Friday, August 29, 2008

Being The "Baby" Nurse

Whenever I tell someone that I work in L&D they 8/10 say "Oh, you're a BABY nurse!" Wrong. I am not really a baby nurse, I am a "mommy" nurse. True, lots of what we do depend on the baby, and until the baby is actually "outside" we pay lots of attention to Baby, and we make lots of decisions dependent on Baby...but, in the long run, we are the nurses that take care of the MOMMY. Lucky for us, the hospital has found it beneficial to hire an entire set of nurses that specifically take care of Baby once it is in the big, bad outside world.

Well when new L&D nurses start on the floor, the people in charge have decided that we should all spend a day working with the Admit nurses from the nursery to learn what to do if in fact one of the "baby nurses" doesn't make it to our delivery. My hospital is the only hospital that I have found that is cool enough, safe enough, smart enough, etc to require a NICU nurse to come to all deliveries and be present when the baby is actually born. Any other hospital that I've been in says that "we call a nursery nurse if we need them..." but here, they come the same time the docs and scrub techs come to the delivery. They're a normal part of the team. Now when we're as busy as we have been lately, it occasionally happens that a NICU nurse may not have a chance to show up for a delivery 'cuz we're having so many of them, hence my day in nursery...

So I got to follow the admit nurses and help with deliveries. There were lots of deliveries, but I only got to go to about half of them because we had our first group of nursing students today too, so there was a nursing student also following the admit nurses. I got to do lots of nursery when I worked last summer, so it wasn't really anything "new" for me, so I let the nursing student get her fair share too. It was interesting to have a student remember that I was in her shoes just two years ago. Crazy...
Babies today: 3M/1F=4
Babies total: 9M/4F = 13
Vag: 7M/4F = 11
C/S: 2M

Wednesday, August 27, 2008

Kinda Sorta On My Own

So I got a little more taste today of what it was like to be "on my own." I felt pretty independent, with someone right there if I needed anything, but the nurse that I worked with (it was J's day off) was awesome about being there when I needed her, but otherwise saying "let me know if you need anything!"

I did a PIH eval almost totally on my own, 2 recoveries really on my own, and I got to do a lot of a labor with minimal assistance. Well, probably more assistance than I realized, but I really did feel like it was "my" patient. I'm sure that in a few months I'll be wishing that I had someone to help me and check up on me, but right now, I'm kinda enjoying the somewhat-independence. All then nurses are great at encouraging me about everything, but N is great about saying "see, you know how to do this." "You know more than you think you do." I need to hear that, and hearing if from more than one person is what really starts to convince me of that fact. There were just a few things she had to remind me of, and I did lots of the charting by myself, and talked to the docs too. I can't wait until that's just routine and I don't get so worked up about it. I swear I get tachycardia every time I have to talk to a doc on the phone or in person. I start stumbling over my words and I totally forget everything I had thought out to say. Then I look really dumb!

Our labor patient was a lot of fun today, she's a nurse too, so she was very understanding. When I blew her IV she didn't bat an eye and she was fun to talk to and it was obvious that she knew what was going on and understood what it was like to be a nurse.

I'm in nursery tomorrow...I hope it's busy, otherwise it can be a long day. Maybe I'll get more of my orientation manual filled out. Now doesn't that sound fun!

Babies today: 1F
Babies total: 6M/3F = 9
Vag: 4M/3F = 7
C/S: 2M

Monday, August 25, 2008

Craziness and Happy Drugs

So I really am still here...just been so exhausted this is the first time I've taken time to sit down and think about everything that's happened. Last week we did more ante's...but after Wednesday...we're done with them! It all went crazy on Tuesday, when we walked in and ended up taking a 35.4 weeker over to the main OR to take out her appendix. She had this "excruciating" pain in her abdomen that wouldn't go away, and her WBC count was 21, so after a bunch of surgery consults we roller her, a big 'ole baby monitor cabinet and a c-section kit (just in case) over to the main hospital for an open appy. Usually they can just do it laproscopicaly, but since she was more than 20wks pregnant, they actually had to cut her open. So J and I had to sit over there for the entire hour case and watch the baby's heart rate. It was cool though, they didn't give her general anes because that wouldn't have been good for baby, so they just did a spinal epidural like they would do for an epidural. That same day I went up to 6th floor (psych) and did a NST up there. I was a little scared that they might make me stay...

