Tuesday, September 30, 2008

356 Babies or Bust!

I had the best patient today that I've had in a long time. It was a great way to come back to work after a few days off, and a good vacation in Branson. J and I were slotted for 2 inductions. One multip pit induction at 0700 and another cervidal from the night before. The board was crazy (what's new...) and there was no way we were gonna be able to handle both of them, so J took the cervidal and I took the induction.

I was pretty proud of myself overall for the day, much better than the last epidsode I had at work. I love the doc that we had, and the couple was as nice as could be. Lots of fun, great at interacting with eachother and with me. They were wide open for anything and when baby was born at 1109 everyone was surprised! One of my favorite things is when the parents don't find out the sex of the baby. It makes it awkward calling the baby "it" all day long, but it's so fun to see the faces of Mom and Dad when they find out if it's a boy or a girl at delivery. It's like opening Christmas gifts! this was the kind of couple I pray for every morning as I'm walking into work. I wish all my patients could be like that :)

I sat around and did 3 triages this afternoon, I'm getting pretty good at in, pee, monitor, call doc, computer chart, and send them out the door. I had one girl in, assessed, monitored, and out the door in 57 minutes from the time she walked into the building. I was pretty impressed with myself!

Back for another fun day tomorrow. We were actually all hoping for new patients today, since it's the last day of the month we're number crunching and we are gonna be within 1 or 2 of an all time record, 355 babies in one month. I know that doesn't sound like a lot to normal people who, according to the president of the college I went to, thinks that all there is to a delivery is "popping a baby out" or even to those nurses who work in a big teaching hospital where 500 babies a month or so is totally normal. But we aren't THAT big of a hospital, we have 17 labor rooms and only 9-10 nurses staffed on a GOOD day shift. We've had days this month where we've delivered 15-18 babies in a 12-hour shift...that's everyone pulling a lot of weight! So we're gonna be pretty excited if we break our record. The managers were even talking...drumroll please...PIZZA! Not that we'll have time to eat it or anything ;) So it's up to night shift, let's hope they can sneak in another 3-4 babies before midnight!!!

Babies today: 1M
Babies total: 17M/14F = 31
Vag:11M/13F = 24
C/S: 6M1F

Friday, September 26, 2008

Leader or Follower?

I love reading other people's blogs, I think it's cool to be able to read what's going on in other people's lives and think that these stories are really happening...right now! I follow most of the blogs listed in my Blog Roll, and I just added a spot to show the people that follow my blog and read my stories! So, if you like reading about my adventures, let me know and add yourself to the "Follower's List"!

Thursday, September 25, 2008

Do I Really Know What I'm Doing?

So yesterday was the first time I really wondered if I'm ever going to be a Labor nurse like the nurses that I look up to. I worked with N yesterday, 'cuz I needed an extra day. The patient I walked into at change of shift was about 1 1/2 hours into pushing, and trust me, that's the worst time to switch patients. The first thing you see of them is them up in stirrups and you're supposed to go over and introduce yourself? Right...I wasn't too convinced that this gal was gonna be a great pusher, and we pushed and pushed in this position and that position for another hour and a half. I wasn't seeing much progress and I think we were both getting a little frustrated and poor girl was getting tired. Then Dr. M walked in and somehow put his hands on the head and made it happen. I love Dr. M, he did the first delivery I ever saw and I've always just thought he was a good doc. N came into the delivery, but she scrubbed in to help Dr. M so I really was kinda doing it on my own. That was the first time I actually had to think it all through and do all the pieces myself, and I don't think I was really prepared. I've decided that it's really hard to jump into the middle of someone else's delivery and then when the Dr. comes in and works magic and you're not expecting it, it's really easy to get behind.

