It seems like it wasn't all the long ago that I began my job as a L&D RN. I was on orientation for almost a year because we have a top notch orientation program. As a new RN to begin with entering a specialty field like OB, I knew I needed intense training. This influenced my choice of where I accepted a position. In our unit we systematically go through every type of patient you could encounter and train new nurses until they feel totally comfortable taking anything that walks through the door. The categories we go through are:
Postpartum mom and baby
"Baby Catching" or the immediate care and resuscitation of the newborn
Circulating on Cesarean sections
Scrubbing for cesarean sections
Outpatients (rule out labor, preterm labor, rule out ROM, bleeding, decreased fetal movement, etc)
Labor and Delivery
High risk (mostly antepartums: PPROM, preeclampsia, Previa, etc.)
Anyway, I worked my way through all of these categories and began practicing on my own and have been doing so for a few years now... And, recently, I was asked to take on the role of "Preceptor." I am now teaching the new nurses who come on the department all of the things they need to know to function independently.
When I was initially asked to fulfill this role, I was currently the newest RN on the floor. I questioned my supervisors decision to put me in this position... But, she seemed convinced I would do well, so I agreed to fill the need if she needed me to. To my surprise, I thoroughly enjoy the preceptor role!
I began by having the new nurse mostly follow me and learn through observation and we moved to the point now where I am mostly following her and observing her, offering feedback and double checking charting. I ask her questions as we go to ensure her complete understanding. For example, if we have a non-reassuring fetal heart rate I will ask her what may be causing the pattern we are seeing, what we should do about it and what orders we can expect from the doctor.
Some challenges I find during precepting revolve mostly around my patience. I didn't previously think I had a problem being patient... But, it is incredibly nerve-racking when I send the new RN into the room to do something simple that would take me 2 minutes and 10 minutes later she is still not out of the room. "What is she doing in there?" "Is something wrong?" I find it hard to not DO. When there is a list of things to do to get a patient admitted and I could easily do it quickly.... I have to sit on my hands and wait for the learner to work her way though the tasks at a painstakingly slow pace.... not doing anything wrong, just taking a LONG time to do everything. It makes me wonder how much of this my preceptor felt when she was teaching me.
I do enjoy it, though. More than I thought I would. My pupil is almost ready to leave the nest and fly by herself. A few more weeks and she will be set loose. It makes me proud to see her progress. Teaching is not something I ever thought I would enjoy... I always liked to have my patient and keep busy... But, surprisingly, I will be happy to take on my next orientation assignment.
Showing posts with label nursing profession. Show all posts
Showing posts with label nursing profession. Show all posts
Saturday, September 17, 2011
Thursday, July 29, 2010
The Joy of Birth
My husband asked me a few weeks ago if the joy I used to get when attending a birth was still there now that I am at a birth nearly every day I'm at work. I told him, regrettably, that it did become somewhat routine for the most part. I am usually busy tending to the needs of the patient, making sure the doctor's orders are followed, lab work is normal, set up is ready in time for the birth and keeping a watchful eye on the fetal heart rate tracing - doing interventions as needed and alerting the doctor of any problems. Pretty clinical most of the time.
I hadn't really thought about it much... But, yeah... for the most part the joy I used to experience as a doula at births is largely gone. It made me sad to realize this.
Then, about a week or so ago, I attended a birth that transported me to that old joyful experience once again. It was a breath of fresh air. I can't put my finger on exactly why this particular birth touched me again... but it did. I found myself laughing and cheering at the end.. and when the baby was actually born, I was clapping! The labor nurse: clapping!! The doctor looked over at me and said, "You can start the pit now." And it snapped me back into reality: Oh, I am the nurse. Oops!
It was lovely. I wish I could say each birth still touched me the same way.. But I am at least glad to say that I am still able to be moved by birth.. If not every birth then some.
I hadn't really thought about it much... But, yeah... for the most part the joy I used to experience as a doula at births is largely gone. It made me sad to realize this.
Then, about a week or so ago, I attended a birth that transported me to that old joyful experience once again. It was a breath of fresh air. I can't put my finger on exactly why this particular birth touched me again... but it did. I found myself laughing and cheering at the end.. and when the baby was actually born, I was clapping! The labor nurse: clapping!! The doctor looked over at me and said, "You can start the pit now." And it snapped me back into reality: Oh, I am the nurse. Oops!
It was lovely. I wish I could say each birth still touched me the same way.. But I am at least glad to say that I am still able to be moved by birth.. If not every birth then some.
Wednesday, June 9, 2010
2 Years
This week marks 2 years that I have been working as a Labor and Delivery Nurse. The time flew by... I know it's so cliche to say so... But it feels like it!
I have had many experiences in the short 2 years I've been doing this and I've learned a ton. I've cried more than a couple times... some times out of joy sometimes out of sadness and even out of frustration.
Some of the memories I've made will stay with me forever - I hope.
I remember my first medication error. I thought I would just die... I administered someone a percocet instead of a Tylenol with codeine. Thankfully, it wasn't a grand error in the scheme of things... But it did make me a better nurse. I became even more vigilant when administering medications to patients. The best way for me to learn, I've found is to actually get in there, do it and learn from my mistakes. Our hospital's medication administration system is antique to say it nicely... and this coming year we will be updating it to the "bar-code" system... which will aid in preventing further errors like this one that devastated me as a new nurse.
I remember the first time I had to resuscitate an unresponsive newborn. I've gone through many certifications as a new maternity nurse, but the one I use most often - even daily - is my neonatal resuscitation certification.... That combined with my ever available co-workers make "catching a baby" one of my favorite things to do.... Thankfully it is few and far between that I actually have to put into action the resuscitation measures ... but it has happened a couple times... all with good outcomes.
I remember the handful of times I got the privilege of delivering the babies - when the doctors didn't make it to the birth in time. It is an awe-inspiring event for you to be the first set of hands that touch the fresh, new baby... Yours are the hands that check for the nuchal cord... that gently guide the head and shoulders over the perineum... It is just awesome and part of what motivates me to keep moving forward towards my ultimate goal of being a midwife.
I remember with sadness the few fetal demises I had the opportunity to be a part of. The heaviness in that room when the breathless baby enters the world... Never to take it's first breath or cry its first cry... It stays with you forever.... Peace little ones...
I remember the joy of attending my first VBAC and first vaginal breech birth with our new rouge, trail-blazing physician, whom I absolutely LOVE!!!
I've been blessed to have been led to this particular place of employment as my first experience as a labor and delivery nurse. I kind of thought I would find aspects of this job I liked... But overall I thought it was going to be a necessary step towards the direction I feel compelled to head into; But, I have honestly come to absolutely LOVE being a labor and delivery NURSE.... Yes, it is still a necessary step towards my goal of becoming a certified nurse midwife... But it is a step I will cherish forever and one I could honestly be very happy at for a long time.
I have had many experiences in the short 2 years I've been doing this and I've learned a ton. I've cried more than a couple times... some times out of joy sometimes out of sadness and even out of frustration.
Some of the memories I've made will stay with me forever - I hope.
