Birthday Nurse

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 jus...

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 30 wks ...that's gonna hold a bed for as long as po...

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...

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....

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 wor...

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! Whate...

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 n...

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 2 nd baby, she precipted with her 1st baby, and almost did with this one...tha...

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 ...

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 , star...

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 nurse...

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,...

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 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. Go...

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! Anywa...

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. ...

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 midni...

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...

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 ri...

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 ou...

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...