Everything went pretty well until the end when he was repairing. She had a posterior vaginal laceration that seemed to just want to keep oozing no matter how many stitches he put in. He was already 30min late for his office so that didn't put him in the best mood, and then this laceration kept oozing. He wanted some vag packing so I went to go get it. I knew exactly what he wanted, but had no idea where to find it, it's not something that we use...ever on the unit, so it's not something I've gone looking for before. I learned a long time ago that it's usually better to just ask someone where something is if I'm in a hurry and don't have time to just stand around looking for it. So I asked one nurse where it was, she had no idea what I was talking about. So I asked another nurse, they handed me something they thought was it, took it back into the room, Dr. M said "that's not going to work. What were they thinking?" So I went out and found another nurse...still nothing. 3 items, 15 minutes, and a very frustrated Doctor later, we found one roll of packing and he was only an hour late for his office. Amid comments such as "does anyone know what's going around here anymore?" and "Where's the person in charge when we need them" he left without writing in the chart or clear orders. When he came back over for another delivery later, he was still upset about it and even asked me "How long exactly did we have to wait for the packing to get put in place?"

The one thing I didn't want to ever do is develop a bad reputation with doctors, because I've seen that once they don't trust you, it's nearly impossible to earn their trust again. I don't want to always be known as the "new nurse who doesn't know what's going on" but at the same time, I am new at this, and I don't know everything, but I still feel like I'm supposed to, especially around the doctors. I just hope that this one delivery isn't what Dr. M thinks of every time he sees me as a nurse.

The couple turned out to be fantastic, really sweet and the baby was beautiful. I went over and saw them again this afternoon after my wonderfully exciting basic dysrhythmia class...flashbacks to Critical Care class last semester. So I guess yesterday wasn't all bad, but it did frustrate me a little bit. Every time I feel my self-confidence level rise the littlest bit, something happens that sends it crashing back down. I'm waiting to make that one decision, at the right moment that proves to myself that I really can do this.

So things I learned yesterday:
1) Make sure that you're comfortable with the situation that you walk into. When I was nervous about what I was doing yesterday, and pushing with a patient all by myself I should have told N and not just pretended that I was perfectly fine with it; that's how I'm going to get myself in trouble.
2) Make sure that you're ready for delivery/procedure before it happens. I should have taken 5 minutes to really make sure that I had the room set up how I wanted it before I started pushing with the patient in the first place. Cord gases, pads, towels, etc, etc. That would have saved me from being flustered when the "magic" happened in the first place.
3) Deep breaths are a good start for any problem. I know (well, I think I know) that Dr. M wasn't necessarily upset at me personally for not being able to find the packing, but I shouldn't have let it get to me personally even if he was. I did make a right decision by asking someone, but when one person couldn't find it, I should have just gone straight to someone I KNEW could help me(central distribution) and then at least have been able to tell Dr. M that it was certainly coming.
4) Just like so many nurses have told me already, becoming natural at this takes time, and there's nothing I can do about that. The only reason they seem like they've been doing it forever is because they have been. I have to take it one shift at a time and learn what I can from that shift and apply it to the next one. That's just a rough lesson to learn.

Babies today: 1F
Babies total: 16M/14F = 30
Vag:10M/13F = 23
C/S: 6M1F

Monday, September 22, 2008

Rockstars For A Day

I was really worried that Sunday was going to be like Saturday with not much action. I was half wrong. J and I got a really nice unblocked multip who had SROM'd at like 0130, and was not 5-6cm. She went really fast and we had a cute baby boy at 0805. She did so good, and had such good control. I want to be like that when I have a baby! I see the other side of it too, the people who try to do it naturally and have absolutely NO control and are all over the bed and saying lots of choice 4-letter words. Those patients grind on my last nerve and I wish it could be a nurses' order to get an epidural.

As we were walking back from taking our first patient over to postpartum I was thinking it was gonna be a long rest of the day b/c there weren't any more patients for us to take. I went into the galley to get a cup of coffee and get a page that there's a patient at the end of the ramp needing a wheelchair. 30 minutes later we had another baby. That's my kind of delivery! Well, actually, it was a little harried and I kinda just stood by and watched it all happen. I'd like to think that I did something to help but I'm not sure if I did or not. I think after doing so many deliveries, everyone seems to go onto auto-pilot when something needs to happen fast. I still have to stop and think about each step, but they know just what to do and what's priority. It's like a 3 person job when someone precips like that, but talk about an adrenaline rush! That's why I love it!

