Birthday Nurse

I apologize ahead of time if I miss totally obvious reasoning for why this happened, but to me it just didn't make sense... G1 29weeks presents to L&D sometime Monday afternoon for higher blood pressures and just not "feeling right." Her mom used to be a nurse in an OB's office, so of course Grandma knows "exactly" what is going on...anyway, her pressures weren't pretty (150's/100's consistently) but since it was a busy day in the office, her doc wanted us to just watch her and treat her pressures with labatalol . Her urine was dipping 4+ protein and you could tell there was some swelling going on. Labs came back " ok " not fantastic, so doc ordered a 24-hour urine to check protein, etc. So that buys her at least a 24-hour stay. She got her first dose of steroids for fetal lung development and hung out 'till Tuesday afternoon. Tuesday, her pressures are even worse and her 24-hour urine came back with 6 GRAMS of protein. That...

This nurse is too tired and too grouchy and too frustrated to really go in depth about her day at work. I don't think I will ever understand why some people (in this particular case doctors) do what they do when they do it. I feel like I did absolutely nothing today, got nothing really accomplished except watching my patient get sicker and sicker before my eyes and then handing her off to night shift to section 45 minutes after I left. A section that should have happened at about 0900 this morning, and by 1500 at the latest.Let's say that at times today, my line monitoring baby's heart beat was flatter than my toco line sitting on a uterus that was picking up only breathing. The toco line was at least a little jiggly! Sigh...more tomorrow when I won't blog things I'll regret later. Bottom line is -- babies today: ZERO

I think everyone on the unit today would agree that today was just a day that went on forever. It wasn't bad, it just was never ending! I had an induction, multip who went from 1-"baby" in 3'50". Not too bad! Note to docs: when the nurses who are doing your induction don't start their shift 'till 0700, don't tell your patient to be there at 0630, and then when you show up at 0705, please don't be upset that she doesn't have an IV yet and that the nurse isn't just waiting around for you to AROM . I get nervous easily anyway, and when the doc is standing in the corner of the room drumming his fingers while I'm trying to start an IV and just say "good morning" to my patient that I've known all of 3 minutes, I get even more nervous! I don't think I really got my thoughts gathered 'till AFTER delivery. Oh well, live and learn. I ended up doing a bleeding/cramping triage later on. It amazes me how the patients we as n...

So after yesterday, I have yet ANOTHER card to add to my wallet :) My NRP card is not nestled next to my nursing license, CPR and BCLS cards. I'm aiming to have all the letters A-Z after my name soon... haha ! The class really wasn't as hard as I thought it was going to be. I was all worried, but I think I could have gotten through it and done the test and gotten in all filled out in way less than the 8 hours that it took yesterday. Oh well. My one BIG question about the class was: why did they pick instructors to teach the class who have nothing to do with NRP ? One of the instructors is the educator for all of Women's & Children who does NO patient care; one works Mom/Baby every once in a while and does a lot of education, and the other is the NICU manager. The NICU manager, I see that. She does NRP stuff and has done it for years, but she taught 2/9 sections! When I saw her today I told her that we voted for her to teach it ALL next time... J thinks I should go...

So I'm not sure why I'm tired after today, it really wasn't that big of a deal. But go figure, the first/only shift I've worked since Sunday and I just totally felt like sitting on my butt and being lazy. I knew ahead of time that we had signed up for C/S, so that thought was in the back of my head. Call me picky, but C/S really aren't my favorite. I'm not really sure why, but I just feel like the nurses don't really get involved, and I sure as heck don't feel like and L&D nurse circulating a C/S. Really, I put in an IV, play secretary/scheduler for the docs/scrub techs/and anesthesia and then stand in a corner with a mask on for 45 minutes, do my little fundal checks for 2 hours and that's that. I don't feel like that is L&D nursing in the least. Our patients were terrific today, great couple, second baby, and finally a girl! Normal 39wk repeat C/S, but then one of the cord pH's came back nasty and last I heard baby was in the NICU ...

Between the 2 12's in a row, and then babysitting last night until 2300 after I got off...I got no blogging done this weekend! Actually, for a weekend stint, it was decent. It was never crazy busy, but weekend rarely are. We had a total of 6 deliveries on my two shifts, and I did 3 of them, so 50% for me, not too bad! Saturday morning I was excited because I got to deliver my friend from church. It was kinda fun, but it also makes you look at everything differently, and I don't know that I like that. Not only are you thinking of it in a medical way, but you're also thinking of it as "I really know this person" in brings in a whole new aspect. But good delivery, first time delivering "as a nurse" with this particular doc. They're one of those docs that us nurses sometimes roll our eyes at. At times says things that we wonder if really should be said in a delivery in front of patients. But I'm sure that I have said things maybe that shouldn't ...

