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Typical day at the postpartum unit and precautions

Posted

Hi, guys! I'm going to an agency assignment tomorrow as a new grad to postpartum unit. I've never worked a day in L&D and scared as heck.

Could someone please tell me what I'm looking forward to and what I need to look out for? I would like to know the progress of a typical day also. Thanks in advance for any advise. It would be a life saver!

doularoz

Specializes in NICU. Has 6 years experience.

Since new moms are usually not sick you are looking out for abnormal things in mom and baby. Make sure mom can empty her bladder withou diffuculty. Abnormal vs in mom and baby esp temp and resp in baby. Babies can go bad even if they seem ok the first day you want resp 30-60. Above 60-70 and they should not be fed po bacause there is a risk of aspiration. Report abnormal vs to a coworker that knows unit protocals. You also need to make sure they are not cold. Parents tend to leave their babies very loosely wraped and they get cold easily. PP moms have hot flashes and they assume the baby is as hot as they are. As far as the moms go you need to check for pp hemorrhage and uterine atoney. There should not be big clots or gushing when you press on the fundus and the uterus should be midline and at the umbilicus or below. This is a general rule some people do vary. Hopefully you will have a resource person and I would ask about anything I am not sure about. The other thing you should watch for is s/s of preeclampsia. This can occur during the postpartum period. S/S are increased BP, swelling, clonus, headach, visual changes and epigastric pain. This doesn't usually happen but it can. Good Luck

Thank you so much for your advice, Doularoz. I never thought that I would be responsible for the baby too. Now I'm going to look over newborn assessment also. I'm so glad I posted the question even late since I got this very valuable info out of it. I'm going to check this board once more before I go to work tomorrow morning so if anyone has anything else to add I would greatly appreciate it.

Scared newgrad :imbar

Don't be afraid to ask questions and find out what your particular unit will expect of you. You will not be involved with any L&D. You should NOT be asked to attend any deliveries to do baby unless you have your neonatal resuscitation certification. Take it wasy. being a new grad and a traveller will not be easy. Don't be afraid to say "I don't know" and don't let any nurses put you in awkward situations. Usually agency nurses have previous experience. make sure you are not puting yourself on the line legally. remember, your license is at stake. I am not tryng to scare you, but to make sure you protect yourself.

Thanks for your advise, betsrn. I completely agree. To my relief, the shift got cancelled. They did try to make me go to postpartum unit at another hospital. I declined. I took this assignment because I felt obligated to take it and the staff coordinator at the agency sorta bullied me into it. I do feel that it's crazy to be in charge of patients when I haven't even had one day of training. Which unit do you think is less challenging for a new grad? I have two years experience at the LTC as a LVN and almost two year experience at a home health agency as a LVN. I'm starting orientation at an ICU from Dec 13th but until then I need to make at least a little bit of money. Any ideas?

I am wondering about your registry. Personaly I will refuse to be team leader/charge if the registry sent me a new grad. IMO ALL registry/traveler nurses need to have a minimum of 1 year experience working in whatever department they plan on working registry in. I read that you have LVN nursing experience in LTC. Perhaps you can request assignments only with this patient population for now. Having your new RN now is a completely different world of skills and responsibilities than your LVN. I am glad to hear that you will be starting orientation in ICU next month. Ask yourself this "Am I willing to risk my new license (not to mention patients lives) for a few dollars". IMO if you have to be asking what to expect/how to assess/care for patients for work tomorrow.......don't do it! I'm not trying to put you down....in fact I admire your initiative to start working. This in itself shows that you want to work and will probably do quite well in your career. Good luck.

