Monday, September 28, 2009

50 Best Blogs for Neonatal Nurses | Nursing Schools : LPN RN BSN MSN : Online Nursing Degree

50 Best Blogs for Neonatal Nurses Nursing Schools : LPN RN BSN MSN : Online Nursing Degree

This is what I find surfing the blogging world...I had no idea!! Check out #9!! It makes me feel special :) Congrats to all the other bloggers out there who made the "Top 50 List" too!!

Saturday, September 26, 2009

Question to All My L&D Nurse Readers!!!

Things have been super busy/crazy/insane at work these last several months (welcome results of winter "coziness"!) and it has led us night shift people to think about our staffing situation. I'm asking for your advice/input/ideas!! My question are you staffed on your units? What have you found that works best and what doesn't? How do you handle putting nurses on call? Any suggestions would be MORE than appreciated!!

A little bit about our unit...

We are a 17-bed L&D unit for both labor/delivery and antepartum. We average between 320-340 deliveries a month during most of the year, closer to 300-320 during the winter. We don't have a separate antepartum unit/rooms nor a triage area. We have 17 rooms that we use for all of the above. We triage/labor/deliver then after 2hr recovery move patients to postpartum.

We have 2 OR's and then 4 separate PACU rooms for our 2hr C/S recoveries before we move them to postpartum. Our L&D nurses do both vag and C/S deliveries, and then we are are the ones who are responsible for moving them to postpartm (a good 30minute process). Unless we have to we don't usually have both a C/S recovery and triages out on the floor. If we take a C/S back we're "in the back" until that recovery is over.

We have NICU nurses staffed in our well-baby nursery and the NICU "admit" nurse comes to all our deliveries to catch our babies.

We have one charge nurse who is over L&D/postpartum/NICU and our Women's & Children's unit (usually an extension of M/B but can also take GYN surgeries/peds patients). The charge nurse doesn't do patient care.

We are usually staffed 4:1 antepartums, 2:1 or more often 3:1 labor patients and whoever can handle it takes the next patient that walks through the door. If we have Mag patients we are usually 2:1 as along as they're somewhat stable, sometimes have a mag patient + a labor or something else.

Our L&D nurses can all float to mom/baby and if we're OK on labor and M/B is short then we get floated. None of the M/B or NICU nurses float to L&D.

Our core staffing is minimum of 3RN's. Most of the time we're staffed with 4-5RN's/night. If we're lucky we'll have 6 or 7. We usually have 2-3 scheduled cervidils on the weeknights plus a 0730 C/S that comes @ 0530. Day shift usually brings in between 10-12 RN's. If the day charge nurse thinks we are overstaffed for the night shift someone (rotates by dates or requests) is put "on call." If we need the "on call" person during the shift they have to be there within 30min of being called. If you get "called in" before the shift is half over (0100) it's time-and-a-half 'till 0100, and if you come in extra it's time-and-a-half.

Finally Some Babies!!

Wow, I'm been doing this blog in spurts lately...I end up doing it AFTER I've worked for the week 'cuz there's not much energy in between shifts! This month has been crazy busy, we were already pretty close to 300 babies when I left on Thursday morning!! I've had several nice deliveries, 2 of them last night!! Yay for double deliveries!

The two last night were 2 within an hour, that's always good for getting the heartrate up! I did one delivery of "my girl" that I'd had since the beginning of the shift, then walked out and there was another girl that was 7-8 and for some reason the nurse that had her wanted me to take her and finish her delivery. I'm not sure why but the girl was unblocked and there wasn't much time to argue!!!

By the time I walked down to the room (for the first time) the midwife said that she was 9+ and wanted to get back in the tub. I wouldn't have gotten her up to the tub at that close to delivery, but the midwife did so I didn't' say anything. I'm realizing about this time that there is NOTHING in the room. No IV fluids hooked up, no pit for after delivery, nothing set up for cord gas collection, no delivery equipment. Wonderful...

I got everything ready and thank goodness too 'cuz when the midwife got the girl out of the tub and back on the monitors we had heart tones in the 70's and needed to have a baby NOW. It was a long 5 mins while she broke her water, tried to have her push, then cut an episiotomy...I was calling people, getting the laborist to stand by, asking some of my nurse friends to come be some extra hands, etc. Baby came out fine though, mom did great, and my heart rate finally returned to normal...

