Birthday Nurse

It's an OPINION!

2010-10-05T22:05:00.000-05:00

I figured my comment about home-birthing might cause some stir.....and I think I was right. Let me just say up front (again!) that this is MY OPINION. It doesn't mean that it's the only opinion or heck, even the right opinion! It's just how I see things through my eyes.

Someone asked what we have in a hospital that wouldn't be available at home. I'll admit that I've never been to a home birth, but from the research I've done here's a small list (not all inclusive) of things we would have in a hospital (not necessarily at every delivery but available within seconds) that usually wouldn't be available at home:

~ 5 L&D nurses
~ 4 NICU nurses
~ 2 Neonatal Nurse Practitioners
~ a full team to take care of mom after delivery and a separate team to take care of the baby after delivery
~ a labor bed that can be adjusted to many different positions to facilitate McRoberts maneuver (plus lots of others)
~ a full OR team/equipment (including anesthesia) ready for an emergency C/S if/when we decided we needed it

In my situation I think the things that helped the most were having all the (very experienced) hands ready and able to help. If it had been just the doctor and me in the room things could have turned out very differently. There is also no way that I could have taken care of the critical condition baby after he was born AND taken care of mom at the same time.

I know the great majority of births (home and hospital) turn out fantastic, happy healthy mom and happy healthy baby. I know midwives are trained and many have more experience than some doctors. I know that sometimes in hospitals decisions are made because of the extra monitoring that lots of times happens and that lots of times in the hospital we err on the side of "preventing" instead of "reacting." My experience over the weekend reminded me how quickly a situation can go from normal, routine, and uncomplicated to emergent, critical and life or death. The thought that keeps running though my head is "why would I want to take the chance of the one birth that doesn't go as planned being MY baby's?"

If It Scares Us It Must Make Us Stronger...Right?

2010-10-04T13:03:00.001-05:00

Every nurse has experiences that they never forget....shoulder dystocias are some of those experiences. Not going to go into detail....but all 7 nurses and the doctor were shaking pretty bad after a very cute and chubby baby destined to be a linebacker came out safe and sound. Scenarios like that are what put lots of things into perspective:
~the high acuity of what I get to do every night
~the great teamwork we have as a unit
~and why home birth is such a bad idea in my book!
This mom didn't push very long, nobody would have guessed after a recent sono showed a <7# baby that he'd be a tight fit!! If this mom had tried to deliver at home, the outcome would not have been good.....for her or baby.

On a less tense note...I got to deliver a baby for one of my friends from church this week. Those are so fun! Not only do I get to help Mom and Dad welcome their new baby but I get to watch her grow up over the next couple years. It's like a premature ending when I deliver a baby and then move them over after 2hrs and maybe see them one more time. I don't usually get to see the "continuing project" over the next few years! This is the fun way to do it!

It feels like maybe our crazy summer is winding down. The last few nights at work have been a little more relaxed. Several deliveries, but not the crazy non-stop, no more rooms, no more nurses pace we've been running all summer. A total of 339 babies in September! Waiting for the 2 sets of triplets to come in any day this month.....

Babies this Month:1m

Babies total: 111M/122F = 233
Vag:82M/94F = 176
C/S: 29M28F = 57
Babies 'caught' = 2f1.5m

The Babies Keep on Coming

2010-09-19T22:19:00.000-05:00

Even though I live in a large metropolitan area, it continues to amaze me how many babies we continue to deliver every month. It's not like we're the only hospital in the city, there are several other hospitals who deliver just about as many babies as we do......and the last few months we've been >350! A week or so ago we had 23 babies in 24hrs...and with only 17 labor rooms that makes for some crazy times!

I've been doing lots of thinking over the last several weeks as we're losing some nurses to day shift and have a new traveler with us and just in general about how much the last 2 1/2 years have changed me as a nurse. We were all sitting around talking (one of our rare moments of peace and quite!) about 'seniority' and off all the nurses on our night shift I'm 3rd on the list for seniority. Not by experience by any means, but by employee time at the hospital. And there are several nurses with less experience too. I don't feel like I've been doing it THAT long!! But having some of the newer nurses come up and ask ME about what I think about a strip or what I would suggest they do in a certain situation...it still surprises me. The things that used to scare me to no end are things that don't really phase me any more and the things that I didn't used to think were necessarily a big deal see the significance in now! I think I've grown up a lot.

I worked an extra 15hr shift last week, went in at 2300 and left the next afternoon at 1400 after the delivery. It was a great bonding experience with the patient and her husband, but I don't think I realized it until how much we bonded until I was talking to them in the NICU a few nights later. They kept saying over and over "you helped us so much. We didn't realize how much our nurse would actually do and how little we would see our doctor. We couldn't have done it without you, you made the whole experience so positive even though it didn't go exactly as we had planned." This was the same couple who had a doula who told me that since I didn't have children of my own I didn't really know what it was like to be in labor...hmmmmmmm. She had a point...but I thought that my point of delivering way more babies than she had was a valid one too. But, I think I will always feel slightly dis-advantaged as a labor nurse until I have my own kids someday.

One thing I always seem to struggle with when I have patients who have doulas is when they ask their doulas for "permission" before they do anything. The patient was thinking about getting an epidural after 10+hrs of backlabor and no real cervical change. She had been talking about it and going back and forth and I asked her if she wanted me to start her fluid bolus prior to her block. She looked right at her doula and said "what do you think?" When her doctor wanted to start pitocin a few hours later after she was comfortable and still not changing her cervix...again she looked at her doula and said "what do you think?" (after waking her doula up from the nap she had been taking on the pull-out mattress) HELLO!! This is not your doula's labor! This is your labor, your baby, your body, your experience! You don't need your doula's permission!!! Doula's are great support people, they're awesome, don't get me wrong. But (most of them...and especially not the one in the previous scenario) they're not trained medical personnel...they're not your doctor or your nurse...don't ask their "permission"!

Several of us L&D nurses have thought that we could make a killing working as doula's on the side :) Best of both worlds!!

Babies total: 108M/119F = 227
Vag:80M/91F = 171
C/S: 28M28F = 56
Babies 'caught' = 2f1.5m

Lots of Babies!

2010-08-07T20:58:00.002-05:00

July was a record setting month at work...for all times! 361 babies in 31 days...with an 18-bed L&D, no antepartum unit...that's a lot of babies! We had 6 sets of twin, 4 of which happend the last week-and-a-half. I had at least one 3-delivery night (all vag!) plus several 2-delivery nights. We were a busy bunch for sure :) I think all of us nurses are more than happy if we don't break the record again for a VERY long time! It was kinda cool though, I delivered the record-breaking baby one morning(356) and then came back that night and delivered the new record-setting baby (361) that night. How cool is that?!

We had a lot of earlier babies too...2 sets of 31wk twins, some 32wk PIH moms...our NICU is full to overflowing! Job security is amazing!

I was thinking this week that the begining of August marked my 2-years as a L&D nurse, and my 2-years as a nurse period. I sure feel like I've been doing it longer than that (and am very guilty of telling my patients that I've been doing it longer than that...just to make them feel better). I know there is still tons that I have left to learn, but so many things that I used to think were such big deals aren't that big of deals anymore and things that used to get me all flustered don't any more. I think that's a good thing. And yet everytime I go to work and get in the "just another day at the office" funk, I have a delivery, or a patient, or a conversation with someone that makes me remember what an amazing job I have and all the miracles that I see happen every night at work. Whether it be working hard with a mom to delivery that miracle, or working hard with that mom to keep her pregnant just one more day. Ah...life is good :)

Babies total: 100M/114F = 214
Vag:75M/87F = 162
C/S: 25M27F = 52
Babies 'caught' = 2f1.5m

#200

2010-06-02T09:03:00.002-05:00

My 200th baby!! I've been waiting for like a week for that and it took one of the nursery nurses to point out that I had it last night! And check out these stats...

Babies today:1m
Babies total: 94M/106F = 200
Vag:70M/80F = 150
C/S: 25M25F = 50
Babies 'caught' = 2f1.5m

A 3:1 split on the vaginal deliveries vs C/S's...
Almost a 50/50 split on the male/female deliveries...
An exact 50/50 split on the male/female C/S deliveries...
And 3/200 babies I got to catch... :D That one's the best one!

Less than 2 years to make 200 babies, that's pretty good I would say!

Birthday Twins!

2010-05-22T04:45:00.003-05:00

Every year (all 2 so far..._ that I've been a nurse I've worked on my birthday. Last night it was the night of my birthday, this year it was supposed to be both ends. Everyone thinks I'm nuts for doing it, but I personally think that it's kinda fun! I've gotten birthday twins both times, and that's fun for me!!

This year I looked like a slight idiot doing it, but it all worked out OK. I had a triage come in for bleeding and she sure wasn't bleeding, and she was contracting every 7min, SVE unchanged from the office earlier in the week, cervix way posterior and she said she wouldn't have come in except for the "bleeding." I sent her home with some vistaril after I told the doctor "she's not bleeding or laboring." She was back 1hr later, contracting every 2-3min and 3-4cm. Chalk one up to my great triage skills!!! Oh well....she delivered a few hours later, blocked and comfortable, girl #3 with 2 pushes! We almost had extra people at our birthday party after I picked up the phone and accidentally switched 2 numbers in the doctor's sleep room and asked the friendly lab tech to come to my delivery. Oops...

Almost at 200 babies! I was hoping to hit #200 before midnight on my birthday but I got put on call. Good thing I picked up a couple extra shifts last weekend!

Babies today: 1m/1f
Babies total: 93M/106F = 199
Vag:70M/80F = 150
C/S: 24M25F = 49
Babies 'caught' = 2f1.5m

Catching Babies!!

2010-05-15T02:19:00.003-05:00

I must say....I've been waiting to catch a baby for a long time now! It's been almost a year since I've caught a baby! Yet another reason I love unblocked multips with no doc in house :) Yay!! I have yet to catch a nice, normal controlled delivery, all my babies just shoot out at me. And once again, one glove on and one glove off. I guess it's my signature :)

Shift change, I had just gotten report. Grand multip, unblocked, on pit, ruptured. The doc had just called, she was 5cm and he said to call him when we were ready. I checked her about 20min later and she was 6cm. I stuck a warmer in my room and put a delivery table outside my door just to be ready. Someone else delivered and needed a gelpie, so I went in to help them look for one. I got back to my room and my Mom said "I gotta puke..." I put on a glove, sure enough, there was the head. I grabbed the phone and called the laborist's room.....it rang....the head came out...I put the phone down in the bed....reduced the nuchal while telling Dad to find the delivery button....the rest of the baby came out....Dad found the delivery light and I found my emergency badge button....a nurse brought me the table and I clamped the cord, let Dad cut it (spraying blood EVERYWHERE...note to self, milk the cord next time)....baby to warmer....cord for pH's....cord blood for nursery....about that time the laborist came dashing in and I let her deliver the placenta. Mom was intact and very happy that the baby was out! I was impressed 'cuz the only blood I had on my scrubs was from Dad spraying blood everywhere. Nice!

The rest of the shift followed the pattern and I did 2 more deliveries. One a Mom who walked in 9cm with a bulging bag who I was afraid I was going to catch too, but she was a prime who had great control and only pushed for 30min. I learned my lesson though and had the laborist in the room with me for that one!

I went in for an extra 6hrs tonight and had yet another unblocked multip on pit who was 5cm when I got there. Thank goodness that doc was hanging out in-house at least, he almost missed the delivery anyway. I would have caught 2 babies in a week, but he wouldn't have been quite as laid-back about missing a delivery as the doc on Wednesday night!

So that's 3 babies I've caught in less than 2 years. Yay! My knees were still shaking a little bit, but not near as bad as the first time!! Now I want to do it again!!

Babies today: 2f/4m
Babies total: 92M/105F = 197
Vag:69M/79F = 148
C/S: 24M25F = 49
Babies 'caught' = 2f1.5m

Teaching

2010-04-22T15:24:00.002-05:00

For as busy as we've been lately...it's been pretty ok! It's so nice having enough night staff to go around, and my phone hasn't been ringing off the hook every night looking for help! So what's the answer going to be? We're sending more nurses to day shift....of course! But, we will survive, because we always do, and we'll laugh our way through it :) I've realized over the last few weeks how much I love the girls I work with. They are 50% (some nights more) of why I love my job so much!

I got my first "thank you" from a student that's been working with me. I got so excited! She wasn't even really "my" student, but she needed some more shifts, so she's been working a couple nights with me over the last few weeks when her normal preceptor wasn't working. It's been fun and really an eye-opener for me. I've never really "preceptored" anyone before. It's hard for me to preceptor new nurses to the floor because most of them are older than me, and have been doing this for a lot longer than I have, just at different/slower/smaller hospitals. Telling someone who's older than me what to do or how to do something is still one of the things I'm working on, so I'll stick with students and new nurses who I've still got some (if however small) senority over! It's fun to watch it click for the first time for these new girls. I remember when it clicked for me and that's when I got hooked...

Babies total: 89M/102F = 191 (almost 200)!!!
Vag:65M/78F = 143
C/S: 24M24F = 48
Babies 'caught' = 2f0.5m

14 in 7

2010-03-13T05:59:00.004-06:00

Does Friday night have an OB curse everywhere?! It's like a full moon...Friday nights have a reputation for being beyond crazy!! Walk in the door @ 1830 and there are no empty rooms...and the board is FULL of labors! Labors are good....it means that they will get delivered and open up a room eventually...but they also can't be stacked up with one nurse, so it takes more nurses to take care of a board of labors over a board of antepartums. Still...I'd rather take labors anyday! Most of the labors were inductions hanging around from 0700, anywhere from 4-8cm.

First clue that maybe the night is gonna be full of surprises, in the midst of a pushing marathon a family member passes out, splits their head open and is unresponsive on the floor. It took 3 docs and multiple nurses calling down to ED to have them send a gurney up to get her. "Well...can you put her in a wheelchair and bring her down, we're busy." Um...no. She's unconscious, we can't jus put her in a wheelchair and bring her down!! After a few minutes she woke up and after some stitches she came back up to see the new arrival :)

I started the baby cascae with a vag delivery about 2030, about 3 minutes of pushing. Yay!! I'd taken care of this mom on multiple antepartum admissions and it was fun to get to do her delivery to wrap up the pregnancy.

About 10min into her recovery I took a triage (to our only empty room. She was about 3/100 with a BBOW and contracting every 3min. In the midst of asking her admission questions she mentions "I'm scheduled for a C/S next week." Hmmm...maybe the fact that you're a repeat C/S x3 is something you should mention to the doctor on-call when they tell you to come in. Thankfully that doc was already in-house in the midst of a C/S, so we prepped and followed pretty quickly. Baby #2 for me!!

As soon as I come out of the OR we keep the OR's running and double up PACU recoveries. I headed back out to the battle field and took another labor patient from a nurse going home. This gal never really made leaps and bounds of change but she was hurting and contracting pretty frequently and wanted an epidural. The doctor wanted to AROM her, but I convinced her to let me get Mom comfortable before AROM.

Epidural went fine, and so the doc came in to AROM her. She was having quite a bit of bloody show, and when the doctor checked her there were several clots. The fluid with AROM appeared to be clear but we kept a pretty close watch on the bleeding. About 10min after AROM, heart tones started sliding. Turn, turn, O2, fluid bolus etc. No response. Doctor was sitting at the desk and she came in and put on a scalp lead. Still low heart tones. So to the back we run. No time for an epidural dose, so we had to sleep her. By the time we got to the OR heart tones were much better and we all breathed a little better. 7min from the time we left the labor room to delivery (including waiting for anes to put Mom to sleep) and less than 45sec from incision to delivery. Our manager was there working the floor with us and both she and the doctor said they were pretty impressed with how fast we moved. That was the most people I've ever seen in the OR at one time, but I'm so thankful for each one of them!! Baby came out only slightly stunned but did great and Mom was good afterwards. Pretty good size abbruption.

As a whole, we had 14 babies in 7hrs that night, and I had 3 of them. Needless to say...I slept like a LOG the next day! Funny thing too, I wasn't even originaly scheduled for that night, but had switched nights with someone else...That's one of those nights you don't forget!

Babies total: 80M/99F = 179
Vag:62M/76F = 138
C/S: 18M23F = 41
Babies 'caught' = 2f0.5m

Still Here!

2010-02-15T18:45:00.003-06:00

I know...it's been over a month since I talked about babies...but trust me, they're still coming! We beat our record for deliveries in January...ever. >330 in 31 days...we thought that was pretty impressive! It's seemed to me that for as many deliveries as we've had I personally haven't done very many :( Lots of cervidils and antes. Maybe my turn is coming soon :)

I did have some excitement Sunday morning @ 0600 when a SROM walked in and was in the best abbruption pattern I'd seen in a long time! Right off the bat banging out contractions every 30-60sec. Baby looked like one nice straight line (NOT a good thing). When I went to check her instead of a gush of clear fluid I got a handfull of blood. Of course we didn't have a laborist (in-house OB) that night, so I had to call her doc and get her to come in. I am so thankful for my amazing labor-nurse friends! We had the doc on her way, an IV started and a chart put together in about 15min of her getting there! After some IV fluids and some O2 baby started looking beter and she wasn't saturating pads with blood, so doc decided we had time for a more controled C/S. We didn't have to sleep her or anything too scary-run-down-the-hall, but still had a (>9lb) baby in 1hr 15min! Nice way to end the shift I guess.

Poor girl, she was more than a little scared, and was planning on going all natural. I have my doubts that baby would have fit anyway, didn't seem like a very big pelvis. Hopefully next time around she'll get the chance to VBAC!

I promise to start making a better attempt at posting on a more regular basis!

Babies total: 75M/95F = 170
Vag:58M/73F = 131
C/S: 17M22F = 39
Babies 'caught' = 2f0.5m...I'm TOTALLY in the mood to catch another baby! Another nurse got to catch one this weekend when the Dr. got stuck in the lounge when the infant security alarm went off...I want my turn!!

End of A Decade

2010-01-01T11:42:00.002-06:00

And how did we finish the last week of the year?! Like crazy nurses at work! Our "goal" to beat a yearly record of babies was to deliver 315 this month. Because of the holidays we were a few behind, but I think this last week we went crazy and ended up at 300. I worked Christmas night...and the next 3. Christmas night was super slow, we were in the middle of a huge snow storm. I sat for 8hrs without a patient! It was pretty amazing :) We sat around and made no-bake cookies in the lounge and had some good laughs.

