You can teach an old nurse new tricks

So, I'm on my third new nurse to precept now. My first night with her was last night... She comes from a state many states away from us... she used to work in a large hospital where they moved people through in an assembly line type fashion.. In the door, epidural in, pit going, baby out.. moved to post partum... next patient... She also typically cared for 2 laboring patients at a time. Well, we have the luxury most nights of having one-on-one nursing care for our laboring mothers.

When we came on our shift we were assigned to a woman who was 8cms. She had no pitocin and no epidural. So, I told my preceptee that we would be getting the woman out of bed and in some type of water... it could be the jacuzzi tub or the shower.. whatever.. no woman should have to do transition without an epidural OUT of the water... In my opinion... The new nurse was astounded... First of all when I suggested we get her out of bed to urinate she couldn't believe it... She said they never would have done that... Let alone get her out of bed to take a long hot shower... Well, we did it... we got mom in the shower and she was LOVING it....

This nurse who had been a L&D nurse for several years (in the teens) said she felt like a new nurse on the job last night... She said she never stayed with her patients in labor... we stayed in the bathroom with her spraying her back with hot water and massaging her .... She couldn't believe the way we practiced nursing.... And, when I went to get the patient in hands and knees she said to me she has NEVER had a patient in that position. Ever. In that many years of nursing. Wow...

Well, I guess she learned a few new tricks from this younger nurse last night... Nice healthy 9 pound baby born direct OP!

From Student to Teacher

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.

Being Pulled

Since being off of orientation I've been put in the rotation of "being pulled" to other units of the hospital if we have a low census and all of the scheduled nurses on OB are not called for. I have gotten pulled twice so far.

The first time I got pulled to a medical surgical floor for a "One on One." This means I was sitting with one patient for my entire 12 hour shift because she was elderly and confused. She kept trying to get out of bed and pulled at tubes/wires, etc. So, needless to say that was a LOOONG 12 hour shift!

The second "pull" was to the Neonatal Intensive Care Unit (NICU). I enjoyed that pull. I got assigned two babies to care for... they were stable and basically needed meds given, monitored, fed and rocked every now and then. Eventually I am supposed to be cross-trained to the NICU... and I think I will enjoy this training.

Since being off orientation, I'm experiencing everything for the "first" time... For example, My first time circulating on a c-section ALONE... my first time tirating pitocin on my own.... etc. etc... Surprisingly, I get a little nervous... I know I can still ask people questions, etc... But I do love my job!

High Risk Weekend

Last week while working there was a slow period one night, so I got out my notebook (I keep a notebook at work with helpful reminders, policies, etc for easy reference)... I was making a "wish list" of sorts of things I wanted to get more experience with and reviewing them for when the time came. I decided that I wanted to care for a pre-ecclamptic mom and I wanted to be in on an emergency cesarean for the experience of having to work quickly and to sharpen my skills.

Well, not more than a few days later, both of those "requests" were fulfilled. I had a weekend that could own no other name than "My High Risk Weekend" because of the high-risk patients I was fortunate enough to care for.

Friday night I arrived and was assigned to an outpatient who just arrived from the Dr.'s Office with uncontrolled pressures. So, she was fresh...nothing done yet... a great starting point. It turned out her pressures spiked super high and we had to admit her and start her on Mag. !!!! I WAS THRILLED!!! Not, of course, because she had to have Mag, but that I was the nurse assigned to her and I was going to start and run the Mag... What a great experience!! I had run Mag before, but it was already started then and the woman was half way delivered before I took her over.

So, having just reviewed the protocol and mathematical equations needed to run Mag for the loading dose, maintaince dose, etc... I was READY!! I even surprised myself at how quickly I figured out the correct flow rate, etc... Anyway, then we had to induce her as well... So all night long I ran the mag, monitored her response to it and managed her induction hand in hand.

She didn't end up delivering on my shift, but I didn't feel slighted at all.... I was simply grateful for the high risk experience I was able to gain. Then the next night I was assigned to her again...she was postpartum now but still on Mag.... So, I cared for her and her "mag baby" - both who were tired and "mag'ed out" - another good experience.

Then, as if it could get any better, My last night of the weekend, Sunday, I was happily caring for a SROM mom who was in labor...Lovely couple. She was progressing beautifully, then we got word on our unit from the EMS that they were bringing a 30 week mom in with massive vaginal bleeding. I would never normally do this, but I actually chose and was allowed to give up my lovely labor patient for this potential abruption.

And, it WAS a massive placental abruption!!!! I've only read about them... But I actually was able to be involved in caring for her during diagnosis and during her emergency cesarean section.