I remember my first medication error. I thought I would just die... I administered someone a percocet instead of a Tylenol with codeine. Thankfully, it wasn't a grand error in the scheme of things... But it did make me a better nurse. I became even more vigilant when administering medications to patients. The best way for me to learn, I've found is to actually get in there, do it and learn from my mistakes. Our hospital's medication administration system is antique to say it nicely... and this coming year we will be updating it to the "bar-code" system... which will aid in preventing further errors like this one that devastated me as a new nurse.
I remember the first time I had to resuscitate an unresponsive newborn. I've gone through many certifications as a new maternity nurse, but the one I use most often - even daily - is my neonatal resuscitation certification.... That combined with my ever available co-workers make "catching a baby" one of my favorite things to do.... Thankfully it is few and far between that I actually have to put into action the resuscitation measures ... but it has happened a couple times... all with good outcomes.
I remember the handful of times I got the privilege of delivering the babies - when the doctors didn't make it to the birth in time. It is an awe-inspiring event for you to be the first set of hands that touch the fresh, new baby... Yours are the hands that check for the nuchal cord... that gently guide the head and shoulders over the perineum... It is just awesome and part of what motivates me to keep moving forward towards my ultimate goal of being a midwife.
I remember with sadness the few fetal demises I had the opportunity to be a part of. The heaviness in that room when the breathless baby enters the world... Never to take it's first breath or cry its first cry... It stays with you forever.... Peace little ones...
I remember the joy of attending my first VBAC and first vaginal breech birth with our new rouge, trail-blazing physician, whom I absolutely LOVE!!!
I've been blessed to have been led to this particular place of employment as my first experience as a labor and delivery nurse. I kind of thought I would find aspects of this job I liked... But overall I thought it was going to be a necessary step towards the direction I feel compelled to head into; But, I have honestly come to absolutely LOVE being a labor and delivery NURSE.... Yes, it is still a necessary step towards my goal of becoming a certified nurse midwife... But it is a step I will cherish forever and one I could honestly be very happy at for a long time.
Wednesday, March 17, 2010
Night-time Nerves
Why am I up at 4am on a night I'm not doing the night shift on the OB unit? I'm a nervous wreck about my teaching debut today!
I accepted an offer to teach OB clinicals for half a semester at my Alma Mater. So, now I am the nervous instructor where once I was the nervous nursing student.
The source of most of my anxiety comes from the fact that I am doing my clinicals at a hospital that I do not work at. I have to use their pyxis/electronic medication computer system, etc. and learn their protocols, etc. I just wish it were at the hospital I am already working at where those details were not a source of stress to me and I could just focus on mentoring the students.
Another source of stress is in the details. As a practicing nurse on OB, when I assess a postpartum woman's fundus, I feel it and can automatically tell if it is appropriate or of concern without really thinking much about it. But, now I have to go back to my textbook days and be able to site that at X number of hours postpartum the fundus should be midline, firm and at X-finger-breaths below/above the umbilicus, etc. etc. Another example: when I listen to bowel sounds on a post cesarean section mother, I put my stethoscope on her abdomen and can tell relatively quickly what we are dealing with. But, that will not be good enough. I will have to now instruct student to listen to each quadrant in a clockwise motion before palpation for X number of seconds and count the number of bowel sounds heard and their characteristics in order to successfully assess the patient. See what I'm saying?
And, as I former student who lived for the DETAILS, I know there will be a student or two who are just waiting to test the new instructor and deem her fit/unfit to instill knowledge into them.
Anyway, dispite all of my fears, I am looking forward to it. I used to do doula work at this hospital, so I am hoping to see some of the doctors and nurses I used to work with years ago. And, it is a new experience. One I am thankful to have.
Wish me much luck, please!
I accepted an offer to teach OB clinicals for half a semester at my Alma Mater. So, now I am the nervous instructor where once I was the nervous nursing student.
The source of most of my anxiety comes from the fact that I am doing my clinicals at a hospital that I do not work at. I have to use their pyxis/electronic medication computer system, etc. and learn their protocols, etc. I just wish it were at the hospital I am already working at where those details were not a source of stress to me and I could just focus on mentoring the students.
Another source of stress is in the details. As a practicing nurse on OB, when I assess a postpartum woman's fundus, I feel it and can automatically tell if it is appropriate or of concern without really thinking much about it. But, now I have to go back to my textbook days and be able to site that at X number of hours postpartum the fundus should be midline, firm and at X-finger-breaths below/above the umbilicus, etc. etc. Another example: when I listen to bowel sounds on a post cesarean section mother, I put my stethoscope on her abdomen and can tell relatively quickly what we are dealing with. But, that will not be good enough. I will have to now instruct student to listen to each quadrant in a clockwise motion before palpation for X number of seconds and count the number of bowel sounds heard and their characteristics in order to successfully assess the patient. See what I'm saying?
And, as I former student who lived for the DETAILS, I know there will be a student or two who are just waiting to test the new instructor and deem her fit/unfit to instill knowledge into them.
Anyway, dispite all of my fears, I am looking forward to it. I used to do doula work at this hospital, so I am hoping to see some of the doctors and nurses I used to work with years ago. And, it is a new experience. One I am thankful to have.
Wish me much luck, please!
Friday, March 12, 2010
Doctor Drama continues
With the risk of sounding like a broken record here, I'm going to talk about problems with another doctor. Dr. "Hostile," whom I talked about before has somehow been able to maintain an appropriate attitude while around me ever since our conversation. So, I suppose he is showing me proof that doctors can hear your complaints and change - If they want to. He still has his quirks.... but he is SOO much more respectful... I'll deal with the quirks.
This other doctor, I'll dub "Dr. Miserable." She is just that: miserable. She is a relatively young doctor who hasn't been practicing very long. But, she truly acts like she hates her job. She gets upset when she is called in while she is on call. She audibly sighs and says things like, "Great!" or "It figures" to our request for her presence on the unit. What can I say: women come in and have babies. It is kinda what we do here.
I do agree being an OB/GYN is a demanding job. But, do I have sympathy for her? Ummm, NO! She chose this career. She is being amply compensated for her efforts and I am about done hearing how miserable she is. She made a comment one evening while working late at the hospital that she only saw her daughter 5 hours in the last week. Well, shall we compare notes? I just worked 5 straight 12 hour night shifts. I wake up 1 hour before leaving for work and spend 1/2 an hour getting ready... So, in the last 5 days I've only seen my children 2.5 hours. And, I don't get paid nearly as well as she does to NOT see my family.
The point is everyone on maternity works hard. Everyone is stressed at one point or another. But, the difference is in the actions of the people. If we as nurses acted like the doctors freely do and wear our emotions on our sleeves and huff and puff and sigh and yes - even swear at people when we were asked to do OUR JOB - we wouldn't be working there long... would we? But, it seems to be totally acceptable for the doctors to be able to do that.
We need to work together. Everyone would rather be at home with their families. Everyone would like to be independently wealthy. But, few are. The rest of us have to work together and not make things worse on everyone else by being disrespectful to others because of our own personal misery.
The last night I worked another nurse took Dr. Miserable into an empty room and addressed her actions... So, here is hoping that she listened and will respond appropriately in the future. We shall see. She is so young, though... and has so many years ahead of her to practice medicine... If she truly hates it, I hope she can figure it out and move on to anohter field. For her own good as well as those she has to work with.