The next 3 nights...were not so laid-back and relaxed. We had like 19-20 babies every day, there were a bazillion inductions/c-sections scheduled and we kept hoppin'! I had a good delivery each night, did my first c/s with the new (kick me!) charting system and survived :) We all learned a valuable lesson about not opening our mouth about our shift being over and took a crash c/s back at 0643 at change of shift. Craziness!!

Ready to see what another year brings! How many babies, how many new experiencs, how many more things I can learn!! I feel like a totally different nurse than I did last year, and that's a good thing :)

Babies today: 3f/4m
Babies total: 72M/88F = 160
Vag:55M/68F = 123
C/S: 17M20F = 37
Babies 'caught' = 2f0.5m

1:1

2009-12-19T06:51:00.002-06:00

What an interesting beginning to my week. One that I wasn't too happy about...until after the shift was over and I took time to think about it.

We're one of the only hospitals in the city that has a psych unit (and it stays pretty busy!) For the last several weeks they've had a pregnant woman upstairs who came in with suicidal intentions (she wanted to cut her baby out). So they've been doing NST's etc on her and had just done an amnio and schedule her for an induction. Well, lo and behold, the same day she was scheduled for a cervidil, her water broke. So down to our unit she came. Her and her 1:1 status.

When I got there she had just gotten admitted and started. She was on pit and planning to go unblocked. So I settled down in my hard wooden chair for a very long night. When the FOB decided to come up to see her (one of many social problems) she decided to get an epidural to make him happy, and proceeded to progress nicely. She was a super pusher and let's just say there was some serious "counter pressure" waiting for the doc to come. Note to docs sleeping in the lounge: if you're going to sleep, please make sure the phone is on so we can get you when we need you!

When I left in the morning, I had left that room a grand total of 3 times. Once to pee, once to shove some food in my mouth and once to page the doctor. I felt rather helpless not even being able to go get zofran on my own. I felt even worse b/c I knew the rest of the girls were dying with people walking in and staying, but I couldn't do anything to help!

Afterwards, when I really got to thinking about it, it was a pretty cool experience. Being able to be there, at the bedside, and not knowing I was next up for triage, or knowing that I had other patients to take care of, but being able to focus on one woman, her labor and her experience. I would do it again. If only our staffing would allow for that...

Babies today: 1f
Babies total: 68M/86F = 154
Vag:52M/66F = 118
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Fired

2009-12-12T10:13:00.002-06:00

I know, 3 weeks is a long time to go without blogging...but 3 weeks is a long time to go without a baby too!! We've all been running our tails off at work the last several weeks, but I've seen no fruits of my labor. I keep getting antes, cervidils or getting a labor patient started and then leaving them blocked, comfy and well on their way in the morning...just to let someone else get the fun of delivering :( Even worse are the nights I've come in and had 3 recoveries to move...that's just the dirty work!! Oh well...I guess it's all a part of the process, so I'll do it anyway.

I did get "fired" for the first time by a patient this week. I was more than a little upset and hurt by it...until I found out that there hadn't been a nurse yet that she'd gotten along with...including the "reverend mother" of the unit (the sweetest, most caring, gentle, knowledgeable nurse on the unit). The first words out this woman's mouth were "how old are you, how long have you been a nurse and do you have any kids?" I guess my answers of "23, 2 years and no" weren't good enough for her. I didn't mention the fact that I've helped/observed with birthing a baby many more times than she has. I know, it's no replacement for actually doing it myself, but it has to count for something, right? She wasn't happy with the fact that since she was already being induced early for PIH and really high pressures that I said that an epidural might be something to think about, simply because as labor progressed and her pain got worse her BP's were going to naturally keep getting higher...and wasn't really what we wanted (hence the fact we were delivering her early). She did go on to deliver unblocked, so I guess that showed me. From here on out I will no longer be asking someone if they would "like" me to check their cervix to see how far they're dilated...since I'm the nurse and supposed to be managing them. Good grief. I felt bad for the nurse I handed her off to...

Since Thanksgiving I have yet to work another 3 in-a-row. I've been using up some of my required PDO time, so I've only been working 2 scheduled days, plus whatever extra I pick up. This next week I go back to my 3 nights...and I hope I survive!!

Back to the Babies...

2009-11-20T17:49:00.003-06:00

I'd forgotten how hard it is to go back to work after a long stretch off! Maybe that's because it's been so long since I had more than 2 days off in a row! After going in extra for a few hours both last Thursday and Friday I was off 'till last night! Count it...that's 5 whole days off!! It continues to be super, crazy, insane busy at work. We had 7 deliveries just on night shift alone, with a board full of cervidils and antepartums to beat. We were busy, but thank goodness we had 7 nurses there too! I had my first delivery in what's seemed like ages. At least 2 weeks I think.

I wasn't all sure that it was going to be vaginal, but she did it!! I was so proud of her! 1st baby and a great support system in her sister, boyfriend and boyfriends' mom (even more impressive that the baby wasn't this boyfriend's but from a previous relationship). It was fantastic!

We've had 210 babies as of midnight on the 18th...that's a lot. If it weren't the holidays next week I think we'd really be breaking numbers this month...is everyone else this busy!?!

Babies today: 1m
Babies total: 68M/83F = 151
Vag:52M/62F = 114
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Babies Everywhere!

2009-11-07T04:11:00.004-06:00

I set a new record at work last night...3 babies in a shift! I don't think I sat down all shift! And I know I didn't have a chance to pee all night (but that's nothing new anymore) :(

I had one delivery right off the bat @ 1845. Sweet little gal I had cervidiled the night before. Getting induced early for low fluid, never really thought she'd deliver vaginally. She did awesome!!

Got delivery #1 recovered and moved, then took over another labor patient from another nurse. She was 5, blocked/comfy and went from 5 to complete in about 45minutes! She was a great pusher and had a fantastic soundtrack of "pump-it-up" music that we played while we pushed. It was the best pushing session I've had in a while! It gives the nurses energy too! She had a little bit of a long repair afterwards, but was a trooper about it.

Got delivery #2 half way recovered before my next patient got there. She labored pretty well, tried the tub, tried an epidural that didn't really work. She SROM'd then was really hurting. In the midst of trying to redose, then finally having them just put in a combined spinal epidural she was laying on her side involuntarily pushing. We called the doc for delivery, had the laborist standing at the bedside and about 3 nurses in the room. We knew as soon as we laid her back we'd have a baby, you could see the perineum bulging with every involuntary push...

The CSE worked great and she got comfy really quick. Her doctor got there and then didn't I look like the idiot when we pushed for an hour and delivered straight OP. Fun, fun times. That was the first baby I'd ever seen delivered straight OP though. It does look quite odd when they come out looking at you instead of looking at the ground...

The day shift nurse who came in and tried to take over in the middle of the delivery (my turf...back off!) asked how the night had been. I said we'd been pretty busy, 5 or 6 deliveres. She said "we long for the pace. Must be nice." I bit my tongue but really, really wanted to say something along the line of "must be nice to have 2 or 3 times as many nurses on day shift too..." Oh well, all the babies get here and it always works out :)

Babies today: 1m/2f
Babies total: 67M/83F = 150
Vag:51M/62F = 113
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

She's Finally Here!

2009-11-07T03:48:00.005-06:00

One of my favorite things is when I get to deliver someone who has personally asked me to be her nurse. It gives me a warm, fuzzy feeling in my stomach that someone picked ME to be their nurse and I wasn't just the one who got assigned to her! One of my friends asked me months ago to be her L&D nurse and we've just been waiting and waiting. I think the waiting's been worse on her than me...she's been ready for this baby to be here for months I think!!

I just finished a stretch of 8 days off and was out of town for part of it and we all knew that's when Little Miss was going to make her appearance. Mom had been contracting for days and days. She'd gone in for a labor check and wasn't doing anything. She was scheduled for an induction a couple days past her due date and wasn't too thrilled about that. Finally, my first day back at work, she came in ruptured and delivered in 3 hrs!! It was so fun! Super delivery and a super sweet baby. Congrats to Mom, Dad and big brother!!

That was the night we did 5 c/s in a row. Started W 1845 and rolled the last patient out of the OR at 0400. We had at least one nurse in the OR or recovery room all night. The patients just kept walking in and staying. It was crazy.

P.S. To doctors sleeping in the call room down the hall: when I call you for delivery, please don't take 5min to walk down there, sit on a stool to put on shoe covers and take your own sweet time then yell at me because I'm not "holding the head in well enough." I am ready for delivery when I call.

Babies today: 1f/1m
Babies total:66m/81f = 147
Vag: 50m/61f = 111
C/S:16m/20f = 36
"Caught":2f/0.5m

12 Out Of 14

2009-10-24T11:33:00.003-05:00

Just finished up working 12 shifts in 14 nights...not something that I would recommend doing again for a long time to me or anyone else. That's a lot of work in a not-very-long amount of time!! We have been so busy that the norm anymore is to have no empty room and have to put the elective inductions on hold just because we don't have anywhere to put them!!

I could have easily worked both of the nights that I didn't if I had wanted to...but I just couldn't knowing that the first time it would have been 9 nights in a row and the second time would have been after I had stayed over from night shift 'till noon the next day and couldn't force myself to go back at 1900 that night. Anyway...is everyone else seeing a big increase in baby #'s for October?! Our thing is too it's not just "babies" it's pre-term stuff and antepartums filling up the board! A complete previa at somewhere around 30wks...that's gonna hold a bed for as long as possible, kidney stones take a bed for a couple days, all this H1N1 stuff floating around...never a dull moment!

We were even having babies in the hallway this week!! One night the phone rang about 1940 and I picked it up. I hear "This is the ED, we're bringing you a patient in active labor and we need the laborist to meet us in the room." They say that all the time and lots of times the patient ends up being like 10wks pregnant or something. So I asked when her EDC was, who her doctor was, etc. The freaking-out-lady on the other end says "No, no, no! Listen to me, we need the laborist down here." I asked if the patient was delivering and the lady said "yes" and hung up the phone! So someone when to go grab our laborist who was in the middle of surgery and I flew over to the ED with a precip pack and asked the nurses where the delivering lady was. They said "oh, they just took her upstairs." Hold it...I thought she was delivering and they needed the laborist stat...

I met the laborist, the gurney with a grunting patient on it, and an ED tech in the hallway on the way to L&D. The patient kept saying "I need to push..." and when we rolled through the door of the room we heard the screaming under the sheets. Sure enough...welcome to the world baby! Mom was a grandmultip and baby's UDS came back positive :( Sad story, but sure added some excitement to our evening...we were simply counting our blessings that the baby didn't come out in the elevator on the way up from the ED! The ED told us they looked under the sheets and didn't see a baby so they thought they should bring her up to us.

For as much as I've worked, I don't even really feel like I've had that many babies! I had 4 this week...and I thought that was impressive!

1st one was a primip who acted about 10 years younger than she really was. If your mom is talking baby talk to you...are your really ready to have your own baby?! She was unblocked because "you know epidurals paralyze you...". When I first checked her I could have sworn she was complete, so called the doc, put her up in stirrups and pushed twice....then when she finally let me really feel...nope, she was more like 8. So out of stirrups and to her side. Thank goodness by the time the doc got there she was more like a rim that slid back pretty easily. The delivery was a little chaotic, she pulled her IV out twice while we were pushing, wouldn't listen to the doctor, wouldn't push...but baby finally (somehow) came out and screamed right along with mom. Healthy mom, healthy baby, and mom could walk to the bathroom on her own...fine with me!!

Another fun baby that same night, mom came in and did great, got her epidural about 7cm, doctor was there and AROM'd her and she pushed about 30 minutes. Thankfully it happened to be a little slower moment in the shift and before mom got her block for about 2hrs I got to pretty much sit in the room with her and coach her through it. The dad asked me afterwards "do you always get to sit in the room with the patients like that? That is so cool!" I wish I DID have the chance to do that with everyone!!

My last night of my stretch was the best one, even though even before I got to work that night I had decided in my head that I was quite done with work for a few days and was not too excited about going back. When I walked in the door they told me that I was going to need to take care of a recovery who wasn't moved because "she hadn't eaten yet." Her recovery was over, but since she was still working on her dinner tray they hadn't gotten her up to the bathroom yet. I'll be honest...the recovery/up to the bathroom/moving process is my least favorite thing about L&D. So...as soon as day shift left I went in, got her up to the bathroom and moved her. Now why couldn't have have been done before I got there? I don't understand.

So after moving my recovery the patients keep on rolling in. Took a non-contracting SROM back to her room and got her settled, just as my cervidil showed up. Loved both couples!! Cervidil was a couple so excited about getting to have their first baby. Dad was just finishing up his residency and it was so nice to have someone in the room who knew how to help if I needed it! An extra set of hands when I was starting the IV, he knew how to silence an IV pump...but was so non-threatening about it. Other couple was their 2nd baby and had lots of family in the room all night.

I don't know where they ordered the batch of cervidil that we had that night...but it was doubly potent for both of them! I put it in and both of them took off! About 5min after I put the cervidil in the "scheduled" cervidil she was contracting every 1-2". I got both of them epidurals before midnight and ended up pulling both cervidils and both labored on their own. An hour after I pulled the scheduled cervidil she was still contracting every minute and I ended up terbing her. I NEVER terb cervidils!!! I figured the doc would be ticked in the morning. My SROM girl delivered right at shift change and I handed her off to a day shift nurse right after baby came out. I went in to say goodbye to my other patient and just for curiosity sake I checked her. She was 7! How to do you get to 7 after I terb you for hyperstim!!!

I begged to stay and deliver her and somehow it got approved, so I got to stay! When the doctor came around about 0745 she was almost complete..and delivered within an hour!! I was so excited and it was a great delivery. Both mom and dad said Thank You over and over for staying over my shift for the delivery. That makes it even better. Great ending to a LOT of work! Isn't that the way it was supposed to be?!

Babies today: 2f2m
Babies total: 65M/80F = 145
Vag:49M/60F = 109
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Still Here...

2009-10-14T16:26:00.003-05:00

Promise I haven't fallen off the face of the earth! More like into the crater of work! Even though it's the middle of October we're still busting at the seams and somehow managing to survive and laugh about it.

Several fun babies lately...all girls, go figure!!

There were moments that I felt like and idiot, a bad nurse and almost shed a few tears on the job...but then I look back on that night and think of all the things I learned and all the things I did that I didn't know I new how to do! I learned all about doing a D&C in our OB OR's...something I'd never done. How to do a sterile vag prep (I've talked to 1 nurse on the floor who'd ever had to do that...). I learned that I could put a scalp lead on someone who was 1/60/posterior when I had heart tones in the 50's (even the doctor was impressed at that!)...and I learned that I could stand up to a doctor and get what I needed for a patient. I also learned that I have some of the BEST co-workers ever. They're always there when I need them, they always are willing to help me out and I love them!! We just got 2 new nurses coming off orientation on day shift and they said they've already noticed a big difference between days and nights and how supportive night shift is of one another and how it's a team approach instead of everyone nurse for herself. I like that :)

I almost got to catch a baby the other night, I was all excited! But the doctor was in the lounge so I made sure she made it. You gotta love those multips who push once and all of a sudden the baby's crowning :)

Babies today: 4f
Babies total: 63M/78F = 141
Vag:47M/58F = 105
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

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

2009-09-28T05:56:00.000-05:00

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!!

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

2009-09-26T22:39:00.004-05:00

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 is...how 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!!

2009-09-26T04:29:00.003-05:00

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

2 Little Boys

2009-09-18T23:34:00.004-05:00

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

Ready for Another Baby

2009-09-09T11:17:00.005-05:00

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

Only 2

2009-08-20T05:41:00.002-05:00

Only 2 birthdays in the last week :( We've been having babies right and left it seems...I just haven't been involved in them. That makes me sad!!! I want some babies!! It seems like I've had cervidils and antes a lot lately. Boo.

Neither of my birthdays have been terrifically outstanding either. Pretty "run-of-the-mill" almost...for lack of a better word...boring! The first one was a close friend of the doctor...so get this...the doc stood in the room and pushed with her for an hour and a half!! Seriously?! I love this doc, she's great, one of our favorites. But come on. I can think of only a handful of things that can make an L&D nurse feel more useless and a waste of space than standing at the perineum and pushing with the patient the entire time. Makes it even worse when the patients husband is there, and so is her sister...who is a pediatrician. So for an hour and a half I stood in the corner, dumping some astroglide everyonce in a while while doc, patient, husband and sister carried on their own wonderful conversation and the doc did my job!! I was a little sad :( The poor kid crowned for about 20 minutes "stretching". Mom didn't have any major tears...but that poor baby head was bruised and looked horrible!!

2nd birthday was a C/S after pushing for an hour with a kid who wasn't in there straight and a doctor who ran out of patience and a mom who wasn't the hottest pusher. Baby ended up being >9#...the most exciting part of the whole section was the section that happened across the hall at the same time.

We only have 2 OR's, so our rule is not to run them both at the same time (to ward off the emergency walking in). The first time I ever saw them run @ the same time was a couple weeks ago when we had to crash a patient...let's not do that again. Until Monday night. We had just taken my mom back and baby had just come out, when the charge nurse sticks her head in and says that the scrub tech needs to open up the other OR for another case. Huh? When we hear that we suspect emergency, so the scrub tech left to open and prep for the other case and sure enough, pretty soon the other patient came back. After my 2 docs were done closing, they broke scrub and left my OR. So I'm left in a pool of blood, my patient still draped, and the CRNA hanging out at the head. I asked the docs if one of them could do a final count with me and I was told bluntly "we can't. we didn't do the initial count so we can't do the final count." And they walked out.

So now what? I scrubbed in and at least covered the incision. Then counted and thankfully found everything. Then I called out to the desk to see if someone could come back and help me move my patient. My patient was number than a 2X4 and not the smallest mom. So I started cleaning her up by myself and finally the 64yr old charge nurse comes back to help me move out. All the more interesting. So 30min after closing time...we roll out of the OR.

