eandgsma

Hello, I have question for you L&D RNs out there. I had a 2100 scheduled cervidil induction come in who I had prenatals for but no H&P. I assessed her, did an SVE and called the MD for orders. I also told the MD that I had no H&P and that, according to hospital policy, I could not start the induction unless I had one. She asked how long has that been a policy and I told her it has been for some time and it had been reiterated at the OB meeting. I offered for her to fax me one or email me one. She said this is getting too complicated, send my pt home and I will have her rescheduled at "Big Box Baby Hospital" instead. I told her that is fine if she wants to do that but I find it hard to believe that "Big Box Baby Hospital" doesn't have that same policy. She said they didn't. I asked her to tell the pt herself, which she did by phone. The pt told me the MD said she was too busy and to reschedule blahblahblah. I told the pt the truth, that we could not start because hospital policy is that we have and H&P and the MD could not provide one at this time so she rescheduled. Poor pt! I called by Director and she agreed with me. She said the CMO agreed that it is JC that regulates that all ELECTIVE procedures have an H&P before starting. So, anyone starting elective inductions without an H&P out there? Or having the same issue with MDs? This is the 4th time in a month that the MDs have been flipping out on us because of this issue. Its not my fault that your staff didn't send one over with the prenatals. It is very frustrating for the RNs and the pts. Thanks!

Hello all, I'm curious...how many of your hospitals have an OB in house? How many deliveries do you have? I ask because we do not and we have around 200 deliveries a month. It makes me uncomfortable that many times there is no OB in house for emergencies. An example...a G5P4 repeat c/s (this would be her 5th) came in with extreme abdominal pain, abdomen was hard, FHTs down and we immediately got things started for c/s but her OB was not in house and lives 30mins away. Thank goodness another OB from another group just happened to be there and got the baby out while the pts OB came in 45mins later. That girl had a complete abruption and had to have a hyst. She went to the ICU. What would we have done if the other OB wasnt there? The argument I'm getting from hospital management is "who's going to pay for an OB in house?" My suggestion is to make the ER drop in OB stay in house, what's the difference? They can bill the OB to whom the pt goes to for their services if needed. That's exactly what happened in the above case. So, what do you all do? Thanks!

Hi and welcome! Here's what we do: 1. We wear our own scrubs or hospital scrubs to circulate. 2. Our docs don't prep, ever. 3. Our delivery tables are made up in the hall or in closets between rooms and only brought in the room for delivery. We don't have time limits on them, they are sterile and covered. Hope this helps!

WOW! Amazing!

I don't know about their residency program but I do know that they just closed their L&D unit at Hillendale, releasing 40 of 50 employees on that floor. But, I do work with RNs who used to work there and they liked it. They only left because of the distance. I hope you get in.

I know this is true at three hospitals in my area (greater Atlanta) including the one I work at.

Check out http://www.watchtower.org. That is their official website. - N

At our hospital we are no longer getting call back unless you work >40h week. We are not getting raises this year, which sucks for me cuz I'm at the bottom of the pay scale. Our on call pay is being cut from $4/hr to $2/hr. If you work 7a-7p you no longer get shift diff for 3p-7p. We are also on a hiring freeze. They were talking about reducing our shift diff for evening and night shift as well as weekend diff, but they didn't do that for now. The problem I have is that we are usually understaffed at night and if they need to call in nurses to work, no one is going to come in unless its for call back. Since they eliminated call back, we will be understaffed. One example, there is a Sat coming up that there are only 2 nurses scheduled, no one wants to work it or switch cuz they won't be getting call back. WTH are they going to do? Glad I'm not working that night. I'm curious...of those who replied with cutbacks, how many are not for profit vs. for profit hospitals?