So today I got my unblocked patient to practice all the things that all the smart nurses and mom's out there have been telling me! G4P3 age 21 was my induction stats this morning. Wowza ! I'm 22, and I'm a Gz ero and planning to stay that way for a while! Anyway, this gal was much more "normal" than I was expecting, and she said she'd had all 3 of her other babies unblocked and had been induced with two of them, so this wasn't a new process at all for her. I have 100% confidence that she could have done the whole deal without me sitting in there by her bed all day, but after a few minutes of watching how the dear FOB was acting, I felt too sorry for her to leave. He sat in the recliner (all 400lbs of him), with a box of doughnuts and the comments I heard (when SportsCenter was below a dull roar) were "Want a doughnut...oh wait, you can't have one!" "Hurry up, just push and get the baby out!" "This is taking way too long, it...

So the goal from here on-out on orientation is more deliveries! It's gotten pretty standard that J and I each have our own patients now, we usually get assigned two, I get one and she gets one, and then she walks in during delivery or if I need something. So, it's a lot more of me on my own, which is really good for me. I had a different doc than the one I had all last week, and I was ok with that. This doc is a lot lower key and doesn't make me QUITE as nervous. For the first time in a long time I had a not-so-nice strip to play with. Nothing too crazy, but we did get some pretty decent variables from about 3cm on, and it's a good thing she went from 4-complete in about 45 minutes. For a prime that wasn't too bad! It was good for me to get to work with the strip and try different things to try to get the variables to go away: turning, turning, checking, turning, fluid bolusing , turning, O2, etc. Looking back on the strip nothing really ever worked, but baby recov...

Sheesh ...today wore me out! I don't really know why, but it was just intense from the start! My induction (I really do love inductions, I'm going to miss them when I go to nights...) was a multip , but you would never know it. Not in a million years. She was a typical "princess" that belonged to our "princess" doctor. The doctor is really good, but if she a) is in a grouchy mood b) just flat out doesn't like you or c) things don't go just her way, there is trouble ahead. Trouble started pretty quick... The induction got there late, so I was late getting her IV started. She was freaked out about the whole induction thing, even though things were the same way with her first baby (also an induction). As we're walking into the room she asks me "Now what is this induction thing about, and how does it work" so, starting out at square one, it was like that all day. I really don't mind explaining things to my patients, in fact, I like it ...

Wow, ok , I have been totally blown away by the awesome, amazing comments that have been left on my last couple blogs answering all my questions. I feel like I've learned more by reading comments from REAL moms who have done AMAZING things during their child's birth than I ever could have just by asking other nurses what they suggest. Thank you so much for all the tips and suggestions. I've ordered/looked up some of the books that people suggested, so now I'm really excited! I think my perspective has totally changed on natural childbirth. I have felt like a horrible nurse standing there watching my patients "suffer" and "hurt" when I guess I can almost compare it to a good work out: no pain no gain, and how much more you appreciate something after your work for it. Not that you don't appreciate your baby immensely after you deliver no matter if you had pain meds or not, but those of you who can go without medical pain relief...you amaze me! ...

Thank you for all the feedback on the natural labor posts. As a new nurse, these are the things that I'm still trying to learn, so all the feedback, ideas, thoughts are great and very, very informative. So my next question is: What are the things that help the most if you're trying to go natural, or even if you have pain meds ? What are the things that you as a laboring mom want to hear, what can I as a nurse tell you that is going to make this process what you want it to be? What things can I do to let you know that you're supported? I know labor is different for everyone, but as a general rule, what works? I told a couple of the nurses the other day when I had someone "unblocked" I feel so dumb standing by her bed saying "in through your nose, out through your mouth" "keep breathing" "good job" "you're doing great" I would think that would get old after about the 2 nd contraction, and if that's all my nurse kept t...

So I really like this feeling of being more independent. I felt really bad for J today though, I like it I get to work "with" her instead of her just "watching" me. I really, really want to know that I can do it and that I an handle it on my own, but I like to work "with" her too. Here I go getting all mushy again...haha. ANOTHER awesome couple today, I'm getting so lucky! It was nice to have a multip after yesterday. I was so proud of my couple yesterday though, she pushed out a >9# baby about 45 minutes after I left last night. Go her!! Anyway, great delivery today. I got to do lots more patient education, which really, honestly is when I feel like the best nurse. I love it when I know what I'm talking about and can make my patients feel calmer, relaxed and informed. This poor gal, her first delivery was slightly rocky. She had a family practice doctor, a pretty big baby, she couldn't feel to push, she got a really bad 4 th degree tear, a...

I got a comment on one of my previous posts about a precip delivery who didn't get an epidural before she delivered and who had great control vs. some patients who I see come in who don't have such good control. "Sometimes losing control is how a woman copes with birthing naturally. While swearing and writhing all over the bed are annoying to you, it's the patent's birth." I agree totally with this statement. After going back to read my previous blog, I probably should have tried to make my point a little clearer and not come across so grouchy about it. I have nothing against someone going unblocked or without pain medicine during a delivery. In fact, I admire them! Totally, 100% admire them. They have something that a lot of people don't have: mental and physical strength and endurance! The patients that I really, truly feel sorry for are the 1st time moms, especially, who come into labor not knowing anything about what it's goi...