I was NOT a happy camper and when I asked what the emergency was next door...I found out it was a failure to progress section and the doc called it right after I went back for my section. There was no fetal distress, no maternal distress, no fever. No complications, just no cervical change. Then she said that ACOG standards are "30minutes from decision to incision" and insisted that they go back that instant. The charge nurse tried to get her to wait, but she said no. Then they said she could go to the main OR if it was an emergency, but she said no, she wanted to go to our OR's. Seriously?

Thank goodness everything turned out OK, all the instruments, laps, sutures, blades, everything was present and accounted for when I counted and when 2 other people went back and counted. The whole situation made me nervous and a little frustrated. Patience doctors...patience!

Babies today: 1f/1f
Babies total: 58M/70F = 128
Vag:44M/52F = 96
C/S: 14M18F = 32
Babies 'caught' = 2f0.5m

I Hate IUFD's

2009-08-12T08:59:00.002-05:00

We've had 5 IUFD's (Intra-Uterine Fetal Demise) in the last week. 21wks, 33wks, 32 wks, 35wks and 36wks. Come on! That is WAY, WAY, WAY too many. I haven't taken care of a demise in a long time, since that one last Christmas that hit me so hard. I feel like I've helped with almost every one, but last night was the first one that I've actually taken care of since last December.

I hate them so much. All these babies who never have a chance, most of the time we never even know what happens. Mine last night was a rare case, he had a chromosome anomaly that the parent's had known about for most of the pregnancy. They were prepared, then were expecting something like this, and they knew exactly what they wanted. That makes it so much easier on us nurses, and in some ways, I think it makes it easier (at the time) for the parents. They had all their family there, they had all the little outfits for him there, they had their cameras, they had a name, they had everything and they had a plan.

The baby was perfect. He was handsome, adorable, and looked AMAZINGLY good for probably being dead for going on 36-48hrs. I was thankful for that. Mom, Dad, and all the family got to hold him. Dad got to give him a bath, they took picture after picture, they all helped with footprints, I did plaster molds for them, and when I left, Dad was sleeping in the recliner with baby on his chest. Wow.

I hate IFUD's. They're my least favorite part of OB nursing, because they're not fair. Not fair at all. And there's nothing that I can do to prevent them.

Babies today: 1m
Babies total: 58M/68F = 126
Vag:44M/51F = 95
C/S: 14M17F = 31
Babies 'caught' = 2f0.5m

Ante City

2009-08-10T08:15:00.003-05:00

I promise, promise, promise that I still blog once in a while! Somehow, when I'm so exhausted in the morning, blogging's the first thing that gets put off. So I have to wait 'till I have a day off to do it! Those seem to be pretty few and far between anymore...

I was scheduled to work Thurs/Fri/Sat last week, and I did. But Wednesday I went in and worked extra at the last minute. I was mowing all day long, and they called looking for help during the day shift that afternoon, and I couldn't do that. But then the 2nd time they called me @ 1700 looking for help that night I felt too guilty to say no. So I jumped through the shower and went in. I don't think I've caught up on sleep after that...

It has been raining antepartums and pre-term patients for the last week! I swear, we'll have 5-9 antes on the board every night...and when there's only 17 rooms total...that doesn't leave room for too much else! I can't wait for our new unit that is supposedly going to have an antepartum wing...and I hope heavens to betsy that I don't have to work it more than once or twice a month. Antes aren't too bad...but I didn't work medsurg for a reason! We have everything under the sun sitting on our unit...a couple pneumonia patients, kindey stone patients, patients with diabetic issues...and the thing is, is all these things are fine, but they don't really have anything to do with being pregnant! You treat a kidnestone patient the same way whether she's pregnant or not, same with pneumonia. So besides a NST every shift, or in some cases, every day...they're a med-surg patient. But medsurg or any other unit won't touch them if they're pregnant...so they sit on our unit taking up nurses and rooms. All fine and good until you have 349 babies in a month, and then things get a little tight! They don't stop coming in either...we clean out a bunch of the "green names" (antes) and another troupe comes in to stay for a few days. It's taking 2 or 3 nurses just to take all the antes every shift!!

I was the "resource nurse" on Thursday nights. That really just means that you're in charge of assignments and the bad guy telling someone that they have to take care of the next triage that just walked in. Our unit is pretty good about figuring out who should take the next patient, so it's not too bad of a job...most nights. When we got there it was crazy, and it never really slowed down. People kept walking in...and staying...and more people kept coming in. I think at one point we had about 9 nurses there. I had all the antepartum patients, we had one patient who was a cervidil on an insulin drip, we had 2 DIU patients, we had a patient who pushed for 3 hours and then had a C/S and bled and ended up with a bakari balloon, we had no rooms aka nurses on postpartum so we "couldn't" move out any of the delivered patients...it was the never ending night. I never want to be "in charge" again!!! Here I thought it would make me feel all grown up to be the resource nurse and make me feel like I was finally "stable" as an L&D nurse...not so much. It pretty made me want to run and hide and tell someone else to handle the issues of not having enough nurses to take the patients!! Thank goodness for my amazing team who helped shuffle patients and make sure everyone got what they needed.

I only had one baby out of all 5 days I worked. That delivery wasn't even very exciting, she was complete when I got there, we pushed for 10 minutes and had a baby @ 1913. And then it was back to triaging "preterm labor" patients who came in doubled-over in pain, I put them on the monitor, got a FFN, checked them and found them closed, watched them "contract" for an hour, re-checked them, dipped their pee, maybe gave them a glass of water and miraculously cured them and they walked out after I had to wake them up. Do people have nothing better to do at 3am than come to the hospital? And are people really so tired of being pregnant at 24, 28, 30, 31 weeks that they want to be in labor so bad and have a baby in the NICU for months? Tough it out a few more weeks and take home a healthy baby!!

Anyway...so I worked Wednesday night, Thursday night, Friday night, Saturday night, and I went in extra last night from midnight to 7. So I've got tonight off...and then I start my "real 3" for the week!

Babies today: 1f

Babies total: 57M/68F = 125

Vag:43M/51F = 94

C/S: 14M17F = 31

Babies 'caught' = 2f0.5m

Still Here!

2009-08-04T00:09:00.003-05:00

I'm still here...don't worry...haven't fallen off the edge of the earth. Even though, after working 6 out of 7 nights in a row...I was pretty sure that it was going to be a good possibility. I had a couple nights of antes, a couple good deliveries, several quite nights...except of course the one night that I asked for "call." That night it was crazy busy.

One of my nights included a double-forceps delivery. Mom was a very petite woman, and baby kept turning OP and wasn't very tiny. Finally after pushing for an hour and a half the doctor came in and used one pair of forceps to turn the baby and then another pair to expediate delivery. This particular doc is a pro at forceps, and is one of only a few who I would trust to use them. But still...they always make me a little nervous. Especially since this was the doc who the LAST forceps delivery I saw with him was when he missed the stool he was sitting on and fell and knocked out one of the nursery nurses. This delivery went off without a hitch besides a nasty 4th degree tear for mom...

Another night tested my patience to no end. My patient had some psycho-social issues, plus some mental dissabilities. That was a little difficult for me. I'll be honest, I hated my psych rotation in school, I have always had a hard time with it and accepting it as a real disease just like cancer, diabetes, etc. I know it is a real disease, it's just always been something I've personaly sturggled. The patient was not handeling labor well, she wasn't tolerating any pain, wasn't taking suggestions to help with coping and had limited coping skills all together. Her cervix wasn't changing, and when it finally did start changing and after an IUPC, she started begging for a C/S. I talked to the doctor, and we did end up sectioning her, good thing too because her baby was >9#!! Afterwards, I felt like a horrible nurse for not having more patience, for not pushing for a vag delivery and for giving in to the section so easily. Honestly, I was pulling for the section myself just because I didn't know what to do next! So next time I'll have more patience...

To round out my 6 our of 7 nights...a very fun family came in, 2nd baby, SROM, 4-5cm. Got her a block quick, settled her down...and then something just didn't feel right when I put the foley in. There was a major crease on the baby's head, like major molding. After a very awkward exam, I finally asked someone else to come and check, cuz I wasn't 100% sure it was a head I was feeling. Sure enough... it wasn't! So we headed back for a section.

One of our night nurses delivered during my stretch, so it was cool to get to see her and her baby while they were there. I wonder how perspectives change after being on the "patient" side of our job :)

Babies today: 1m/1f + 2f
Babies total: 57M/67F = 124
Vag:43M/50F = 93
C/S: 14M17F = 31
Babies 'caught' = 2f0.5m

Wednesday

2009-07-16T09:21:00.003-05:00

Sunday night kept a 30wkr with no pre-natal care pregnant one more night on Mag prior to her C/S in the morning, plus a few triages. Since when are Mag's 1-to-1?!

Went in extra for a few hours on Monday night from 2300-0200, did a C/S recovery. Then wasn't expecting to get off @ 0200 after the desperate phone call I'd gotten, but since I was there I decided to just go to the gym anyway. That was a little weird working out by myself @ 0300 and 0400...but it felt good when I was done!

Last night...got my butt kicked. I took a girl who was 6-7, blocked, on pit. Figured she'd deliver soon. Then another SROM who was 1/80 who had been 1/80 all day. She'd had a leep, so I figured after that band broke she'd start making some change. Planned on MAYBE getting her delivered. Well...things just snowballed from the get go. Assessed both patients, then my 1st girl had heart burn, then my 2nd girl needed checked and an IUPC, she was 2-3 at that point. Then I couldn't trace her baby so I put a scalp lead on (2nd one ever...yay for me!!!), then walk into my 1st patient's room and the doc's in there and she's complete, so we rushed to get the room set up, then I pushed with her for an hour.

While I'm standing at the perineum pushing I notice my strip in my 2nd room looks horrible. So I called out the desk because I obviously can't do anything about it while I'm pushing. "We'll send someone in." 5" later it's still having deep variables after each contraction...call back out to the desk. "oh ya, we'll send someone in." Finally it starts to get better and someone comes and and tells me that she's 7. Ok...

Then right after my 1st delivery (with a nasty 3rd degree repair) someone tells me, your other patient's complete and the doc wants you to start pushing. Ok, well then someone's gonna have to take my recovery...

So from one delivery to another, and since we had turned the pit off with her bad strip we started pushing and were only pushing every 5-7minutes. Finally the doc let me re-start the pit and we delivered in about 2 hrs. By the time I sat down to chart I had been pushing/delivering for about 4hrs straight! And had I charted ANYTHING in the computer? Of course NOT!!! I loved both of my patients and husbands, so that made it a fun 4hrs at least :)

I finally finished moving, charting, taking care of the couplet that I was keeping about 0330 or 0400 . Just in time to get a preterm twin rule out. I ruled her out pretty quick but then had to wait for a fetal fibrinectin to come back and finally sent her home about 0630 just as day shift was pullin up.

Another crazy night at work...I think we had 6 or 7 deliveries between 1900 and 0700. Sheesh...this is AMAZING job security!!

Babies today: 2f
Babies total: 56M/64F = 120
Vag:42M/49F = 91
C/S: 14M15F = 29
Babies 'caught' = 2f0.5m

Thursday

2009-07-16T08:52:00.003-05:00

So after my stint on Mom/Baby on Tuesday...I picked up the back half of someone's shift and went in 2300-0700. 2 great couples (one of them I saw 3 times since she was a cervidil and already tucked in when I got there) and what I thought was a great delivery right before shift change.

Then I found out on Sunday that they had just shipped the baby off to the high-end children's hospital in town because she had pulmonary hypertension and was not doing good AT ALL!!
She was pretty unstable and they were thinking about maybe a heart/lung bypass machine. Poor girl! Poor parents! I loved them!!! I haven't heard anything else about the baby...but I'm worried. I hate it when anything goes wrong with one of my babies. And I hate it even more when it's a term baby where everything's expected to go perfect! Sigh...I know it was nothing to do with the delivery or anything I did, but it's still tough to swallow.

Babies today: 1f
Babies total: 56M/62F = 118
Vag:42M/47F = 89
C/S: 14M15F = 29
Babies 'caught' = 2f0.5m

Tuesday

2009-07-16T08:28:00.003-05:00

Well, I guess this is technically talking about LAST Tuesday...shows what my life has been like! I went in at 1730 for J so she could go to a party, and so I took her c/s recovery. I had admitted the girl the night before...just a little on the high-drama side of the scale. I finished her recovery and the anesthesiologist wanted to keep her on L&D overnight with hourly vital signs re: some panic attack issues on the OR table (we don't ask questions...we just follow orders...). So I was set to take her for the night, then they tell me that actually, I'm going to give report on my post-op and go take a full team on Mom/Baby for the night. Come again?

So...wait 'till 1900, give report to ANOTHER labor nurse to take my recovery back out to the floor, then hightail it over to Mom/Baby to get report on my team of postpartums and babies. I'm already flustered b/c I'm running behind schedule and that threw my whole night off.

Here's the kicker that made me mad...I asked if there was any chance that they would call me back over to L&D during the night and they said no. They would call in L&D nurses for X1 1/2 and leave me on postpartum. This is turning into an issue for me. I don't mind floating if I need to, and I did it and whatever. But I still don't understand how it is our problem if mom/baby nurses don't want to come to work. I don't see how the river only flows one way. L&D nurses can cover for mom/baby and SOME mom/baby nurses can do feeder grower in the the NICU. But NICU can only do NICU, and nobody from anywhere else would dare touch a still pregnant mom except for us. So who gets shorted in the end? And yet who's problem is it to fill in for all the other unit's being short? Whatever...

But I survived, did a little breastfeeding 1-on-1 and grew more thankful that my REAL job is one that I LOVE and that I don't have to settle for something I can just tolerate. And I proved to myself that I CAN handle a postpartum team and leave with everyone breathing at the end of the shift...I do feel lonely over there without my group of nurses. It's even weird if I have to go back over for something...I feel very alienated, and it's obvious I'm not "a part of them" that night. Hmmm...something to think about!

So kudos to all you postpartum nurses out there! THANK YOU for all you do and for doing it so I don't have to!!! :D

Here We Go Again...

2009-07-06T08:00:00.003-05:00

And the craziness at work hasn't slowed down over the holiday weekend at all!! Took my labor patient back for a section @ 2000...what a painful section it was. I had all kinds of pain orders from the doc after the section was over. It was going to be that kind of recovery. Then when the patient slept through most of recovery, I didn't want to keep pushing meds on her. Then got a nice chewing out from the postpartum nurse because the patient (who had no pain tolerance) rated her pain 7/10 when she got over to the other side. "Why didn't you start XYZ pain meds in recovery if she hurt so bad?" Well...because she was sleeping through recovery and couldn't keep her eyes open even when I was checking her fundus. Didn't sound like she needed pain meds to me!

Moved that section recovery and took a ROL who walked in 3cm and ruptured. 20 minutes later she was 6cm so I called the doc and said "you better head this way..." and she did. Then as I'm hanging up the phone "the scream" happened. I ran in, patient was easily complete, thank goodness the laborist followed me in. We got her in stirrups. Someone called the doc who was on her way and she said "don't let her deliver, I'm on my way!" Far be it from me to tell a multip who's complete, unblocked and +3 not to push. Doc walked in as the laborist was delivering the placenta. Thank goodness the laborist backed me up 100%.

I'm half way through my vag recovery when one of the breech PPROM (preterm premature rupture of membranes) started having very ugly decels. The laborist who had just walked out of my delivery went down to check her and there was a foot in her entrotis (vaginal canal). Time to head back to a C/S! I was really the only one who could take her, so I (kind of) handed off my recovery and ran down the hall with the new C/S. She was still contracting away so they slept her ( I went from never doing a general anes C/S to 2 in a week!). I went to go put in a foley and when I spread her labia, the ENTIRE foot was sticking out. There is just something all wrong about that. I didn't think I could get the foley in, and the laborist said " just push the foot out of the way..." so I did and somehow got the foley in. Not really sure how that happened, but if I NEVER see a foot hanging out of a vagina again that will be OK with me...

So finished section #2 for the night. There was another ROL that I should probably have taken but another nurse already had her started, so I took the next one. The first patient delivered, mine didn't. I gave the nurse a hard time and said that I should have taken that first ROL because then I could have beat a personal record and had 4 babies in a shift. But looking back, 3 babies is MORE than enough, considering that I didn't admit my vag delivery 'till after she was already over on postpartum. I'm sure I missed something on charting, but everyone was breathing when I left, so I'll fix charting tonight if I need to. I'm getting on a role here, I'm not gonna know what to do if I go a night with less than 2 or 3 deliveries!

Babies today: 1f/2m

Babies total: 56M/61F = 117

Vag:42M/46F = 88

C/S: 14M15F = 29

Babies 'caught' = 2f0.5m

7 Wasn't Enough...

2009-07-05T00:25:00.003-05:00

I was so thankful to have a day off yesterday! I knew how crazy it had been, so I took brownies up to work last night about 2100. The board looked beautiful!! Couple green names and 2 ROL's. Why can't I work on nights like that!?!

So I dropped the brownies off and on my way out the door I made a funny comment about "now I don't want my phone to ring tonight because I've already driven over here once tonight!" I should have kept my mouth shut...!

Sure enough, about 0245 my phone rings. When I'm in a dead sleep I don't really think about what I'm doing and I just grab the phone and answer it. Sure enough "we need help! People just keep walking in!" Ok...I'm on my way. I couldn't say no after what I'd said earlier, and after the week we'd had, I know what it's like when nobody will come in to help. Only as I was getting ready to walk out the door did I realize that it was torrentially pouring buckets outside...no wonder the flood gates had opened at work (pun fully intended...).

When I got there I took one of the nurses SROM girls. After looking closely at the board I don't think it was quite as desperate as it had sounded on the phone, but I'm guessing it had all hit at once and when people keep walking in, there's no telling when they're going to stop walking in! So I checked on my girl, I actually used to work with her at the hospital day care before I went to nursing school. That was cool. She was ruptured and contracting, but hadn't really changed much from the office per the nurse who had admitted her. She didn't want any pain meds quite yet, so I let her rest for awhile. The doctor had given pit orders but I decided that since she WAS contracting, I would give her an hour or two to see if she did it on her own.