So we worked again on Wednesday...and I swear, J and I gave so many narcotics I left feeling like a street corner drug dealer. We had appy girl who still was rating her pain a 10/10, even though she still had her epidural. She refused to move much, at least when anyone was watching her b/c it "hurt too bad." It was quite the drama show...she'd be sleeping until someone would walk in, then her pain was a 10/10. I'm sure it hurt, but a 10/ can't sleep when your pain's a 10/10. Se got her spinal weaned, then she was popping handfulls of percocet and we were giving her morphine every hour. Right before I left I finally convinced her to dangle at the edge of the bed and pulled her epidural. It's a circle, and people don't understand. It hurts, so you don't move, so then you get stiff and your "problem" doesn't heal, so it hurts, so you don't move...I know it hurts people, but bite the bullet and'll help in the long run, I PROMISE!

The same day we were handing out narcotics to appy girl, we had a girl down the hall who had gallstones. You can't take that out during pregnancy b/c of where it is, so she's in for the long haul. But she's rating her pain a 7/10...all day long. Even with a continuous morphine PCA and then a dilauded phenergan and benadryl and zofran. TOO MANY DRUGS!!! I ran around so much on Wednesday, and I heard so many people complain about pain, and had nothing work to make them feel better that I was almost crying when I left. Not crying because I was upset, but crying b/c I was just tired of dealing with people's problems and not having anything work that I was just fed up! But then after work I drove to Manhattan for 3 days, so everything was good. We did find out that right after we left, appy girl's doctor gave up on the pain source and delivered her anyway...

So then I worked the weekend. J and I decided we were way done with ante's so bring on the labor patients! Saturday we had a nice little Indian couple who had a nice delivery. Mom had about every complication except for PIH...GDB, IUGR, GBS+...oh brother! The worst thing about the whole day was that neither the mom or dad wore deodorant...oh dear! But baby was super cute, and my 1st girl :) It's about time! We did a couple triage's after moving the first couple over to Mom/Baby, so that was good. Triage teachs me a lot, and they really hone my assessment skills.

Sunday was just as busy as Saturday. It didn't help that when I woke up my clock said I rolled into work about half an hour late. Not bad considering it takes me a good 25minutes to get to the hospital. That's one sinking feeling in my stomach that I don't mind if I never feel again. J just laughed, but I felt horrible. I guess when she told the family that I was running late, they said "maybe she's just hung over." J thought that was pretty funny.

So the multip that we started with delivered by 0900, and we had her moved over about 1045, then had another patient waiting for us. Primeip who thought her water may have broken about 2000 the night before, but then thought she just peed, so stayed at home, and felt more leaking Sunday morning. Oh brother...she was ruptured, and now everyone's worried about her getting a temp for prolonged ROM. She wasn't really in labor, and even after 6 hours on 20mu of pitocin, she still hadn't changed, so when J and I left she was getting ready to head back to the OR for a primary C/S. That sucks for her. I guess some pelvis' just aren't made to push a baby through, or maybe hers just wasn't ready.

Two days on, now two days off. It's nice to get babies again!

Babies Today: 2F
Babies Total: 6M/2F = 8
Vag: 4M/2F = 6
C/S: 2M

Saturday, August 16, 2008

Is it Uterus's or Uteri?

So Friday we got a little comic relief from my new favorite patient. We had 2 "custodial" ante patients who are in for the long haul, plus an induction who wasn't on the books, then a couple triage's later in the afternoon. Had an great vag delivery which kinda made up for the mess on Wednesday. The Mom and FOB from the fetal demise on Wednesday came over to see us before we left for the evening and brought over handwritten thank you cards. That really meant a lot to me. I didn't know what to say to them on Wednesday, but they were grateful for what I did. If I could do anything to make their loss just a little easier, and helped give them some memories of their baby boy, then I did what I needed to.