This other doctor, I'll dub "Dr. Miserable." She is just that: miserable. She is a relatively young doctor who hasn't been practicing very long. But, she truly acts like she hates her job. She gets upset when she is called in while she is on call. She audibly sighs and says things like, "Great!" or "It figures" to our request for her presence on the unit. What can I say: women come in and have babies. It is kinda what we do here.
I do agree being an OB/GYN is a demanding job. But, do I have sympathy for her? Ummm, NO! She chose this career. She is being amply compensated for her efforts and I am about done hearing how miserable she is. She made a comment one evening while working late at the hospital that she only saw her daughter 5 hours in the last week. Well, shall we compare notes? I just worked 5 straight 12 hour night shifts. I wake up 1 hour before leaving for work and spend 1/2 an hour getting ready... So, in the last 5 days I've only seen my children 2.5 hours. And, I don't get paid nearly as well as she does to NOT see my family.
The point is everyone on maternity works hard. Everyone is stressed at one point or another. But, the difference is in the actions of the people. If we as nurses acted like the doctors freely do and wear our emotions on our sleeves and huff and puff and sigh and yes - even swear at people when we were asked to do OUR JOB - we wouldn't be working there long... would we? But, it seems to be totally acceptable for the doctors to be able to do that.
We need to work together. Everyone would rather be at home with their families. Everyone would like to be independently wealthy. But, few are. The rest of us have to work together and not make things worse on everyone else by being disrespectful to others because of our own personal misery.
The last night I worked another nurse took Dr. Miserable into an empty room and addressed her actions... So, here is hoping that she listened and will respond appropriately in the future. We shall see. She is so young, though... and has so many years ahead of her to practice medicine... If she truly hates it, I hope she can figure it out and move on to anohter field. For her own good as well as those she has to work with.
Tuesday, December 1, 2009
Exhausted
I've just come off a four night run of working.... I have tonight off then have to work 2 more nights.... During this time I found out my dear friend and co-worker's baby died and I had to attend the viewing just before work last night.... To top all of that off, "Dr. Hostile" as I will now call him was on call last night....
In spite of all of us nurses who were working had just came from our co-worker's baby's viewing, we were able to bind together and make the most out of the busy night and make it through.... That is until Dr. Hostile showed up in the wee hours of the morning for an imminent delivery. He was down right rude, curt and - yes - hostile towards me.... and what had I done to him.... Unless I had accidentally ran over his pet dog on the way to work..... NOTHING!!
He treats me as if I am not good enough to assist his highness. Pheph.
Yes, he was the straw that broke my back last night. And, I'm down right tired of it. I need to find a way to calmly and directly address him about his behavior and attitude and how he can turn what would have and should have been a lovely delivery into a stressful, hostile event.
There is so much in this world that hurts and that is unfair and rightly makes you stressed out... Why make more?
In spite of all of us nurses who were working had just came from our co-worker's baby's viewing, we were able to bind together and make the most out of the busy night and make it through.... That is until Dr. Hostile showed up in the wee hours of the morning for an imminent delivery. He was down right rude, curt and - yes - hostile towards me.... and what had I done to him.... Unless I had accidentally ran over his pet dog on the way to work..... NOTHING!!
He treats me as if I am not good enough to assist his highness. Pheph.
Yes, he was the straw that broke my back last night. And, I'm down right tired of it. I need to find a way to calmly and directly address him about his behavior and attitude and how he can turn what would have and should have been a lovely delivery into a stressful, hostile event.
There is so much in this world that hurts and that is unfair and rightly makes you stressed out... Why make more?
Saturday, March 28, 2009
Superstitions
Nurses are superstitous creatures. If you doubt it, just walk onto a calm nursing floor and utter the words: "It's quiet today."
Yes, in the world of nursing if you say it, it's bound to happen.....
If you are having a good streak on IV starts, you don't dare mention it out loud or the next vein you puncture will blow and you'll be off of your streak.... Or, if you order chinese food; the unit is bound to explode into unforeseen craziness, the likes of which will leave even the seasoned nurse bewildered.
Thus far, I've had a hard time accepting these "myths" as I don't tend to buy into such beliefs. However, I've received an initiation of sorts into the eerie world of nursing superstitions recently on the floor.
Two events happened that now have me wondering if I shouldn't just hold my tongue when certain thoughts enter my head afterall.
A couple days in a row we would reach the "nearly over" point on the floor at about 5:30 or 6:00 am where we would start to make our patient rounds one last time, tying up our loose ends and preparing for the fresh infusion of day shifters to descend upon us.... Then, just as we were finally reaching the end of our "to do" list, a "Rule Out Labor" outpatient would arrive. "Darn it"... we would think, "Why couldn't her husband have drove just a little slower and arrived at 7:30 instead???"
So, after a few days of this happening consistently.... We got to that point again one morning and I said, "Isn't it about time for our 6 AM "Rule Out Labor" outpatient to get here?"
The glares I got from my lovely and normally very friendly co-workers were just plain evil. OOPS... sorry guys... It remained quite.... The doctor who was there to witness my mishap of words had left to go to her office... It was still calm..... Then, the phone rang and the secretary took down some information and hung up. She then announced to me, "Dr. So-and-So wanted to tell you that your "Rule Out Labor" patient is on her way over." Yes... You guessed it.... That day I was the overworked, overtired nurse that morning who got the bumm assignment of evaluating the outpatient who strolled through the door at change of shift. :)
Then, a few days later it was a particularly long and arduous night made even more difficult when things stalled to a motionless halt around 3 AM... I fought to keep my eye lids from closing from exhaustion... When things get quiet on night shift, the most effective way for me to stay awake is to keep busy.... with anything... clean, stock rooms, organize, anything.......
So, after doing the dishes in the break room and sitting down the exhaustion began overcoming me.... I said to my co-worker, "I wish I had an outpatient to get me over this hump this morning."
WOW.... Did I live to regret that request.....and all of my co-workers reminded me that the mess that was to follow was "MY FAULT."
Within 45 minutes of me uttering that dreadful sentence, the unit was in mass confusion.....
First a lovely "Rule Out Labor" outpatient arrived and I gleefully accepted this assignment. I went into her room to do my initial evaluation and assessment..... But, when I walked out of the room a mere 20 minutes later the scene at the nursing station was vastly different from when I entered. The secretary was fervently pulling papers, filling charts and faxing orders.... The charge nurse was on the phone calling in all possible helpers.... There was a crew of NICU nurses assembled outside of a LDRP room complete with a warmer, neonatal crash cart and the neonatologist. And, there were all of my innocent coworkers in room 422 trying to manage the now emergent 25 week abruption patient who walked through our doors just seconds before her amniotic sack ruptured.
Yes, mass confusion ensued. Every available hand was preparing for a crash cesarean.... and I found myself standing in the nursing station with 6 babies (who I knew nothing about because I wasn't their nurse) and a labor patient to admit (because my lovely "rule out labor" was indeed IN labor).
Yes, there was no way I was falling asleep at this point. That worry was far from my mind.
So, you can see a littel glimpse into what makes us nurses believe that superstitions are alive and well...... With good reason.
Yes, in the world of nursing if you say it, it's bound to happen.....
