Thursday, June 25, 2009

Babies Anyone?

Needless to say, it's been beyond crazy at work. I somehow managed to slip by on-call for part of my shift Friday night, I couldn't believe it! Then the calls started coming...

Saturday night...sorry I have a wedding Sunday morning!
Sunday... the manager of the entire Women's & Children's department called...twice!...sorry, I've got a bridesmaid dress on and I'm getting ready to march down the aisle!
Monday...just got off a mower after 5 hrs in 100 degree heat.
Tuesday... I was scheduled to work, and sure enough it was crazy. Somehow we've only had like 3 or 4 nurses scheduled every night, to cover an completely full board. We had more nurses there on time and a half pay than we did straight pay Tuesday night! I delivered a girl on mag about 2100, and as I walk out of that delivery with pressures of 160's/100's I get a page that there's a cervidil coming that I need to take. Since when is an unstable mag patient not 1-to-1? Whatever works I guess...
Wednesday...crazy again! I had one laboring patient and triage. Isn't that my favorite hat to wear? But it turned out not so bad. The labor patient I got at shift change was an SROM from early in the day who hadn't really gotten into any kind of labor pattern, and was stuck at about 2cm. I got report on her, got a quick triage about 1930 and had her gone before an hour was up. Then as I'm wrapping up the traige walks in another rule out SROM...who was very SROM'd. So I got her started, got both patients blocked, got my first patient an IUPC and a AROM of her forbag and attempted to tuck them both in to sleep.

About the time I started trying to chart my every 15minute heart tones on both patients since 1900, my 2nd SROM girl started having variables, so I went in to check her and flip her. She was almost I called the doc. That was my first mistake....I guess I thought going from 3-9.5 in an hour was impressive so I thought I should update the doctor. I guess I should have waited until she was complete and ready to deliver! The doctor came in and was upset that we weren't pushing yet! Um...first baby, she wasn't even quite complete. All I really wanted was for her to come and sleep and be there for delivery. Heck, she didn't even have to come yet! I just wanted her to know that we went from 3-9.5 in an hour! So the doc set my room up, rush, rush, rush, stood in there and pushed with us for an hour! I felt like a retard, totally useless, there were several implications made that maybe I wasn't the best nurse and that I clearly didn't know how to do my job. I felt like I had never done a delivery before! That will teach me to call before I should...

Half way through pushing with that patient, my other patient had several impressive variables so another nurse went in to check her and she was 7-8. Nice! So I finished my first delivery, checked my other girl, she was complete, tried to give report to a M/B nurse about my first patient so I could go push with my second but couldn't ever find the M/B nurse so I was an hour into my recovery before I could actually focus on my patient who was complete. Then my doc calls and says he's across town getting ready to head into surgery and he'll be another 45min-1hr before he's there. Ok...

Long story short, everything went great, she had a fantastic delivery. I had never done a delivery with that particular doctor and I loved him! He was great! Great bedside manner, very personable, calm, cool, collected. He knew his stuff and was great at explaining everything to the patient. He came up to me afterwards and said thank you for all my help, that I did a great job and that he wishes more of his patients came to our hospital. Total opposite experience from 1st delivery!

I haven't done 2 vag deliveries in one shift in a long time. I didn't realize until after I was leaving that I hadn't really sat down all night except to chart and that I was a little hungry! Oh well, the price I pay for loving my job and getting 2 babies in one shift! One of each none the less. It was kinda cool, neither couple knew the sex of their baby before delivery, so after the first one was a girl I told the second couple that they needed to have a boy so that I could have one of each on my shift, and they did!

2 shifts so far this week...3 babies, not bad!!

Babies today: 1f...1f/1m
Babies total: 51M/53F = 104
Vag:39M/41F = 80
C/S: 12M12F = 24
Babies 'caught' = 1f1/2m

Tuesday, June 16, 2009

Awaiting Sweet Sleep...