Baby looked great, and finally about 0530 the patient said she was getting more uncomfortable and wondered what she was dilated. So I checked her and something just wasn't quite right. I couldn't really find a cervix, and couldn't feel any suture lines, it was just all kinds of funk. So I had the original nurse check her and she didn't know what it was either...but she was definitely more than the 2cm she was when she came in. So we grabbed the ultrasound and then had the laborist come verify presentation, sure enough, it was a butt. You would have never know from where we were picking up heart tones, but then mom mentioned that "I have been feeling the baby kick me down low." Hmmm...well, no vag delivery for you! So we called the doc, Mom was about 5-6cm, and we took her back for a C/S. Baby was born just before 0700, little girl, perfect, adorable and sure enough...butt first!

So...8 deliveries in 1 week, I caught a baby, I checked (and almost pitted) a breech baby, I did a crazy, messed up C/S with a bakri balloon, rectal cytotec on the table and general anesthesia, I got along good with the docs, and I got 1 day off before I do another 3 in a row! Ah..the life of a labor nurse :)

Babies today: 1f
Babies total: 54M/60F = 114
Vag:42M/45F = 87
C/S: 12M15F = 27
Babies 'caught' = 2f0.5m

Thursday

2009-07-04T23:51:00.005-05:00

By Thursday night I was seriously dragging. We had all gotten our butts kicked all week long, and you could tell all us nurses were getting near the end of our strings...

I took my patient back for a C/S about 1910 after her being a cervidil the night before and then on pit all day and having made NO change. That and the fact that every time she rolled or changed position baby would have a nice 5-6min decel. A C/S was definitely the best decision for her and her baby. She was a young mom, first baby, and she was giving the baby up for adoption after 24hrs.

Got her all ready and back to the section we go. That's where things started spiraling out of control. We had a great anes team on that night, and usually it takes all of about 10 mins to get the spinal in and the patient comfy. So we started working in the back, since we didn't really want to move mom and cause another decel anes tried to put the block in while Mom was laying on her side. This is nothing new for them, and it's usually no problem. Well the CRNA tried...and tried...and tried...and tried...about 30 minutes of trying. The patient started getting a little uncooperative and stressed out about the block as time went by. We finally called the anes doc to come and he tried a couple times on her side, and then said we had to sit her up. So we sat her up and he got it in, then the patient started freaking out that she couldn't breathe. She said it was only on one side and even though she was satting 100% on room air she started getting out of control. They waited long enough for me to get the foley in and prep her and then they slept her. At that point, I knew I was getting in over my head in things I'd never done before. So...let's just keep the ball rolling!

It's amazing how fast people start to move when the mom's actually slept instead of with just the block. That's impressive! So baby came out fine, but then of course it couldn't just be all said and done with...the uterus wouldn't firm up, it stayed soft and "soggy". So...1 dose of methergine IM. Still boggy. So let's try something else. 800mcg cytotec...rectally...on the table...by me. Seriously? This is not a skill I learned in nursing school OR during orientation! Anyone tried to shove 8 little pills up a rectum while the patent's strapped down on a narrow OR table on her back? Without breaking sterile technique during an operation? MORE than a little difficult. Add in the fact that this patient isn't the smallest patient I've ever taken care of either. Seriously...

Too bad her uterus still didn't clamp down...so let's try some hemobate...nope...more methergine...nothing. So when all else fails, pull out the bakri balloon. This is a balloon that actually goes into the uterus vaginally and is filled with fluid to completely fill the uterus and put pressure on it so it stops bleeding. Never done one of these either. So let's list the NEW things that BirthdayNurse got to do during ONE c/s:
1. General Anesthetic
2. Rectal cytotec on the table
3. Bakri balloon
4. Hemobate intrauterine

That's too many new things to learn in one night!!! So 2hrs after we got in the OR, we left the OR. I'd never recovered a patient with general anesthetic, or a bakri balloon, or one who was as out of control as this girl was after general anesthesia, so I very willingly handed off my recovery to a different nurse and took her patient back for a C/S.

Thank goodness the 2nd section went according to how it was supposed to, other than her begin 29wks with PPROM, but baby was great for 29wks, mom did fantastic, and I got a chance during recovery to finish charting on BOTH patients! After moving my recovery I finished up another recovery for another nurse who was going home, meanwhile people kept on walking in the door...

After finishing up the last recovery, I went back out to labor land and picked up someones blocked/comfy/tucked-in labor patient who turned out to be the same girl I had sent home the morning before after she slept all night off vistaril. I was happy she came back in labor.

I took another multip ROL who was actually ruptured but only about 3cm. She wanted a block too, so I got her comfy, charted and sat down for about the 1st time all night. It was about 6, so I went in to check my ruptured girl one more time before I started some pit on her and low and behold she was about 8cm with a nice bulging bag. The doctor was sitting out at the desk and when I told her she said "well, let's rupture her and then I'll deliver her before I leave." Ok...whatever you say! So AROM, drag in some delivery equipment and have a baby at 0635!

Another 3 baby shift...and my 1st boy of the week! I was seriously starting to wonder if there was something in the water to get all these girls! And 2 of them have had the same name, and 2 of the other's have rhymed!

Babies so far this week...7. I think I'm done for the week!!!

Babies today: 2f/1m
Babies total: 54M/59F = 113
Vag:42M/45F = 87
C/S: 12M14F = 26
Babies 'caught' = 2f0.5m

Wednesday

2009-07-04T23:38:00.003-05:00

After Tuesday night I was already tired and it was only my 2nd shift! The fact that I picked up an extra 6hrs Monday night really threw me off, and I couldn't even tell you what day it was!

Wednesday I took a patient that followed me in the door for a rule out labor (ROL). I ruled her out after an hour, made her mad that I was sending her home, and tried to explain that I couldn't "force" her to leave but that I really thought she'd be more comfortable not in our beds and not being able to drink, eat or smoke her cigarettes. She finally decided to leave.

Then I took another ROL, got her in a bed, then got a page that somehow it was my turn to take ANOTHER patient. Ok...so I ran for about an hour and a half, the on-call doctor for the 1st patient decided that since she lived an hour away she should stay and would "probably go into labor during the night." I got her settled, gave her 50mg of vistaril to help her sleep (same sleepy effect of benadryl) and she slept the rest of the night. Hmmm...maybe not real labor?

2nd ROL went home, and I finally sat down to chart on BOTH patients. All fine and good, got everything caught up, I was good to go! Then another ROL walked in, of course it's my turn. She was definitely in labor and wanted a block so IV, block, check her and she was pretty near complete. Her doc came in, we had a great delivery! All right then! This was another doc who isn't always known for being super friendly but she came and sat at the desk with all us nurses and chatted for a while waiting for her other patient across the hall to deliver. I really like it when the docs sit out with us and socialize and just share in good old conversation. It breaks a lot of the the doctor/nurse walls down and makes everyone seem a little more human.

Right at shift change the same ROL that I had sent home 12 hours before came back and her cervix had changed, so she got to stay this time. You could tell she wasn't very happy, but in my mind, she got to go home for 12 hours, she got to eat and she got to smoke the cigarettes she wanted. She couldn't have done any of that if she had stayed. I'd say she was better off at home.

Total deliveries for the week so far...4

Babies today: 1f

Babies total: 53M/57F = 110

Vag:41M/45F = 86

C/S: 12M12F = 24

Babies 'caught' = 2f0.5m

Tuesday

2009-07-04T08:47:00.003-05:00

I could sum up this last week in 1 word: CRAZY!! But...to be fair, I'll post about each day. Since it's Saturday now (and this recaps Monday through Friday) I may be minus a few details...but all my numbers are correct!

Monday night started the ball rolling. I took report on a very nice patient from one of the day shift nurses. The patient was a multip already in labor, already had an epidural and was comfortable. So it was the waiting game on her. She labored very nicely.

About 1930 I took a triage who came in contracting, it was her 4th baby. She was in great control, but was ready for an epidural ASAP, so I got her blocked, comfy and then sat down to chart. Meanwhile, my 1st patient was starting to have a few variables, so I went to check her and she was complete. I set her up and we only pushed a few time, called the doc in and had a very nice delivery! I came out of her delivery, stuck my head in to check on my 2nd patient and she mentioned she was feeling a little bit of pressure. Sure enough, she was complete. So I somehow managed to hand off my 1/2 way done recovery to another nurse and went to my other delivery. She pushed about 2 times, we called the doc and had another great delivery. I check the times and it was 1hr and 5min apart from my 1st delivery. Nice work for before midnight :)

The doctor for my 2nd delivery can more often than not be a little difficult to get along with, even though I've never had any troubles with her at all. We had a great delivery, she was very chatty, happy and sociable the whole time. When I came out to the desk afterwards, one of the other nurses said "whatever you did to get on her good side, don't get off of it!" I don't know what I did either...

As I was sitting down to chart my admission database on my 2nd delivery patient (who said that admission stuff has to be done BEFORE the baby comes out?!), I head a blood curdling scream from a room and any labor nurse knows the sound of "the baby's coming" scream and that was for sure it. I dashed into the room, threw the cover off the delivery cart and sure enough under the sheets there was a head full of dark hair crowning up nicely. The actual nurse was standing at the bedside holding the sheets up looking slightly panicked (I don't blame her!) I grabbed the top pair of gloves off the delivery cart, reached down and caught the baby just before the laborist walked in. Baby went to mom's tummy, cord clamped and cut and I let the doctor take over. Hey, a TOTAL step up from the last baby I caught...at least I had on gloves, and I didn't get anything on my scrubs! It was a slightly awkward angle to catch a baby since I was standing behind mom, but whatever works I guess...

What a way to start a week. All girls! And chalk another baby up that I've caught :) I'll take one of those ANY day!! Counting the 2 babies I had + the one I caught we had 322 babies in June! That's alot!

Babies today: 3f
Babies total: 53M/56F = 109
Vag:41M/44F = 82
C/S: 12M12F = 24
Babies 'caught' = 2f0.5m

Friday Night

2009-07-01T09:26:00.003-05:00

Probably should talk about Friday night before I talk about the craziness of last night!

Friday night...I walked into a girl who was unblocked and on pit but who really hadn't changed all day. I walked down with the day shift nurse to check her right before shift change...she was 8. (Still unblocked). Got the room all set up, gave her a few more contractions...checked her again...she was 9.5...few more contractions, complete. Please let the doc get here! I didn't put her in stirrups 'till I had the doc present and accounted for and I was sure I was gonna catch the baby...but I didn't. Nice delivery, she was so proud of herself for going un-blocked, and with good reason! I love it when they think they're only 2 and then realize that they're like 8 or 9 or complete. It's amazing how well they stay in control that way vs. knowing that they're getting closer and closer. I wonder if it really is a mind game!!

So I hung out with my postpartum cuplet (since I've been trained now...hahaha!). Did the whole breastfeeding thing, etc, etc. Then about 430 I got a R/O labor/SROM who was indeed in labor and SROM'd. I got her block, comfly, did my charting and checked her about 0630 and she was complete! Got the doc there, pushed 1 and a half times and had a baby at 0658...handed off the recovery to the day shift nurse and left the unit at 0710. That's how I like it! Get the fun of bonding with the patient, do the delivery, sign the chart and walk out. I think every delivery should be that way :)

So...3 shifts this week...5 babies...all vag...what a week! Reminds me why I love my job (most of the time!)

Babies today: 2m

Babies total: 53M/53F = 106

Vag:41M/41F = 82

C/S: 12M12F = 24

Babies 'caught' = 1f1/2m

Babies Anyone?

2009-06-25T23:12:00.002-05:00

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 charting...in 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 complete...so 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

Awaiting Sweet Sleep...

2009-06-16T13:20:00.001-05:00

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...

1st of 2 IAR

2009-06-15T08:15:00.003-05:00

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 patient...plus 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! Whatever...it 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

Boards Re-Visted

2009-06-12T23:01:00.004-05:00

It's been an interesting week...it 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 that...work 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!

2009-06-12T22:48:00.003-05:00

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

Another Day

2009-06-10T19:02:00.004-05:00

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 is...to 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! Well...at 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

Dreading the Next 2 Weeks

2009-06-09T01:33:00.003-05:00

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 mess...no 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

I'm BACK...

2009-06-05T13:00:00.002-05:00

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 do...so 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!!

Ready For Some Time Off

2009-05-28T01:19:00.002-05:00

Don't know why, but it seems like I have been working ALOT lately! And the sad thing is...I really haven't been! I haven't done the 6 or 7 IAR thing for a long time, just my 3's with 2 off in the middle. But this is my last set of 3 before my "long stretch" and maybe that's why I'm tired. This week kinda messed me up too with the holiday. I didn't get to work my Sun/Mon/Tues, instead it was Mon/Tues/Wed...so I've been behind a day all week!

After my rough week last week I've been a little over anxious/nervous every time I come to work too. I didn't get my first baby 'till Wed, and that was a C/S that wasn't supposed to happen but baby only tolerated the cervidil for about 5 hrs before it got grouchy. I've done cervidils the rest of the week, I guess I had a recovery one night too, but no babies. :( Sadness for me!

I'm super glad that I get a few days off now, I need some time to sleep and exercise some, that's fallen by the wayside too many times the last few weeks. My bike wreck injuries are slowly healing and I'm not grossing my patients out anymore :) Horray!

So Much Better

2009-05-22T22:59:00.002-05:00

So much better night at work last night...I had no nightmares today while I was sleeping! I must say, I love the nurses that I worked with. I guess I was more shaken up about the whole run-in with the doc and the crappy strip from Wednesday night, plus the 30wk SROM from Tuesday night than I thought. I had at least 3 nurses come up to me last night and tell me that I was a great nurse, that it just takes time to get the docs to trust you, and that the particular doctor didn't have a nurse there who hadn't had a run-in with her at least once. The couple nurses that had looked at my strip said they wouldn't have done anything different than I did, and that I did all the right things. That almost made me cry all over again! When I'd left Thursday morning I really felt like the worst nurse ever and that I had totally missed something super important and that I put my patient into real danger. But after all these nurses who have 10+ years of experience were saying the same thing...I didn't feel so bad!

I had a couple cervidils last night, dealt with a little drama/out-of-control pain issues...then finally gave some stadol which must have been pretty strong 'cuz Mom went from moaning and screaming with her contractions to sleeping for 6 hrs. Stadol must be a miracle drug! (or maybe once she didn't think about her contractions any more she just slept). Either way...no babies, but no doctors mad at me either :) Off for a few days now, going to enjoy the graduation weekend at my brother's school and I'm back Monday. Happy long-weekend to everyone1

Another Night...Another Lesson

2009-05-21T08:36:00.003-05:00

Ok...so Tuesday night I learned that I should stand up to doctors when I want something or think something should be done for my patient. Last night I learned that it's probably better to call the doctors TOO often than not enough...and to go with my gut feeling instead of listening to what other people are "suggesting" even if they may have tons more experience and their opinions make you feel better about the situation at the time.

My strip turned to @(#^ last night, and after one run-in with the doc earlier in the evening I wasn't too excited about calling her back and asking for her to come back in to assess it. I had one nurse saying "ya...maybe you should call" and another nurse who has worked there WAY longer than any of the rest of us saying "no...it doesn't look that bad. If it was bad you'd be doing something about it not just sitting here watching it." Ok...so I didn't call 'till the patient was almost complete, then the doc came in and I got the very "subtle" feeling that she wasn't too happy with me, and we ended up in the OR.

The baby came out fine, Mom was great, but I get the feeling that I'm just going down the list of doctors and one by one losing their trust...not that I ever really had it in the first place. It's so hard being new and trying to figure out all the doctors. It's worse than a soap opera because everyone likes things done just a little different...and you know you're gonna do it wrong. I think the one thing that I want most as a nurse is to have the doctors hear your name or hear your voice on the phone and have the credibility for them to listen to what you're saying. For the first thing that flashes through their minds NOT to be : "why is she taking care of my patient? I hope she doesn't totally screw it up" or "can I really believe what she's saying?" or to have them worried about their patient because they know I'm the nurse. I've never once had a doctor tell me "hey, that was a good call" or "thank you for calling me when you did" or "you made the right decision" instead it's "why didn't you call sooner" or "why are you calling me now?" or "why hasn't this been already done?" or "why did you do that?"

On our way back to the OR this morning, and hearing the doctor talking to the other doctor assisting her saying "did you see the strip? why didn't she call? this never should have happened." I totally, 100% understood why one of the new nurses to OB just quit. I totally understood...

Babies today: 1m
Babies total: 46M/48F = 94
Vag:34M/38F = 72
C/S: 12M10F = 22
Babies 'caught' = 1f1/2m

Breaking Patients

2009-05-20T16:39:00.002-05:00

So after getting sent home @ 0200 on Monday night, I got the dreaded 'you're on call" phone call @ 1745 last night. I was seriously on my way out to my car...bother. So I sat around after having slept all day, kept texting one of the nurses at work who assured me that everything was nice and quiet and under control. So finally about 0115 I sent one more text saying I was going to bed. My phone rang exactly 10 minutes later "we need you!" Ok...here I come.

I loved my patient that I had, she was 30+1 weeks and had just SROM'd. Absolutely nothing was done for her when I got there other than a sterile spec by the laborist to confirm rupture and that she was closed. Ok...so IV, antibiotics, one dose of beta, tuck her in. She was "cramping" every 5-10 minutes she said but didn't say they were any more intense than a menstrual cramp. I finally called the doc about 0430 just to let him know that she was still contracting every 5" or so and if he wanted me to do anything about it. He said "no, just watch her and call her primary OB @ 0645 with an update." Ok, wrote those orders and watched.

Her baby looked amazing, and the patient even got a little sleep. Then about 0630 I went in to check on her and she said the last few contractions had gotten worse, she puked on me (that's way too many patients that have puked on me in the last few shifts!) and said she felt some pressure. So I checked her...she was 4/100/-1. So the primary OB got called a little earlier than 0645 and he wasn't too happy that she hadn't been mag'd already. So we got the mag bolus in, I gave report to day shift and she delivered while I was walking out the front door. The doctor got there, and last I heard baby was doing good. My heart was pounding most of the morning though. That was a little intense for the end of shift! The patient was AMAZING and handled everything perfectly.