If you are having a good streak on IV starts, you don't dare mention it out loud or the next vein you puncture will blow and you'll be off of your streak.... Or, if you order chinese food; the unit is bound to explode into unforeseen craziness, the likes of which will leave even the seasoned nurse bewildered.
Thus far, I've had a hard time accepting these "myths" as I don't tend to buy into such beliefs. However, I've received an initiation of sorts into the eerie world of nursing superstitions recently on the floor.
Two events happened that now have me wondering if I shouldn't just hold my tongue when certain thoughts enter my head afterall.
A couple days in a row we would reach the "nearly over" point on the floor at about 5:30 or 6:00 am where we would start to make our patient rounds one last time, tying up our loose ends and preparing for the fresh infusion of day shifters to descend upon us.... Then, just as we were finally reaching the end of our "to do" list, a "Rule Out Labor" outpatient would arrive. "Darn it"... we would think, "Why couldn't her husband have drove just a little slower and arrived at 7:30 instead???"
So, after a few days of this happening consistently.... We got to that point again one morning and I said, "Isn't it about time for our 6 AM "Rule Out Labor" outpatient to get here?"
The glares I got from my lovely and normally very friendly co-workers were just plain evil. OOPS... sorry guys... It remained quite.... The doctor who was there to witness my mishap of words had left to go to her office... It was still calm..... Then, the phone rang and the secretary took down some information and hung up. She then announced to me, "Dr. So-and-So wanted to tell you that your "Rule Out Labor" patient is on her way over." Yes... You guessed it.... That day I was the overworked, overtired nurse that morning who got the bumm assignment of evaluating the outpatient who strolled through the door at change of shift. :)
Then, a few days later it was a particularly long and arduous night made even more difficult when things stalled to a motionless halt around 3 AM... I fought to keep my eye lids from closing from exhaustion... When things get quiet on night shift, the most effective way for me to stay awake is to keep busy.... with anything... clean, stock rooms, organize, anything.......
So, after doing the dishes in the break room and sitting down the exhaustion began overcoming me.... I said to my co-worker, "I wish I had an outpatient to get me over this hump this morning."
WOW.... Did I live to regret that request.....and all of my co-workers reminded me that the mess that was to follow was "MY FAULT."
Within 45 minutes of me uttering that dreadful sentence, the unit was in mass confusion.....
First a lovely "Rule Out Labor" outpatient arrived and I gleefully accepted this assignment. I went into her room to do my initial evaluation and assessment..... But, when I walked out of the room a mere 20 minutes later the scene at the nursing station was vastly different from when I entered. The secretary was fervently pulling papers, filling charts and faxing orders.... The charge nurse was on the phone calling in all possible helpers.... There was a crew of NICU nurses assembled outside of a LDRP room complete with a warmer, neonatal crash cart and the neonatologist. And, there were all of my innocent coworkers in room 422 trying to manage the now emergent 25 week abruption patient who walked through our doors just seconds before her amniotic sack ruptured.
Yes, mass confusion ensued. Every available hand was preparing for a crash cesarean.... and I found myself standing in the nursing station with 6 babies (who I knew nothing about because I wasn't their nurse) and a labor patient to admit (because my lovely "rule out labor" was indeed IN labor).
Yes, there was no way I was falling asleep at this point. That worry was far from my mind.
So, you can see a littel glimpse into what makes us nurses believe that superstitions are alive and well...... With good reason.
Friday, March 13, 2009
Getting Away From My Roots
I had lunch today with a doula friend of mine.. We had maybe only had lunch together once since I became a practicing RN. We were catching up on each other's lives... telling stories, etc... She called me out, and rightfully so, when I was telling her about being called in to work yesterday for two sections.... "Sections?" As a doula, I would never call a woman's birth a "section." Sections are pieces of grapefruit... Not a childbirth experience.
I realized, yes... I had used to be more careful about my terminology... The little things like that really mattered to me as a doula... and as a mother... What has happened during the past year that I didn't even blink an eye when referring to "2 sections."
I excuse a lot of my lack of "doula care" during deliveries now due to the fact that I am still learning and perfecting the role of the nurse at a birth... and I am so focused on doing all of the procedures correctly, and documenting properly and communicating with the doctors responsibly... That I don't focus so much on the things I did as a doula... giving a back rub and a quick pointer on positioning & movement to a mom and dad going through transition... etc. etc...
I have said (and truly believe) that when I get the "nurse stuff" under my belt and am able to preform my RN functions automatically without much purposeful thinking going into it, then I will be able to more actively incorporate my doula training and experience into my nursing practice... I do think that this will happen... But, now I wonder by that time how many other little things like calling a birth a "section" will I have let creep into my practice and view as normal?
Will try to be more conscience..... Yes, I want to train to be a good OB nurse, But I don't want to lose my convictions along the way.... afterall, those are the things that led me to become a RN in the first place.
I realized, yes... I had used to be more careful about my terminology... The little things like that really mattered to me as a doula... and as a mother... What has happened during the past year that I didn't even blink an eye when referring to "2 sections."
I excuse a lot of my lack of "doula care" during deliveries now due to the fact that I am still learning and perfecting the role of the nurse at a birth... and I am so focused on doing all of the procedures correctly, and documenting properly and communicating with the doctors responsibly... That I don't focus so much on the things I did as a doula... giving a back rub and a quick pointer on positioning & movement to a mom and dad going through transition... etc. etc...
I have said (and truly believe) that when I get the "nurse stuff" under my belt and am able to preform my RN functions automatically without much purposeful thinking going into it, then I will be able to more actively incorporate my doula training and experience into my nursing practice... I do think that this will happen... But, now I wonder by that time how many other little things like calling a birth a "section" will I have let creep into my practice and view as normal?
Will try to be more conscience..... Yes, I want to train to be a good OB nurse, But I don't want to lose my convictions along the way.... afterall, those are the things that led me to become a RN in the first place.
Wednesday, March 4, 2009
OB Education Day
Today at work we had a whole day of simulations, drills and re-certifications. It was one more thing on my plate to study for and prepare for, so I'm glad it is over. But, it was actually a great day as far as learning opportunities go.
To begin we went in and took our NRP neonatal resuscitation examination right off the bat. Can we say stressful?!?! I felt very good about most of the questions until I got to the sections that covered the skills I don't routinely use because we have a NICU that responds to our intubation and prematurity needs. So, I was sweating it a little bit towards the end, and was glad to have that certification out of the way for 2 more years!
Then we rotated through various workshop/stations throughout the remainder of the day.
First I went to a respiratory class/workshop. We reviewed the basic lung sounds heard and the characteristic and causes of each. Mainly focusing on coarse and fine crackles as they are what we are continually assessing for as a sign of pulmonary edema in the women receiving fluid boluses, mag & pitocin.
Then, I went to a postpartum hemorrhage class. This was one of my favorites. We had a simulation where each of us had to be in charge and SBARR our help who arrived and organized the whole effort. We reviewed causes including uterine atony, retained placental fragments, trauma like lacerations, etc, and thrombine disorders. We went through all of the interventions we should be prepared to carry out like 2 large bore IVs, O2 via non-rebreather mask, Labs (PT, aPTT, INR, Fibrinogen, type & cross for 2 units), and medications/dosages (methergine, hemabate, pitocin & cytotec).
