Saturday, February 28, 2009

Shift #2 in Bullet Points

I can't think in compete sentences, let alone paragraphs this morning, I'm are the bullet points from the last 24hrs

1. My cat slept with me and woke me up at 1400

2. Went to go give blood before work, the first gal blew my AC...that takes talent! Then the "head" phlebotomist stripped the tubbing to make sure it was really blown...I thought I was going to come off the chair, that hurt! Ended up giving out of the other arm, but have a VERY impressive bruse on my L arm from the 1st attempt

3. Worked out at the gym for an hour between giving blood and wonder I'm tired

4. Got a SUPER wonderful couple from J who delivered a >9# baby before 2100 for me. It was a perfect delivery. Just enough pushing to really engage the dad and get him really excited, he could see the progress with each push and you could just see his eyes light up! Yea!

5. Took a MVA triage right after delivery and tucked her in for the night, baby looked beautiful all night :)

6. Started a foley for a mom/baby nurse who had tried twice on a patient who spiked a temp, couldn't pee, etc. Talked on and on about how difficult the patient was...the patient was sweet as could be, just scared. After a little explanation, everything went great, easy foley.

7. Walked back on the unit after transferring my 1st delivery, guess I'm up next for triage! Little gal who was 2 and we finally figured out was ruptured. Walked in at midnight and delivered before 5. Another great couple, another great delivery. Funny, both deliveries were with the same doc who "ruled the board" and we had to call back in after he had gone back home after the first round of deliveries, he was actually very good about it...a rarity!

8. Everything seemed to hit the fan about 5am, what's new. A pt walked in 7, 4 people were wanting blocks, day shift couldn't get home fast enough. Walk out into the parking lot at 0745...4inches of show to scrape off my car!

9. Could barely keep my eyes open on the way home

10. Back for 3 more nights, then a few nights off, thank goodness!

Babies today: 2f

Babies total: 38M/34F = 72

Vag:28M/28F = 56

C/S: 10M6F = 16

Babies 'caught' = 1f

Friday, February 27, 2009

Night 1 of5

The first night after my "long stretch" is ALWAYS hard to come back to! I just had a great 8 days off, went on a little vacation to see my grandparents, got called 3 times to come in extra (of course I was either out of town or already had other plans...), then almost got put on call tonight but begged to come it, then realized I should have taken all 'cuz I would have gotten called anyway and then gotten time and a half for 6hrs...oh well.

I am so ready to pass on the triage hat to someone else. I saw it by my name tonight and wanted to scream! Seriously, I'd be happy with two easy cervidils whose babies behave all night and mom sleeps with their ambien! But that gets boring too, so I'm not going to complain anymore. All I could see was another 7-8 triages for the night and seriously, that's too much. So I had one antepartum all night, did a couple triages, then had a grand multip (10th pregnancy...) come in SROM'd who delivered unblocked for me after a couple hours on pit. She did great, it was a nice, super fast delivery, the doc walked in from the sleep room down the hallway and the head was sliding out, 1 min after she was complete. Gotta love those un-blocked mommy's!

I sat in an empty room and charted for 30min after shift change to catch up on my 5hrs of heart tones since admission and make sure I didn't forget any lose ends with my antepartum. It's the little things that I tend to forget!

So after a rough start, I'll take a patient in pretty good control who knows what she's going through. At least then I know I'm not stuck with whatever walks in the door next! Off to bed to snuggle with the cat, then back for night #2!

Babies today: 1m
Babies total: 38M/32F = 70
Vag:28M/26F = 54
C/S: 10M6F = 16
Babies 'caught' = 1f

Wednesday, February 18, 2009


Thank goodness I am done for a few (8!) days! Of course I didn't get call last night, and the longer the night went on, the worse it got, and the funnier/more ridiculous it got. We knew ahead of time that we had a @#$% of stuff already scheduled, 5 cervidils, plus all the un-delivered people left over from day shift. So we walk in and the board looks like poop, and it just gets worse. I start out taking the fresh ROL that's sitting in the lobby, and the triage gates open. We had 11 triage patients walk in through the door, I took 7 of them, and the last one ended up being a repeat C/S. Of course our whole computer system was down, so I got to learn how to paper chart. I'm sure I missed SOMETHING, but at this point, all my people were breathing and that's what counts...right? So here's my night in a nut-shell:

Pt #1 - rule out labor feeling "pressure". She was 2cm...sent her home in an hour
Pt #2 - "I think my water broke" what's your due date? " I don't doctor never told me. It's sometime in July." "July when, because it does make a difference." "I don't know..." even though we don't take people less than 20wks along, she came up and got the extreme vaginal makeover with a sterile spec, a fern exam, etc, etc. No SROM...bye-bye!
Pt#3 - I know I have a 9cm uterine cyst and it hurts. 1 1/2hrs later after a T#3, pain is gone, bye-bye!
Pt#4 - I haven't felt the baby move in 4 hours...amazingly reactive NST. Bye-bye in 45minutes.
Pt#5 - I have pain. "Where?" "I don't just hurts." "Rate it on a scale of 1-10." "10." No contractions, closed cervix, have to wake her up to ask her questions. Dx: round ligament pain. After 2 extra-strength Tylenol...bye-bye!
Pt#6 - I'm having contractions. Ok, this one was legit, and she was a repeat C/S...after I convinced the doc to come it we did a C/S. No big deal...right? Except there were horrible abdominal/intestinal adhesion's he found when he cut. So an hour after initial incision was made we had a baby. After 18 suture, pulling the whole small intestine out of the abdomen, repairing the holes in it, pushing it back in, and 2 hours later we rolled out of the OR. That was the longest C/S ever!
Pt #7- oh wait, that's the the scheduled 0730 C/S that I'll just get ready since I'm already in the back finishing my recovery.

I have an 11:00 flight out of town to enjoy some vacation days! Yippee! I'm exhausted...

Babies today: 1f
Babies total: 37M/32F = 69
Vag:27M/26F = 53
C/S: 10M6F = 16
Babies 'caught' = 1f

Tuesday, February 17, 2009

Not So Sure About It

It's been a long time since I have wanted NOT to go back to work. Usually I can have a rough night and then move on...but I seriously do NOT want to go back to work tonight. It's been a long first two nights of this set of 3, and I'm just not sure I can do one more. I'm trying to pick out the positives, like I get 8 days off after tonight, and I'm getting to go out of town tomorrow morning after I get off, and I made it though 2 nights I can make it through 1 more...but it's not helping too much!

I had a nasty strip tonight, had to run to the ER and catch a baby and then do the recovery of the mom who spoke NO English. I loved my cervidil couple, they were amazing, but their baby just wouldn't cooperate! I'm still working on this "control" thing, and realizing that I can't control what the baby's doing and I can't necessarily "fix" anything, but it doesn't make my pulse any slower when the baby's pulse is! Anyway...

I left a board full of inductions, and some inductions on hold. I know there are at least 5 cervidils scheduled for tonight, plus anything that's left over from today, plus everything that walks in. There are 5 nurses scheduled for tonight, there's no way for me to get call. The one time I ask to be put on call...of course I don't get it.

I have a ton of laundry to do, I have no idea what time I'm gonna get to leave in the morning, I know I won't get packed for my trip tomorrow, I have to be ready to go by about 9am. This is not gonna work...I think I'm going insane and I'm going to cry :(

Monday, February 16, 2009

Triage Queen

Normally...I hate triage, because usually that means I get stuck with a crazy patient or someone who walks in and shoots a kid out in a contraction or two or they're hurting so bad they're climbing off the bed. Last night however...I was the triage queen and did a delivery/recovery and then did 4 complete triage's and sent them all home. I was quite impressed with myself. I can't really count the delivery as mine because it happened at 1840 and the day shift nurse did it, I just walked in and helped with the housekeeping items that need to be done when a patient goes from 6 to complete in a few minutes. But I did that complete recovery, then it was just pretty steady sending one person home, then another walking in and then sending them home in an hour or so. I don't want triage every night, but last night wasn't bad, I'll take it!

This is my last set of 3 before my 8-day-off stretch. I'm ready! 2 more nights, and then I'm out of town for a few days and at least not at the hospital where I feel like I've lived for the last two weeks!

Babies today: 0
Babies total: 37M/31F = 68
Vag:27M/26F = 53
C/S: 10M5F = 15
Babies 'caught' = 1f

Friday, February 13, 2009

3 out of 3

I am always happy when my 3rd of 3 is done! It makes me feel like a new person! Gotta enjoy 2 nights off, suck it up for 3 more then have 8 off. Yippee! I love the 8 off, but the 3 sets of 3 are kinda long if I'm honest about it.

It started out CRAZY tonight. I think, from the way day shift talked, that it was crazy all day long. I was "happy" with my 4 antepartums, and slowly just worked on getting my 30wk PTL who was happily contracting away to settle down, discharged my N/V girl and discharged my epigastric pain girl and helped my kidney stone girl settle in. After I got my two discharged and my 30wkr stopped contracting and fell asleep the night was good. I was actually pretty proud of myself for not freaking out, making decisions and being pretty self-sufficient. The rest of the unit was a mess too, just busy, busy, busy and lots of people walking in at shift change. I swear, it's those dangerous hours of between 5:30 and 7 on either end of the clock. They should just not be there!