Anyway, so this patient comes in because when she was at the office her doctor told her she was dilated to one and she was a scheduled for a repeat c/s 'cuz the baby was breech so she didn't want her to go into labor. Anyway, so we get her all settled in and J went to check her, and before she did, the patient said "now just a heads up, I have uterine didelphys, so check the right one." I have totally HEARD of this, but never actually SEEN it. There are different "degrees" of it, but this particular patient had two cervix's two separate uterus' (or is it uteri) and a vaginal septum. She was totally cool about answering questions and said that the first time she ever went in for a pap she had more visitors than ever 'cuz all the staff who'd never seen one wanted to see what it actually looked like. I didn't get to check her, but J said it was about the weirdest thing ever, and when she felt the baby's feet that totally weirded her out too. Long story short, the gal got to go home, but I totally want to be her nurse for her section in a few weeks!
She told us some great stories too, but since this is a PG blog...she did say she has to tell her husband at times to "just pick a side." J and I were rolling. It was cool to feel her stomach, you could feel the baby on her right side, but then her left side was soft and "normal." If you put the US or toco on the left side, it was the same empty hollow sound you'd get if you put it on any random woman's stomach. It was cool. So chalk that up as something else I'd never seen before. I swear, only a L&D nurse would be bemoaning the fact that this lady didn't have a block, because I would totally have been all over checking that cervix.

Babies Today: 1M
Babies Total: 6M (I need some girls!)
Vag: 4M
C/S: 2M

Thursday, August 14, 2008

Life Isn't Fair

I've been thinking a lot about our fetal demise yesterday. This wasn't my first demise that I've helped with, but it's the first one that has been anywhere near term, and the first one that was actually considered alive at delivery and then died later. I guess the technical term is "expired" but that to me sounds like a gallon of milk being past it's expiration date. This is a baby, not a gallon of milk.

When Mom and FOB walked in yesterday it just hits you "THIS ISN'T FAIR!" Mom was only 21, and her first baby and she looked so young and innocent, and yet so grown up and calm and collected. I know when she walked in she was still denying that her baby wasn't going to make it and she had this secret hope inside that everything was going to be ok. When we asked her the typical "why are you have a primary c/s" question, she didn't say it was because the baby was breech, or that the baby was going to die. She said "because the baby's head is too big to fit through my pelvis." Just like it was a normal problem that lots of babies had. I didn't see a tear or really hear her say much of anything the whole pre-op process. As her nurse, what was I supposed to say? I haven't decided if it's best to dive right into the whole "I'm sorry your baby's gonna die" speech, or if it's best to wait for them to talk about it first. If I don't say anything, then I feel like I'm just avoiding the subject, and I know that's not really the right thing to do either. But shoot, it's not an easy conversation or subject to bring up!

When the baby came out in the OR, the body came out and it looked totally normal. Baby was breech, so they got the legs, butt, arms, torso, shoulder out, and then the head kinda got stuck. From the US's we knew baby was going to have hydrocephaly (fluid on the brain so a swollen head), but it took lots of pulling and lots of fundal pressure to finally pop the head out. The head was very enlarged, and the body was limp and floppy. The eyes were wide open, but they never moved, never blinked, just started. There was never an attempt at breathing, but the heart beat for 2 hours. It's not fair.

I felt so sorry for the FOB in the OR. He totally broke down and just sobbed in the corner. Mom's dad was in there too and was taking pictures of the baby like any proud grandpa, and I never did see him cry. I was so proud of the FOB, he held the baby and sat by Mom and they cried together.

I remember when I didn't pass my boards and I felt totally empty inside, like everything I had worked so hard for was totally gone and nothing would ever be right with the world. Dad told me that maybe this was God's way of helping me to identify in just a small, small way with the Mom's I would work with who lost their babies. I didn't really think I'd be able to try out that theory so soon. I think he was right though.