I am an L&D RN who has had both a hospital birth and a homebirth, both before I became an RN. I was very pro-natural birth, anti-intervention, etc before I really understood the reasons why these interventions were done. Now I understand the reasoning behind many of the interventions. OTOH, I also understand the reasoning behind not wanting many of the interventions. So, from that perspective and now practicing as an RN in L&D I'll tell you my personal opinion. When people come to the hospital wanting a natural birth I expect them to be VERY educated on their options and reasons WHY they want a natural birth. Too many times we have pts who think they want a natural birth with no interventions but they are not educated as to why we have certain interventions or they don't know how to cope with labor because they didn't attend classes or read a book! That drives me nuts. I think people should be open minded to certain things like IV access for an emergency. If you don't need it then good, but if there were an emergency, it'd be a lot easier to just hook a line to a saline lock vs. sticking you in an emergency. I'm all for pts ambulating, using a birth ball, trying different positions for pushing. But I do like to know how baby is tolerating labor, so please come back for 20 mins of monitoring (or whatever hosp policy is). It actually makes my job easier if my pt is ambulating in the hall. Birth plans...they do seem to "jinx" a person far more than the avg pt. I don't know why, they just do. In the end, I try to help my pts who want to go natural to get their goal and I'm proud of them either way. It seems you are an open minded and realistic person by your comments in your post. Please keep in mind that first babies generally take longer to come out, labor is painful and exhausting. Don't beat yourself up (or let anyone else) if you just get to a point where you absolutely cannot take it anymore. It happens. It happened to me with my first baby. I wanted a natural birth, I got a SL and intermittent monitoring. I had a doula. I labored for 24 hours with a 1cm change in dilation. I finally agreed to amniotomy. I was exhausted from no sleep. I tried everything to get things moving and to tolerate the pain (birth ball, showers, walking, etc). I finally gave in to an epidural. It relaxed me enough to where I was ready to push within an hour after the epidural. So a total of 30 hours of labor, one hour of pushing and I had a 8lb 10oz baby. Now the second baby, my homebirth, it was a total of 3h45m from start to finish. Very painful but because it was quick I made it. Well, I hope this was somewhat helpful to you. I wish you the birth you are hoping for at the birth center!! Congratulations and please let us know how it goes.

That's very true!!! I had to look up the license date as it is.:)

In other words, when is your first year over? Is it the day of graduating from nursing school? Is it the day you got your license? Is it the day you started your job after graduation? I'd like to know because I can't wait for it! If its the date of graduation, that'll be December 13th. If its the day I got my license, that would be Feb 6th. If its the day I started my job, that would be December 30th. Whatever day it is, it can't come soon enough! LOL!

At my last job we just had a sterile drape over our arms like a big napkin (as someone else described) and the doc handed the baby over. Now we have a "baby nurse" who scrubs, gowns and gloves to catch the baby. I think its overkill. Why not just have the sterile drape that the doc is in contact with? Now here's another wrench...what about with multiples? When you have someone scrubbed to catch one baby and put that baby down, then you are no longer sterile. You either have to have someone else scrubbed, gowned and gloved OR another person with a drape to catch the subsequent baby(babies). Now THAT could get expensive if you had all those people getting sterile. A sterile drape would work just as well and be more cost effective. There has to be some sort of study out there on this though. I wouldn't even know where to begin to look though! - N

First of all, I'd like to thank everyone of you for responding to my vent. I was still really upset when I wrote my post. I have taken everyone's words to heart. I do need to give this place more time. I'm still getting used to their routines. I really loved my last job and I liked how organized it was. Growing with this facility is a bit of a challenge for everyone, including me. But I will give it more time. I do need to get a bit of a thicker skin and that will come with time and experience. I thanked all those that rallied around me and they all said they've BTDT. Thanks again!