Last night will get blogged about AFTER I have not been up for 22 1/2 hrs and when I am in a better mood...

Monday, June 15, 2009

1st of 2 IAR

So because of a fetal monitoring class this week that's required (even though we're not getting paid for it...) my schedule got all mixed up. Instead of working Sun/Mon/Tues and then having my long stretch off, I work Sun/Mon, class all day Wed/Thurs, then work Friday night. Then they "had" to switch my schedule next week because someone else had to change nights so I'm working like Tue/Wed/Fri. It makes no sense to me, and I can't say that it's all working out just how I want it, but I'm sure I'll survive somehow. It will be nice only working 2 IAR this week for a change instead of 3!! Looking @ the positive :)

I started out the shift tonight with a postpartum mag the baby. So even though they still say that I need to orient to M/B, they feel free to assign me a M/B patient before I've been over there. Maybe now they won't feel the need to float me over there since they can just assign me a M/B team over on labor now! wasn't that big of a deal. Mag is mag, and a baby is a baby. He ate/pooped/wet for me, so I guess I did OK with him!

When it started to get a little busier they finally called in the M/B nurse they had at home on call (they had me take the mag girl instead) and she came in and took my PP mag, I took a SROM and got her delivered, then took another ROL who I ruled in pretty quick and had her blocked and comfy and a good 4cm by the time day shift got there! So it all worked out pretty nice. Now off to sleep before tonight gets here. Who knows what adventures it will hold... :D

Babies today: 1m

Babies total: 50M/51F = 101

Vag:38M/39F = 77

C/S: 12M12F = 24

Babies 'caught' = 1f1/2m

Friday, June 12, 2009

Boards Re-Visted

It's been an interesting was 1year ago (not by exact dates, but the 2nd Wednesday in June) that I took my nursing boards for the first time. That is one day I will never forget. 3hrs, 270 maximum number of questions, left the test in tears.

It was 1 year ago (again, 2nd Friday in June) that I found out that I didn't pass boards the 1st time around. THAT is for sure a feeling I'll never forget. Seeing that big FAIL next to my name and that horrible sinking feeling in my stomach. I was the girl nobody ever expected to have any kind of problems with boards...and I was the one out of the class who failed. I felt like I was NEVER going to be a nurse, that maybe this wasn't what I was supposed to do, that all my years of work and dreaming had come to just and dreaming without ever achieving my goals. I never felt as worthless, stupid and ashamed in my life.

The next 45 days were the toughest ever, and I'm still not sure how I ever got through them! Well, actually, I do know. It was because of the awesome L&D nurses, especially J, who encouraged me and helped me see that I still WAS going to be a good nurse, and that even the best nurses sometimes have to try again. It was a rough but valuable lesson, and one I am SO thankful that I'll never have to attempt to re-learn. If I never see/hear/think about the word NCLEX again that will be OK with me!

So I made a better memory this year...I had my 100th baby AND I bought my first (NEW) car! That's a better way to remember the 2nd Friday in June :D

Baby #100!

Another 2 crazy nights to finish out the week...Wednesday night was another attempt to float me to M/B...that lasted about long enough for me to finish my C/S recovery. Then I took a cervidil, another triage or two, then got a SROM that I got started and ready for dayshift. Pretty good night overall. Loved my cervidil couple, and the SROM couple was pretty hilarious.

Thursday night was another night in the zoo. I got to take my cervidil couple back from Wednesday just as she was complete, so we had a baby by about 2000. She did so good, but had had a LONG day on a LOT of pitocin to get the active labor going, so she bled after delivery. Some methergine and 800mcg of cytotec later and she was OK. I always love to finish those cervidil deliveries, especially if they do it without being cut. I get the start process and the finish process too!