It was a physically and mentally challenging and draining weekend. It was awesome.

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.

Sometimes You Just Have to Laugh

It has been since before new years that I scrubbed in on a section; so, I went in this morning to scrub for 2 c-sections. I was worried about going over a month and forgetting everything I had learned.

It was a good thing for me to do... I remembered most everything, but was a little rusty in the beginning.

I had the same doctor for both. During the first section, after delivery of the baby, I un-capped the TB syringe and handed it to the Dr. to draw up cord blood. I then set the cap down in the placenta pan. He ever so gently and correctly instructs me to simply toss it off the field so there is no chance of it coming out of the pan and being lost in the patient....as the cap is not a part of our count. I say, "Oh, Ok. That's a good point." So, I hand him the second syringe and appropriately toss the cap off the field towards the garbage. The rest of the surgery moves along fine...

Next surgery: Remembering the teaching from the first section, after the delivery of the baby, I pulled off the cap of the cord blood syringe (or what I thought was the cap) and tossed it off the field. I hand the Dr. the syringe and look down at it. I had pulled off the entire needle with the cap and promptly tossed the needle off of the field!! He looked straight in my eyes and just laughed. I chuckled too... and just said, "I tossed the needle off of the field."

The circulating nurse quickly supplied us with a new syringe WITH needle attached.

But, seriously, a dozen different doctors would have handled that a dozen different ways. I was incredibly lucky that today this particular dr. just decided to laugh.

Counting my blessings today..... Afterall, it was funny.

Update on Scrubbing

My crash course in becoming a scrub nurse is over. And, like a few other things I've encountered, it wasn't nearly as bad as I had made it out to be in my head.

I dreaded learning this last role of the L&D nurse..... But, it turned out to actually be something I kinda enjoyed. I think it may be my perfectionistic nature.... But, I liked the exactness and precision that was called for. I kept the surgery field and my mayo stand (the tray the instruments lay on during surgery) meticulously in order... It felt good to arrange the instruments around the mayo stand in a precise order... then as an instrument was discarded by the physician, I lined it back up in its proper place.... I found it natural to keep right up with the suctioning and "blotting" as they call it....in order to keep a clean surgical site....

The thing the doctors desire the most out of their scurb nurses is for the nurse to "Anticipate." No, it's not enough to know your instruments and hand them to the Dr. quickly when asked for... You must learn to "Anticipate" what instrument the doctor wants so they don't have to burden themselves by asking for the instrument... They can simply put their hand out.... HA!!! (sorry, that made me laugh)... It's true, though

Anyway, by the last section I did, I actually "anticipated" correctly at one point. The doctor was doing a tubal at the end of the section... So, I watched carefully and purposefully remembered the order of the instruments he needed while doing the right fallopian tube, so when he got to the left fallopian tube he simply held out his hand (WHEW, I was glad that I had paid close attention on the right side!) and I correctly gave him the right instruments in the correct order throughout the rest of the tubal..... A Small Victory.... But it felt good.

It was not bad at all.... In the second week of training, I did 5 sections independently.... I feel ready to go with this part of it now, too. Although, all of the sections I scrubbed in on were scheduled... I would like to do one soon that is an emergency... Just for the experience of needing to do all of it in a rush.... Not that I wish anybody an emergency situation... I just want to be experienced and prepared for such a situation, you know.

Scrubbing

With my orientation coming to an end, the time has come for me to learn the role of the "scrub nurse" during a cesarean section. From the beginning, this has been the one aspect of my job that I dreaded learning. Why? Mostly because of the high stress environment that cesareans usually are - especially on night shift, where I am. Usually the operation is being performed as an emergent resolution and everyone is under a lot of stress - compile that with any little extra thing and people - yes, specifically doctors - tend to lash out at the closest thing/person to them: THE SCRUB NURSE.

What a silly reason to not want to learn another skill that can only make me more valuable as a L&D nurse... But, it's the truth. And, I've seen more than one instrument being "tossed not so gently" at a scrub nurse and heard more than one "not so nice" word being yelled at them too.

I've gotten some advice from a nurse I've come to admire... She said she actually likes to scrub and I confided in her my fear of being yelled at and having things taken out on me with no room for error... She said she doesn't let it get to her and never takes it personally. She said that if the doctor cannot even hold it together to do an operation - which is his job, then it is the doctor's problem, not hers. The instruments are lying right there within both her and the doctor's reach, so if she accidentally hands him a straight mayo instead of a curved mayo, and he's in such a rush to have the correct one, then he is perfectly capable of reaching over and grabbing the right mayo, for goodness sakes.

So, last week was my learning week.... I scrubbed in on some - yet didn't do the scrub nurse job yet... I start that this week - Tomorrow AM I have two sections to scrub in for....