I moved across country and got a job in a smaller unit than what I came from working nights (L&D). I worked nights at my last job. Granted, I am still a new grad, but I am tired of being treated like crap. I hate this new unit. There are people on dayshift who have never worked in another facility, ever, for 20+ years. This unit is growing fast and they can't keep up with it. It is so disorganized, there is one charge RN for M/B, NICU and L&D. That's waaayyy too many people to be responsible for IMHO. I came from a very busy unit but it was organized. Anyway...here's my problem. I have the older dayshift nurses come on and give me crap for the stupidist things, most of which are not my fault. I am still trying to figure out their jacked up system, especially when it comes to paperwork. This morning I had had it. I had a pt come in, in pain, GBS unscreened and the MD said lets just watch her, don't admit her, but give her IV, abx and x1 dose nubain w/phen. I do that...then I get another pt, SROM, writhing around in bed, takes 3 RNs to get an IV started, unit sec doesn't get her banded and this is at 6am. I didn't have time to get her consents, nothing. SO...the MD comes in at 6am and checks 4 pts, 2 are mine and admits both of mine..at the same time. I go out front to find the dayshift RN getting info from a chart that I hadn't made up, the sec did. I was behind because of the SROM pt and IV problems. I tell her, sorry, I haven't had time to get the consents signed yet and she starts rolling her eyes, slamming the chart, etc. I try to give her report and she just asks when her abx were given and walks away. I call her by name and ask if there is something wrong. She lays into me about how the consents should have been done, she's been here all night and I said, the MD just NOW admitted her, she was a clinical pt before. The RN walks off. I go to the CRN and she's like "what just happened?" and then I go to the med room and start bawling. I'm tired, I'm stressed, I can't take anymore crap for stupid things. The RN who was blasting me walks in to get meds and sees me crying. She says, don't cry, I didn't mean to get you upset. I said, that was completely uncalled for out there, you should not have acted like that to me. Its not my fault that the MD just now admitted her, I didn't have an order to admit her so that's why the consents weren't done. I had another pt that I was trying to deal with who is being uncooperative. She says I'm just tired of things not being done when day shift comes in...I said You know, I don't sit around on my butt all night, I work. She says, I know you do, I've worked with you. I said then why are you taking this out on me? I'm sorry I didn't get the consents done, everything happened at once. She hugged me but at this point I couldn't stop crying. The tears wouldn't stop. I had both day and night shift CRNs come and tell me she was wrong, they were sorry, etc. Now, I'm just embarrassed that I couldn't stop crying and get a hold of myself. I was very tired and I didn't need to be treated like crap for no good reason. Something else happened as well with the day shift sec, she started laying into me and I just pushed back. I'm done being walked all over. I don't care if I'm "new", I don't deserve to be treated any differently. I do my job, I am a team player and I'm tired of this day shift vs night shift bs. As it is I have to drive an hour both ways to get to this stupid place. I'd rather fly back to CA and work one week out of the month than work here anymore. I never had issues like this where I worked before. I wish I never left. If you've made it this far, thanks. I just really needed to vent. Thank you!

You must be in north county. You will have to go south if you are. PPH is very difficult to get a job as a new grad and Tri-City has the hiring freeze. Sharp usually starts listing their new grad positions around now, keep checking daily. Scripps usually waits a bit but check their site daily as well. I hope you find a job soon! - N

What floor? I did a clinical rotation second semester of RN school there. Its a small hospital. What information are you exactly looking for? -N

I externed for a year before being hired into L&D. I was allowed to do everything along with my RN. I started IVs, I gave meds, I interpreted FHT tracings, I did VEs, I helped with deliveries, I did baby assessments, I inserted foleys, I placed cytotec, I charted everything I did. All the RN did was show me how, back check what I did, checked my charting, made a preceptor note to show they were responsible for me. It was an invaluable learning experience for me. It helped me in school as well because I became more confident in caring for my patients in clinicals. I was no longer afraid every morning when I stepped into a patient's room to do assessments, etc. I was hired to the floor I externed on as a new grad and I was an easy preceptee. There were a few things I hadn't had a chance to do when I was an extern that I did when I was a new grad though, like put on an FSE. I still have not been successful putting in an IUPC. That's because we don't do them very often. Take this time to learn all you can, asks lots of questions! And have fun!