I can't decide which of the horrible situations would be the "best" either. To know all through your pregnancy that your baby wasn't going to survive after they were born, or to go through your full pregnancy, or even part way through your pregnancy, go into labor, and then find out...I pray, pray, pray that I won't ever have to really find out. I just wish I knew what I could say to help those mom's in some small way. I know after boards, no matter what anyone said it didn't really help. Everyone was so kind and said the "right things" but there just isn't really anything you can say to make it better. But saying nothing isn't the right thing to do either.
This is the part of L&D nursing that just makes no sense. While there's nothing like seeing a baby come into this world, there's nothing like seeing one slip out either. I wish we could have one and not the other.

Wednesday, August 13, 2008

Just A Little Overwhelmed...

I am way glad that I don't have to work tomorrow. After today, my head is spinning and I need some time to sit and think though everything that I learned and absorbed and experienced today. I told J today that I don't need anything else on orientation, because in the last 2 days, we have done everything. We did ante's and a vag delivery/recovery yesterday, we did a scheduled section today, and then we did a non-scheduled section for a fetal demise that totally just finished off my day today.

I should have known that today was gonna be crazy. I thought J and I had gotten everything lined up to do ante's for a while so that was totally what I was expecting when I walked in, but no, we were scheduled for the 0900 c/s. That's cool too, I really don't HATE doing much of anything around there, I need practice at it all. So we got our little primip ready and as we're getting ready to walk back, the doc calls us from the main OR and says that his 0730 case got bumped b/c of a staff meeting he forgot about, so it wasn't gonna start 'till after 0830, so we didn't end up in the back 'till after 10. So baby #1 for the day. Section went fine, we caught a missed lap and he had to go back in and dig it out and reclose her up. I guess those things do happen in real life!

So things got interesting when we were about 30min into our 2hr recovery and we hear that there's a patient coming over from an office that is ruptured, and breech and has known multiple fatal anomolies. So who's gonna do her section? Of course J and I will!

Poor J, she gets a million and one props. She is the most amazing nurse ever. She takes whatever is thrown at her and just does it, and does it right, and makes it all look so easy. I don't know how she does it all. I got a crash course in C/S charting today, and poor J's trying to take care of two patients, look over my shoulder while I'm sifting through the chart and explain things and being the most amazing preceptor and she still gets it all done in less time than it would take a regular nurse, and you never hear her complain about it.

I think that everything that I got to do for the 1st section made me a tiny bit more helpful on the 2nd section. The 2nd case was just a mess, with no papers filled out, the family didn't really know what they wanted done with the baby after delivery, they were still in denial I think. There wasn't good doctor communication which made everything just all the more hectic. Nobody really knew exactly what was going on until it just happened.

The baby had hydrocephaly, it's head was 45cm around. They weren't positive what was wrong with it, but I think ti was something genetic. Mom was only 21, and this was her first pregnancy. She was 36.4, so not even full term, but baby looked so perfect except for the big head. When he came out he had a heart beat, so it was considered a live birth, but he made no attempts to breath. He had a heart beat for almost 2 hours afterwards. Things like that just tear me up. I didn't actually cry at the hospital, but I think I was so wrapped up in the charting and just the overwhelming everything that I was focused, but it's kind a hitting me tonight.

J had to leave at 1600 and so another nurse came on, and then there were 3 of us back there, and I was in the middle of it. When J was there it all seemed to be going pretty smooth, but then when she left I felt like it kinda fell apart. So then from 1600-2000 when I left, it was just chaos, and I'm not really sure that everything got done, but I felt like I did ok for myself. I was actually left back in the recovery room with the patient, baby and everything for an hour while the other nurse went to a meeting. So I got the photographers in there, got more paperwork filled out, rounded up another nurse to help me and got lots of ends tucked up and finished all on my own.
I was so spent and worn out by the time I left. I called Jennifer and she asked me how my day was and I said "well, I LEARNED a LOT." I wouldn't say my day was great, having to help a family though the loss of a baby they never really to a chance to know is never "good," but I feel like I really learned and got to do a ton. I think that's the best way to learn...sink or swim!