I had antes a couple times this week. I was supposed to be orienting a new hire one night, she's been a nurse for a while, used to do L&D but then took 12 years off to raise her kids. She's like twice my age and I always feel a little funny "telling" people who could be my mom what to do. Anyway, first time I was orienting anyone in the first place so I'm already a little nervous, I don't like antes, I feel way more comfortable with a labor patient, and yet I'm supposed to teach someone how to do it. We had a FULL load of antes, and one of them had been admitted a week or so ago for bleeding...and had bled 4 times during admission and was on her 6th bleed for the day. The doc showed up right at shift change to assess her and got another clot out, wanted to cut her, it turned into a long process, we had to call in another nurse to take her back to the OR, and it was almost 2100 before I got to my other patients rooms. Not good patient assignments, but everyone turned out OK!

I feel like I've been living at the hospital lately. If I hadn't been sick one night last week I would have been there 5/7 nights and all the nights have been crazy! Thank goodness it's job security!!

Babies today: 1f2m
Babies total: 63M/73F = 136
Vag:47M/55F = 102
C/S: 16M18F = 33
Babies 'caught' = 2f0.5m

Friday, September 18, 2009

2 Little Boys

No babies this week, but last week I went OOT (out of town) before I got to talk about the 2 nice deliveries I had one of the nights I went in extra. The first was a C/S that was walking to the back as I came on. I almost feel guilty "claiming" that baby because I hardly even got to say "Hi I'm BDay Nurse" to the mom before the drape goes up and the baby comes out. Then in recovery they are usually so out of it, and after laboring all day, all they want to do is sleep. Doesn't leave much time for the "bonding" time. But nice, quick section. We were actually in the OR from in time to out time less than an hour. That's pretty impressive! It was a one of my favorite CRNA's on too, so that always lends some humor to the situation.

I was ready to go home after my section recovery was over and I probably could have, but there were 2 patients who were almost complete so I told them I would stay until both of them delivered so that then they would have 2 more nurses open. The 1st delivered pretty quick but the second one was an un-blocked primip and she took several hours to get from 9cm to complete. She was about 9.5cm and it was almost 1am when a SROM came in that I went ahead and took all the time thinking "I kinda wish I had just gone ahead and gone home already!" But I took her down to her room, she was 4-5cm, ruptured, multip who had gone natural with her 1st baby (all 28hrs of labor) and wanted to go natural again. Ok, that's all cool. Until she'd been on the monitor for 5min and I was doing the "interview" and she had a contraction...and I had a nice variable decel. (I thought this article on interperting a fetal heart rate tracing was really good. It's a decently short overview, and does a good job of covering the basics of what takes lots of time and experience to understad and apply!)

So after watching a few contractions there were several things that became apparent...these variables weren't going away with position changes, mom was NOT going to get off the monitors on my watch (or license) and she needed to make cervical change QUICK or she was gonna get a section. The doc for that group is known for NOT watching ugly strips for very long, and the last "questionable" strip I had with her I got my head bit off for not calling her sooner, so within 15mins of Mom showing up, I had someone start my IV while I called the doc. I told her right up front that I was having decent variables with each contraction, and that mom wanted to go natural. Surprisingly, she came in to the hospital without me even asking!

When she got there mom was a good 5-6cm, and in GREAT control. The doc came down to the room, checked her and looked at the strip. Then proceded to tell me that baby was "fine" and that what I was hearing was the monitor moving during a contraction and picking up mom's heart rate. Then she left and went back down to the Dr's lounge. I don't usually argue with doc's but I KNEW that wasn't mom's heart rate, so I slapped a pulse ox on mom's finger (to monitor mom's pulse), had another nurse come down and listen and when she agreed with me that it wasn't mom's heart rate I put a scalp lead on baby'shead. The more of those I put on the better I'm getting at them!! Anyway, by this time mom was a good 7-8cm and my variables weren't getting any better. Variables into the 60's and 50's (dropping from a baseline between 130 and 140bpm) sound horrible to a labor nurse and you find yourself holding your breath between beats just willing it to beat again. I finally called the Doc again and said "just FYI I put a scalp on and now my variables are in the 50s lasting throughout the contraction." She came down and thankfully mom was complete. She pushed twice and had a baby with a tight nuchal...but came out screaming!! Thank heaven she was a multip and went fast!