After we had baby #2, there was absolutely nothing. We got lunch and sat in an empty room and watched the Chiefs game on TV, and didn't feel guilty at all! I did send one triage patient home, but that was the excitement for the afternoon. When we left at 1845 there was one recovery patient and 4 nurses to take care of her. Makes up for our 20-21 baby days last week.

Babies today: 2M
Babies total: 16M/13F = 29
Vag:10M/12F = 22
C/S: 6M1F = 7

Saturday, September 20, 2008

No Babies :(

I think today was the first day since I've been a "Real Nurse" that I haven't had any babies :( That makes me sad! I got really close though, we left a girl almost complete and he delivered at 2006 (yes I called back to check on her about 2130...I'm a sucker!). It was the weekend, so pretty quiet. there were all of 3 nurses on today plus two orientees...ha! J and I had 3 ante's and we sent them out the door and then got another triage with "vaginal pain" and sent her home in exactly an hour. We could have sent her home earlier, but it's protocol that they have to be on the monitor for at least an hour, so we took that and no more. The doctor listened to what I told him about what her s/s and he said "well, nothing I can do about it. Send her home." Seriously, you're pregnant...you're gonna have a lot more "vaginal pain" pushing that baby out than you are right now...



We had an 18yo prime walk in with SROM, thick mec and 4+ cm about 1430. That's who delivered after we left. She was barely 120# pregnant, and scared spitless. We didn't bond with her mom right away, she was doing all the talking for the patient and refused to let her get an epidural. She wouldn't give us any reason, just that she didn't want her daughter to get one. That about sent J and me off the deep end. You don't just say "I don't want my daughter to have an epidural" when you're daughter is sitting in bed crying and too scared (either of you or just in general) to say anything but let tears roll down her face during contractions! We finally laid it down and said that it was her daughter's decision and we couldn't just take Mom's word for it. So she got a block and pushed out a 7# baby! That's like a decent % of her own body weight. Anyway. In my opinion you shouldn't be having a baby at 18 in the first place, but it's not a perfect world.



I got another look into another world when an ante who at 17wks pregnant found out she was pregnant, and had to have a special prescription for her all important PNV's because she had to have Medicaid pay for them because she couldn't afford them. Here's some earth-shattering news: babies cost a LOT more than PNV's. If you can't afford your PNV's...how are you expecting to support a child? Just something to think about...



Babies today: 0 :(
Babies total: 14M/12F = 26
Vag:8M/11F = 19
C/S: 6M1F = 7

Wednesday, September 17, 2008

Threats...

So J threatened to take me off orientation today after 2 deliveries that I did pretty much on my own. I guess that's a good thing, but more than a little scary too. She said "you don't even need me anymore!" But that is so far from true. The moment I get put on my own something bad is gonna go down and then I'll be freaked out forever.

Yesterday we had a leftover cervidil from the night before, and then she didn't change so we put in another cervidil "just stick it on your fingers and shove it up somewhere high" were my insertion instructions...haha! Anyway, this primip gives up after 1 1/2 cervidils, so she ended up being a section. Jamie had started another induction in another room, so I was doing the cervidil pretty much on my own, but then I got another nurse to go back to the OR with me. So circulation and then a section recovery. I ended my day with a nice little R/O rupture that I ticked off when I told her that she wasn't ruptured and to come back next week for her induction. Now isn't that exciting...

Today was a little more eventful. We started off with a VBAC induction. She labored really well and we had a baby at 1234. I was pretty excited about it, I did 95% of it on my own. I'm starting to get my little spiels about labor, induction, "turning," epidurals, etc. It's kinda funny.