Babies today: 2M c/s
Babies total: 4M
V ag total: 2M
C/S total: 2M

Tuesday, August 12, 2008

Ante's for the Long Haul

So I knew even before I started orientation that there are 3 basic parts to being a labor nurse: antepartum patients, labor patients, and C/S. Of those three, I'll take anything that gets me at least 1 delivery on my shift, but I'd much rather have a labor patient all day and end with a vag delivery than do a scheduled C/S, and I'd rather do ANY of those than do antepartum patients. Not that it's the patients that I mind, but come on, if I wanted to do antepartums I'd work on MedSurg or something. It just doesn't seem any different to me than sitting around and doing NST's all day. Some nurses love it, and I give them 3903 props for that, because I don't have that kind of patience. I love labor because something's always going on, there's just enough adrenaline to keep the whole 12-hours interesting, most of the time.

Anyways, so today was my first day with J and for some reason nobody remembered that, so she got 3 ante patients. Bummer...but then we decided that we'll just do those to start with and get them done, then move on to the "exciting ones." We started out with 3 names, we had one sent home by 1030 and another gone by 1230, and before the first one left, we helped another nurse get an epidural in a patient, and then ended up keeping her and delivering her about 1600. That's cool with me! Poor J, I curse her every time I work with her!

It was cool though, I really felt like I did a TON with our labor patient. I did almost all the charting and felt pretty on top of it. I know that MedSurg nurses, etc are turned loose with like 6 patients within 2 weeks of orientation, but somehow this seems different to me. So I did a ton with our labor patient, and then in the midst of all that we kinda admitted and discharged another patient that I did almost totally by myself. I always feel "in charge" of a patient when I get them from the waiting room, take them back, hook them up, do their little interview and really find out what's going on with them and stay on top of it from the beginning. When I can start a patient, then I feel like they're mine. I'm a very possessive person...and I think that's gonna be one of my biggest challenges: learning when I've got enough and not trying to do everything. Learning when to say, "no, I can't safely handle that patient load" because I want to do all the exciting stuff, I have to learn to slow down and just do what I can. Bad labor nurse Beckie! But I'm learning, and I felt like I learned to multi-task and still handle it today...that's cool!

So I guess the next couple weeks are gonna kinda be just "ok" and not all that terribly exciting with all the ante's, but I'm sure I'll learn lots, and it'll get them out of the way. Lots of triage and some stuff that really could turn into big problems if it wanted to. But go with the flow, it's all about learning at this point, and it's all part of the game. But I got my baby today, all 8#14 of him...that's a good size baby for an 18-year old...but more on that later.

Babies today: 1M
Babies Total: 3M
Vag: 3M

Friday, August 8, 2008

Birthday #2

How uncreative of a title is that...but at the moment that's all I can think of, so I'm sticking with it. I don't know why I'm so exhausted, but I'm getting ready to lay down and take a nap that I've been thinking about all day. I think I may die when I actually have to work a 12 next week...maybe I should try getting some sleep the night before and see what happens.

I worked with a different nurse since J wasn't there today, which was totally ok but I'm ready to work with J next week. I really enjoy working with N though, she says it like it is and she's great at making me feel like I'm the one taking care of the patient, not just standing in the shadows. I was more than a little bummed and worried about how the day was gonna go when things didn't start off too hot with 2 missed IV sticks. The first one was totally crazy and bled fine until I tried to draw labs, then it clotted or something and I couldn't even run the fluids though it. The second vein disappeared when I did the lidocane, so N had to put it it (we have the 2 stick rule). I think it kinda frustrated the patient and her husband and even more so her husbands' mom. I'm pretty sure they wrote me off after that, but they came around by the end. Must be my very charming nature...ha!

I figured we were in for a long day after the bad IV's, and then when the patient was asking for an epidural before the Dr. even showed up around 0830. This was baby #2, so everything was compared to last time. Even the "long" pushing of 30 minutes she did the first time ;) I must say, I've never seen a dad more interested in the delivery process. I've seen lots of great support coaches and comforters, but he was all up in everything, not in the way, but just very involved. He wanted to watch the epidural and when we put her up to stirrups he got all ready and put gloves on and wanted to stand where he was right next to the Doc, so we gave him the AstroGlide job. It was cool, and his wife was ok with it too. Their 1st little boy was adorable and kept us in stitches all day. He was pretty excited for his little brother, and ever time Mom would have a UC or we'd turn her, he'd come over and say "I love you Mommy. Are you ok, Mommy?" It was so cute.