Thank you for everyone's support after the JCAHO incident last week! I'm singing praises that I got 5 days off and a vacation to TN after that! Today the state Health Department showed up, thank goodness they went to visit Mom/Baby and not us! So as I was leaving today, J told me, "I'm not so sure you need much time left on orientation." No! Don't tell me that yet!!! I WANT more time on orientation! I got blessed with another lovely induction couple, postdates by about a week. They were great! I was very, very, very sad when I left and she was just about complete after working for 12 hours to go from 1/50 and then work with her for 10 hours without a block and then she finally smiled again and I had to walk out the door! :( She almost got me to stay when I took the baby warmer in the room and she asked me "aren't you going to stay and help me?" No..............but I'm heading back in the AM so they're first stop on my list to go visit. ...

It was the middle of the afternoon that I thought I saw my whole nursing career flash before my eyes. Every hospital person knows what JCAHO is. Well they usually come at a time when I'm not working, and in school you don't have to deal with them. Guess that all changes now! The "mock" JCAHO people came around (we found out later they weren't so "fake" afterall...) and of course want to see all the units. By the time they get to L&D we're on C/S #5 of the day, we have a bunch of triages and look, one labor patient on the board. Guess who's patient she is?! Someone sends me to go get J and have her talk to the group of 15 people standing around the nurses station in their business suits. J comes out to the desk and tells our manager, "I haven't touched that chart. Beckie's had that patient on her own 'cuz I've had my own two triages!" So now guess who gets to talk to Joint Commission?! Thank all the higher powers that...

Today was a day from I'm not sure where...really, I'm not sure where it came from. When I first looked at the board today J and I were next to a primip who was 9/100/0 and a patient of the same doctor that I had my little "learning experience" with last week. Hmmm ...but I figured it would be a fast delivery and then who knew what we'd get the rest of the day. I got report from the night nurse and was getting ready to walk into the room when there was a little discussion about assignments and J and I ended up taking one of the 2 0700 inductions for the day that another nurse had just taken back into the room. So we did a little switch, I gave my report and card to another nurse and grabbed the induction chart and walked into her room. The couple was great, this makes 2 days in a row with totally normal, fun, interactive couples! I'm on a roll :) Baby came out great, she was adorable, big brother loved her, she was a bottle baby, it was a great morning. We eve...

So I was totally thinking about NOT blogging tonight because it's been a day from I don't know where and I have a flight for TN that leaves at like 0715 tomorrow which means I have to leave at 0530 to get to the airport on time. BUT, I decided that I had to tell at leas a few stories about today, so I got on and was checking out the blogs that I read every time I have the chance, and look what I found... Birthday Nurse -- A new grad on L&D, and new to blogging! She creates a nifty running total of how many babies she has helped enter this world, and tells things from a new nurse point of view. Check out her blog, and help support her on her journey into labor and delivery nursing! At Your Cervix is one of the most amazing blogs I've read, and it's probably the reason that I started writing down my stories too. It kept me awake multiple nights that I worked as a 1:1 aid this summer before passing my boards, and many nights after that. The stories are great, the ...

I had the best patient today that I've had in a long time. It was a great way to come back to work after a few days off, and a good vacation in Branson. J and I were slotted for 2 inductions. One multip pit induction at 0700 and another cervidal from the night before. The board was crazy (what's new...) and there was no way we were gonna be able to handle both of them, so J took the cervidal and I took the induction. I was pretty proud of myself overall for the day, much better than the last epidsode I had at work. I love the doc that we had, and the couple was as nice as could be. Lots of fun, great at interacting with eachother and with me. They were wide open for anything and when baby was born at 1109 everyone was surprised! One of my favorite things is when the parents don't find out the sex of the baby. It makes it awkward calling the baby "it" all day long, but it's so fun to see the faces of Mom and Dad when they find out if it's a boy or a girl a...

I love reading other people's blogs, I think it's cool to be able to read what's going on in other people's lives and think that these stories are really happening...right now! I follow most of the blogs listed in my Blog Roll, and I just added a spot to show the people that follow my blog and read my stories! So, if you like reading about my adventures, let me know and add yourself to the "Follower's List"!

So yesterday was the first time I really wondered if I'm ever going to be a Labor nurse like the nurses that I look up to. I worked with N yesterday, ' cuz I needed an extra day. The patient I walked into at change of shift was about 1 1/2 hours into pushing, and trust me, that's the worst time to switch patients. The first thing you see of them is them up in stirrups and you're supposed to go over and introduce yourself? Right...I wasn't too convinced that this gal was gonna be a great pusher, and we pushed and pushed in this position and that position for another hour and a half. I wasn't seeing much progress and I think we were both getting a little frustrated and poor girl was getting tired. Then Dr. M walked in and somehow put his hands on the head and made it happen. I love Dr. M, he did the first delivery I ever saw and I've always just thought he was a good doc. N came into the delivery, but she scrubbed in to help Dr. M so I really was kinda doin...