An hour into the recovery I claimed the triage crown again and started my 1st of about 4 more triages. One in, one out, one in, one out. Trying to get my 3rd triage of the night out about 0415 when another nurse catches me in the hall and tells me that I have just acquired the new SROM that just walked in and is a repeat section. Oh, and she's 35 weeks. Soooo...thanks to a LOT of help from my amazing nurse team we got her ready and had a nice C/S about 0500, rolled into recovery @ 0630 and had all my paperwork and computer charting done! I was super impressed with me and all the help I got from everyone else. I couldn't have done it without them. I did realize in the middle of the section that I hadn't sat down long enough to even pee all shift...but it DID make the shift go fast.

My C/S baby was baby #100 since starting as an "Real Nurse" last August. I took a second and thought about that in the OR...I can't believe that I have done that many deliveries in less than a year. Granted, that includes all my orientation babies, but still...that's pretty darn good for a 1st year new grad! It makes me feel like I've accomplished a lot in the last several months. It makes all the rough nights definitely worth it!

I said something in the OR about it being my 100th delivery and the doc laughed and said something about seeing if I was as motivated and enthusiastic in 10 years or so. I've had lots of the older nurses smile and pat me on the head when they hear I keep track of all my deliveries, but when I've been doing this for 10 or 15 years and someone asks me how many babies I've delivered, I want to be able to tell them!! I've kept track this far, why stop now?

Babies today: 1m/1f
Babies total: 49M/51F = 100
Vag:37M/39F = 76
C/S: 12M12F = 24
Babies 'caught' = 1f1/2m

Wednesday, June 10, 2009

Another Day

First of 3, after 1 off...gotta love the extra on the paycheck, right? When I showed up for work, I had 2 recoveries...and then I hear the wonderful news that the new plan to cover all the short staffing float more labor nurses to postpartum!!! Now isn't that just a way to solve all our problems? So all us new nurses get to be the first ones "cross-trained" to mom/baby. I will do it, because I have to, but let me just say this:

#1 I became a LABOR nurse
#2 The biggest downfall of a delivery is the 2hr recovery period
#3 Since I do those 2hr recoveries...isn't that postpartum?
#4 Why is it L&D's job to cover the short staffing of Mom/Baby?

Ok, I'm done complaining :)

So, as I'm walking over to PP after moving my recoveries I'm hard-core praying for a triage. And one shows up! :) ROL who was scheduled for an AM induction, her cervix didn't change in an hr and a half, but then she had 2 nice little variables so I tucked her in for the night.

Then as I'm tucking her in I got the sweetest couple down the hallway. Mom was going all natural for the second time around, she did great! I felt bad for her that she didn't get her doctor, but she was a rockstar. Very vocal, but hey, if that's what it takes that's what it takes!!

She bled a little in recovery so I kept her for an extra hour or so. Meanwhile I got another 37wk triage. Put the baby on the monitor and it was flat with a heart rate in the 210's! Just a little high. Mom had a fever, so after we got that calmed down, gave some tylenol and some antibiotics she was looking much better when I left.

I got the C/S ready for this morning too. 6 patients in a night...that will teach them to float me to mom/baby! least until my next shift. I'm afraid I'd rather just do it then to worry and stress about it every time I come in. So I'll bite the bullet and push on some fundus' for 12 hrs...

Babies today: 1f
Babies total: 48M/50F = 98
Vag:36M/39F = 75
C/S: 12M11F = 23
Babies 'caught' = 1f1/2m

Tuesday, June 9, 2009

Dreading the Next 2 Weeks

They called me to work extra tonight in the middle of the afternoon...I told them that I am NOT super nurse and I can't work 8 nights in a row! Sigh...

The rest of the weekend was as crazy as Thursday night, only with less staff. We all ran our butts off! I had really nice deliveries both nights, so that was at least worth it. My girl on Friday night pushed 2 1/2 times...I'm glad the doctor came as soon as I paged her or she would have missed it!! Baby came out with a nuchal and was a little floppy, but pinked up pretty quick once he got moving.