What are the roles of the scrub nurse? We are responsible for the sterile field. We set up the sterile instrument tables and drape the patient.... If anyone breeches the sterile field, they hear about it from us.... We then proceed to assist the Dr and his assistant by handing them instruments, suctioning or blotting blood with a sponge from the field to improve the surgeon's vision of the field. During repair, we load needle holders with the appropriate sutures (chromic, vicryl, etc.) according to what layer the Dr. is repairing. For example, the uterus takes a different type of suture than does the peritoneum...and the peritoneum takes a different type than the bladder flap, etc. We may help establish homeostasis by assisting with cauterization of bleeders. The scrub nurse also takes part in the instrument count before, during and after surgery to ensure nothing was "left behind."

So, all in all it is not a hard job, but like I said, the scub nurse must hold it together under pressure, know her instruments and not take lashing out behavior personally.... I'll work on it. Thankfully, the vast majority of sections I've attended the doctor's behaved themselves just fine.... It just so happens that the few times I've seen Dr.s lose their cool it was during a section -- Directed at scrub nurses....

Night Shift Update

Quick update before I go out again tonight... I've worked 2 weeks on nights now and the grade has been raised from a "D" to about a "B-."

It is a different pace from Days... Mostly more laid back... no supervisors and doctors running around. We nurses handle a lot of the stuff ourselves and only correspond with the doctors as needed on the phone and call them at the very end when birth is imminent.

I have a problem sleeping... I work 3 nights in a row then am off 4, typically. The first day after I work, it is nearly impossible for me to get to sleep and stay asleep... Therefore, making the second night working the worst. Then, I have NO problem sleeping the next day.

Ups and Downs...
But overall it is better than I thought it would be originally

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.

Random Things

Heard around the House recently:

"Can you believe in Santa and not believe in Rudolf, because I don't think that reindeer can have a red, glowing nose." - Lance, age 8

"Did you know that both 'poop' and 'puke' can be nouns OR verbs!" - Isaac, age 10 (Obviously following his aunt's bent for meticulous grammar usage)

Thinking we were Lucky:

When I originally bought Mark's PSU football tickets I thought I ordered them for yesterday's game against Michigan State... But, I received tickets for the Indiana game. Anyway, I'm glad that mistake happened....and we weren't stuck outside "cheering" in 20 degree, snowy weather yesterday.

Change of Shift:

Tomorrow I start my new shift: 7pm - 7am. I'm not sure if it's a good or a bad thing yet. I can see both sides.... I will be home 4 days a week and only work three. I will be home during the day every day.... I will sleep while the kids are in school.... But, not sure how I'll adapt to switching my sleep schedule back and forth like that.... Historically, my body is sensitive to changes... with migraines being my main affliction when anything goes awry. Here's hoping for the best. Any night shift-ers or previous night shift-ers with advice would be welcome!!

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.

The Good, Bad & the Ugly

Yesterday was a great day - milestone wise - for me at work. I was assigned to an AROM induction that I handled the whole way through from admission to IV start and AROM to epidural to birth and recovery - INDEPENDENTLY!!! My preceptor didn't even have to come in the room.... I was thrilled.... Because there has usually been a point sometime during the labor that I get the "deer in the headlights" look and get lost or sidetracked as to what I need to do next... But yesterday I held it together the whole way through!!

I didn't do everything perfectly, and there is room for improvement... But I'm thrilled to be on my way to independence in labor/delivery nursing.

Speaking of imperfection.... Yesterday I did the "set-up" which involves setting up a sterile field with the doctor's instruments for delivery on it - each dr has their own specific preferences, etc. for how they want it set up. So, I was doing the sterile set up and I thought to myself, "Hmmm, this table seems different than usual." But, not being able to put my finger on what was different, I covered the table when I was done and went on. Then, when the doctor came in for delivery, he uncovered the table and said, "Are we trying to save space?" I looked at it and thought for a second about what he said then realized what was different.... I forgot to pull up the side table flap that makes the table about a foot longer when it is pulled up..... He laughed when he saw that I realized my mistake... I said, "Can you tell I'm still on orientation?" :)

That doctor is pretty easy going and easy to work with... But there is one doctor in particular that intimidates me, regretably. I try to not feel flustered when working with him or calling him...but without fail I am flustered and I inevitably do or say something stupid/absent-mindedly because of it. For example, the other day I was calling him with lab values and I read off the one value as being "0.0" as in saying "zero POINT zero." DUH! It's just zero. And then another time he was leaving the floor (by way of the back staircase) when I received a panic WBC value on my patient. So, wanting to catch him quickly, I ran over to the stair case and called his name right before the door closed. He turned around and I (having never gone down that staircase before) pushed on the door to open it... Nothing. Then I pushed again... Nothing!!! He rolled his eyes and said, "Push the green button." Sure enough, there was a big green button on the wall beside the door that said, "DOOR."