So after we delivered baby #1, we got almost though her recovery when we took a ROL who came in about 7 with a bulging bag of water. That is the weirdest feeling. I checked her and was totally thrown off. She said she'd been having UC's all day, but that she had been 30/80 in the office the week before. I thought she was pretty close to about 6-7, but then I thought there was no way that was right, so I asked J to check her. She was 7, but we got her an IV, some IV pain medicine, an epidural and comfy before AROM. She delivered at 1721. She and her husband were awesome, it was so cute, the husband sat in a corner with an notebook and took notes on everything. What time they got the hospital, what time they got checked in, what time we gave her meds, what time we turned her, etc. He wasn't doing it to "check-up" on us, but I think that he did it so that later when things weren't that hectic they could go back and look at it and re-live their daughter's birthday. I thought it was a cool idea. I love couples who come in prepared, but also who come in with an open mind and listen and ask questions. Those are my kind of patients.

So 2 deliveries in a day...not to shabby! We had 2 days last week with 21/20 deliveries and we're almost 190 in September. J told me that if I keep giving her perfect charts to review after a delivery she's moving me to nights and then getting me on my own. Not yet...I'm not quite ready!

Babies today: 1F1M
Babies total: 14M/12F = 26
Vag:8M/11F = 19
C/S: 6M1F = 7

Friday, September 12, 2008

Edpidurals Are From Heaven

When I first started nursing I kinda thought that epidurals really weren't that big of a thing, and I always told myself in the back of my head that they were kinda the "easy" way out. My mom never had one with any of us 3 kids, and I figured that they were "ok" but you could really do the whole process without one...I'm starting to change my tune big time.

After J and I got report on our cervidal from last night, we quickly did a precip delivery in another room at 0731, and then I promptly resumed care of the gal we originally had and t kinda stayed that way for the rest of the day. J had to leave at one, and came in a few times to help me out, like during the 7-minute decel after a hyperstim on 5mu/pit and when I couldn't find heart tones, but other than that, I did most of it!

When we took over care, patient was 1/20/-3 and had "No epidural!" on her chart. Great...0645 is too early in the morning to see that. So when I started pit and she actually felt her first UC she was all over the bed, hyper-ventilating, on her hands/knees, sprawled in 7 different positions...J kept paging me "you really need to find FHT's..." I had ultrasound gel all over her and me, was on my knees by the bed, handholding the monitor for at least 45 minutes, trying to get more than 30sec's heart tones at a time. All this before 0800. After she was AROM'd things just got worse and the no pain medicine turned into an epidural at 1000. She was a much happier patient after that, and it was actually a really good day.

It's funny the patients that you bond with. We can have one couple that J absolutely loves and I could take or leave, and then I'm not sure J was hot on the group today, but I really bonded with them and was in the room most of the day. They asked lots of questions, but it's things like that that make me feel like I know what I'm doing, when I can answer questions and help them understand. So baby #2 for the day was born at 1724, right after J left, and I was pretty happy with how it went. Baby was VERY cute, and Mom and Dad were excited. Dad even stopped bouncing on the birthing ball long enough to get into the whole delivery thing. Maybe they were a little immature, but entertaining at least!

I told Jamie that when we work again on Tuesday she's supposed to help me focus on the things that I need to work on the most. Besides cervix exams. I want to know what I need to keep working on, besides just the making it habit stuff. Like do I need to work on talking to doctors, do I need to work on explaining things to patients, what are those types of things. Or does it all come with practice? The problem is, with practice comes the chance of screwing up...and that's my least favorite thing to do!

Babies today: 2F
Babies total: 13M/11F = 24
Vag:7M/11F = 18
C/S: 6M

Wednesday, September 10, 2008

A Day You Don't Forget

I can think of fewer cooler things than watching a set of twins born vaginally...except for one of them being born vaginally breech. I got to see it today...and it was awesome! There's something out of this world about watching one baby be born...but two? And one coming out with it's butt first...that just doesn't happen! There were 14 people in the OR (where all twins are born, just in case we have to crash into a section): mom, dad, 2 nursery nurses, the Neonatal Nurse Pract., 2 scrub techs, 2 nurses, 2 docs, a pre-med student, a CRNA and another nurse. Then the two babies. That's a big birthday party...in a not very big room! It was way cool though.