Occasionally when we are swamped, we have a seasoned med-surg nurse come from another floor and help us out with our postpartums and even then, we have to orient her a bit (but we never leave our helpers hanging anyway). Personally, I don't think that any new grad should ever consider working for an agency. Without experience, I think you are really putting yourself at risk (not to mention your patients and colleagues). I also feel that any agency that "bullies" you is no agency to associate with. I would either NOT work at all (if that is at all possible) or find out if you could start your ICU orientation (I assume that is going to be a permanent position) a bit early. You will have to do the general hospital orientation before you start in the ICU anyway. If you absolutely have to do something for $, I'd do the LTC as it sounds as if that's where you have already worked as an LPN already. You only have 3 weeks to wait to start your new job anyway. Good luck.

Thank you all for your concern. I really do feel bullied or at least pushed into taking the assignment and will reconsider working for the agency. The staff coordinator was such a personable lady that I tried not to think of it as bulliying but rather encouragemnt. I personally know of a few new grad RNs that have done well working agency but I don't want to risk my license let alone my patients' lives. I will continue to work as a LVN in my LVN agency for the time being even though I will be making much less $$. I know I can do LVN job comfortably. I get so much support when I ask for advice in nursing forum and really wish we were as well behaved as we were in our work places not be a part of a young-eating prefession. :chuckle

Now that you are an RN, why would you work for the agency as an LVN?

I'm talking about continuing to work for the agency I used to work for as LVN. Since I really shouldn't be working at an RN agency as a new grad I still need to be making some money until I start my perm. The case I used to work full time has a couple of days available this week that I'm gonna pick up. I've managed to squeeze (literally) $2 more than I used to make so it's better than nothing. :chuckle I wonder if I need to sign the chart as RN or continue signing LVN. This is a LVN job afterall. What do ya think?

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

I'm talking about continuing to work for the agency I used to work for as LVN. Since I really shouldn't be working at an RN agency as a new grad I still need to be making some money until I start my perm. The case I used to work full time has a couple of days available this week that I'm gonna pick up. I've managed to squeeze (literally) $2 more than I used to make so it's better than nothing. :chuckle I wonder if I need to sign the chart as RN or continue signing LVN. This is a LVN job afterall. What do ya think?

Check with your employer and your State Board of Nursing. If you are in posession of an RN license, then that is the standard to which you must perform legally.

If you have not yet been issued an RN license, then you must continue to identify yourself as an LPN, and function as one.

Good luck!

If you are a licensed RN, then you should identify yourself as one.

It would feel so weird to sign RN next to my name now. Sorta excited to... :chuckle Since this is a case I used to have as a LVN, I wonder if other shift LVNs would think I'm trying to show off or something. :uhoh3: But I'm sure they know me by now (I've been doing that case for over a year 1/2) and won't think anything of it.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

It would feel so weird to sign RN next to my name now. Sorta excited to... :chuckle Since this is a case I used to have as a LVN, I wonder if other shift LVNs would think I'm trying to show off or something. :uhoh3: But I'm sure they know me by now (I've been doing that case for over a year 1/2) and won't think anything of it.

It's not a matter of showing off. It's a matter of properly identifying yourself according to the terms of your State Nurse Practice Act, and then performing to the standards required by your education and licensure.

I completely agree with you. :)

SheaTab

Specializes in RN Education, OB, ED, Administration. Has 6 years experience.

A good thing to remember for postpartum assessment is BUBBLE HE:

B- Breasts: nipples sore, cracking, etc.

U- Uterus: fundus.. midline, firm, at what level in relation to the umbilicus..

B- Bladder: Can you void, burning or pain, etc.

B- Bowel: BM... I shudder to think! OUCH! Bowel sounds after a section.

L- Lochia: Typically rubra; flow: scant, small, moderate; no foul odor, etc.

E- Episiotomy- approximated, clear

H- Homan's

E- Emotions

AND... Lord, don't forget PAIN!

Cheers!

KRVRN, BSN, RN

Specializes in NICU.

You should sign your name with the RN title. I also think that since you do hold an RN license, you would be expected to perform to the scope of an RN. You also deserve to be paid as an RN if you will be expected to perform as one.

Thank you for the great advice, SheaTab. It's really a great way to assess post partum patients!

Congrats on your baby girl to be, KRVRN!

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