I had a short day again today and was only on the floor 'till about 1230, then again from about 1315-1500, trying to avoid overtime. I made it to the 1337 delivery though! I like deliveries with Dr. L, he's a good doc and really good to the patients (at least from what I've seen).

So 1 baby today, plus a hand in a few triages so that wasn't bad. I did lots of paperwork, and I think remembering the charting is coming back slowly but surely. I get most frustrated with myself because I have to stop and think about every step that I'm doing. It seems so natural for all the other nurses, even the newer nurses make it all look so easy, but I feel like I'm bumbling around and always forgetting something and just always a little off kilter. N and J always assure me that it will come with time, but that I have to give it time and not expect it to be 2nd hand right away. But time is the hard part!

Babies today: 1M
Babies Total: 2M
Vag: 2

Thursday, August 7, 2008

Welcome To The Rest of My Life

***Forwarning...I tend to ramble when I type, so my feelings won't be hurt if you just skim the blog and read the interesting parts. Happy reading!***

To make a long story marked the beginning of the rest of my life...the rest of my life that I've been waiting the last 22 years for. I guess I'm officially still on "orientation" until the end of tomorrow, but today was my first shift on the floor as an official NURSE! Not just a nurse, but a Labor & Delivery nurse...on the same floor of the same hospital where I was born. That's kinda a cool feeling. The nurses that have been there since before I was born don't like it when I mention to them that they could have been my mom's labor nurse, and now I'm coming back to work with them, but they let me hang around anyways :)

I just graduated from nursing school this past May, and this has truly been the longest summer of my life. I didn't pass my state boards the first time I took them in June, so then I had to wait a torturous 45 days (and really, it was torturous) to re-take them. After another test that included all 265 questions, I was postitive I failed, but God still works miracles, and I found out last Friday that I passed...and all I got for it was a piece of paper to put in my wallet...haha!!

I've been in orientation all week, and I'm not really sure that I learned a blessed thing, but I got paid for it so I guess it could have been a lot worse. Since I've been an employee at the hospital for the last 6 years in various positions (Child Care, Nurses Aid, Internship, etc...) I got to skip all the 'general' orientation, but I've been there and re-learned how to work the computer system, how to run an IV pump, I've gotten yet another tour of the hospital (I've given those same tours, but I guess this was just a refresher course), and I've listened to lots of information that I probably will never use on L&D, but at least I'll have it for reference in the future!

Today was the first day that we were allowed to "try out" the unit that we're going to be working on. I think the other new RN's in my orientation group were going to learn where the time clocks were, where the bathrooms were on the floor, maybe how to work the beds, all that fun general stuff that you get when you're doing good when you've figured out how to get from your car to your assigned unit. I got to jump right the the fun stuff---delivering babies! I did a 3-month internship on L&D last summer, and I did my senior preceptorship on the unit for a month in April, so this was just another play day. I love what I do, so to me it really is like a play day, I look forward to it! 12-hour shifts are long, but when you love what your'e doing, it's not really work...right?

The same nurse is preceptoring me for the next 3 months that I worked with last summer and in April...and what would you know, my first shift as an RN and she wasn't there today :( But there are so many amazing nurses up there that one of them said it was totally fine if I was her shadow today. I only worked an 8-hour day (heaven forbid I get over 40 hours this week!) and I still got my first baby as an RN!

Amazing couple, even if they hadn't been my first family as a new nurse they would have gone on my list of favorites. This was their 2nd baby, they were totally relaxed and laid back. I spent most of the day today in the room just chattin' it up with them. Totally cool. She was great about everything and she had a great delivery. I told her she needed to have him by 1600 because that's when I left. She came through! 1556, 9#3, 20.5in long. That boy had a head full of hair! He was so cute as a 1minute old baby can be I guess. We had about a 45sec shoulder dystocia...boy when those happen they seem longer than a few seconds...I wouldn't mind having patients like them every time, but I know that's not the case more often than not. But my first day, my 1st baby as a "Real Nurse" I can't complain!

Babies Today: 1M
Total Babies: 1M
Vag: 1