I can't help but wonder if there was something I should have done differently though, if I should have pushed the Mag issue with the on-call doctor and laborist a little harder or what. All the nurses at work said I did everything I was supposed to do and that it was more between the docs than me. But my heart goes out to the patient who all of a sudden has a 30wk baby she wasn't expecting. Sigh...drama, drama, drama.

Birthday Twin!

2009-05-19T03:28:00.003-05:00

So Monday was my birthday, and I wasn't originally supposed to work. But then I switched a shift with another nurse so she could do something with her daughter...so I ended up working. I know nobody likes to work on their birthday, but I thought it was kinda fun! I had put in the request book that I did want a labor patient, because if I was gonna work my birthday, then I didn't want antes or postpartum!

The worst part of the deal was that I only got one night off (Sunday night) between my 2 sets of 3 IAR, so that was kind a bummer. But tonight was good!

I did get my birthday twin, a nice couple, a good delivery. She delivered right around 2100 and had a little girl! Yay! It's kinda weird to think that not-all-that-many years ago that was my mom and dad looking at their first baby and not sure exactly what hit them...then here that baby is helping another mom and dad do the same thing! That's pretty cool :)

It turned out that we had 3 back-to-back-to-back deliveries all within about an hour of each other...so I really got about 3 birthday twins! We all moved our patients over and went from 6 nurses down to 4, then when there were 3 of us sitting around with no patients someone else had to leave. It was my turn by dates and for once nobody else wanted to leave. Most of the time people are jumping at the chance to go home early, but not tonight I guess! So I had to leave about 0215. I didn't really want to go, 'cuz I'm back the next two nights and if I was already there for 7+ hours there was no point in leaving. Bother...

My very cool family brought up treats to the floor about 2200, I was way surprised! It's my brother's finals week at school so he and mom are pretty tied up, and I knew I had to work so took a nap today so it wasn't really any different than any other day, even though it was my birthday. But then I got a fun surprise at work with the food, so I was excited. I'm pretty lucky (and so are all the nurses who work with me!) to have such cool parents!! Maybe I'll make working my birthday a habit!

Babies today: 1f
Babies total: 45M/48F = 93
Vag:34M/38F = 72
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Done With The Weekend

2009-05-17T03:59:00.003-05:00

This weekend has been CRAZY. Not "no end of patients" crazy, just steady and "nobody goes home" weekend! After the 33wkr came in with no heart tones on Friday night, things just snowballed.

I feel like I've gotten SUPER lucky though. I've had AMAZING patients and AMAZING delivereis EVERY NIGHT!! Makes up for that week of all antes and NO babies! Anyway...I'm pooped!

Friday night I got a totally cool patient, she's a nurse at one of the children's hospitals in town. I feel an extra bond when the patient is a nurse too, even if they don't know the first thing about labor. I think there is something to be said for having the common ground of just working in a hopsital. They know what it's like to get tied up with doctors, they know what it's like when things have to change or don't go EXACTLY as planned, they've learned what it's like to go with the flow. Even if you're not a nurse, you still understand the environment and how things work. She had a beautiful delivery, she was 6+ feet tall, dad was like 6'6", baby was big too, but looking at mom you would never know! Baby had a nuchal X2 and her poor little face was SO bruised! Worst bruising I've seen in a very long time. After baby got weighed, Mom realized that she weighed the same, was the same length and also had a nuchal when she was born. Talk about "like mother like daughter". They were so greatful for a baby that they'd been trying hard for, and were happy with how everything went. Yay!

Last night, another early delivery in the shift, less than an hour of pushing, another >8# baby, amazing family, funny as everything. I love patients who make me laugh and will say anything they're thinking. Dad kept asking when he was going to get to put on the gown and mask and hat (gotta love those 80's birthing class videos...updates anyone?!). So I finally gave him one of C/S hats and masks. He decided that after he put the hat on he looked more like a food service worker than a doctor, so he didn't wear them for delivery. It was so cute. He wanted to cut the cord so bad, and when the doctor started to clamp it Dad yelled "I'm supposed to do that!!" We laughed and said that the doctor had to clamp the cord first, then handed him the scissors and let him cut the cord. He apologized for getting so excited and I said I was glad that he said something instead of missing out on the opportunity he wanted...but it was pretty funny.

After delivery/recovery I did one triage that I sent home, and then got a 26wkr with pyelo that I bolused, gave some antibiotics and tucked into bed. Then about 0400 the "bus" rolled in and I got a labor patient who was dying with uc's, sat down in bed, started a contraction and promptly said "I'm going to puke." I grabbed a bucket and ALMOST got it to her, which she missed and all over my hand it went. Remind me to ALWAYS wear gloves when I'm anywhere near a patient because who knows when they're going to spew. It was gross. I'm patting her back and telling her she's doing great all the while gagging with every heave. I don't do puke.

Her 6y/o step son had come to the hospital with them and was sitting on the couch wrapped up in his pj's and a Thomas the Train blanket and I figured we'd have either tears or another pile of puke in the corner but after she was done and I was dumping the contents of the bucket he was like "Dad, is that throw up?!" Leave it to a 6 year old.

After I threw in an IV and got some zofran on board I promptly walked back to the OR and told the doc that I had a patient of hers who needed a block. I felt bad later, I don't even think I asked, I said "she's been here 15 minutes, she's 3/100/-2, she's puked on me and I'm waiting on labs for a block." She kinda said..."uh...ok, go ahead." I guess I'm more assertive than I thought!

She did change her cervix and was 5 with a bulging bag and was laughing watching her contractions on her monitor and not feeling a thing. I totally was wishing that she'd come in at like 2000 instead of 0400 so I could have done her delivery. Oh well...

I can only hope I get 3 more deliveries this week too! I switched a shift with someone so I'm working on my birthday and I requested a labor patient. If I'm gonna work my birthday then I at least want a birthday twin!

Babies today: 1f1m
Babies total: 45M/47F = 92
Vag:34M/37F = 71
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Hard To Go Back

2009-05-16T05:44:00.005-05:00

So after my little "bike accident" on Monday...I've turned down more extra shifts at work than I EVER have. Mark this one down for the record books...I didn't even step foot inside the hospital since I left last Wednesday morning 'till I went back for some simulation drills this Wednesday night! That's over 7 whole days...gotta be a record for me!!! I'm sad about all that extra that I missed :(

I felt super guilty and stayed for 2 hrs after the sim drills to do a C/S recovery Wednesday night and counted it my extra shift for my week off. And then did a full 12hr shift Thursday night. Things haven't slowed down...that's for sure!

I did have a nice delivery, first one in a while after having antes all week last week. I went in early for a nurse so she could leave @ 1730...it's amazing how just an extra hour or two at work can make the shift seem never ending. After the delivery I took a cervidil, then another cervidil, then handed them off, then took one back, then did a triage that I sent home. Ah...the staffing matrix...

I'm still sore after my date with the pavement this week, and all the docs are mad at me for not going and getting the "full workup" after it happened...but one wrote me an RX for some stuff to keep the scabs soft so they look nasty, but at least they're not cracking and splitting open when I sit down or bend my arm. The bruises are turning nice colors :)

I got a Facebook message from a friend telling me that one of their relatives was a cervidil that night, and would I please take care of her. What a compliment! She took right off the cervidil too, I got her blocked and she delivered pretty early after I left. Yay for her!!

Babies today: 1m
Babies total: 44M/46F = 90
Vag:33M/36F = 69
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Bike Crash

2009-05-11T23:11:00.009-05:00

Ok...one more story from my "non-work related life."

Beautiful day today, so I decided to go for a bike ride instead of the running I was planning to do. There's a great trail just down the road that's about 24-miles round trip from end to end, so I thought it would be a great day to ride it. Set out, it's beautiful! About 5 miles into the ride there's a small hill on the trail that got wiped out in a flood a few years ago and they've never totally finished it, it's still gravel and torn up trail pieces. It's normally no big deal, but today my tire caught on it "just so."

I skidded to a stop on my elbows and knees and the first thought I had was "it's gonna be a sore ride home from here." I've whipped out numerous times before (running, rollerblading, etc.) and I usually pick myself up and head back, 'cuz how else am I supposed to get there? Anyway, as soon as I got up everything hurt, especially my L elbow. My first hope is "I really hope my elbow's not broken...I gotta go back to work on Thursday!" A very nice older couple about 50ft ahead of me had heard me crash and they turned around to make sure I was OK. I told them "I'm fine!" at the same time thinking "Ok, maybe I'll just have my dad come and get me..." I whipped my phone out of my shirt (I had no other pockets...where else was I supposed to put it?!), walked my bike over to the edge of the trail and called my dad.

I got out "Dad, can you come pick me up at X access point on the trail..." and that was about all I clearly remember. I remember bits and pieces...the couple helping me sit down; my dad saying "where are you again?"; feeling really dizzy; not being able to focus; feeling my head go side to side; thinking "Come on BirthdayNurse, just open your eyes and focus!"; thinking my knees really hurt and hearing my phone ring again but not knowing how to answer it; the woman asking me my Dad's phone number and having to think really, really hard about what it was, and then not even being sure that I said it out loud.

The couple called 9-1-1, even though I kept saying I didn't need it. About 5-7minutes (from what they told me) I finally snapped back into it and was OK. About that time my dad and sister got there...along with 2 cop cars, a fire truck, an ambulance and the park rangers. They checked me out, cleaned up my road rash, had me sign a HIPPA form (first time I've been the signee of one of those...) found out I was a nurse, asked me if I wanted to go to the ER (I said absolutely not) and said thank goodness I was wearing a helmet!

Next time I'm gonna do it up good and deserve an ambulance ride! Good thing I don't have to go to work 'till Thursday, I'm best friends with the Advil bottle at this point. I had forgotten how many nerves are effected scraping off that top layer of skin!!

Top "owie" on my L knee

L elbow/forearm
(this is the one that's obnoxious!)

R wrist

Both arms

Week's Worth of Work

2009-05-07T18:19:00.002-05:00

Things I realized this week:

1) I hadn't had antes in a long time
2) I had antes twice this week and that was enough for a long time
3) Antes are all just little time bombs ready to explode...and I'm always afraid that they're going to explode on my shift!
4) If they don't explode...antes are boring after the first couple hours
5) I went all week with no babies...that made me sad and only slightly grouchy on my last night
6) I actually am going a WHOLE WEEK without working extra (because I was out of town the nights I wasn't working...)
7) I have GREAT job security...

And Another Night...

2009-05-03T00:22:00.003-05:00

12hrs Monday night, 12 hrs Tuesday night, 13.5hrs Wednesday night, got a call and went in @ 0430 on Friday morning, then got another call last night and went in from 2300 to 0400. Part of 5 shifts in 1 week! I took tonight off before I start my 3 IAR tomorrow.

When I got there last night they re-evaluated the board and kinda figured that they hadn't needed me as desperately as they thought they did, several of the patients ended up going home, and they did some re-assignments. If we get called in, we get paid for at least 2 hrs, so I figured I'd sit for 2 hrs and then go home. I helped move a patient or two, did some random stuff and was just about to leave when one of the doctors came down from the lounge and said he had a patient coming in who thought her water broke. He said that her own doctor was coming on call at 0700, so to just tuck her in and wait for the morning. So I said I'd hang out, get her started, then leave.

Story short, she delivered an hour and a half after walking in. 3rd baby, SROM'd, unblocked (delivered all 3 kids without one!), it was great! She came in 5-6cm which was what she'd been for the last week or so and said her contractions started after her water broke. Funny how labor happens when it's supposed to!! I think I finally got her admission paperwork done about 45minutes after she delivered.

I felt bad for her after the delivery. The delivery was flawless, she pushed maybe 3 full times, no tearing. The on-call doctor made some off-handed jokes, and then said "maybe next time you should try an epidural...just for the heck of it! Haha..." and he left. She asked me later, "did I do something wrong? Was I a bad pusher? Was it a bad delivery? Why should I have gotten an epidural?" No, no, no! She was a rockstar! She did everything perfect! I was so ticked at the doctor for what he said! Why would you tell anyone who just pushed out a baby without any meds (she didn't even want nausea meds!) that they should try a block "just for the heck of it"? Come on, now! Made me mad...

Came home and tucked myself into bed at about a quarter to 5 this morning and slept great! Enjoying my one night off...and starting all over tomorrow!

Babies today: 1f
Babies total: 43M/46F = 89
Vag:32M/36F = 68
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Finished!

2009-04-30T17:49:00.002-05:00

For an un-usual 3IAR (Mon/Tues/Weds nights), this week's been pretty good! They called me 2 minutes before my alarm went off yesterday "can you come in early?!" it always scares me when DAY shift is calling for help, because seriously, if they have 10 or 12 nurses there already, how do they expect a night staff of 5 MAYBE 6 to handle it? And yet we always do...anyway, that's besides the point.

So after getting ready and across town in rush hour traffic, I finally clocked in about 1800. As I was walking in, I met the couple I had triaged the night before and ruled OUT of labor, in the lobby. Guess the UC's came back! Nobody was expecting them, so I jumped at the chance to take them again. They were really sweet and I had been sad to send them home yesterday morning anyway.

She was a good change from that morning, and I had her admitted, AROM'd (per doc), comfy with a block and all my paperwork done by 1930! Everyone else on night shift was just getting started!! My girl did AMAZING and we had a baby by 2200. Not bad for being 3/100 when she came in and a first baby! Great delivery too. It was quite the waterfall when the head came out, amniotic fluid was shooting up and over the legs, but nobody got wet! Made a nice puddle on the floor though...ha!

Waited on a patient that was called in for like 5 hours...never came. So I finished my recovery, sat for a while, did a traige, was walking her out the door and met another one coming in. The 2nd one was one of the presentations (crying, huffing/puffing, screaming, out of control) that has all the nurses running into the room to catch a baby. Throw on a glove, lay her down on the bed...can't find a cervix anywhere...oh wait, maybe I can feel it...WAY back there.
"Sit on your fists..."
ALMOST can reach it...just a little further...there it is! MAYBE I can get a finger in it...and it reaches half way down my finger.
"Honey...you're a tight one...and maybe 40-50%...yes I know your contractions hurt...how long have you been contracting?"
"Your first contraction was 15 minutes ago? Well let's see what a few more do, maybe your cervix will change."
2 hrs later, among many inappropriate comments from the 15 people in the room (including a friend who I had taken care of during labor...who abrupted 30minutes after my shift ended...), poor girls cervix was still the same and as long as nobody reminded her she was having a contraction she would talk and laugh through them. But as soon as somebody said "ok, breathe through this one, it looks big!", there were tears and labored breathing. I think sometimes "support people" need to be reminded of the meaning of "support." I really felt bad for the poor girl! She was sweet as could be, and I don't think she was convinced she was in labor, I think everyone else freaked out and convinced her she was dying. There were some not-so-very nice comments as she was leaving...

Not back 'till Sunday! Ready to enjoy a nice, rainy, muggy weekend with grass about 5 inches long that's way too wet to mow...

Babies today: 1f
Babies total: 43M/45F = 88
Vag:32M/35F = 67
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

HELLP

2009-04-29T08:28:00.002-05:00

Seriously, I have had some sick patients lately! My PIH friend from early yesterday morning that I thought we should deliver ASAP...platelets dropped to 50, livers into the 800's, never got past 2cm. :( Section in the afternoon, then I got to take care of her last night. She felt so much better after she got delivered and her baby is ADORABLE!!!

6hrs postpartum I got a couple quarter sized clots out, increased her main line with some pit in it and hoped they'd go away. Then 45min later, I got a fist sized clot out. 800mcg of rectal cytotec fixed that...no more bleeding!!! Glad we got the bleeding stopped while we could, her platelets were 40 at midnight. Sheesh!

She was a tough IV stick b/c of all her swelling, and so they had put in a 2nd IV in before surgery yesterday. We could use it to draw labs off of...oh my goodness. I think all mag patients should have an extra IV to draw labs off of. It was AMAZING! No searching for a vein, no digging, no extra needles...just pulling off blood into a syringe and then transferring to the vac-containers. I'll do that ANY day!

I'm going on a baby dry-streak again. Time to fix that!!

Night #1

2009-04-28T08:10:00.004-05:00

Night #1 after having 5 wonderful nights off (except one night I went in @ 0300 so a nurse could leave early for her vacation)! Nice little recovery...nice little cervidil who actually slept...I swear mine NEVER sleep!....and a "nice" little PIH gal who came in at 0415. Severe Right Upper Quad rent pain/brisk reflexes/Liver enzymes of 400+ and 300+ ("normal" is <30)/3+ class="blsp-spelling-error" id="SPELLING_ERROR_3">mag'd her and then pitted her. Wonder what time she'll get cut? They were the sweetest couple, I would take them back tonight...

Party for 3

2009-04-22T22:06:00.003-05:00

Ok, hold the phone...last night...there were THREE nurses on L&D...ALL NIGHT LONG!!! I was a little nervous about it, combined, the 3 of us have about 4 years of experience, two of us are '08 grads, the other an '07 grad. Not that we're not capable nurses...but I know there's lots of stuff I've NEVER done, and if some train wreck walked in we'd be in deep meconium! But...the night was great!

I sent a triage home, there were 3 antes, I took a SROM, there was a cervidil, then after my delivery we had 2 ROL's walk in and then we had the 0730 C/S to get ready, but together we got it done! We were all pretty proud of ourselves. We had 4 nurses at home on call, so that made us feel a lot better, but we didn't' need them! When we were leaving this morning I kept looking around wondering where all the night shift people were...and then remembered that there were only 3 of us!

My delivery last night was a little crazy, she was a multip, SROM, started some pit, got a block, the doc came in when the patient was about 7cm and then hung out in the break room. When the patient was about 9cm and feeling "pushy", the doctor got a call that she'd just had a patient walk in compete and +2 station at a different hospital. What to do? Does she leave my patient and rush and TRY to make the other delivery (that she probably won't make...) and end up probably missing both deliveries, or does she stay with my patient and just tell them to deal with the other patient since she won't make it anyways?