Next was lunch...we all went to subway.
Then I attended a session on CPR/CPR on the pregnant woman, including perimortem cesarean sections, which I pray I never, ever have to be a part of. According to recommendations, a cesarean section should be preformed within 4-5 minutes of a woman coding - right there in the room. Scary stuff.
Finally, I went to the neonatal resuscitation session where we did our mega codes. We each took a turn being in charge of the code and walked right through various scenarios including PPV, chest compressions, intubation and umbilical venous catheters for pushing volume expanders and meds. It was good to get my hands into the crash cart and locate all of the supplies, etc as it is not done unless needed usually.
So, overall, I truly enjoyed the day of practice and review. I feel fortunate to have a position at this hospital. They are organized and value important things like the education and continued training of the nursing staff. It was a good (yet long) day.
To begin we went in and took our NRP neonatal resuscitation examination right off the bat. Can we say stressful?!?! I felt very good about most of the questions until I got to the sections that covered the skills I don't routinely use because we have a NICU that responds to our intubation and prematurity needs. So, I was sweating it a little bit towards the end, and was glad to have that certification out of the way for 2 more years!
Then we rotated through various workshop/stations throughout the remainder of the day.
First I went to a respiratory class/workshop. We reviewed the basic lung sounds heard and the characteristic and causes of each. Mainly focusing on coarse and fine crackles as they are what we are continually assessing for as a sign of pulmonary edema in the women receiving fluid boluses, mag & pitocin.
Then, I went to a postpartum hemorrhage class. This was one of my favorites. We had a simulation where each of us had to be in charge and SBARR our help who arrived and organized the whole effort. We reviewed causes including uterine atony, retained placental fragments, trauma like lacerations, etc, and thrombine disorders. We went through all of the interventions we should be prepared to carry out like 2 large bore IVs, O2 via non-rebreather mask, Labs (PT, aPTT, INR, Fibrinogen, type & cross for 2 units), and medications/dosages (methergine, hemabate, pitocin & cytotec).
Next was lunch...we all went to subway.
Then I attended a session on CPR/CPR on the pregnant woman, including perimortem cesarean sections, which I pray I never, ever have to be a part of. According to recommendations, a cesarean section should be preformed within 4-5 minutes of a woman coding - right there in the room. Scary stuff.
Finally, I went to the neonatal resuscitation session where we did our mega codes. We each took a turn being in charge of the code and walked right through various scenarios including PPV, chest compressions, intubation and umbilical venous catheters for pushing volume expanders and meds. It was good to get my hands into the crash cart and locate all of the supplies, etc as it is not done unless needed usually.
So, overall, I truly enjoyed the day of practice and review. I feel fortunate to have a position at this hospital. They are organized and value important things like the education and continued training of the nursing staff. It was a good (yet long) day.
Saturday, February 14, 2009
Life as a Med-Surg Nurse
So, this blog is supposed to be thoughts from an OB Nurse.... But recently, I've been feeling a little like a Med-Surg Nurse..... You see, when the census is low in OB, we take post-op Gyne patients... Sometimes it will be a hysterectomy or my all time favorite to say in report the "Salpingoophorectomy" AKA removal of an ovary and its fallopian tube...
Anyway, the last few days we've had a low census, so we had about half of our patients being Gyne patients. I was kinda disappointed at first when I saw my assignment...afterall, the whole reason I suffered through four near tortourous years of nursing school (and am still going) is so that I can care for women who are giving birth.... Not women who are loosing their reporductive organs... But, like other things in the past (scrubbing, to name only one), I was pleasantly surprised at how much I didnt' actually mind my post-op gyne assignments.
I've found out that I'm glad I have this aspect to my job as well. I have the opportunity to keep my general nursing skills fresh and sharp with the occassional med-surg assignment...and, I can appreciate more the whole circle of a woman's reproductive life.... Helping women to celebrate pregnancy and birth; then, encouraging them to embrace and accept menopause, whether natural or surgical...it is a new stage for them to acclamate to, one that they may not be prepared for.
I've found that allowing them to talk to you about their feelings in a general way is healing for them... For example allowing the woman to say to me, "I've always loved being a mother" without them having to verbalize, "I'm sad I'm losing my uterus." Listening and understanding is what they remember about you as their nurse, not that you kept their JP drain empty or their SCDs on or their IV going... You know?
I'm still in the honeymoon phase, I suppose. But, I still love my job - nearly every aspect of it - and think every single minute of nursing school was worth it!
Anyway, the last few days we've had a low census, so we had about half of our patients being Gyne patients. I was kinda disappointed at first when I saw my assignment...afterall, the whole reason I suffered through four near tortourous years of nursing school (and am still going) is so that I can care for women who are giving birth.... Not women who are loosing their reporductive organs... But, like other things in the past (scrubbing, to name only one), I was pleasantly surprised at how much I didnt' actually mind my post-op gyne assignments.
I've found out that I'm glad I have this aspect to my job as well. I have the opportunity to keep my general nursing skills fresh and sharp with the occassional med-surg assignment...and, I can appreciate more the whole circle of a woman's reproductive life.... Helping women to celebrate pregnancy and birth; then, encouraging them to embrace and accept menopause, whether natural or surgical...it is a new stage for them to acclamate to, one that they may not be prepared for.
I've found that allowing them to talk to you about their feelings in a general way is healing for them... For example allowing the woman to say to me, "I've always loved being a mother" without them having to verbalize, "I'm sad I'm losing my uterus." Listening and understanding is what they remember about you as their nurse, not that you kept their JP drain empty or their SCDs on or their IV going... You know?
I'm still in the honeymoon phase, I suppose. But, I still love my job - nearly every aspect of it - and think every single minute of nursing school was worth it!
Monday, February 9, 2009
The State of the OB Floor
So, What's been up on the childbirth front?
My sleeping after night shifts is getting considerably better. I used to have an awful time of sleeping the day after.... Waking up frequently, not getting to sleep easily... Well, that all seems to be changing. My last 3 day stretch of nights went great! I fell right to sleep and slept for hours before waking. In fact, the last night I worked, I went to bed at 9am when I got home and slept until after 4pm that evening before waking up even once! Sleep makes everything better.
I have scrubbed in on c-sections with every doctor with practicing privileges now. So, I'm scrubbing independently now. I still really like scrubbing... It is a surprise to me, but I don't mind it at all.
I am trying to make some positive headway with the one doctor who has been giving me grief. Out of all of the doctors there, every single one of them have gone to my nurse manager telling her what a great job I'm doing and how quickly I learn - every one of them EXCEPT this one particular doctor. I think I've written about him before.... Well, he's still on my case. The other nurses tell me he does the same thing to every new nurse and it is sort of like a right of passage or some such nonsense. Anyway, I think the ground is just starting to thaw, and hopefully his obsession with making my shift miserable will pass soon enough.
I've gotten a string of high risk patients recently, which is really what I need experience with. I've managed several PPROM patients (pre-term, premature rupture of membranes). I've had a stillbirth induction unfortunately, and I attended a birth where the doctor didn't make it....I nearly didn't either as the head was already out when I went in and I caught the baby, literally...clamping and cutting the cord and all.