I THINK I have have determined something about the difference between night/day shift. I haven't worked day shift in a few months, but from what I remember, everyone on dayshift is very self-sufficient. They come in, look at the board, most switch their assignments and then they do their thing. They fix their own problems, they make their own phone calls, unless it's a big emergency they really just kinda are their own person all day. I remember doing that when I worked day shift. When I left for the day I could tell you what I did and about what my patients did, but other than that...I was clueless to whatelse was going on. On night shift, we come in, get our assignment and by the end of the night we've all kinda done stuff for eachother and eachother's patients. Whoever has a free minute helps with someone who's behind on something or just needs to catch up on charting. I think the night catch phrase is "what can I do for someone?" Everyone knows what's going on with everyone's patients. Of course I know I'm speaking in very GENERAL terms, but I've just been thinking about the differences between the two different shifts and the different atmosphere's and the different attitudes that people seem to have towards nursing. Maybe it matters too that the night shift is for the most part younger than the day shift and we still "enjoy" our jobs and it's more than just a way to bring home a paycheck. I know some of the day nurses used to tease me while I was still on orientation about me still "enjoying nursing." I hope the day never comes when I don't enjoy nursing...

Anyway, my random thoughts for the morning. I'm off to bed, then to my high school reunion this weeknd. 5 years! I'm getting so old...haha!

Babies today: 1m
Babies total: 37M/31F = 68
Vag:27M/26F = 53
C/S: 10M5F = 15
Babies 'caught' = 1f

Thursday, February 12, 2009

Today It Was 0500

Here are my new thoughts about nursing staffing in general:

1. Shift change should be outlawed...because you always know that everything is going to go crazy at shift change, no matter what time it is. Everything can be smooth sailing and then right before shift change something will snap and the next shift walks in and wonder just what the @#&* the shift before them did to turn everything into a disaster. Like my ROL that walked in this morning...she was a lose 1.5 (same as she's been in the office the week before) and hurting. She changed to a very tight 2 in an hour, that's not too big of a change, but I didn't feel comfortable letting her just walk out the door. I already had a D/C order if she didn't change and she had a dr's apt scheduled for later that morning. So what is she when the day shift checks her an hour later...3-4cm. Now don't I feel dumb for not having an IV started and everything rolling! I got that impression from the day shift nurse too...after she checked her. Stamp BAD NURSE on my forehead on my way out the door while you're at it!

Babies today: 0
Babies total: 37M/31F = 68
Vag:27M/26F = 53
C/S: 10M5F = 15
Babies 'caught' = 1f

2. We're the busiest OB department in a big it TOTALLY out of the question to have one nurse sit there with no patient when we have 3 nurses, one active labor, and one cervidil that we're gonna turn active before shift change plus an antepartum pre-term? A core staff of 3 is not really enough when all 3 nurses have patients, there's a scheduled c-section coming in at 0530 that we're supposed to have ready to roll to the back by the time day shift gets there and a door wide open for anyone to walk in (or 3 or 4 somebodies as happens more often than not)? I know especially in the bad economy budget is a big, bad word, but what's more important...a budget or patient care?

3. It cracks me up when we can be running around like chickens with our heads cut off on night shift and it's OK, but when day shift shows up and they have 2 or 3 inductions scheduled and twice as many nurses as night shift had, all we hear is complaining about staffing assignments. There's no point in night shift making staffing assignments because as each nurse walks in 75
% of them complain about their assignment and switch it anyway!

4. I'm tired, and I'm going to bed now so I can go back to work for my 6th shift in 8 days. I'd be in a better mood if we hadn't sat around and stared at 2 strips for, oh about 5 hours with NOTHING, and then of course at 0500 3 walk in, one is 5-6 and changing before our eyes, one is getting active, we have a scheduled section, we already have a labor patient that's 8-9cm, and I'm supposed to be AROMing my cervidil, starting pit, etc, etc. I hate shift change!!!!

Wednesday, February 11, 2009

It All Hits The Fan @ 0400...

2 cervidils...not too bad of an assignment. Until you see the two docs that they belong to. Some docs seem to use cervidil just to "guarantee a bed" for an AM pit induction and their cervidil's sleep though the night. Other docs use cervidil exactly how it's supposed to be used, and the cervix "ripens" and the patients cramp a little through the night, but are able to get some rest too. Other docs use it INSTEAD of pitocin and expect their patients to labor off the cervidil...and most of them do!