She delivered 2hrs to the minute from walking in the door. And about 15min before the previous patient that I had been waiting on to deliver before I left! Mom was in SUPER control of herself and I would do an unblocked (or blocked!) delivery like that anytime. She was fantastic. I told her before I left that doing deliveries like that remind me 1) why I love my job and 2) why I don't mind coming in extra :)

Nothing like a little excitement at 2 or 3am to liven things up and get your heart racing!!

Babies today: 2m
Babies total: 61M/72F = 133
Vag:45M/54F = 99
C/S: 16M18F = 34
Babies 'caught' = 2f0.5m

Wednesday, September 9, 2009

Ready for Another Baby

So let's see...I haven't had a baby in a good week! I think I'm failing in the "delivery" part of my job! I can labor them fine apparently...but I have a hard time getting the baby out! I have had 3 nice (well, exciting if nothing else) births the last couple weeks.

1st baby was a super fun couple that I cervidiled one night and then ended up doing the section for the next night because her cervix stopped at 9cm. They were lots of fun and their baby was ADORABLE! Honestly, most newborns aren't that impressive looking...but this little guys was super cute :) I even went back to visit them the next day on my day off to see how they were doing. I love stories like that!

Next delivery was one of those "all of a sudden" ones where I had the C/S papers sitting on the desk because she'd been about 4cm for the last 3hrs. We had put in an IUPC and said we'd give her 2hrs and then were going to the back. 2hrs later she was complete! Yay!!! She did super and half way through pushing we were chatting and come to find out, Dad was an ICU doctor at one of the other hospitals in town. Great! Thanks for the heads up...He was quick to point out that he didn't know anything about L&D but still...a doctor is a doctor! They did an OB rotation in school and he's probably actually "caught" more babies than I have! Oh well...he was a great help when Mom passed out X2 in the bathroom on me 3hrs after delivery. Sigh...I had another nurse in the bathroom with me and the 2nd time Mom went down she really went down to the floor. So there's two L&D nurses sitting on the floor with a naked patient (she'd puked all over her gown on the way down...) on top of them and ICU-doc-Dad holding Mom's head and nobody could reach the wheelchair. So I hit my emergency badge and when everyone else from the floor came thundering into the room there we all were! Sitting on the bathroom floor! All we needed was a wheelchair...

Next baby was the "exciting one". Problem #1: Mom was 5'0"...Dad was 6'4". Not a good combo for a baby. Sure enough, baby was pretty big, we pushed for 2hrs and baby was "gettable" but not quite coming out on her own. So doc came in and put on the vacuum and pulled baby out...all 9#5oz of her! Well, when all of baby came out, poor mom got a really bad 4th degree tear. It wasn't very pretty. So doc gets ready to repair...and Mom's still bleeding...and bleeding...and bleeding. 3 bag of pitocin, 2 doses of Methergine, 1 dose of hemabate, 400mcg cytotec orally and 400mcg rectally...2000cc EBL and doc could start the repair (8 sutures...). Yahoo for nursing teamwork!! We didn't leave that room for an hour and half after delivery. Mom did fantastic afterwards...but she's going to be SORE for the next several weeks!!

Within an hour of my hemorrhage there was a scary delivery next door with a Family Practice doctor. I know many women go to family practice doctors and continue with them for their OB care. It's nice...same doctor can take care of you before, during, after your pregnancy and you can throw in the kid's visit at your doctors appointments too! But think about this: would you let a family practice doctor take care of your heart attack and do open heart surgery on you? I didn't think so...consult the experts for your OB care too...just a word from a labor nurse. Take it or leave it :)

Anyway...this baby was 10#, had a NASTY strip, a bad dystocia (shoulders and body) and then it took the placenta an hour to come out after delivery. We had to call in the OB backup (all family practice doctors have to have an OB back them up during deliveries for emergencies, C/S's etc.) to get the placenta out. Scary stuff.

I don't know if they don't trust me after my Mom hemorrhaged or what, but I've done nothing but antes and triage's since! I did 8 triages the other night...that is craziness!! Here's hoping for some actual babies in the near future!

Babies today: 1m/2f
Babies total: 59M/72F = 131
Vag:44M/54F = 98
C/S: 15M18F = 33
Babies 'caught' = 2f0.5m