She decided to dash to the other hospital, which ended up being OK. I guess the other patient really wasn't complete, she was only 7cm with a bulging bag, then when her water broke the nurse didn't check her again, thinking she would just be complete. So the doctor made the delivery, which in her words was "poop filled" and then headed back to my hospital. We had our laborist (24-hr in-house OB doc) sitting at the desk ready to catch my baby. I figured it wouldn't take too long, but my gal was 9.5 cm with a lip for a good 45 minutes, with the kid sky high in the pelvis. So we just kinda stood around and waited. She was finally complete about the time her doc got back. So yeah for the doc who made BOTH deliveries, and who told me afterwards that my delivery was 100X smoother than the other one :)

After work I ran from the hospital to the school my mom works at. It's only 5.5 miles, but it has the worst hills EVER!!! I did it in under 44minutes though, after 3 12-hour shifts...

When I woke up this afternoon I was/am exhausted, can't wait to turn out the lights, go to bed and not go back to work 'till Monday!!

Babies today: 1m
Babies total: 43M/44F = 87
Vag:32M/34F = 66
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Quiet Night

2009-04-21T09:39:00.002-05:00

I probably just jinxed myself...but last night was so PEACEFUL!!! We had a nurse on call, and probably could have had more if we had really wanted to. We had 2 deliveries, 2 cervidils, 3 ante's and a few random triages that were in and out...and 5 nurses! I had ONE (1) (uno) cervidil all night...when was the last time that happened! It was WONDERFUL!!! Ah...for once I'm not "scared" about going back tonight!

A bunch of us nurses were all talking about different charity or not-so-charity running events that are going around in the area this year, and I think we're going to try to get a group of us together and do some of them. I don't by any means call myself a "runner" but I go out and try to do 4-6 miles a couple times a week. I used to do 5+ miles 6+ times a week in college, but once "life" started, not so much any more. There are several 5k or 10k runs going on that look fun and I would never have guessed that some many of the nurses run. So who knows, maybe it will inspire me to get up off my lazy butt and start really running again.

After all the talk about it at work last night, I thought maybe I should at least go get a little wind after I got home this morning. I knew if I didn't do it as I walked in the door it wouldn't happen 'till a different day. I was planning on 3 miles, and it turned into 6.2. Oh well, it didn't hurt me any I guess.

Gonna go switch the laundry, go to bed, get up and go to my brother's baseball game, then back to work for the 3rd party in a row! Horray...I think :)

One Party Down...Two To Go

2009-04-20T09:56:00.003-05:00

When I walked into work I had a brief moment of celebration as to how nice the board looked! NO MAG!! a couple antes, a couple postpartum's, a couple of early recoveries...it was beautiful. Then when I left this morning...no empty rooms. That's what we did last night!

I admitted 5 patients last night, ended up handing a couple of them off because I can't handle 3 active labor patients at the same time all being admitted within an hour of each other. Sorry...

I started off with a post-partum bleeding, family practice delivery who needed suprapubic pressure, but was intact? I don't think so...when we finally got the laborist in and spec'd her they found a bunch of placental fragments and she used 3 sutures to fix labial tears. Reason #283 why I recommend going to an OB for obstetrical cases...

Handed her off when I got 2 ROL's at the same time. Both ended up staying, and of course I balanced them so that I didn't sit down all night. My goodness...I got the one a block, she was comfy, got the other one a block, was 5 and then complete about 10 minutes later and feeling rectal pressure, turned her to her side to wait for the doctor...for 20 minutes. I knew if I turned her we'd have a baby. As I'm holding Mom's legs together listening to my variables down to the 70's with every contraction I hear someone else walk into a room down the hall, then a nurse call out "she's complete and +2". Sorry, I was a little tied up at the moment, so I think some other nurses took care of that one. My doctor walked in and was like "what's going on?" I rolled Mom to her back, he went to check her and you could just see the head crown up. So he's fumbling to get gowned and gloved, thank goodness I had some gloves on, I'm trying to get the foley out, but figure I better at least grab the head while it's sliding on out with a contraction. He's like "it's ok...I got it..." um, not so much, I was holding the head as he's finishing with the gloves. The bed never did get taken apart, nursery made it after the kid was already up on the abdomen with the cord cut...the doc delivered the placenta and walked out in all of 4 minutes...leaving me with a HUGE mess (in the bed of course) to clean up. Oh well, it was quite the smooth delivery I guess. I was a little bummed because if he had waited another 2 or 3 minutes I would have gotten to catch the baby... :(

I start recovery #1 and then go check my other patient...she's 7 with a BBOW, I figured she was going to blow a kid out any second. She was almost complete when I left, thankfully she and her baby behaved during the chaotic night.

About 0530 everything hit the fan, we had 4 or 5 new patients walk in, I took one who was 5cm and then got in the tub and was 7cm, then was almost complete and unblocked as I was leaving. Ah, the craziness of it all.

It doesn't sound so bad, but it was just constant all night, at least for me. Next time, it's someone else's turn! I'm too worn out for it to only have been my 1st night...

Babies today: 1m
Babies total: 42M/44F = 86
Vag:31M/34F = 65
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Thursday Night

2009-04-19T06:30:00.003-05:00

So it's technically Sunday morning...and this blog is technically about Thursday night. I've been too busy enjoying my whole TWO NIGHTS off (last) week that it hasn't gotten written 'till now...and the Internet connection has been kinda shaky.

Anyway, the craziness continues at work...it was jus a SMALL cluster on Thursday night, ok, so it was kinda a crummy night all the way around. Walked in and the assignment didn't look too bad other than the fact that there were no empty rooms, not enough nurses...and it stayed that way all night.

The atmosphere was kinda set by the fact that they had just found out that afternoon that one of our extended-stay twin mom's had lost one of her babies. She'd been admitted for several weeks and they kept talking about sending her home but just hadn't ever done it. They'd been doing NST's every 8 hours and after a great NST Wednesday night...the NST on Thursday morning had only one heartbeat. It was really, really sad. This poor mom was a G6P2, had had several stillborns before...it made all of us sick. She was only 33 weeks, so they weren't going to induce her, but she wanted to be in labor so bad. I don't blame her! I'd want my healthy baby outside and with me NOW after something like that. The nurse I talked to yesterday morning said that she went into labor and delivered early yesterday and the alive baby was doing great.

So after that small shock to everyone Thursday night, things went from bad to worse. We had a 31wkr break through mag and deliver, we had a set of vaginal twins who turned into a section after baby B flipped breech, in the middle of the twin section a 29wkr broke through her mag and was 4cm with a cord presentation, the carge nurse went ahead and called in all 3 cervidils who were scheduled even though we had no rooms for them, then they got frustrated when they had to wait in the lobby, our footling breech IUGR twins who were scheduled for a section Friday morning SROM'd...and the doctor decided that they could just wait a couple hours until their section...needless to say we were all ready to go home Friday morning!

This last week has been CRAZY! The poor NICU is overflowing with 23 kids (their usual max is 18), they're starting to have to ship kids to the children's hospital in town just because we don't have room. Labor's overflowing, and it's nothing "normal" it's all crazy stuff that's going on!

I've been counting small favors...like the last 2 nights off!

2 Babies, More Mag, 1 More Night

2009-04-16T08:19:00.002-05:00

So after my melt-down post yesterday...I had a mag gal who had been cervidil'd X2, pit all day yesterday and was 5. Then she was complete at 1915 and we had a baby by 2030! Yea! But then again, the baby was only 4#3, so I would HOPE it didn't take too long to push out! Seriously though, more mag? I think at last count (after starting someone else last night) we have 5 patients on mag. That's insane!

Our manager was in helping us 'till 0300 this morning and we had a little chat about an antepartum unit...and those of us from last night NEVER having to work it! Sure, a load of easy ante's is kinda nice every once in a while, but all these pre-terms, mags, etc are too much! I was talking to J on the way home this morning after we called a rapid response on her delivery from last night and she mentioned how nothing was every "low-risk" anymore. Every delivery has some complication or the mom is some kind of sick. Must be something in the water...

So after I got my mag patient all settled down I got a ROL (because I happend to be the only nurse standing at the desk when she walked in) that I got started...and ended up keeping. I've given up waiting for someone to tell me that it's my turn to take a patient. Someone has to take a patient when she walks in, and I seem to be the one standing there most often, so I might as well do it. I feel so bad when these patients walk in and everyone's saying why they shouldn't be the next one up for triage.

So getting her started, still trying to recover my post-partum mag, and trying to beat the computer before it went down for 3 hours for updates...I was scrambling just a little bit. The IA finally said "can someone please help her get her patient started so she can chart?!" Thank goodness for the IA standing up for me! Then everyone was great and helped get an IV, etc, etc.

She delivered unblocked for me at 0630 this morning. G5P4, straight OP, >8#...and intact! Go her! Honestly this is the first un-blocked delivery that I think I've ever done "on my own." I almost caught the kid too, there's not stopping those unblocked mom's from pushing once their complete! The doc just happened to be at the desk watching the strip and walked in just at the right time! Thank goodness...I didn't need that at 0630!

So now it's too bed, then back for yet another playtime in Magland. Sheesh!!

Babies today: 2f
Babies total: 41M/44F = 85
Vag:30M/34F = 64
C/S: 11M10F = 21
Babies 'caught' = 1f

More Of The Same

2009-04-15T09:14:00.002-05:00

I'm still tired of antes, mag, preemie's, twins, etc. I got another transfer from out of town who was 4cm/100% and 30wks. Their NICU was full so they sent her to us...our NICU is full (after our 29wk PPROM delivered) and if she deliverers we'll have to ship her baby to the children's hospital. So start some mag, listen to her complain about her foley all night. I would have taken out her foley, but not after the 1st hospital gave her 5L of fluid in 6hrs. Not sure that mag was a good idea after 5L of fluid either...but whatever, her lung sounds stayed clear!

I'm ready for a nice, normal, one-on-one labor patient! No more of this "green" mess! And this was only my 1st scheduled night of 3 this week. I'm regretting going in extra on Monday!

Preemie Land

2009-04-14T10:19:00.003-05:00

Seriously, I think we're running a special on pre-mature deliveries at work...plus a special on twins. I think we've had more <37week deliveries and twins (most of the twins being <37weeks) in the last couple weeks than I can remember in a long time! All these 29 week ruptures or pre-term labors or PIH gals. Yikes!

I was just thinking yesterday that I was actually gonna go a whole week without working any extra shifts. That was until my phone rang about 2000 last night. I think my message was something like..."you can have double time, triple time...and free coffee!" There were no empty rooms at one point, a C/S going on, vag twins, 4 extra nurses, 2 or 3 mag patients, my 29week twins contracting and 3cm, and 2 more SROM's on the way...it was a mess!

I wasn't too thrilled on hanging out all night, 'cuz tonight is when my 3IAR (in a row) starts and I'm sure it's gonna be crazy. Miraculously, I think after a couple deliveries, handing over early recoveries, etc they were able to get all the "extra" nurses out of there by about 0200. I left at 0145, made a McDonalds run for everyone still there, and then got home about 0230. Good thing I took a nap yesterday afternoon!

I slept for a couple hours, got stuff cleaned up at my "house sitting house" let the dog out and headed to my OWN BED! I get to enjoy it for a nap today, tomorrow and Thursday, then I'm "babysitting" for the weekend, then work 3 more IRA, then maybe I can relax on my 8-days off. I'd LOVE to get the lawn mowed sometime in the near future before it's 3 feet long, but the way the weather and my days off have lined up, I'm not sure that's gonna happen!

Half A Shift

2009-04-12T23:02:00.002-05:00

So I love the nurses that I work with :) One of the other nurses offered to split the shift with me last night so that I could hang out with my little brother and go to California Pizza Kitchen (AMAZING!) and a quick comedy show (actually pretty funny!), then I headed into work at midnight. Even though it was only half a shift, I still wasn't sure it was ever gonna end...I was tired!

No babies :( but I did get the "gold star" for the LONGEST rule out labor...she came in at 2000 and I walked her out the door at 0635 this morning! She wanted to be in labor, her doctor wanted her to be in labor, but after 10 hours...still no real cervical change and miraculously a little Nubian let her sleep. So after a little nap, she went home.

I got a SROM started and all lined up for day shift and did lots of charting. I was READY to go home at 0700. I felt really bad, we had a 29wk gal come in with PPROM (preterm premature rupture of membranes). Start some steroids and start the clock. She'll be hanging out a while...hopefully! I think NICU is a little tight, they don't want a 29 week baby if they can help it!

It was cold and rained all day, I think it's supposed to supposed to do that every single day that I'm off this week, but you know it's supposed to be nice and sunny Tuesday/Wednesday/Thursday! Go figure!

Why I Don't Do Mom/Baby

2009-04-11T08:17:00.003-05:00

Why don't I do Mom/Baby (postpartum) nursing? Because I can't handle it. I don't know why I can't handle it, but I can't handle it. I don't understand the charting, I don't really, truly understand the correct "assessment" of it...I just don't get it. Hence why I don't do it. Well, why I didn't do it until last night. There were lots of not-so-nice words going on in my head when I saw my assignment was 2 post-partum mag patients, plus one of their babies. I've done postpartum mom's...never the babies. I'm NOT a baby nurse, I'm a MOMMY nurse...once the baby is on the outside, it scares me just a little because I don't know what to do to it or how to fix it if it breaks. I can't roll it on it's side to get it off the cord, I can't put on a scalp lead to hear the heart beat, I can't run to the back for a C/S if all else fails...besides a pacifier in the mouth I don't know how to fix a baby!

Anyway...I was the first night shift nurse there last night and they were just writing assignments on the board when I got there. I said something about my assignment which probably wasn't the most professional or adult thing to say, but I said it anyway. J was sitting there and said "well change it, you're the only one here." So I asked the nurse writing the assignments up to change it and she said "I didn't make the assignments, it's not my fault." So guess who ended up keeping the post-partum mags? It doesn't seem quite fare that day shift can come in, change every single assignment if they don't like it, but nope, the assignments have already been made for night shift, we can't change them now! Sounds a little fishy to me...

But I did survive, actually got the turn the mag off for both mom's at 0330, gave them nice big glasses of water and let them actually sleep for a few hours without the hourly reflex checking, blood pressures, etc.

Thank goodness for the well baby nurse who helped me with "my baby" and drew labs and knew how to make sure it stayed not-broken for my shift. I'll stick to mom's with the babies inside, thank you!

Dang Cord Blood Collection...

2009-04-10T09:15:00.005-05:00

The board looked like crap when we came on at 0700...we cleaned it up and actually sent on of the 2 extra nurses home...then we had about 10 patients walk in and there was not ONE EMPTY room when day shift came on. We had put 6 inductions on hold to...oh brother! I wheeled a C/S out of the OR and did about 20minutes of her post-op recovery before they decided they needed me to traige, so I handed my C/S off to a scared-spitless mom/baby nurse who'd never done C/S recoveries before while I went and got N/V chick in a room and an IV started.

Things calmed down for a while, then I took a rupture, then while I was getting her blocked in came another girl who according to her doctor was "dying" over the phone, got her blocked, etc, etc. The rest of the night flew!

I loved my SROM couple, I wish all women went into labor like that! Her water broke, she came in, was feeling "tightening" but not hurting, decided to just be done with it, got a block before she was dying, got some pit started, she labored great, pushed about 15 minutes and we had a baby about 0630! I will take a no-drama delivery like that ANY day of ANY week! The kidd-o came out in some way I haven't seen before, and neither has the doc. You could tell when mom was pushing that this kid was twisting his head all around and it spun every which way. When the head delivered he was looking at mom's L thigh, then when the doc went to deliver the top shoulder like usual, no the kid flipped totally around and the bottom shoulder came out first with the hand way up by the chin. That kid did AT LEAST a 180 degree spin on the way out. We were all just kinda looking down there trying to figure out what was going on, but mom was intact...can't ask for much more than that!

I had the cord blood collection kit all filled out, then totally forgot to throw it on the table for delivery. As the doc's about to walk out of the room it hit me...what a horrible feeling! The poor doc was super good about it, we played with the cord, we played with the placenta and actually got a good 100cc into the bag for collection, that's WAY better than I thought we would...thank goodness! I think nurses should get an extra bonus for a cord blood delivery...just another thing for me to remember after a 12-hour shift!

I'm hoping that last night is not a pre-cursor to what's going to be this weekend, that was just a little too crazy! It's the storm + a full moon...not a good combination!

Babies today: 1m
Babies total: 41M/42F = 83
Vag:30M/32F = 62
C/S: 11M10F = 21
Babies 'caught' = 1f

Not So Much Work Related...

2009-04-08T18:58:00.003-05:00

So I know at the beginning of this blog I promised it would only be "work related" stories and experiences, but I couldn't pass this one up...

I went to the dentist today. NOT my favorite place to go (but who likes the dentist?). I had the first appointment after lunch and was on my phone when they called me back. As soon as the hygienist opened the door and called me back I had this sneaking suspicion that I knew her from somewhere. I kept thinking to myself "why is she so familiar? Why should I know her? Where have I seen her before!?" I figured I'd seen her at the hospital before, some random place, etc. I just couldn't place her. It was driving me nuts! All I knew is that I've gone to this same dentist since I was 2 and know all the hygienists, and this one had DEFINITELY not cleaned my teeth before!

Anyway, I sat down, we chatted a little bit and got all ready to start the wonderful process of cleaning my teeth. The TV was on some soap opera and she started flipping channels trying to find something slightly entertaining. We chose some Hollywood Inside show and there was a clip of Melissa (from the Bachelor) on Dancing With the Stars. The hygienist asked me if I watched DWtS and I said "no, but I want Melissa to win because I watched the entire season of the Bachelor." She kinda smiled and said "really? Did you know I was on that show?"

As soon as she said that it totally hit me who she was and why she looked so familiar! It was Shannon! And I had watched her every week! How crazy is that? So I sat in the dentist chair for 30 minutes thinking of all these questions that I wanted to ask her but yet I didn't want to sound like this crazy Bachelor fan and go all spastic on her...it was kinda weird!

She was super, super nice, and afterwards we talked a little bit while waiting for the doctor to come in. She wanted to know where I worked and said that several of her friends were expecting babies and I think some of them are coming to my hospital...I told her that I every Monday night that I worked I would try to avoid watching the Bachelor in the patient's rooms so I could watch the whole thing when I got home. All she said about the show was that it was a "crazy experience." I can only imagine...

I called my sister (another Bachelor fan) and told her, I don't think she believed me. Frankly, I don't think anyone I've told has believed me! On the show none of the bacheloretts had listed as a hometown, but Shannon did said that ABC had them give their hometown for the show.

