Birthday Nurse

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 f...

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 ...

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 th...

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 i...

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 ...

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 an...

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, th...

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...

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...

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 ...

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...