1st day in L&D

(Above: typical L&D room. But NOT in a county hospital!)

Yesterday went well! Ironically, I got to shadow one of my good friends (Bella from my previous post) whom I met during my original start in nursing school--she graduated when I "should have" graduated about a year and a half ago. It is really odd that we ended up doing that--and I'd like to think God had something to do with it--after all, everything has worked out so strangely that I just believe God has me in this job for a reason...

When I got there I was shown into the nurses lockeroom and told to put on some scrubs. Got my greens on and met up with the antepartum nurse I was to shadow until they got a patient in L&D. Yesterday was a slow day around the unit--the nurses were thrilled because they have been slammed as of late but I was a bit disappointed.

My antepartum nurse had three patients--two with uncontrolled diabetes and one with pyelonephritis. So, not very acute. I followed her around and watched how she organized. I actually felt pretty comfortable--knew what she was doing, was able to answer all her questions, and enjoyed the whole process. It was so different from clinicals. I didn't feel intimidated or stressed out so I felt like I learned volumes more. In school I felt so threatened with failure all the time that it really increased my stress level and reduced my absorption of information.


The nurse was efficient and very careful--in fact, she was so careful giving insulin that she drew it all up separately. For instance, one patient had 70U NPH, 38U of Novolog and 8U Regular Insulin on sliding scale ordered. She gave the patient THREE shots. She said because she was giving so much she didn't feel comfy giving it all together. Yet we are taught how to properly mix insulin in school (clear before cloudy) and all insulin doses are double checked by another RN, so I personally would have been comfy giving the pt it all in one dose--to provide comfort AND safety to the patient? Opinions?? Of course, I kept my mouth shut! :) I am new, after all. (One of the other nurses gave her a hard time, though.)

Because I was in antepartum I missed a c-section for abrupted placenta of 33 week twins--that was ok as there were a million people in the OR (but secretly I wish I had seen that!). After all the antepartum meds and assessments were done, there was little to do so I spent about an hour in the breakroom helping the nurses put together a buffet of Mexican food. I was told that if I wanted to get really fat, I was on the right unit as they eat all the time. Tehe.

Finally got a laboring patient and was able to shadow my friend. Our patient was admitted at 4-5 cm dilated and was a primip. She didn't deliver while I was there but I learned so much about setting up the room, was refreshed on monitoring, got more practice with strips, and got to see the whole charting process. FHT (fetal heart tones) are charted on this unit q 30 minutes under 4 cm, then q 15 min from 5 to 10 cm, then q 5 min at 10 cm until the baby is born. One of the neat things my friend taught me is that charting should read like a story. You should be able to go back and read EVERYTHING you did like a storybook. She would consistently go back through her charting and make sure it was timely and relevant.


Ok, so my only concern and what I may change based on my very limited experience thus far: to me it seemed that there is an emphasis on watching the strips to the point that time with the patient is reduced. I understand the strips need to be watched closely, but I saw a lot of the nurses sitting at the nurses station just charting strips and only going in the rooms when called or when they needed to investigate. Now, maybe I missing something, but I think I will want to be more present. Because I have to chart every 15 mins during active labor, I want to be IN THE ROOM with my patient more. Providing more comfort measures.

Also, what do they do w/ patients who don't want to be on continuous monitoring? I requested with my pregnancies that monitoring be done for 15 min out of every hour. I know that is "more work" for the nurse, but man is it more comfy for the patient. Because I am in an inner city teaching hospital, I am going to see a lot, learn a lot, but also struggle with all the interventions these patients endure out of protocol. I must somehow incorporate my idea of holistic care into my practice at this hospital. There has to be a balance.

I know this is getting long, but one more nifty thing I noticed was the camaraderie and teamwork amongst the nursing staff, residents and anesthesiologists. Maybe the fact that everyone is dressed alike lessens barriers? Haha. I don't know--it was the 1st time I have seen a break in the hierarchy. The only time things got weird was when an attending in a coat and tie walked on the floor. Everyone got real quite and a return to the "natural order" of the floor was seen for a bit. Then the attending would leave end everyone was friendly again. Strange.

Ok, enough! Sorry to go on and on. I am soooooooooooooooooooo excited about my job. I am on FIRE! Oh yes, and I am getting those clogs! :) My feet were really sore yesterday...

(PS I updated my blog. If I am missing your link, let me know and I will fix it! All my links were deleted with my update!)