Birthday Nurse

For an un -usual 3 IAR (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 s...

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. 800 mcg 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 2 nd 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 pu...

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 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...

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...

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...

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,...

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 go...

I'm still tired of antes, mag, preemie's, twins, etc. I got another transfer from out of town who was 4cm/100% and 30 wks . 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!

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...

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 clo...

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...

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 ...

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 oper...

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,...

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. ...

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 cha...

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...

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?

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.....