So...my brush with a celebrity for the day :) Maybe I can recruit some patients for my dentist! Haha!

Not Much Sleep

2009-04-07T08:23:00.003-05:00

So I've been impressed that I haven't been into work since I got off after that staff meeting Wednesday night! I had a great weekend in Branson with my brother's baseball team and my favorite Branson show, so that just topped things off! I'm sitting freezing my butt off at my brother's baseball game yesterday afternoon at 1630 and my phone rings...go figure! I felt guilty, 'cuz they had called me Saturday night and I wasn't in town, so sure, I'll come in for time and a half. They called me back an hour later and said "well, we're OK now, but will you be on call?" Sure why not, I've just been up since 0830 this morning. I know nurses do that all the time, but I'm not most nurses and I need my sleep!

Now a smart nurse would have left the baseball game and gone home and slept in case she got called in. No, I sat there for another hour or so, saw my brother blast a 2-run homer over the fence to win the game, and then went and ate, let the dog out and went to bed about 2130 with my alarm set to call at 2345 to see if they would need me at 0100. My phone rang about 2330...and I was at work by 0005.

So...me and my 2 antes hung out for the night. My one ante who un-plugged her own monitor to go to the bathroom and didn't need anything all night...and my other ante who was on mag and was refusing another bag of it and was more worried about the TV remote working than probably getting delivered at 29 weeks. Some people just don't get it!

Anyway, I'd love to go to sleep now, but instead I'm going over to the school to help with the hot lunch program, then I'm supposed to teach piano lessons, then I have a mandatory "charting class" this afternoon at the hospital. So maybe I'll get a nap about, oh say, 1900 tonight? Sigh...But extra money is extra money for a new car, so...

D-O-N-E

2009-04-01T21:27:00.003-05:00

I don't know if it's because I haven't slept well this week or if I'm just ready to be back at "my" house instead of house sitting, but this week has worn me out! And I haven't really worked any extra shifts! I'm ready for my 8 off...

Last night was really good actually, a good way to end my last 3-in-a-row. It wasn't too terribly crazy, I had a couple antes and then triaged a few. One of the other big hospitals in the city was on diversion (what's new?) and so we were getting all their triages, etc. I feel sorry for everyone when that happens, the patients don't want to be at our hospital, the docs don't want their patients at our hospital when they were planning on going to the other one, it's tougher on us because we don't have any records or pre-admit papers and so it makes the whole admission process take longer which means it takes longer to get anything done for the patient, etc. So that kept us hopping for a while. We had a couple midwife patients which was interesting last night, we only have 1 or 2 midwives that come to our hospital so having the midwife there was a new experience for me. Interesting to see some of the different ways care is handled.

I took a 19 week traige from the ED last night. Our unit's cut off for triage is 20 weeks (I don't know the exact reason, but that's always been our rule). The patient didn't see one of our OB's but her doctor had given her a due date in August per a sono she had had early in pregnancy and her LMP. The ED doc (who is NOT an OB) re-sono'd her and said that his sono said she was 21 weeks and so he had to send her upstairs. We went round and round and round about the fact that you can't just re-sono someone and change their due date, especially at 19 weeks! He said she needed featl monitoring, so I went and dopplered heart tones in the ED. That's all we would have done upstairs, we can't get a strip on at 19 weeks. Was that enough? No, we had to fix her since she was pregnant. So she got discharged from the ED, came up sat on the bed for 25 minutes with a toco on, we dopplered heart tones, the laborist asked her a few questions, we did her mountain of computer/paperwork and by that time she didn't hurt anymore and went home. Seriously? I felt bad for the poor patient!

For some reason several of us were a little slap-happy most of the night so a good time was had by all. It was our traveling nurse's last shift, that was sad. She's an amazing nurse and has been fun to work with. We all wish that she was going to stick around as full time staff!

We all realized it was April Fool's this morning so we filled in all the empty slots on the board with crazy patients for the day shift, then when real patients started coming in about 0500 we had the poor charge nurse so confused that we erased it all. It would have been funny though...

I went in a little early tonight to cover for one of the day nurses to go to the staff meeting, then I went to the staff meeting, then the board looked like "someone puked red and green" and I thought I might have to stay and help out for a while, but when I left they at least were forming a game plan to make it work. It looked worse than our April Fool's prank this morning! I think there were 2 nurses there extra already, so one of the docs told me to leave while I could, so I did :) Now 8 days off, a weekend in Branson, and a little R&R (including a dentist and an eye doctor's appointment)!

Should Have Been 2...

2009-03-31T09:20:00.002-05:00

I should be happy that I got a delivery last night, and I should be more excited that I survived the night and went the whole night only have 1 patient at a time (for a total of 2) while everyone else was getting slammed!

Walked in and pushed for 45minutes with a patient who was complete and had already been pushing for a while, then took her to the OR and had a baby about 2100. That head was in there all kinds of crooked and all her conehead was off to the side. No wonder she wasn't going anywhere...

Came back out to the madhouse after my recovery and then it snowballed. One by one, everyone under the sun came in, and stayed! One walked in at midnight and was 8cm that another nurse took, we all rushed in and got her started, then 10 minutes later another walked in that I took, she was 6cm and ruptured (leaking anyways), we figured we'd have babies flying out every which way! We got them both blocked and comfy in a good time frame, doctors called, orders written, computer charting done, etc. Then the 1st one delivered and mine didn't...and didn't...and didn't.

She stayed 6cm for a couple hours, then I re-checked her and felt a forebag that was in the way. I turned her to her side and baby took a MASSIVE dump to the 60's for a good 5-6 minutes. It was just a little scary. It was one of those decels that even the monitor can't pick up so nobody knew I was dumping, it just looked like the baby was off the monitor. I was flipping, pulling oxygen, grabbing a scalp, turning again, trying to find a heartbeat, shaking, trying to push my emergency badge just to get a second set of hands. I finally called out from the room phone and asked another nurse to come in. Too many things to do, not enough hands, a blocked patient who can't move on her own and the forever embedded "thump.......thump.......thump....." it makes 2 or 3 minutes seem like a lifetime! We ruptured the forebag and put on the scalp, heart tones came back up and the baby looked beautiful the rest of the night.

I finally started some pit and started pushing at about 0600. I pushed with her 'till about 0710, even though I figured the kid would have flown out after 2 or 3 pushes. No such luck. I gave report and left the room 'cuz I knew I was gonna be back tonight...and the baby delivered at 0715 about 2 pushes after I left. I was NOT a happy nurse. I feel like I totally gave up and should have stayed for 2 more contractions. Now I feel like a bad nurse to the patient and the nurse I gave report to. Bother...back for more tonight!

Babies today: 1f
Babies total: 40M/42F = 82
Vag:29M/32F = 61
C/S: 11M10F = 21
Babies 'caught' = 1f

Night 1 of 3

2009-03-30T07:52:00.003-05:00

Ah, my last set of 3 nights before my 8 day stretch off! Hooray! People think I'm crazy for doing 3 in a row, and I do too a lot of times, but I enjoy my 8 days off, and at least I get in a rhythm for those 3 days on! Anyway...

Last night was actually really, really, really good. I had a very fun couple who were totally into having a baby. Her water had broken yesterday afternoon and she was...0.5cm dialated. Not a good place to start when the first thing she had written down was a birth plan with NATURAL all over it. So she'd walked, then we did the tub, then she walked some more, then she was almost 2 after 6 hours, then we started a little pit of pitocin and then she was still only about 2-3. I felt so bad for her. She was trying so hard, her husband was so supportive, she wanted to go natural for all the right reasons and I wanted her to do it so bad.

She finally begged for the epidural, rested and was 5cm in an hour, then complete an hour after that. That's what an epidural will do for an exhausted body! Pushed for about 30 minutes and was holding her baby. I was so proud of her, and I hope in retrospect she's proud of herself too. We had a nice long talk about the whole labor process and the hard things about the water breaking and not being in labor and it being your first baby and being closed when you start out. I know it's possible to go totally natural with the first baby and I think she totally could have done it, but it was a rough starting ground for her I think she just wore herself out. I am 100% convinced that her 2nd baby will be different and I know she'll do it.

She was my only patient all night, another nurse delivered 32 weeks twins who went from 2cm to complete in 20 minutes. That was a little excitement at 0200! i think we're running a special on umbilical cords with "true knots" in them. My baby came out with a nuchal, a true knot and it's feet all wound up in the cord. One of the twins had a true knot and I think a baby had one last week. Parent's don't know how lucky they are when those kids come out ok. It may have explained my two random decels last night though!

I think Joint Comission is coming "to a hospital near us" this week...let's hope they come on day shift and after Tuesday night!

Babies today: 1f
Babies total: 40M/41F = 81
Vag:29M/32F = 61
C/S: 11M9F = 20
Babies 'caught' = 1f

Custom Words

2009-03-28T23:57:00.004-05:00

I was flipping through my phone's "added" words that I've used in text messages and you know you're a L&D nurse when these are the words you've added:

~bleeder
~cerclage
~cervidil
~clonus
~cyst
~dink (as in a "dink" check...time to push!)
~epidural
~forceps
~ICU
~intubate
~keflex
~lidocaine
~NICU
~PIH
~pooped
~scrubs
~SROM
~a number of doctor's/nurses/staff people's names

Talk about a language of our own...Now here's the test...how many of these words do YOU know and/or use on a daily basis?

Done For the Week

2009-03-27T08:15:00.003-05:00

I only worked 2-nights this week since I got call on Tuesday, but seriously, I think I'm just as worn out! I feel like I've worked 3-nights...and I guess I technically did work an extra 9hrs on Sunday night, but it still wasn't 3-in-a-row. Convinces me all the more that half the effort is the mental part, and I had to psych myself to get ready to go to work Tuesday anyway before they put me on call.

Anyway, I had a nice delivery last night, well, I guess it was good. The poor girl had been in the hospital all day since about 0800 contracting randomly, but never changing her cervix all day. The day nurse tried 3 or 4 times to send her home but she said "it still hurts" so more stadol, etc, still no cervical change. So the on-call doc when in about 1930 to try to convince her it was just false labor and do go home...surprise surprised, she was 4cm instead of the 2cm! So she got to stay...

I got her blocked, labored, started some pit, put on my very own scalp lead...I was quite impressed with myself :) Then mom spiked a temp right before delivery, then baby came out with a temp, we'll see how that all ends up. Nuchal X1, no wonder I had variables all night!

We're switching our IV catheters over to new ones, and I get a candy bar (or so I'm told) because I started 2 of them last night. They are quite different and I have to stop and think about exactly how they work every time I use them. They're nice 'cuz they have a built in extension tubing and a saline lock on them, but they're just a little different. Does anyone else use these where they work?

Anyways, so I'm done 'till Sunday night, then starts my 8-day stretch again! Hooray!! I'm lying on my bed watching the beginning of our forested 5-9inches of snow start to fall. Seriously, it was like 70 earlier this week. Gotta love midwest weather! Happy weekend everyone!

Babies today: 1m/1f

Babies total: 40M/40F = 80

Vag:29M/31F = 60

C/S: 11M9F = 20

Babies 'caught' = 1f

C/S Land

2009-03-26T09:22:00.004-05:00

Someone write this down...I was acutally "on-call" for 12 whole hours Tuesday night! That has happened ONE other time (back in December) since I've been off orientation. Everyone else is always complaining of how they always get put on call, I guess my days have just lined up right! Good think I picked up those extra 9 hours Sunday night, that made up for the 12-hours that I got all of $2 an hour to sleep! It's ok though, I slept horrible Tuesday afternoon, and yesterday afternoon too. Random phone calls from people with the wrong numbers, realitors trying to show the house, etc. Fun times.

So yesterday afternoon I had just rolled over and turned off my alarm about 1630 after a fitfull nap and my phone rings, it's work. "Can you come in early? Like 1700..." Well, I haven't taken a shower, put my contacts in, let the dog out or even really woke up yet, and it takes me a GOOD 30 minutes to drive, but sure, I'll be there ASAP. I clocked in at 1710. Not bad if I do say so myself...

So I delveged into C/S land last night, I took one section back when I got there so we delivered about 1840 then did a 2hr recovery, came out for about 10 minutes then took a VBAC who had just decided she wanted a section too, so she delivered right before midnight. Another 2 hours in the recovery room that turned into closer to 3 hours because it wasn't "convient" for mom/baby to take her at the moment so they wanted us to "sit" on her for awhile. So next time we have a labor patient walk in, even if they've called and told us they were coming, I think we'll tell them to "sit in the lobby" until it's convient for us to bring them back. I'm sure that would fly...

Then I did a little triage who was scheduled to deliver at a different hospital in 2 days, but they were on diversion and she was contracting, so her doctor sent her to us. Poor girl, she didn't want to be at our hospital, it was 0430, and as soon as she got there her contractions spaced out and she didn't change. She was frusturated that she even came and wanted to go back home. Her husband was funny, he said "who was I to stand in the way of a pregnant woman coming to the hospital?" Ha!!

We're partying for no real reason tonight at work, so I had to go shopping after I got off, then make cookies, finaly I'm heading to bed knowing that I'm gonna have to get up early to finish getting stuff ready for work. So much for my workout today! Bother...

Babies today: 1m/1f
Babies total: 40M/39F = 79
Vag:29M/30F = 59
C/S: 11M9F = 20
Babies 'caught' = 1f

March Madness in Baby Land

2009-03-23T19:40:00.006-05:00

So I worked Thursday, Friday, Saturday nights and was planning on enjoying 2 whole nights off before my next set of three. I slept really well yesterday afternoon, got up about 1730, took the dog for a 6mile run then was doing laundry and just relaxing in front of the TV. I love to watch PBR bull riding, so I was just finishing up round two from the weekend about midnight. I took out my contacts and climbed into bed...ah, sweet sleep! And then my phone rang...seriously?!

So into work I went, and left about 9am this morning. It really did get crazy last night, it was a good thing I went in. I thought right at the beginning that they might send me home after my obligated 2 hours, but then the flood gates opened. I took a SROM about 0200 and then I was set for the night, got her blocked, comfy, etc. Meanwhile the madness kept happening. We had a mom walk in with 3 beats of clonus, horrible super reflexive, etc. I swear, we're continuing our PIH special! This was the kind of girl we were all waiting to run down the hall when she seized. Then about 0545 in walks a mom...complete. For being complete shews totally OK, just a little grouchy (I would be too at 0545 when I was hurting!). She made the comment, "I don't want an epidural." That's good hun, because you don't have time for one!

When day shift came on we seriously did not have an empty room, we had 12 labor patients and I think all the day shift nurses were doubled up with inductions or labors. I made the "mistake" of re-checking my girl that I had just started pit on and she was complete at 0655. I didn't have the heart to leave a day nurse with an induction and a complete patient, especially since I really liked my patient! So I hung around, did her FANTASTIC delivery (she pushed 3 times and was intact) and left around 9.

I got all warm and fuzzy this morning when my patient said "My friend delivered here a few months ago and when I told her you were my nurse she said "she was my nurse too! You have a good one!" " Aw...my heart went pitter-pat! She remembered me and liked me enough to tell her friend I was a good nurse! Yea!

I put "no" next to my name for tonight, I can't do 8 in a row, and I still have to work my 3 this week, Tues, Wed, Thurs. I will admit that we had a great crew there last night, so that made it all the better. I love going into work when there's a fun group of nurses!

Babies today: 1m
Babies total: 39M/38F = 77
Vag:29M/30F = 59
C/S: 10M8F = 18
Babies 'caught' = 1f

1st Set of 3 Down

2009-03-22T08:27:00.003-05:00

One of the big plus sides of working 3 nights in a row is that it makes the days go quick! It seems like I just woke up Thursday afternoon and now it's Sunday morning and I'm going to bed! It's gone quick (and I haven't worked out at all during those days...that makes me a little grouchy!)! I have decided a few things after the last 2 nights: I'm ready to have a baby, I've gone lots of days without a baby!!! I'm tired of Mag! I think our hospital is running a special on Mag.

Friday night I sat on my butt the big majority of the night. I had one long-term ante and was triage. I did one trainwreck triage who decided she liked me, and wanted to ask for me by name when she came back for her "real" labor. Hey, a compliment is a compliment! After I sent her home I sat, and sat, and sat, and sat. We got a phone call that a hospital 2hrs away was going to transfer a 33wk PIH patient to us, so we all jumped and got ready for that. That was just before midnight. They called report about 0100 and said they were just starting the mag bolus. Then I called them with a question about 0200 and they were just finishing the mag bolus and hadn't left the hospital yet. The ambulance rolled up around 0500. The PERFECT time for a "busy" patient to come in. She was a sick little gal though, way sick.

I think Friday they had 2 PIH patients whose platelets were dropping and got down into the 50's. That's um...bad news. The transfer that I got had AST/ALT's >200 and a crazy high uric acid. Sick, sick, sick.

Anyway, so I was exhausted when I got home yesterday morning, I think more from sitting and sitting for most of the night, I felt kinda like a waste of a person and would much rather of been sitting (or sleeping!) in my bed at home if I wasn't gonna do anything at work.

Then last night, I ended up with the same patient again who was on mag after her C/S. That lasted 'till about 0100 when other rule out labor's started rolling in. Then we combined a couple post-partum mag patients and I took a couple triage's. My great triage from Friday night came back and I ended up with her again, same problem, same doctor on call, same orders, same routine. She and the FOB asked if I was working on her scheduled induction date. Hmmm...don't know my schedule that far ahead!

My labor patient was 6 when I left this morning, so no babies for me for over a week :( I guess I'm back in a few nights and it'll probably be so busy that I'll be wishing for time to just sit on my butt! Ha!

Back to Work

2009-03-20T08:38:00.003-05:00

So my 8-days-off turned into 5-days-off, but that was OK. I was super busy, seems like I had something going on every day while I was off! I was actually a little excited to go back to work last night, we'll see if that excitement can take me through the next 9 shifts!

While I was off a group of us "night-girls" got together and went out to eat. One of the laborist docs came with us too. It was so much fun to get together OUTSIDE of work and not be just gathered around monitor strips, someone having to jump up in the middle of a conversation, etc, etc. Of course work was all we talked about, but it was different. It was great fun, and I'm looking forward to the next time we can all get together.

