Birthday Nurse

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 ni...

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 (10 th pregnancy...) come in SROM'd who delivered unblocked for m...

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...

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...

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 day...

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...

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...

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 bulgin...

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!

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 tog...

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 ...

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 differe...

Only one blog because by the time I went to bed at noon yesterday there was no energy left for blogging... After being off for 7 days after only working that one shift the week before I felt like the biggest slacker in the world! I just didn't want to go back to work! But I did anyway, 2 shifts of zero pay made this week's paycheck look REALLY bad. So night number 1/3 consisted of a cervidil and a ROL who had a horribly crappy strip and the doctor looked at it, did another C/S and looked at it again and said let's cut it. So we did. I always feel bad for the prime's who come in and get sectioned right off the bat for a bad strip or who never really labor. That means the next time when they're baby is fine and they're ready to labor on their own, very few docs are going to let them just because of that first C/S. Getting this gal delivered was the right choice though. The placenta came out in chunks, nasty mec , the baby had a .82 shift and a blood sugar of li...

So instead of 3 shifts this week...1 works just as well for me (though maybe not as good for my paycheck)! I felt 150% better, and survived the night fine, but it was crazy busy. Moved one recovery, blocked my 1cm prime and got chewed by a doctor for an order the previous nurse wrote wrong. I guess "labor epidural PRN " varies from doctor to doctor. I guess maybe I should have called to verify blocking my girl, but most other doctors would holler for double-checking such a standard order. Oh well, the girl went from 1cm-4cm in an hour after her block, so I felt justified. Then she stayed at 5cm for most of the night, then went to complete and was pushing when I left. I delivered another gal who came in contracting on her own and delivered 3 hrs later. She SROM'd in the middle of her epidural, that was exciting, then pushed great and here was baby! All that after all I was going to do was "put her on the monitor." I should have learned that if you're the 1s...

Called in sick again for work tonight, figured better to not risk it since walking down the hallway to get a drink wears me out. So I was scheduled for 3-in-a-row, and now it looks like I'll only be working the last 1 of them, then I was already scheduled for 7 days off. I feel like a slacker, but I knew there was NO way I could keep up tonight, and I'm still running a low-grade fever. I know everyone gets sick, but I can't remember the last time that I really got hit with something. I really, really, really hate being sick! I think it's my "controlling" personality coming out, ' cuz being sick isn't something I can control. So I've been in bed all day, I am bored out of my mind but don't have the energy to do much besides lay here. I really hope I get some kind of energy back by tomorrow night, I am DETERMINED to work at least one of my shifts this week!

The only thing worse than going to work when you don't feel good is going to work, getting nauseous, having to rush out of a patients room to puke and then coming home and puking all night. I've been in bed all weekend and hadn't really thought it was anything more than a sinus infection. I never felt sick to my stomach, never felt anything more than just stuffed up with a sore throat. But as soon as I got to work...uh-oh. At least I just had a cervidil that was supposed to come in at 2000, so I seriously sat in a chair, drank 2 full water bottles and tried to focus really hard to get my nausea to go away. Seriously, I can take a stuffed nose and a sore throat, but if there's one thing that bothers me about being sick it's puking. I hate it with a P-A-S-S-I-O-N. So luckily they were able to call someone else in and I feel like a horrible person because I left her with lots of things not done. I had a triage that I hadn't had a chance to chart on, and hadn...

You know you need a break from work when... *I took 2 Advil this morning and the first thought that crossed my mind was "I need to remember to chart this!" Sheesh...

I don't think there is ever gonna be a shift where I don't do something I've never done before. Last night it was actually "starting" someone on mag, with the 4gram bolus and then the 2gram/hr thing. I've heard too many stories about people forgetting to change the pump rate after the 4grams in 15minutes when they hang the "big bag" and send their patients up to ICU because of respiratory failure, so I was a little nervous. The awesome day shift nurse helped me roll the patient out of the OR and get everything straightened out and the mag started and the paperwork organized and stuff before she left. So I had a fresh section on mag and the patient wasn't one of those who I would call "stoic", actually quite the opposite. This was about her 7 th admission in the last 2-3 months of her pregnancy for various things, but when she got hit with the PIH she got hit hard and really was sick, so even though she was only 33 wks it was a good ...

MUCH better than Tuesday night :) I had a gal who was on Mag for pretty bad PIH . 24-hr urine, then cervidil , then pit...and she was finally complete. She also could barely open her eyes or talk to us b/c of the mag. So the mag got turned off, we labored her down for about an hour, then we pushed for about an hour and a half and had a baby. Poor girl, I really wasn't convinced that she was gonna be able to push a baby out because she was pretty out of it, but she did awesome, and the last half hour or so she actually was 1/2 way on the same planet we were on. I guess that would be the way to do it, be half out of it during the hardest part then come back to reality right before delivery. She and her husband were really sweet. She was pretty alert the rest of the night, even after we turned the mag back on post-delivery and said several times how she thought it was funny how we had kept asking her to "open her eyes and talk". She said she could hear us, but just couldn...

When at 1915 I wondered out loud if it really was only "7:15?" I knew it was gonna be a long night. My poor, sweet patient didn't speak english , but everyone was expecting her to deliver since she was 7cm at 1830. Well after 3 hours of pushing + vacuum, she delivered at 0240. I just got my new Dansko's yesterday, and wore them for the first time last night. After seriously being on my feet for all 12 hours, my feet are a little sore...those are high arch supports! But, I think they'll feel better tonight. Anyway, it was just a rough night all around. Everyone seemed to come in a little on eggshells, they closed down our parking garage and turned it into "visitors/doctor" parking (so now I'm gonna have to scrape frost in the morning!). I realized AGAIN, what a difference working with "team players" can make and the importance of having SOMEONE open for triage. I pray that the new unit that we're working on has a triage/antepartum uni...