Baby "A" had always been vertex. On the first scan this morning she was still head down, but "B" was almost transverse, but slightly breech with her butt down. Baby "A" came out in about 1/2 pushes and was way fine. Then "B" didn't flip around to easily. Her bag hadn't ruptured yet, and the doc had 2 hands up inside trying to grab feet or something to swing her around head down. The other doc was running the sono and coaching the delivering doc through the process. They guessed that "B" was small enough to try a breech delivery versus putting Mom to sleep and doing a section. It took a few minutes to get baby turned around at all, and I think we were just barely seconds away from opting for the section, but then all of a sudden the delivering doc said " I have two feet, let's go!" and a couple pushes and out came a butt and then a baby! It was way cool.

If I repeated all the things that our very "entertaining" patient told us/asked us today, I'd probably get my mouth washed out with soap...it was a long day. But I learned alot...twins are fun but a lot of work. They're twice as hard to monitor, an it's twice the paperwork and Mom is twice as uncomfortable. But, I guess you get twice the prize in the end :)

Babies today: 2F
Babies total: 13M/9F = 22
Vag:7M/9F = 16
C/S: 6M

Tuesday, September 9, 2008

12-hr Shift...17 Babies

I guess when you walk into work during a thunder storm that's been going on all night and see absolutely no green (ante) names on the board and every room has a red (labor) name...you know it's gonna be busy. And when you see that one of the room's has twins and there's another set of twins scheduled for a C/S you know you're gonna have lots of babies before the day shift goes home!

I only got one of the 17 babies, but once again, I did it all by myself...almost. Even more than Friday. It was a VBAC which was the first of those I've done. It doesn't really change anything, except that you're more careful with how much Pit they get and you almost always get an IUPC so you don't hyper-stim. I got to FEEL a cervix change, from a very tight 2 to complete over a full day. Another multip who went fast at the end, but when she was till only about 5.5 at 1700, I was positive we weren't gonna meet the baby. But at 1751...here comes baby! I was positive on every one of my exams, and that is the coolest feeling in the world; confidence!

I got the message that I have to take 60hrs of vacation before December 20. I'm gonna take about 6hrs in a couple weeks, and maybe another day or two in October. Taking is vacation is something I don't have a problem doing :)

Babies today: 1F
Babies total: 13M/7F = 20
Vag:7M/7F = 14
C/S: 6M

Sunday, September 7, 2008

6-Complete in 15 Minutes

Friday was my day to work with my "other" nurse. I think it's been really good for me to have two main nurses that will let me work with them. J teaches me a ton every time I work with her, and then N makes me go out and do it on my own...and I ususally surprise myself with the confidence I come away with.

Friday we had a carryover induction/cervidal from the night before. This was her second baby, and she was bound and determined she didn't need an epidural b/c she hadn't gotten one 18months ago with her first baby 'till she was 9cm, and by that time it didn't really help her. She was about 3 when I came on, and the doc came over and was denying any pain. Then the doc came over and broke her water...and then it started hurting. I figured it was gonna be a long day, especially after we started Pit and they weren't just "natural" contractions anymore. I figured I would be spending the bulk of the day in by her bed helping her through it. All this time and N hadn't even walked into the room yet...it was really MY patient! About 0930 I came out to the desk and did my "happy nurse dance" because she had said she wanted an epidrual. Not because I forced her to get one, but I think because I got down on my knees by the bed and told her it was her choice, that we weren't gonna make her do anything, and that this baby was going to be so lucky to have her as a Mom. She was much happier after her epidural. I even set up the pump right...expcept for taking the cap off the tubing...oops!