Things stay pretty busy on night shift for us. The vice president of the hospital came around the other night to talk to us and reassure us that the hospital is still strong in light of the current economic condition. Hospitals all around are laying off and cutting back. Apparently our hospital is still making money and is not in trouble, but the struggling economy is having a trickling down effect -- People are cancelling elective surgeries because they lost their insurance coverage when they lost their jobs, etc... So, the VP informed us that they are putting a freeze on hiring right now. But they do not expect that any layoffs are in the future.
The good thing with a nursing degree, I believe, is that I will almost always be able to find work with it. It may not be in the department I want it to be or during the hours I would like... But, work as a nurse will nearly always be available. Luckily, the VP informed us, that we OB nurses picked one of the safest specialties to practice nursing in, as far as job security goes.
My sleeping after night shifts is getting considerably better. I used to have an awful time of sleeping the day after.... Waking up frequently, not getting to sleep easily... Well, that all seems to be changing. My last 3 day stretch of nights went great! I fell right to sleep and slept for hours before waking. In fact, the last night I worked, I went to bed at 9am when I got home and slept until after 4pm that evening before waking up even once! Sleep makes everything better.
I have scrubbed in on c-sections with every doctor with practicing privileges now. So, I'm scrubbing independently now. I still really like scrubbing... It is a surprise to me, but I don't mind it at all.
I am trying to make some positive headway with the one doctor who has been giving me grief. Out of all of the doctors there, every single one of them have gone to my nurse manager telling her what a great job I'm doing and how quickly I learn - every one of them EXCEPT this one particular doctor. I think I've written about him before.... Well, he's still on my case. The other nurses tell me he does the same thing to every new nurse and it is sort of like a right of passage or some such nonsense. Anyway, I think the ground is just starting to thaw, and hopefully his obsession with making my shift miserable will pass soon enough.
I've gotten a string of high risk patients recently, which is really what I need experience with. I've managed several PPROM patients (pre-term, premature rupture of membranes). I've had a stillbirth induction unfortunately, and I attended a birth where the doctor didn't make it....I nearly didn't either as the head was already out when I went in and I caught the baby, literally...clamping and cutting the cord and all.
Things stay pretty busy on night shift for us. The vice president of the hospital came around the other night to talk to us and reassure us that the hospital is still strong in light of the current economic condition. Hospitals all around are laying off and cutting back. Apparently our hospital is still making money and is not in trouble, but the struggling economy is having a trickling down effect -- People are cancelling elective surgeries because they lost their insurance coverage when they lost their jobs, etc... So, the VP informed us that they are putting a freeze on hiring right now. But they do not expect that any layoffs are in the future.
The good thing with a nursing degree, I believe, is that I will almost always be able to find work with it. It may not be in the department I want it to be or during the hours I would like... But, work as a nurse will nearly always be available. Luckily, the VP informed us, that we OB nurses picked one of the safest specialties to practice nursing in, as far as job security goes.
Tuesday, January 6, 2009
Some Things to Check Out
Click here for a yummy recipe for Chocolate Chip Pumpkin Bread.
Click here to read a Great article online from the Los Angeles Times on Midwifery care in America. It sums up the state of birth in the US quite well, highlighting the disparity between the amount of money being spent on obstetrical care in the US and the sad results seen in our rank of 41st among industrialized countries.
Click here to read about President Bush's "Healthcare Conscience Rule." This is a sticky subject. One that I'm not totally set on my stance about. I do think direct care providers like physicians should have the ability to decide for themselves and their practice what services they will perform. However, where do you draw the line? What services and what providers does this cover? Only abortions? Only for religious reasons? The wording of this rule seems to allow for any procedure, any service worker, and because of any "moral" persuasion.
What would the repercussions be if a secretary refused to bill for a patient's IUD placement? What about when the person who cleans instruments refuses to clean circumcision trays and instruments? Do you see how this can snowball into one huge, subjective license to refuse services?
And, if a provider can refuse to perform services, can they also refuse to offer them and refuse to provide full informed consent to their patients... Can they refuse to tell the potential patient all of their choices - whether or not they would personally choose them - Can they refuse to tell them the risks, benefits and alternatives of all possible procedures applicable.
As a healthcare provider, myself, there are certainly parts of my job I would love to refuse to participate in. But, is that my choice? I am employed by the hospital I work at. I agreed to provide the services of a registered nurse on a maternity floor. So, that entails many things I would not personally choose for myself, but that others do choose for themselves (elective cesarean sections to name only one).
I am ok with that as long as there is full informed consent. Who am I to make decisions for others? Who am I to say that I know what is better for them? And who am I to practice selective nursing. If I agree with your choices, I will provide you care? No. That is not what I signed up for. I agreed to help those in need of medical services, no matter why - no matter if their "Good" or "Bad" choices put them in need of this medical care.
There just seems to be a whiff of judgementalism to this "healthcare conscience rule." A wiff that makes my stomach turn. I've lived through my share of legalism and judgementalism... People thinking they had superiority over me and authority to judge me because of what they would label as "wrong" or "bad" choices.
Unless you are walking in someone's shoes, you cannot know all of their reasons for their choices.... There is a lifetime of history behind each person's current situation. You must meet them where they are... accept them as they are... and help them no matter why they need your help.
Rant over. Off my soap box. "I'm just saying (As sis would say)."
Click here to read a Great article online from the Los Angeles Times on Midwifery care in America. It sums up the state of birth in the US quite well, highlighting the disparity between the amount of money being spent on obstetrical care in the US and the sad results seen in our rank of 41st among industrialized countries.
Click here to read about President Bush's "Healthcare Conscience Rule." This is a sticky subject. One that I'm not totally set on my stance about. I do think direct care providers like physicians should have the ability to decide for themselves and their practice what services they will perform. However, where do you draw the line? What services and what providers does this cover? Only abortions? Only for religious reasons? The wording of this rule seems to allow for any procedure, any service worker, and because of any "moral" persuasion.
What would the repercussions be if a secretary refused to bill for a patient's IUD placement? What about when the person who cleans instruments refuses to clean circumcision trays and instruments? Do you see how this can snowball into one huge, subjective license to refuse services?
And, if a provider can refuse to perform services, can they also refuse to offer them and refuse to provide full informed consent to their patients... Can they refuse to tell the potential patient all of their choices - whether or not they would personally choose them - Can they refuse to tell them the risks, benefits and alternatives of all possible procedures applicable.
As a healthcare provider, myself, there are certainly parts of my job I would love to refuse to participate in. But, is that my choice? I am employed by the hospital I work at. I agreed to provide the services of a registered nurse on a maternity floor. So, that entails many things I would not personally choose for myself, but that others do choose for themselves (elective cesarean sections to name only one).
I am ok with that as long as there is full informed consent. Who am I to make decisions for others? Who am I to say that I know what is better for them? And who am I to practice selective nursing. If I agree with your choices, I will provide you care? No. That is not what I signed up for. I agreed to help those in need of medical services, no matter why - no matter if their "Good" or "Bad" choices put them in need of this medical care.