Something like not knowing how to push open a door seems silly and almost laughable...But on that particular day it sent me over the edge. We had just had a hard delivery with a baby born with an apgar of 1, then 4 and was transferred to the NICU - at the same time the baby was going bad, the mother had a postpartum hemorrhage and we lost her IV site and I was scrambling to start another so I could infuse pitocicn while giving hemabate and methergine......So, follow that kind of delivery up with an un-open-able door and you get tears. After I was done receiving orders on the patient with the panic value, I went back to the nurses station and lost my composure and cried. The un-open-able door was the straw that broke the camel's back, you could say....

So, I've had bad days and good ones... It just so happens that yesterday was a rather good one... :) So, I'll enjoy my day off today!

The Latest on Labor

I've been doing labor orientation for almost a month and I LOVE it! It was a bit intimidating at first. I felt like I was overwhelmed with the MANY things RNs have to assess and chart during labor that I was totally paralyzed to do any of the things I normally would do as far as comfort measures as a doula. But, slowly I'm finding myself more able to incorporate my doula training and experience to some extent. My hope is that as the nursing tasks become more second nature to me, that I won't have to dedicate so much time focusing on them and can slowly transform and grow into a well rounded, caring and competent labor nurse. Today I was able to help with hands on pain management - doula style - for about 1/2 an hour and not get too far behind in my charting... little steps

There is a ton of charting, as I expected....but even more so. According to what's going on in labor (early vs. active, pitocin or epidural infusions) the protocols vary. So, there are a lot of protocols to learn.

The vaginal exams are going GREAT... It only took about a week of fumbling around before I was accurately calling the dilatation/effacement/station.... I can only attribute that to the many years of visualizing the changing cervix and teaching my clients about theirs.....

The first time I was independently doing vag exams on a patient all day was a little stressful for me... I was so used to the safety net of my preceptors checking the cervix either before or after me and giving me feedback.... But, on that first day, I was so nervous.... Especially when I checked the patient and she was 9-10cm. My preceptor said, "Ok, then, I'll call the doctor." Inside I was thinking: "WHAT?? Don't you want to double check???" But, we got the patient ready and started pushing when I decided she was complete. The doctor came and I literally held my breath when he put his glove on and checked her..... All was good... She was complete.

But, my preceptors have told me stories of calling the doctor, having the patient up in stirrups only to have the dr. tell them the patient is 4cm. What a day that must've been... and they survived... and became great labor nurses... so, I've vowed to give myself time and permission to learn from my mistakes.... So far so good with the vaginal exams, though.....

Thursday I go to a fetal monitoring class. I'm looking forward to learning more about appropriately interpreting the fetal monitoring tracings. I learned some in school and am learning "on the job" during actual births, but I like classroom learning, too... having a list of scenarios or examples and knowing the right thing to do in each situation (is my accounting background showing through?). Regardless, I think Thursday will be helpful.

On Vag Exams

This past week or so has been filled with learning labor - and a part of that is learning vaginal exams.

Usually how it is taught is the "learning nurse" does a vag exam on the patient right after another experienced nurse, who directs the "learner" where to feel and what the correct interpretation of that particular exam is.

So, my first exam was done with a doctor who had just examined the patient. The doctor was finished and instructed me where to go and what to feel..... Honestly, all I felt was a bunch of mush! I was so nervous I didn't say that, of coarse, I just nodded and got out as fast as I could.

Then, a few hours later, my preceptor examined the same woman and it was my turn again. So, I hesitantly went in again..... It was there!! I actually found the cervix and felt it --- Small successes.

Next, I have to not only find them but accurately interpret their dilation, effacement and station.

I did a few vag exams since... accurately pronouncing one cervix as "4" and then inaccurately calling one "7" that was only "6."

The hardest was doing vaginal exams on a person I knew..... Yeah, kinda uncomfortable...but you get past it and move on......

Who's Got Your Back?

I've mentioned here before how great I think my co-workers are. They are a true team. If one person is in a spot with her patient where she needs a hand or has too much building up - everyone is there for them... No complaints, they are just there. They ask each other if they got time for lunch or a break yet, and take over the other person's patients to provide breaks when needed. And, when I had a baby born that needed resuscitated, I pushed the "code white" AKA "HELP!" button and within seconds there were 2 nurses there by my side helping me to resuscitate the baby.