So...1st cervidil didn't seem to be working, it got pulled and another one got put in at 2300. She was sleeping, then all of a sudden woke up in rip-roaring "pain" is all she would say. Never described it, never said "it hurts here" just "it hurts". I swear I saw 1 maybe 2 contractions all night, she was extremely hard to monitor. Anyway, I finally convince her to let me do an exam and sure enough, she's 5 with a bulging bag. All this at like 0430. She got a block (thank God for good anesthesia, 'cuz she could have been a hard one to get, but he did great!), and delivered at 0530 after breathing though lots of contractions waiting for the doctor! She did great, I was proud of her, I'm glad it happened when it did and not much later!

My other cervidil...was only a cervidil for about 2 hours, because she started contracting every minute and went from closed/thick/high to 2/80/-2. I went round and round and round with the doctor about pulling the cervidil, but he finally let me pull it and after the tub, walking, the birthing ball, etc, etc, she was 6/100/-1 with a bulging bag right after I got my 1st cervidil delivered. She begged for an epidural after no sleep all night and then they were calling the doc for delivery as I was leaving at 0740. She did AMAZING all night. She breathed perfectly, she moved, she worked with the contractions. I think she could have done it if she had had just a little better start. I was so, so, so proud of her. I wish, wish, wish that I could have just had her as a patient and camped out in her room instead of having my other laboring cervidil and another rule out labor all at the same time.

Thank heaven for other night shift nurses who pitched in and really helped me tonight when I needed them. They got me all caught up on my charting while I was delivering and helped put patients on and off the monitors...they're amazing!

Babies today: 1m
Vag:27M/26F = 53
C/S: 10M5F = 15
Babies 'caught' = 1f

Monday, February 9, 2009

The "Perfect Nurse"

So I have LOVED reading all the comments to my post about the "perfect patient." So here's my flip side to it...for all of you mom's out there who have labored, or who will labor someday, or any of you dad's/husbands out there who have been with or will be with your wife/significant other when they give birth, what would you describe as your "perfect nurse"? 'Cuz really, that's what I want to be!

Sunday, February 8, 2009

Talented Doctor

The friend who sent this to me wanted to know if any of the OB's that I work with could do this...can yours?

A gynecologist had become fed up with malpractice insurance and HMO paperwork and was burned out. Hoping to try another career where skillful hands would be beneficial, he decided to become a mechanic.

He went to the local technical college, signed up for evening classes, attended diligently, and learned all he could. When the time for the practical exam approached, the gynecologist prepared carefully for weeks and completed the exam with tremendous skill. When the results came back, he was surprised to find that he had obtained a score of 150%.
Fearing an error, he called the instructor, saying, "I don't want to appear ungrateful for such an outstanding result, but I wonder if there is an error in the grade."

The instructor said, "During the exam, you took the engine apart perfectly, which was worth 50% of the total mark. "You put the engine back together again perfectly, which is also worth 50% of the mark."

After a pause, the instructor added, "And I gave you an extra 50% because you did it all through the muffler, which I've never seen done in my entire career."

3rd of 3

I feel like I've actually been a labor and delivery nurse this weekend! Overall it's been a great weekend and that makes me love my job...but still be excited for 2 days off before another set of 3-in-a-row.

I took over J's patient last night, we were heading back for a repeat C/S after she made cervical change. It's weird getting report FROM J instead of WITH her, but I know that there won't be a bunch of stuff that I have to do or stuff she forgot when I take her patients. I do really miss working with her though :(

Anyway, so great repeat C/S. Mom was a nurse at another hospital and she pretty much fit the bill for being the perfect patient. She never complained about anything, she knew what she wanted and needed and was super engaging with everyone involved. Everything went smoothly and she enjoyed the experience, which meant everyone else did too.

15minutes after I walked out of my section recovery we had a R/O SROM come in and it turned out to be the same lady from the marketing department who filmed the promotion video that I was in on Friday. We had talked quite a while during our 2-hr filming session and she said she was postdates and was scheduled for an induction on Tuesday and was just waiting to go into labor on her own before then. When she walked in she said "I thought I might see you this weekend..." She had a great labor, got to rest with her epidural and then had an 9# baby! For as tiny as she was, we were all impressed with a 9# baby and only a 2nd degree tear! Yea for her!