Saturday night was just one of those nights that I got the triage crown and as soon as I would send someone home another would walk in the door. I did 7 admission data bases (the ump-teen screen computer form we have to fill out for everyone)...that is TOO many! I did get a nice delivery out of the night, so that was good. I felt sorry for Mom, it was her 2nd baby, she precipted with her 1st baby, and almost did with this one...thank goodness for nice strong BOW! She walked in 8cm, with that bulging bag and was in total control .We all flew, got an IV in, bolused her, she wanted a block, called the doc, etc. I knew as soon as that bag broke we'd have a baby, but it stayed in tact. When the doctor checked her she said the same thing and gave Mom the choice of trying to get an epidural or going ahead, doing an AROM and just having a baby. Mom thought about it and decided she wanted the block .We talked with anesthesia and we all decided that it would be best to do a spinal that would work faster and longer. Well...I don't think anything is going to give you much relief at 8cm, and even after the spinal was in she didn't get any relief. She decided to go ahead and AROM and we had a baby in about 3 pushes, but I still felt bad for Mom. She wanted that epidural so bad! She said afterwards "I guess my kids just don't want me to have drugs!" We told her to just come hang out at the hospital when she was about 8 1/2 months pregnant and then we'd get her a block!

The doctor who did her delivery is very pregnant (it was her last on-call shift before her induction) and I really thought she was going to pass out in the delivery. When Mom pushed it was the most "excrement" that I've ever seen during a delivery. It doesn't usually bother me, but the doctor got kind white and I wasn't sure she was going to make it...but she did!

They called me in last night to work extra. It was a empty rooms again. I sent one triage home, then got another one that was a repeat C/S scheduled for later this week. She was contracting every 10-15 minutes and talking through them very easily. She was off the bed when I checked her and was very upset that she hadn't changed her cervix in an hour. She didn't understand why the doctor wouldn't come in and do the C/S now when she was having contractions that hurt when if it had been Thursday morning and she hadn't been having contractions she would have the baby anyway. We went round and round, I gave her some vistaril and tried to give her a fluid bolus, but after missing an IV on a thrashing hand she decided to just go home and "suffer through contractions" since we weren't going to do anything else and left in tears. I hope her contractions stopped...and I'm sure my name is now down for a NOT THIS NURSE request for her c/s later this week...

I left about 4am, after it had sort of calmed down...but then I guess it got crazy again. One nurse last night did a C/S on 33wk twins while I was there and then I guess got a set of 27wk twins after I left that they did an emergency section on about shift change as another one was precipting in the bed. I told her 4 babies in one night wasn't too shabby...!

Slept most of the day today since last night messed me up and I hadn't had much sleep before that. Now it's 2am and I can't sleep, and I have to work the next 3 nights. Surprise, surprise. These next 2 weeks are totally messed up schedule wise because of the fetal monitoring class I have to take. Add a wedding and a bachelorette party in the mix that I'm in charge of and I think I might not be sleeping much for the next several weeks!!!

Babies today: 2m
Babies total: 48M/49F = 97
Vag:36M/38F = 74
C/S: 12M11F = 23
Babies 'caught' = 1f1/2m

Friday, June 5, 2009

I'm BACK...

Seems like I haven't worked/blogged in a VERY long time! But don't fear...the craziness has still be going on, I guess I've just been avoiding it...until last night. I turned down 2 extra shifts in my "8 days off (which was really 7 this time around...)" for 2 different but very valid reasons. I realized when I went car shopping yesterday that maybe a few extra shifts in the near future would be a GOOD thing and I need to stop coming up with excuses like "I'm tired" or "I'm busy", etc...reality bites!