I had antes last night, I didn't mind, they all behaved themselves. I started out with 3, sent one home after a little hassle and spent some good time chit-chatting with the other ones. The one gal has been there for the last month "growing" her babies. I'd be ready to go home too after being in the hospital for a month! Sheesh! She's so compliant though, she really wants to do whatever she can to help those kiddo's. I wish she could give a pep talk to some of these mom's who are ready to give up at 30wks of being pregnant and who don't want the hassle of being in the hospital or on bedrest, etc. She should write a book!

So this was night #1 out of the first set out of 3 of 3 nights in a row. Let's hope they can all go down like last night did. That would be amazing!

Last night for a while...I hope!

2009-03-14T01:07:00.002-05:00

Ok, 6 days a week at the hospital is a lot. I just got home from another 5+ hrs extra this week. It's been insane! I think they had 13 babies on dayshift today, then another 5 after 7. When I left we had the board cleaned up nicely, one ante and one patient who was deciding what she was going to do. I did a delivery about 2100, moved her over and was out of there. Ah...I told them "no" for the next few nights. I just can't make myself go back for 7 in a row. I think things will calm down over the weekend, at least I sure hope so!

So the last couple days there has been a 19wk PROM staying on our unit. Her history is complicated, and it's made me do a lot of thinking. She came in ruptured, and they did some antibiotics, etc, and after thinking about it and considering her history, she decided that really at 19wks, she didn't want to sit in the hospital for the next 5 or 6 weeks waiting until viable age, and so wanted to go ahead and induce delivery which would basically result in a termination of the pregnancy with the baby not being viable. The baby is still alive and they've been dopplering heart tones, etc, but she and her doctor went ahead with the decision to induce. So yesterday they did cervidil/laminaria to manually dilate the cervix. Then this morning they were going to do cytotec and she told the nurse she had been really feeling the baby move all night and didn't want to continue on the induction route. So the doctor came in and talked to her, and I guess she went ahead with the cytotec this morning. Then tonight, she told the night nurse the same thing, that she'd really been thinking about it and really didn't want to go on with the induction and really wanted to just go home. She said if her body kicked in and delivered on it's own then that was OK with her, but she didn't want to go on with the induction. The doctor said whatever she wanted to do and that she didn't have any further advice for her. I'm not sure what's going to happen, but it really made me think. I don't want to start an abortion/termination debate, but seriously I have no idea what I would do if I was in that situation. I know the risks of infection are super, super high, especially after the cervidil/laminaria, etc, but at the same time, I don't know that I could go ahead with the induction, deliver a live but non-viable baby with a clear conscious. I just pray I'm never faced with that decision...My heart goes way out to this woman.

Babies today: 1f
Babies total: 38M/38F = 76
Vag:28M/30F = 58
C/S: 10M8F = 18
Babies 'caught' = 1f

Any More?

2009-03-13T08:29:00.003-05:00

Seriously, we have been a little busy at work. Last night was my second extra partial shift this week. When my phone rang yesterday afternoon and I saw it was work I knew what they wanted and let it go to voicemail. After what the board looked like last night I'm not surprised at all that they needed help. I called back as few hours later and the Charge said that a few people had called back, but one nurse had called in sick, so she wasn't sure if they still could use help or not. I already had plans for the earlier part of the evening so I said I could come from 2300-0700 if they still needed someone...I went in at 2200 and left after 0730. It was crazy.

All I ended up with was a post-partum mag post C/S which was fine. We actually "slowed down" a little for a few hours, then the bus rolled up and we got 3 or 4 walk-ins, then one of the docs called us and told us that one of the other "bigger" hospitals in the city was on diversion, so guess where all the patients were coming! For some reason, any other OB unit can go on diversion, but our hospital never does. Seriously, we've labored patients in the doctors lounge instead of closing. When I left this morning there were no empty rooms, there were 3 inductions sitting in the lobby and there was at least one other ROL on their way. I'm not kidding when I say I was glad to be walking out instead of in! Poor day shift!

So, we'll see if I go back in tonight. J told me today this morning that I need to learn to say "no" and not burn myself out. I agree, but at the same time, I know exactly what it's like to be a scheduled nurse and be there no matter what and have nobody willing to come in and help out when it gets crazy. That's the worst feeling in the world.

Now it's bed time!!

C/S @ 0200

2009-03-12T10:08:00.002-05:00

I worked Sunday, worked Monday, worked Tuesday and had signed up to be "on call" if they needed me last night from 1a-7a, before realizing that I was working Sun/Mon/Tues. Go figure they needed me last night, so I slept from 2200-0000, then went to work, did a C/S and got the 0730 C/S ready for day shift. NOW I can enjoy some time off without feeling too guilty that I haven't been going in extra. It's not my fault that they've been calling only on the nights that I already have plan! Oh well.

I'm house sitting for some friends from church, and I came home yesterday and let the dog out, and went upstairs to bed. Was dead asleep after 3 nights in a row, and all of a sudden I hear this knocking on the front door. I figured it was UPS or someone and they would just go away. No, the door opens and I hear "realtor." Seriously? The people are trying to sell their house but they gave strict instructions to the realtor company that they were supposed to call my cell phone and sent up an appointment before coming. But I guess they gave them the wrong number, and so this guy just came. I stumbled out in my shorts and tee-shirt and poor guy was totally embarrassed. We decided he'd call the reality company back and make another appointment for another time. Needless to say, I'm a little nervous to go to sleep today for fear that someone else is going to come and pay me an unexpected visit!

Babies today: 1f
Babies total: 38M/37F = 75
Vag:28M/29F = 57
C/S: 10M8F = 18
Babies 'caught' = 1f

BUSY

2009-03-11T08:21:00.003-05:00

For as busy as my night was last night, it was actually pretty good, and I was pretty happy with it. Usually I would have been totally stressed out and grouchy, but even though I was running the entire night I never felt totally behind and hopeless, just constantly busy. I had two cervidils, and when I left they were both blocked and had no cervidils.

One was a gal I had actually sent home a couple times several weeks prior who we kind of knew from the beginning was going to be a little "high maintenance." Every time I walked into her room for something I knew I could count on spending at least half an hour or so doing this and that and fixing that and fixing this, but hey, it's all about patient satisfaction. She wanted a block so bad and I was so glad when she was finally 3cm and could finally get her blocked so she could be happy! She rated her contractions an 11/10 for pain, but if she wasn't watching the monitor and was talking to me instead she would talk right through the contractions without missing a beat. Oh well, to each his own pain scale I guess.

The other gal was a cervidil who was sure she ws coming in to get "platocin" and then cervidil if that didn't work. That made me smile all night, I've never heard it called "platocin" before :) She was a tiny thing (125# 9months pregnant. I want to weigh 125# NOT pregnant!) and took off with the cervidil contracting every 1-2minutes. We pulled the cervidil and she continued contracting that often. She got a couple doses of stadol and then finally changed enough to get a block, so she was happy when I left. We got an IUPC and turns out her contractions that looked so impressive on the monitor were actually these little wimpy things that would never dilate her to a 10, so they were gonna start pit this AM. There was no way that I was going to start pit when she was contracting every minute though!

I learned the value of teamwork tonight. The rest of the crew was great when they knew I was swamped. They all had their own patients but nobody was really going active for them and they all pitched in and helped doing little things for me like flipping one girl while I was with another or watching strips while I was getting blocked. They are the bomb and I love them! Yea teamwork!!!

New House

2009-03-10T09:01:00.002-05:00

So today starts my month-long house/dog sitting assignment for a couple from our church. Flying to Hawaii for a month to see their daughter...must be rough :) So I get to watch their very lovable/excitable doggy for a month. I'm most excited at the moment to realize that I can get wireless Internet from a sharing neighbor! Hooray!

Last night at work was pretty good, I got the ante assignment which was OK, I haven't done ante's in a while and they were all well behaved tonight, I didn't break any of them. Sent one home by 2000, made friends with the high-maintenance gal who is "growing babies" until she's 32wks with her twins. She's been there a few weeks and has a few left, so she's settling into a routine. Another gal came in post MVA, wks with a positive KlehourBetke (I know that's not spelled right...), so she got to spend the night and was getting a sono today sometime. Another gal who has been working on N/V/D/temp didn't have any of the 4 for me all night, so I'm hoping she's fixed.

It was actually relatively quiet most of the night, our only delivery was a 18wk DIU r/t prolapsed cord. That was really sad, the baby was totally perfect, you could tell it was just the freak SROM and cord prolapse, no anomalies or any suspected reason for it. Ug. That's our 6th DIU for 2009 already. That's way too many. They had 21wk DIU twins last week, no more purple names!

It got crazy about 0430 again, seriously, is there just an alarm that goes off across the city at that time and everyone starts contracting? We had 3 or 4 people come waltzing in during a 45min span. Sheesh! That makes dayshift stress too because it messes up assignments and it looks like night shift has just been slacking all night, when we totally haven't! We can't help it that everyone walks in an hour before shfit change! Oh well, such is the job some mornings :)

I'm back for one more night, then on-call from 1a-7a on Thursday morning. I'm not sure what I was thinking signing up for that on-call shift, but I did it, so hopefully I won't get called in.

100th Post!

2009-03-09T08:31:00.004-05:00

My all celebratory post and I'm too tired to really think much about what to say in it...

I survived my 2-day OB-ACLS class last week, it was a fun group of nurses to take it with and the instructors (two of our L&D nurses) made it lots of fun, practical and logical. So it was a fun 2 days. Working only 2 nights last week wasn't bad either, even if it did make it 5 nights in a row. I just keep adding letters after my name: RN, BSN, BCLS, NRP, OB-ACLS, CPR. Sheesh! I sound super smart!

Worked my 1st out of three last night, back for 2 more now. I was acutally "on-call" both Friday night and Saturday night and totally expected phone calls, but didn't get one either night. Speaking of, I should write that down for my hours at work tonight! Note to self... I was kinda expecting to get called last night, but I was there in all my glory, with 2 cervidils who actually behaved themselves. One of them had a "little dip" for about 2 minutes right after I got there but then baby behaved the rest of the night and she got some rest.

Of course it clustered right about 0430 and 3 or 4 walked in ruptured/laboring and then our scheduled 0730 c/s didn't show up 'till 0700 (supposed to show up at 0530) so I stayed and helped get her paperwork done. Of course she had no pre-admit stuff. I seriously think that should be a requirement to have any kind of scheduled procedure induction, C/S or otherwise. If you were scheduled for any other procedure at the hospital they'd have you write a book before you could show up for it, why can't it be the same for us? It saves everyone a TON of time, patient included. Ok, off my soap box now.

It was so nice here over the weekend, in like the upper 70's that my windows were open. Now it's in the low 30's and guess who didn't think to close her windows before work yesterday. It is FREEZING! in my room!

Babies today: 0

Babies total: 38M/36F = 74

Vag:28M/29F = 57

C/S: 10M7F = 17

Babies 'caught' = 1f

I Made It!

2009-03-03T08:14:00.002-06:00

I made it 5 nights in a row! Last night was so much better than last night, I think a lot of it had to do with the fact that I KNEW that I didn't have to go back tonight! I about floated out the door this morning, I just need a break from being "responsible" for a few nights! I'll be ready to be back Sunday night I think.

I did a fresh recovery, I did a little triage, I did a little C/S for a gal that walked in ruptured and transverse presentation. I felt bad for her, it was her 5th baby, she's never had an epidural, never had a C/S, what a time to have to have to have a section for an upside baby!

Everyone at work was making fun of me because the Bachelor finale was last night. If I work on Monday nights I always go home and watch the Bachelor Tuesday morning, so I really try not to watch it or see snatches of it at work. EVERYONE had it on last night, a bunch of nurses had a chance to go into an empty room and watch the end of it and I refused to go in because I wanted to come home and just watch it without knowing the end. I made it until day shift came in, and then a bunch of day shift nurses came in and were talking about it, I wanted to run away before I found out the end. I didn't hear the exact ending, just that nobody was really happy about how it turned out. So...now I won't be going to bed for a while because I'm only to the beginning of Molly's date! I hope I'm not TOO disappointed...

Babies today: 1f
Babies total: 38M/36F = 74
Vag:28M/29F = 57
C/S: 10M7F = 17
Babies 'caught' = 1f

Blood Donation

2009-03-02T07:54:00.003-06:00

On a more entertaining note...I gave blood on Friday. I've always been told I'm not the best vein candidate around, but it takes talent to give someone a bruse like this from an attempted blood donation! I thought I was going to come off the table when they stripped the tubing right next to the needle to see if the vein was really blown. That hurts like I never would have imagined! I ended up donating out of the other arm...and have no bruise!

4 out of 5...almost done!

2009-03-02T07:33:00.003-06:00

So I put things into perspective at work tonight when I half jokingly and half not jokingly got told I couldn't work more than 3 nights in a row again because I got grouchy after 3! I think I'm usually seen at work as a pretty happy, optimistic, enjoyable person who likes her job and is a good team player and always ready to help out with things. I didn't feel like that person last night, for the first time I really felt frustrated at some of the other people I was working with and really just couldn't take it anymore. I went in early at 1700 for a nurse so she could go home early and all I heard when I got there was about how busy day shift had been and how day shift is always swamped and they had to call in extra nurses etc, etc. So I took a brand new triage that had just walked in the door, got her all started and came out and my name was next to another patient on the board. Then I noticed it was just a cervidil coming that night. Ok, I can do that. I came back out of my triage room a few minutes later and my name was next to a 3rd patient on the board, it's ok, it's just another cervidil for the night. I jokingly make a comment about everytime I come out to the desk my name's next to another patient. Haha, funny, funny. I sent my triage home, had 5 minutes to run and see my 3 deliveries from the weekend, and come back to find yet another triage with my name on it at the desk. It's now 1900, and I know I have 2 cervidils coming at 2000.

My triage is contracting, multip, post dates, unchanged from her office visit a week ago, I saw the doc on call, she looked at the strip, said it was OK to send her home if she wasn't changed in an hour. An hour comes, her cervix doesn't change, she's still contracting every 5-7", she says she think's she'd be more comfortable at home, I gave her some vistaril and she left. Meanwhile both of my cervidils have shown up, one of the other nurses put them on the monitor for me, etc, etc. These are my 3rd and 4th patients of the night, and I know they're staying for good. So I start getting them both ready, exams, papers filled out the whole 9 yards. I'm on the phone with docs getting orders, cervidils are busy at the beginning.

As I'm walking out of my 2nd cervidil's room there's a big chaos in a room and I find out the 2nd triage I sent home literally an hour before had come back ruptured, 7cm, mec and she spit out a kid in 30 minutes. Nice going, BirthdayNurse. So I feel like the worst labor nurse and it's only 2100.

Meanwhile, 2 cervidils are supposed to be a "full nurse load" and for anyone else they seem to always be that. No, my name managed to get on at least 7 charts last night, people kept walking in, we had 6 patients walk in ruptures last week anywhere from 35wks to 41wks. Somehow my name seemed to pop up as available for every person who walked through the door. I didn't chart one set of heart tones on either of my cervidils until after I gave report to the next nurse this morning.

I was not the only nurse busy, I know that for a fact. I also know that we asked for help multiple times, asked the charge nurse to call in some help, etc, etc, but it wasn't until we had to hand her off a recovery so a labor nurse could take a new SROM'd girl in labor that some phone calls started getting made. I should just learn to keep my mouth shut and remember that I am doing the job that I always wanted to be. I know I'm tired, I know I'm hungry and haven't eaten a real meal since before I started this set of 5 shifts, and I know that this post makes me sound like a whiny wimp! So to everyone that reads this...I really do love my job, I love taking care of patients, I wouldn't trade my job for anything, I just don't like it when I'm trying to take care of too many patients at the same time and don't sit down for 12hrs!

I swear, I don't think there are any pregnant women left in the city at this point! I'm not sure how there can be!

Babies today: 0
Babies total: 38M/35F = 73
Vag:28M/29F = 57
C/S: 10M6F = 16
Babies 'caught' = 1f

Night #3 out of 5

2009-03-01T08:26:00.002-06:00

Ok, so 3 nights down, 2 to go. Seriously, I don't think I'll do this again without really thinking it through! I'm so sleepy!!! Last night was much better than the last couple ones have been. I actually only had ONE patient all night, that is a first in a long time. I wasn't convinced that my sweet little gal was going to make it, but she did it! She was 3cm, 3cm, 3cm, 3cm after SROMing and being closed then being on pit (up to 30mu/min) for hours, and then all of a sudden went from 4cm to complete in like an hour! Yippee for her! Great pusher, great delivery, everything was fantastic! I'm running a streak of amazing patients, and I love it! Very personable, sweet, excited-about-being-parents couples. My favorite!

I told one of the nurses I'd go in for her at 1700 tonight...I'm pooped, it's sleepy time. But that sleepy time isn't gonna last long eough!

Babies today: 1f
Babies total: 38M/35F = 73
Vag:28M/29F = 57
C/S: 10M6F = 16
Babies 'caught' = 1f

Shift #2 in Bullet Points

2009-02-28T08:34:00.003-06:00

I can't think in compete sentences, let alone paragraphs this morning, I'm exhausted...here 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 work...no 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

Night 1 of5

2009-02-27T08:33:00.002-06:00

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

T.I.R.E.D

2009-02-18T08:38:00.002-06:00

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 know...my doctor never told me. It's sometime in July." "July when, because it does make a difference." "I don't know..." Ok...so 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 know...it 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

Not So Sure About It

2009-02-17T08:40:00.003-06:00

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 :(

Triage Queen

2009-02-16T08:10:00.003-06:00

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

3 out of 3

2009-02-13T08:20:00.002-06:00

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

Today It Was 0500

2009-02-12T08:35:00.003-06:00

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 city...is 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!!!!

It All Hits The Fan @ 0400...

2009-02-11T08:41:00.003-06:00

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

The "Perfect Nurse"

2009-02-09T23:10:00.003-06:00

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!

Talented Doctor

2009-02-08T18:40:00.002-06:00

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

2009-02-08T08:08:00.002-06:00

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

The "Perfect" Patient

2009-02-07T21:51:00.006-06:00

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!