I checked her after about 45 minutes of epidrual bliss, put in a foley. She was about 5.5-6, but I told her it wouldn't surprise me if she went quick, it being second baby and all. I drained about 500cc from her foley, and was charting beside her bed and she kept saying that the foley hurt and it just didn't feel right. I hate it when they say that, because then I feel like I either totally missed something, or something's gonna happen that I'm not prepared for. But I was so proud of myself, I stuck on a glove and re-checked her...and she felt complete to me, even though I had JUST checked her! The cervix had swung totally around and the head was right there. So I *calmly* went out to the desk...N wasn't there so I grabbed another nurse and had her come recheck. Ya...complete and +1. We had a baby in like 30 minutes, and only that long because we were waiting on the doctor. I was the one who called the doctor, I really did it all! It was an awesome feeling. And when the patient said afterwards "I couldn't have done it without you" I really felt all warm and fuzzy inside. Maybe I can do this...

After we got her all moved out, we got a triage for R/O SROM. Moms: when you think your water broke, and yet you don't wear a pad or anything to the hospital and your pants aren't even damp when you've been sitting in the lobby for 10 minutes before you get to the room...chances are your water isn't broken. We got an order to check her, and I did it...kinda. I really hate checking un-blocked mom's because I don't know what I'm doing, so it's like hiking in a forest blindfolded...I'm just pushing things out of the way trying to figure out where I am. That can't feel good...So I thought I felt the same thing the doctor felt the day before in the office, so I called her unchanged. Then I had to go back and check her an hour later. I've had multiple people tell me "you're so gentle, my doctor just shoves his/her hand on up in there!" So as I'm walking into the room, I told myself "pretend you know what you're doing and just find that cervix!" So I had her sit on her fists and checked her like I knew what I was doing. I thought I had long figers, but I swear, I wish they were two inches longer! I actually did find the cervix, two fingers side-by-side, nothing more. Unchanged. When I went out and told N that I just "shoved my hand on up" she laughed pretty hard, and said that's how you had to do it! No more gentle comments about my cervix exams!

I did a C/S to round out the day...a little bit of everything I guess. I worked with the same S/T I pulled across the table on Wednesday, so we had a good laugh about that. Ah, the joys of working with people you like. I got to see what happens when they knick a bladder during surgery, got to infuse the methaline blue through the foley...neither I nor the nurse I was working with had ever done it, so the CRNA had to show us how. Learning something new everyday!

Babies today: 1M/1F
Babies total: 13M/6F = 19
Vag: 7M/6F = 13
C/S: 6M

Thursday, September 4, 2008

Lots of Babies!

When I got to work on Tuesday I checked out how many babies we had at the hospital in the month of August...324! That's a lot of babies! Yesterday J and I did c/s...3 of them to be exact while the rest of the floor was completely full...maybe a good day to be in the back! When I left yesterday we'd had 13 babies just on day shift. Nurses get worn out after too many days like that!

So I got to circulate my first c/s almost by myself...of course J was there, so I kinda got to do it on my own...right? I must say, my least favorite part of delivery is the cleaning the mom up afterwards, and it seems like there's lots of that with a c/s. You have to clean them up in the OR, and then again before they leave recovery. There's just lots of rolling and turning and wiping and it's just not my favorite thing to do. Oh well, we had some great families to work with. I like it when the patients are also nurses, because they are fun to talk to and they relate to what I'm doing...kinda.
Funny story from c/s area...we were cleaning up a patient and getting ready to slide her to the bed to take her to recovery. J had to leave for a second so it was just me, the scrub tech and the anes resident to move the patient. No big deal, I just thought in my smart little head that I was gonna have to pull a little harder to slide her over. Well I guess I pulled a little too hard, cuz when I pulled, the scrub tech slid with her and landed smack on the OR table! She said "Beckie! don't pull so hard next time!" It was kinda funny...

When I worked on Tuesday, I really did a lot on my own too. We had an induction and I did all the cervix checks (still not 100% I got them all right, but the baby came out, so I guess that's what matters!) and I talked to lots of docs on the phone and it felt good! The couple was really nice, but it's a good thing J was hanging out close behind me because the patient went from 6cm to complete in about 20 minutes and I never would have figured it out on my own I don't think until the baby was in the bed. Oops...

Babies today: 3M/1F
Babies total: 12M/5F = 17
Vag: 7M/5F = 12
C/S: 5M