I'll take a shift like last night anytime. Steady but not crazy. Never crazy. Yea for 2 nights off, then another set of 3. We had an excellent crew this weekend, we should work that group of people again :)

Babies today: 1f1m
Babies total: 36M/31F = 67
Vag:26M/26F = 52
C/S: 10M5F = 15
Babies 'caught' = 1f

Saturday, February 7, 2009

The "Perfect" Patient

I got a comment on one of my previous blogs that I absolutely loved! A very smart woman said that her goal was to be the "perfect labor patient" and she wanted to know how to obtain that goal. So I've thought about it for a while and here are my suggestions...To preface my suggestions, remember these are my OPINIONS and don't worry, no good nurse will think less of you or take worse care of you if you aren't the "perfect" patient.

#1. Come in with an OPEN mind. It seems like the patients who come into their labor experience with a cut and dried, this-is-how-it's-going-to-happen mind set are the ones who have labors that are nothing like what they wanted. Those who come in who say "a C-section is the worst thing I could ever have happen to me" are the ones who end up in the OR and feel like a failure for not having a successful vaginal delivery. Also, I in no way believe that a C/S is any kind of "failure." It's just a different road to the same destination with different scenery and experiences to enjoy along the way!

#2. Keep in mind that as nurses (and all the docs out there too), our goal is a "healthy/happy mom and healthy/happy baby." Everything we do is working toward that goal. We aren't doing things to be mean, we aren't doing things to you to make things harder, we aren't doing things to you to ruin all your plans that you had, we really just want to make sure you and baby come out OK in the end.

#3. Try to develop a relationship with your nurse. I know that's one of my favorite parts of my job is forming that bond with my patients. When I think of what an honor it is to be a part of this amazing time in their lives it gives me shivers. The patients who come in and see me as more than the enemy who has to do all the "mean things" associated with having a baby (an IV, those painful vag exams, keeping you on those monitors) and let me into the memory that they're making, those are the patients that I remember long after I've moved them over to postpartum. Also, don't be afraid to tell your nurse what you're thinking. What you would "like" to have happen, what you are nervous about, what worked for your last labor (if you've had one) what your goals are for this labor. If you don't tell us we'll never know...

#4. The perfect patient is the one who comes in prepared, has read enough about giving birth to be informed about what to expect (but not just read all the horror stories they could find about all the horrible things that "could" happen) and are excited about delivering their baby, those are my favorite patients. Being nervous is OK and totally expected, but the patients who come in and are ready to enjoy the journey, those are my favorite!

Good luck to all the potential "prefect patients" out there! A "happy patient" is a "perfect patient!"

#5. All the nurses that I also asked for their opinion said that they remember the patients who bring food for the nurses :) Chocolate is ALWAYS a way to make friends with the nursing staff! Ha!

2 Shifts, 1 Blog

Only one blog because by the time I went to bed at noon yesterday there was no energy left for blogging...

After being off for 7 days after only working that one shift the week before I felt like the biggest slacker in the world! I just didn't want to go back to work! But I did anyway, 2 shifts of zero pay made this week's paycheck look REALLY bad.

So night number 1/3 consisted of a cervidil and a ROL who had a horribly crappy strip and the doctor looked at it, did another C/S and looked at it again and said let's cut it. So we did. I always feel bad for the prime's who come in and get sectioned right off the bat for a bad strip or who never really labor. That means the next time when they're baby is fine and they're ready to labor on their own, very few docs are going to let them just because of that first C/S. Getting this gal delivered was the right choice though. The placenta came out in chunks, nasty mec, the baby had a .82 shift and a blood sugar of like 400 when it got to the NICU. Yuck, yuck, yuck.

So then last night I was exhausted and wanted call, but all 6 of us were there. We cleaned up a board that had six labor patients on it and turned it into one labor and 2 CCIN postpartums. Yea for us! My child had a beautiful 6min decel into the 60s and I ALMOST got to see a forceps delivery, but then mom found some umph and pushed the kidd-o out. I love working with that particular doctor though. She is amazing, she is right there with the nurses not just hiding in the back room and she never makes the nurses (especially the new ones) feel stupid or like we ruined something. She's awesome.

So after my delivery and recovery I didn't have a patient the rest of the night and spent it running more than I thought, helping everyone else and just doing little things that needed to be done. My feet are very sore!

I am so ready for a nice, LONG sleep today. I get spoiled by sleeping all the time. I don't know how some nurses, especially the ones who go home to little kids, do it without sleeping! Hats off to you!

Babies today: 2m
Babies total: 35M/30F = 65
Vag:25M/26F = 51
C/S: 10M4F = 14
Babies 'caught' = 1f