Anyway, as I'm halfway to work yesterday (after an hour and a half nap after the car deal...) I get a call from the day charge nurse..."Sorry it's 1815, but we're putting you on call!" Seriously? Here I am thinking that I need extra shifts and I can't even work my regular ones anymore? I was JUST on-call, and I'm half-way to work already! But what can you I drove to the gym (just a different building on the hospital campus) instead of work and ran a few miles, lifted some weights...on about mile 4.5 my phone rang "Well...a twin mom just walked in who's 6-7 so I think we'll need you. Well, only 1 nurse has said we need help so far...Well, I'm not sure if we'll need you LaborNure wise, but I know I don't have NICU help..." Before the conversation could go deeper I said I'd take a shower and come in. Meanwhile thinking "#1 I'm not going to be of any use if they need NICU help, I do mom's not babies (especially 35 week twin babies!) and #2 if I get there and they don't need me, I'm going to be ticked!"

When I walked in I got ticked, but for a different reason. The board looked horrible, there were no where near enough nurses, I didn't even have anything to do with the twins who walked in, I got someone's recovery (why...I'm not sure) and a random ante from someone else. The recovery...ok, no big deal. The ante...a little bigger deal: she's been there for an hour an a half, the baby wasn't on the monitor (she was "too big and hard to trace"...) there was NO paper work or computer work done on her, the doctor hadn't been called, pretty much she'd gotten on a gown and sat in a bed...for an hour and a half!!!! THAT made me a little upset.

So I went down, flipped her on her side and found the baby, got the scoop of why she was there, called the doctor, got orders, helped 3 other people get up to the BR/roll to the OR/very random things, started her IV, tried to get my recovery moved, got told that I was the next one up for triage and that there was a term ROL here in a room for me, put moving my recovery on hold, triaged the ROL, got her situated, gave report on her to someone else, moved my recovery, came back found out the traige had gone from 3cm to 9cm in about 45 minutes, found out my ante was feeling better, did ALL my charting, sat down to breathe...

Round 2 of the night included: helping with the unblocked delivery of my "ROL", sending my ante home after 2L of fluid, setting up delivery packs for day shift, taking over on 2 other antes so a different nurse could go home, taking a ROL at 0530 and then ALMOST getting to catch a baby when mom precip'd in the bed (7min on the monitor, 2 contractions, in PERFECT control, with her 2 y/o standing wide eyed in the corner). I was a little bummed about that one, it was total group effort and when we pulled the covers back and saw the head crowning I grabbed the gloves off the delivery table and was ready to catch the baby, had my hands on the head when the laborist walked into the room. 30 seconds from baby catch #2! :( Maybe next time. At least I had gloves on this time! I have learned that 7mins on the monitor 2 contractions and exactly 1 hr from waking up to contractions to delivery is how I want to have MY babies!!!

Topped off the shift with giving report to a VERY grouchy day nurse who was NOT happy about getting antes and somehow it was my fault...go figure.

Moral of the story (in my personal head, but what do I know?):
#1: don't put nurses on call just because you can pull the strings to make it "ok" for the moment (cuz when it hits the fan it hits fast and nurses don't just magically appear when you need them)
#2: It's easier to have an extra nurse and send them home than to not have enough nurses and wait for them to come in
#3: When you're calling nurses in, don't just stick patients in a room and wait for the called-in nurse to take care of them. They're still patients in the 30mins before the called-in nurse gets there...treat them as such! What if my ante had had a nasty/cuttable strip in the hour and a half she was there before I got her? "Someone's coming" is not a reason not to take care of them before that "someone" gets there! Paperwork/orders/computer work goes with it...getting dumped on when you walk in the door is NOT a way to make friends...
#4: No rooms is a good reason not to move patients from L&D to post partum...not being willing to call a nurse to take them is NOT a good reason. We wouldn't tell a laboring mom "sorry, we have no nurse for you" us labor nurses would suck it up and take her and we'd start at the top of the list and start calling...all the postpartum nurses doesn't help us in that situation, so why do extra labor nurses get to "fill in" and take postpartum patients instead of calling in mom/baby nurses? Somehow that doesn't seem to balance out...
#5: The UP side to a DOWN night is that you can always look to starting with a clean slate the next night (or two...)
#6: I did get a workout in before work which was an added bonus, and I got to go in for time and a half when I got called back in :) Car payments here I come!!