There just seems to be a whiff of judgementalism to this "healthcare conscience rule." A wiff that makes my stomach turn. I've lived through my share of legalism and judgementalism... People thinking they had superiority over me and authority to judge me because of what they would label as "wrong" or "bad" choices.
Unless you are walking in someone's shoes, you cannot know all of their reasons for their choices.... There is a lifetime of history behind each person's current situation. You must meet them where they are... accept them as they are... and help them no matter why they need your help.
Rant over. Off my soap box. "I'm just saying (As sis would say)."
Sunday, December 14, 2008
MRSA in Nurseries
Tomorrow is the last day of classes for the semester. I only took 2 classes this semester. Nurs 390 during the 1st 7 weeks; Nurs 457 during the last seven. Currently, I'm procrastinating - I have to finish up my last project of the semester: a power point presentation on "Electronic Health Records and Their Impact on Nursing Informatics." BORING. But necessary, I suppose.
As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) in Neonatal Nurseries
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
Wednesday, November 26, 2008
Night Shift
I successfully stayed awake all night... That's about the only good thing about my night. It is a very different pace.... I think I much prefer the fast pace of day shift... Maybe because I always have to be doing something... If there's nothing to do, I make something to do....
The other nurses told me it was a slow night for them and it usually isn't that slow... And, I suppose I cannot judge a whole shift on one night.....
But, overall, if I were grading my experience I would give it a "D." I hope it gets better - or I adapt because I'm stuck on night shift for an undetermined amount of time... until a spot comes open on days....and there are many in front of me - seniority wise - who will scoop the daylight shifts up quickly before I have a shot.
So, my goal is to make the best of it....
I had a hard time sleeping when I got home... Even though I was exhausted, I couldn't really fall asleep until about 10am... But, then I slept right through the day until about 3pm.
On an unrelated note, I'm excited about a new purchase we made: A COUCH!! If you've been to our house, you know we were in need of one - badly... The one we had was so uncomfortable...and old... But we didn't want to buy one with little kidd-os around beating it up... Now that they are older, somewhat, we thought it time to get a new one... It is so comfy -- and we bought a matching chair and ottoman. It will look like we have a regular living room suit! It comes next week... I can't wait!
Here is a picture of it. It is a light, sage green color.
The other nurses told me it was a slow night for them and it usually isn't that slow... And, I suppose I cannot judge a whole shift on one night.....
But, overall, if I were grading my experience I would give it a "D." I hope it gets better - or I adapt because I'm stuck on night shift for an undetermined amount of time... until a spot comes open on days....and there are many in front of me - seniority wise - who will scoop the daylight shifts up quickly before I have a shot.
So, my goal is to make the best of it....
I had a hard time sleeping when I got home... Even though I was exhausted, I couldn't really fall asleep until about 10am... But, then I slept right through the day until about 3pm.
On an unrelated note, I'm excited about a new purchase we made: A COUCH!! If you've been to our house, you know we were in need of one - badly... The one we had was so uncomfortable...and old... But we didn't want to buy one with little kidd-os around beating it up... Now that they are older, somewhat, we thought it time to get a new one... It is so comfy -- and we bought a matching chair and ottoman. It will look like we have a regular living room suit! It comes next week... I can't wait!
Here is a picture of it. It is a light, sage green color.
Wednesday, November 19, 2008
The Short End of the Stick
Since I'm still on orientation, my name is written on the board at the nursing station with the category I am focusing on. For example, right now I'm finishing up Labor & Circulation for sections. So, it says that on the board in order for the charge nurse to make proper patient assignments.
Yesterday I had an odd shift and didn't start until 11am. So, when I came on at 11am, I took on one of the other nurse's labor patients. The off-going nurse was giving me report on the patient and said, "Boy, I wish I could just stay with this couple... They are so nice." But, she gave the labor patient up willingly to me, so I could learn; and, she took on two post-op hysterectomy patients who were coming back from surgery (Our floor occasionally takes a few gyne patients if our census is low enough).
Not half an hour later I heard a slight commotion in the hallway but not thinking much of it, I simply closed my patient's door so she wouldn't be disturbed during labor. Then, when I went out for a break later on I found out what the commotion was: One of the nurse's post-op patients went into respiratory arrest and the nurse had to call a full code blue!
Luckily, the code ended well.... But, boy did that nurse get the short end of that stick.... I got a lovely vaginal birth during my shift with time left over to do all of my charting .... and ... she got a code blue.
She laughed at the end of the day and said, "You owe me!"
That I do.
Yesterday I had an odd shift and didn't start until 11am. So, when I came on at 11am, I took on one of the other nurse's labor patients. The off-going nurse was giving me report on the patient and said, "Boy, I wish I could just stay with this couple... They are so nice." But, she gave the labor patient up willingly to me, so I could learn; and, she took on two post-op hysterectomy patients who were coming back from surgery (Our floor occasionally takes a few gyne patients if our census is low enough).
Not half an hour later I heard a slight commotion in the hallway but not thinking much of it, I simply closed my patient's door so she wouldn't be disturbed during labor. Then, when I went out for a break later on I found out what the commotion was: One of the nurse's post-op patients went into respiratory arrest and the nurse had to call a full code blue!
Luckily, the code ended well.... But, boy did that nurse get the short end of that stick.... I got a lovely vaginal birth during my shift with time left over to do all of my charting .... and ... she got a code blue.
She laughed at the end of the day and said, "You owe me!"
That I do.
Sunday, November 9, 2008
Called Off
I got called off work today for the first time. I got up at 5am and took my shower and was getting ready in the bathroom when the phone rang.... There were only 3 postpartum patients there and they all were going home today. So, me and a handfull of others were called off.
Mark commented that he never heard of a job where they could call you and tell you NOT to work. But, the hospital cannot justify paying 7 OB nurses with only 3 patients.... So, unfortunately this is what can happen.
Another possibility (which wouldn't happen while I am still on orientation), is that you could be "pulled" from your floor with a low census to other floors that have a high census. This is a very unpopular option.... OB nurses are sheltered and pretty much separated from the rest of the hospital.... We go into the locked OB unit and don't really emerge until our shift is over. From what I hear, when we go to the other floors to work, it is less than ideal.
We are so specialized that being able to function independently on med/surg floors is unreasonable. We have to be paired up with another RN and get used as LPNs or Aids, mainly. And, when med/surg nurses get pulled to the OB unit, they cannot function independently, either. They have to be paired up with an RN and can only work with postpartum moms and babies.... They aren't trained to be OB nurses and we aren't trained to be med/surg nurses. So, generally, we all would almost rather be called off than be pulled.
But, then you have the fact that when you are called off you are not paid for those hours. I was doing the math today and I lost a pretty penny for having an extra day off this week. But, what can you do.
I did some crocheting this weekend. I finished Lance's hat. Pictures soon. And I started a new project. More on that later.
Mark commented that he never heard of a job where they could call you and tell you NOT to work. But, the hospital cannot justify paying 7 OB nurses with only 3 patients.... So, unfortunately this is what can happen.
Another possibility (which wouldn't happen while I am still on orientation), is that you could be "pulled" from your floor with a low census to other floors that have a high census. This is a very unpopular option.... OB nurses are sheltered and pretty much separated from the rest of the hospital.... We go into the locked OB unit and don't really emerge until our shift is over. From what I hear, when we go to the other floors to work, it is less than ideal.
