Teeny Tiny L&D Units

SmilingBluEyes · Mar 24, 2006

Really, those are some good questions to ask the hospital and / or person hiring you!

HOPEFULLY you have fully-NRP-qualified folks on hand to handle what comes in----and know how far it is to the nearest Level 3 facility should you get a really high risk mom or baby. Transfers will happen, know what to do. Know STABLE like the back of your hand---and hopefully you are really good at baby IV's.

Ask them a lot of questions before you do this----rural nursing is really, really challenging. I know that first-hand. It can also be rewarding. You will be surprised how different it really is, and expected to be more of a jack of all trades, likely.

Just don't put your neck out too far.

SuperFlyRN · Mar 24, 2006

Just wondering if anyone can share some experiences with small Labor units. We are moving to a small mountain town and the hospital that i'll be working at does around 10 deliveries a month. I'm used to 300++ a month. Apparently I will only be on-call until a labor comes in, then I labor, deliver, recover then go home. I've been told a full 12 hour shift is rare. RT comes to every delivery in case you need help with NRP. What are your experiences with this type of situation. I need to ask them more questions but immediately I think of the following questions...
*What if I have a prolapsed cord???
*What if baby takes a huge dump and it is taking too long to recover, do I leave mom's bedside to make phone calls, pull meds, prep for OR???
*What if I have a really bad baby with complicated, undiagnosed issues. I suppose i'd call ER for help. (Had a baby once with a webbed trachea, didn't do well)
The nice part is its one on one nursing care.
Anyway, your thoughts.....
Thanks.

Wow-those are good questions and definately ones to be asking admin/management before the situation happens. Do you mean you will be working totally alone-the only L&D nurse there? Definately an asset to have someone with NRP experience. I would make sure all your concerns are answered.

But the one-on-one not assembly-line-type nursing would be nice.

**canoehead, BSN, RN** · Mar 24, 2006

I worked an L&D unit and was often the only RN. The supervisor was NALS certified, but not confident so you had to do a lot of delegating. Everything was in the room so you could go from a normal labor into C section prep or concious sedation without leaving the room but you must check your equipment before the delivery obsessively. In a dire emergency I had the supervisor, pulled a floor nurse, and the ER doc until we got the OR crew in (bleeding previa). You need to be able to keep an eye on everything at the same time, and move from one thing to another quickly. In an emergency leave the moniter running and chart (or tell someone to chart) on the strip and you will have an accurate timeline.

Remember you will get only healthy moms and babies, and that in the event of an emergency you should have a phone in the room and a Dad that can use it to dial the operator and page emergency assistance to the delivery room. With your experience you will be able to make a big difference to those that do go bad. Preparing for the worst wards off evil spirits. You may enjoy the autonomy, so I recommend you give it a shot.

fergus51 · Mar 24, 2006

I worked briefly in such a place. You had all the supplies in the room, and could get help from ER or the floor if needed. They often weren't L&D competent, but could be relied upon if you delegated specific tasks. There was a cord on the wall you could just pull out if it was an emergency (our code pull sort of). You didn't need to leave the room.

SmilingBluEyes · Mar 24, 2006

You may or may NOT get only healthy moms.THat is why you need to know how close it is to the nearest level 3 NICU and L/D unit. If you get a high risk patient who is unstable, and the nearest tertiary care center is too far, you will be taking care of them til they are stable enough to ship. I sure hope you have a good peds on hand to help out.....

Well in my situation, I was 135 miles (as a crow flies) from the nearest tertiary care center in OK. Guess who got stuck trying to stabilize 25, 26 or 27-weekers that would not wait for bad weather to clear, and helicopters/LifeFLight to come and get 'em????

LizzyL&DRN · Mar 24, 2006

The nearest high level (level 4) is only a 30-40 minute drive down the mountain at Loma Linda University hospital and a much quicker flight if avail. I plan on discussing all my concerns with the director of the unit. I really am excited about trying it out. The assembly line nursing is getting a bit old. I probably only get a chance to really connect with 1 in 5 of my patients due to staffing issues and the volume of deliveries we do. We are always running, running, running where I work:uhoh3: . Obviously the moms that come in are supposed to be low risk, but how many times have you seen a low risk mom go to high risk quickly?(retorical question) I love high risk, so i'll probably do a per-diem shift at Loma Linda to get my high risk fix every now and then. The part that scares me the most is those babies, I have never started an IV on a baby, we have NICU for that where i'm at.

fergus51 · Mar 25, 2006

In some smaller hospitals the docs will even start baby IVs. In my experience, nurses who don't start them often on babies will not be able to get them in on a severe premie. That's why God invented ua/uv lines:) Plus, if you have any warning that you're getting something bad, the NICU's transport team will be there fast.

SmilingBluEyes · Mar 25, 2006

Yep exactly, Fergus. ON very small or fragile preemies, our doc did put in UAC--- we just assisted. I just found this all un-nerving......see, you cannot control who is wheeled or walks in your door and once these folks are there, you are responsible. I have plenty of stories of women delivering preemies in the toilet in our ED or 28 week twins, ruptured sacs, one baby half out, kind of stuff.

I just really felt uncomfortable dealing w/situations like that in such a small hospital w/limited experienced staff. The ED docs wanted nothing at all to do w/all this (of course). So it was usually just the supe, us and the ped trying to cope til LifeFlight came to our rescue.....

Having a higher level (level 4---can't say I have heard of that) facility very close is definately a good thing, indeed. I felt really "out there" where I was....

fergus51 · Mar 25, 2006

I'm the same way Deb. Until I started a NICU job, those babies absolutely terrified me. I just didn't have the training to really help them and it was scary.

BTW, Level 4 is what some people call a nicu that does ecmo. I always called it all level 3s, and we used level 4 as slang for heaven.

SmilingBluEyes · Mar 25, 2006

oooh ty for the education Fergus. I always learn something new here....

Anyhow I think the OP is probably sick of hearing my take on this. If others have other stories, please chime in.

Just be sure you ask ALL these questions------and not stick your neck out too far. My best advice...

fergus51 · Mar 25, 2006

I learned it here too because another poster chastised me for saying level 4 meant heaven:D