on the couch because gravity will naturally pull the baby into OP position and then it's really hard during labor. Do I have evidence for that? Nope, but I thought it was an interesting observation.

What kind of help are you wanting? Other than reassurance that we've all made errors in some form or another, I'd like to encourage you to write an incident report or its equivalent for your facility. You say the proper people area aware, but it is in your best interest to follow the protocol for med mistakes. I'm not sure that there is anything they would do with the patient other than observe closely. This is not a HUGE mistake (relatively speaking) in the scheme of med errors, so for that at least, you can take a deep breath. I also agree with Klone, it seems like an exceptionally large dose.

You could reasonably ask for a chance! Maybe they can start to float you there or have you come in an extra day to shadow. Did you find you really enjoyed breastfeeding your kids or did you find the nurses were of help to you after you gave birth? Is there something you can identify with in the role that you would look forward to doing on a day to day basis? The point of these questions is that it isn't just simply about being ABLE to do the "tasks" or "juggling" the number of patients. This is a specialty area that requires a specific mindset to teach, to evaluate bonding, to intervene when needed but mostly it is about helping them come together as a family unit. Some nurses find MBU to be incredibly boring so you need to find something that would make you an idea candidate for the specialty. Do you like teaching, how do you feel about breastfeeding, about circumcisions, about vaccines, about postpartum depression, etc. These are things you will discuss every single day. How would you like to talk about that all the time, what would your value added be? They need to believe you'd be a good nurse on that unit, so they want to have you. It's not just about the switch. Good luck.

I waited. My fertility was tops then, but the age factor has affected my ovarian reserve. The real problem? Male factor infertility. It seems no one talks about male factor infertility! I did not even really know this was a thing until... We may or may not have had problems had we started earlier, but now it's a much more complicated issue. You have to evaluate your desire for a child. Nursing school can be done with time if you're committed. Baby making can be much more complicated because so much is out of your control (while nursing school is pretty much all you).

Join AWHONN as a student and network within your chapter and at local events. One thing to consider is most certifications will last a couple of years before needing to be renewed. This can get pricey, so it is something for you to consider. Maybe get those certifications closer to graduation (NRP, STABLE, etc). You could become a lactation educator or childbirth educator and try to teach private clients or at community centers. You can also do work as a doula as all of these will expose you to different environments. Working in the hospital setting as mentioned in the previous post is also a good way to get your foot in the door.

Also, consider joining AWHONN and join chapters near you to network with other RNs in the field. Then apply, apply apply. Good luck.

Best advice ever - go shadow an RN! Before you make any changes, make sure you can handle it. There are volunteer programs that would give you exposure to what nurses do - take advantage of them. And while Women's Health is your area of interest, realize that you may need to work in a different department before switching to L&D or MBU depending on your need to work. I do not subscribe to the thought that you need to work MedSurg before moving into Women's Health, however sometimes it's the only area open to new grads (depending on your geo area). You may have to decide whether getting a job is more important than the specific field. Only you'll know that answer when the time comes. As a second career nurse, this was the best advice I ever got. Don't get me wrong, I love my job...but nursing is HARD.

Within the last two months I've had the NICU doctor advise parents against delayed cord clamping due to increased risk of polycythemia for their term infant. They do a routine 30-60 sec delay for pretermers only. Midwives do this practice routinely on term babies, so I was surprised to hear this from the MD. While I have no idea if this was specific for this case, it seemed a stock answer and pretty much made my blood boil.

Try National Guideline Clearinghouse with a search for skin to skin. There is a lot of information available on this topic. National Guideline Clearinghouse | Home Good luck! I love having our moms do skin to skin.