Nope, no mandatory on call time here. You can sign up for voluntary call. You can also sign up to stay home and if you get called to stay home, you get on call pay then time and a half to come in. We get $6/hr for on call. Seems like that's pretty high compared to other places. Lately we've been so busy that they have been calling people in offering double time.

Well, they were on a hiring freeze for one. Second they were unable to get funding for their earthquake retrofitting that is government mandated. If they don't get it done, they are at risk of being shut down. I didn't mean they weren't doing well as far as not being a good place to work. I didn't mean the people weren't good either. I just meant that, like the original poster said, the census is low, there isn't that much work, therefore the OP needed to find extra work. The hospital isn't making enough money. I have friends that work there and enjoy it very much. So, nothing against the hospital itself, just the lack of enough work for some people.

I would look into other hospital systems if I were you. I'm in SD County and Tri-City is not doing well, as you know. If you like hospice, look into private hospice companies like Elizabeth Hospice. Otherwise, look to Scripps, Palomar, or Sharp for a new job. Sharp is unionized but you are not required to be a part of the union. I don't think Palomar is and I'm not sure about Scripps. I'm not sure what your reason is for staying within the Tri-City system? But if there is a valid reason for staying, then I suggest questioning and contacting your union rep as was suggested.

My favorite is the crash c/s at 0700 or the time when the MD kept saying the pt needed a c/s but just let her labor, with lates!, all night long and then took her for c/s at 0658. And I was NOT happy! She decided so suddenly that I didn't have time to chart anything. I had to stay way late to catch up. And we always seem to have change of shift deliveries too. They aren't too bad though, you just chart the delivery, make sure baby is ok and hand off. At least you don't have to do the recovery. For some reason, things tend to happen at change of shift! -N

Babyktchr, Can you tell me what would be seen on the strip with an IUGR baby? A podmate of mine had one the other day and it was pretty flat most of the night, still had mod variability but no qualifying accels. - N

This is what we do with regular tubing with ports. The pit is on portless tubing. We have >8k deliveries a year and yes, everyone gets pit. We have cartridges so we can add on to the pump if needed. Usually, we have LR running to gravity and pit to the closest port. If we need to turn off the pit, we turn off the channel (cartridge). There isn't that much left in the tubing going to the patient because its at the closest port. I'd have to measure it but it can't be more than 8 inches of tubing. It would be interesting to really find out how much is in there. Anyway, we run the boluses out of the primary bag of LR. Rarely do we put our LR on a pump, sometimes if we have to run Pen GK we will because it hurts going in. We would always put the LR on a pump for a mag pt though. But we have to dig for channels usually so they are not used as often. On another subject (but re: pitocin), I so much more prefer it to cytotec. At least we CAN turn off the pit. You can't get rid of a dissolved pill when mom is hyperstimulating.

Hello all, I could use some advice. I am a new nurse, started as a new grad in L&D in January. I externed for a year before that. Due to circumstances beyond our control, my DH's company is dissolving. We will no longer be able to afford to live where we do. We are considering moving across country. So...I need advice regarding leaving my job. I love my job and realize they have invested a lot of money in me. I feel really guilty leaving but there is no way we can survive on my salary and my DH won't be able to get a job paying what he was getting. Would it look bad to other hospitals that I would be applying to that I have 6 months RN experience in L&D? Would they still consider hiring me? How much should I put on my resume as far as training, classes taken, etc? Do I just start calling recruiters, applying online to jobs in the state we are considering, etc? Do I try to find a job and THEN apply for endorsement? How do I go about this? Thanks in advance for your replies.

2:1 in early labor (ie - early inductions are paired), once they hit active labor its 1:1 most of the time. There have been times when its so busy you are praying that one of them doesn't have to push, but that's rare. It's always nice to have a baby nurse too.