This team of nurses is a blessing to be a part of, for sure. But last week, they proved themselves even more supportive. They not only talked the talk; they walked the walk. I had been on a good streak with inserting IVs successfully - THEN, something happened and I got three in a row that I missed. My confidence was in the toilet. So, what did my team of co-workers do? They literally lined up for me to insert IVs into their own arms so I could re-build my confidence! They talked me through each insertion, giving me tips and cheering me on. Afterwards, it felt so good to have the support from these women - now with bandages on their hands and arms from my needle sticks. It must be the same feeling "blood brothers" get.... We've shared in pain together for the good of another....

Now I've started the labor and delivery rotation - with my first day of vaginal exams yesterday... Hopefully I won't need extra help in perfecting this skill... It would be more than a little uncomfortable asking for their help in that area!

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.

Next Topic

At our weekly meeting today, my supervisor, preceptor and I decided to move onto the next area of Obstetrical Nursing: Cesarean Sections.

There are two roles a nurse fills during a c-section, the scrub nurse and the circulating nurse.

In general, the scrub nurse "scrubs" in for the surgery. She fills the sterile role by being an assistant to the surgeon. Sets up sterile equipment, counts, assists during the surgery with instruments and suctioning, etc.

The circulating nurse is not sterile. She is there to coordinate the whole ER including the surgeon, scrub nurse and the baby catcher. She gets any needed equipment or supplies. She records and documents events; makes any necessary phone calls needed. She does the sterile scrubbing and draping of the abdomen. Before the surgery, she prepares the patient with an IV, foley, shave prep and IV fluids. Then, after the cesarean she recovers the patient and the infant.

Moving on.

From now until my cesarean rotation is over, I can probably wake up 1/2 an hour later because it is absolutely useless to spend any time doing my hair in the morning. After one case in the OR with that white cap on my head, there is NO turning back... It's a bad hair day all the way... I might as well just keep the cap on my head from there on out.

Flying Solo

I wrote last week about the fact that I am now doing postpartum patients independently, without my preceptor.

Well, this week, I am off of orientation during baby catching as well. I caught my first baby by myself yesterday! And, it was the biggest newborn I've ever seen.

I was surely scared and nervous as anything... But that fear kept me focused.

Another good thing happened yesterday: I did 2 successful IVs in a row! I have done them in the past as a nursing student.... But working in Postpartum, I didn't have a lot of exposure to it. I did try, but it was unsuccessful. But, yesterday, I did it - twice.

It was quite the scene the first time I did it. My preceptor sent me into the room by myself with an IV pole and a basket full of IV supplies. I tried to appear confident - I didn't let on this would be my first successful IV as a registered nurse, If - in fact - I even succeeded!

Her veins weren't visible, either. SHOOT!! I thought. Then I put the tourniquet on and rubbed, flicked and slapped the back of her hand, hoping something would surface. It did! I could visualize 2 metacarpal veins. ok. So, I prepared my supplies (at least I thought I had) and I went for it. Success. I hit a vein. I got back flow, so I advanced the cath tip. Then I retracted the needle and then..... what? I didn't have the tubing ready. So this poor lady is bleeding out the cath I just put in her vein and I'm fumbling for the IV tubing!! It's just a good thing I put a chux under her arm before I began. In the end it was a bloody mess with an intact IV. Semi-successful.

My preceptor high fived me when I was done, then I was asked to start another one. I didn't want to push my luck, but knew I HAD to master this elusive skill, so I agreed.

This time I wanted to avoid the blood bath of a fiascal I had last time. So, I had EVERYTHING ready before I started. And, I hit a vein agian! There was barely a dribble of blood after this one. Whew. What a stressful event.

But, it certainly boosted my confidence a little.

It was a good day.

A Real Catch & A Real Nurse

Today for the second time since I started working on OB (only 3 months ago) a nurse had to deliver a baby. The Dr was in surgery and couldn't very well leave an opened abdomen to go catch a baby. I guess it happens more than one would think. Especially at a fast growing hospital like this one is.

All went well. The nurse who caught was very experienced and did a great job. In fact, when I walked into the room at delivery to help "catch" the baby, I didn't even realize it was the nurse delivering. I was focused on grabbing a blanket, putting gloves on and watching how close birth was. The nurse was doing all of the maneuvers the doctor usually does; she was calm. It wasn't until afterwards that I noticed who it was.

Today neither of my preceptors were working. This has happened before and I've just been assigned to work with another nurse for the day. But, starting this week, I am working independently - off of orientation - with postpartum moms and babies; so, I worked independently all day. I felt like a "real" nurse. Yeah! Onward and Upward.