We are so specialized that being able to function independently on med/surg floors is unreasonable. We have to be paired up with another RN and get used as LPNs or Aids, mainly. And, when med/surg nurses get pulled to the OB unit, they cannot function independently, either. They have to be paired up with an RN and can only work with postpartum moms and babies.... They aren't trained to be OB nurses and we aren't trained to be med/surg nurses. So, generally, we all would almost rather be called off than be pulled.
But, then you have the fact that when you are called off you are not paid for those hours. I was doing the math today and I lost a pretty penny for having an extra day off this week. But, what can you do.
I did some crocheting this weekend. I finished Lance's hat. Pictures soon. And I started a new project. More on that later.
Tuesday, October 28, 2008
Achy Legs
I just finished with two 8 hour days and am gearing up to do two 12 hour days. My biggest question: What can I do to make my feet and legs stop aching?
I've "obtained" a pair of compression stockings aka TEDS and wear them religiously at work. When I first started wearing them, I could really notice a difference, but now my legs are aching again - from my toes up to my thighs. I've been awakened in the middle of the night with muscle cramps in my legs.
I'm trying to be smarter at work by doing things like pulling a chair into the patient's room so I can sit and chart during labors. And, I never wear the same shoes two days in a row....that seems to kill me, so I alternate. Any other tips would be appreciated.
I've "obtained" a pair of compression stockings aka TEDS and wear them religiously at work. When I first started wearing them, I could really notice a difference, but now my legs are aching again - from my toes up to my thighs. I've been awakened in the middle of the night with muscle cramps in my legs.
I'm trying to be smarter at work by doing things like pulling a chair into the patient's room so I can sit and chart during labors. And, I never wear the same shoes two days in a row....that seems to kill me, so I alternate. Any other tips would be appreciated.
Wednesday, October 15, 2008
Too Funny!!!
My preceptor and I were in a laboring patient's room charting yesterday when the patient fell asleep. The TV was on in the background with the Ellen show on. It caught our attention when Dennis Quaid was talking about the medication error that occurred to his newborn twins. More about that in a second. But, watch this clip of the prank Ellen had Dennis play on unsuspecting people in a starbucks. WE WERE DYING with laughter!!! Trying not to wake up our patient... It was sooo funny:
Now, about the tragic medication error that effected his infant twins and now has his attention focused on eliminating medical errors: Here is a link to a 60 minutes segment that does a good job explaining the near fatal medication error....Watch the video on the webpage - just amazing.
This is a real problem in healthcare... I worry about it DAILY. Knowing that I am human and that I have and will make errors makes me scared to death that I will make a MEDICATION error. I double and triple check my meds, almost to the point of being inefficient... But, honestly, it scares me to think about accidentally giving the wrong drug or wrong dose, etc.
There are technological advances in medication administration available to help control the nearly 100,000 deaths due to medical errors each year. But, they are expensive. Our hospital is implementing a new computer based med system in a few months... I am very pleased as it will be one more check between the patient and a mistake.
Now, about the tragic medication error that effected his infant twins and now has his attention focused on eliminating medical errors: Here is a link to a 60 minutes segment that does a good job explaining the near fatal medication error....Watch the video on the webpage - just amazing.
This is a real problem in healthcare... I worry about it DAILY. Knowing that I am human and that I have and will make errors makes me scared to death that I will make a MEDICATION error. I double and triple check my meds, almost to the point of being inefficient... But, honestly, it scares me to think about accidentally giving the wrong drug or wrong dose, etc.
There are technological advances in medication administration available to help control the nearly 100,000 deaths due to medical errors each year. But, they are expensive. Our hospital is implementing a new computer based med system in a few months... I am very pleased as it will be one more check between the patient and a mistake.
Friday, October 10, 2008
Continuity of Care
During my interview for my current position, one of the questions asked of me was what do I see as a drawback of being a nurse. There were a couple of things that came to mind, but the one I gave as my answer was that in providing care to maternity patients as a nurse (compared to being a doula), there is limited continuity of care. After a nurse's shift, she leaves. She doesn't build a relationship with the patient prior to or after delivery and isn't even guaranteed to be present for the entire birth and recovery.
This fact was pronounced to me this week. I'm now working on labor skills and I spent my whole 12 hour shift with this one couple - One on one nursing - Built a relationship with them, helped them through hours of labor. At the end of my shift, I had reported off to the next nurse and was going back in to say good-bye to the couple when she reported a change, so she was checked again... She was ready to push! And, I was leaving.
I've been to many births, so it wasn't that I felt bad over the missed experience for myself, but this couple who began to build a trusting relationship has to start out all over with a new nurse at a pivotal point in their birth process. I could have stayed longer to be a support to her, but honestly my feet were aching and my body tired after two straight days of 12 hour shifts. Plus there was no way to foresee how long she was going to have to push, etc. This job is truly not meant to be worked more than 12 hours, I don't believe.
While our hospital tries to address the continuity of care issues by having most of their staff work 12 hour shifts and assigning nurses to the same patients day after day, if possible, the issue remains.
This fact was pronounced to me this week. I'm now working on labor skills and I spent my whole 12 hour shift with this one couple - One on one nursing - Built a relationship with them, helped them through hours of labor. At the end of my shift, I had reported off to the next nurse and was going back in to say good-bye to the couple when she reported a change, so she was checked again... She was ready to push! And, I was leaving.
I've been to many births, so it wasn't that I felt bad over the missed experience for myself, but this couple who began to build a trusting relationship has to start out all over with a new nurse at a pivotal point in their birth process. I could have stayed longer to be a support to her, but honestly my feet were aching and my body tired after two straight days of 12 hour shifts. Plus there was no way to foresee how long she was going to have to push, etc. This job is truly not meant to be worked more than 12 hours, I don't believe.
While our hospital tries to address the continuity of care issues by having most of their staff work 12 hour shifts and assigning nurses to the same patients day after day, if possible, the issue remains.
Friday, September 26, 2008
An Awesome Responsibility
This past week a blue, limp and breathless baby was born.
And, the doctor handed her to me.
The resuscitation was successful. My colleagues were there beside me when I needed their help.
Being a Nurse is more than I envisioned it to be.
Being a Nurse is, by far, more than a job to me. It is a commitment. A commitment to learn and continue to learn. To care and hold no biases; pass no judgements. To relieve pain, but also to cause it sometimes; and, to embrace it when we must. To have days that are thankless and tasks that are messy. To be a part of a team, knowing I am not alone.
Mostly, being a Nurse is the act of pouring myself into my passion and being greatly rewarded for it.
And, the doctor handed her to me.
The resuscitation was successful. My colleagues were there beside me when I needed their help.
Being a Nurse is more than I envisioned it to be.
Being a Nurse is, by far, more than a job to me. It is a commitment. A commitment to learn and continue to learn. To care and hold no biases; pass no judgements. To relieve pain, but also to cause it sometimes; and, to embrace it when we must. To have days that are thankless and tasks that are messy. To be a part of a team, knowing I am not alone.
Mostly, being a Nurse is the act of pouring myself into my passion and being greatly rewarded for it.
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